2 - Take Your Position - Skills

Goals Information Skills Drills Questions Review

 Skills to Master

Continue taking control of your back problem by mastering the following skills. These strategies are provided to supplement your visits to the clinic. Not all choices are appropriate for everyone. Perform only the items recommended by your doctor or therapist.

Positions of Comfort

In Session One, you were shown rest positions to help the problem area heal. Recall that stomach lying tends to help with disc problems, whereas back lying with support takes pressure off sore facet joints and spinal nerve roots. The positions listed in this session are beneficial because they promote the neutral spine position.

Side Lying

Rationale

Side lying may be used to position your back comfortably. It helps align your back in the middle of the spine's range of motion—between the extremes of flexion and extension. The neutral position is often ideal for reducing pressure on painful structures of the spine. And it is ideal for moving a fresh blood supply into the painful area, while moving swelling out.

Description

Lie on your side with your back straight and a pillow placed between your bent knees. A second pillow can be wedged behind your back to keep your trunk from rolling backward. Keep your neck in line with the rest of your spine by placing a supportive pillow under your neck.

Recommendations

Follow the advice of your doctor and therapist for best
results.

Concerns

Avoid curling into a ball, which causes the low back to bend too far. Also, if you rest on a mattress or couch that is not firm, your trunk will bend as it sags into the soft surface. You may need to place a rolled towel under your side to keep your spine lined up.

Sleeping

Rationale

Getting good sleep is vital to spine health. Pain and stiffness felt when you wake up may be due to your mattress. If the mattress is too soft, your spine will sag into the soft surface. A firm surface makes it easier to align your spine in the neutral position.

Description

Sleep on a firm mattress. If your mattress is not firm, a rolled towel wrapped around your waist can protect your back from sagging. You may find additional relief by lying on your back with your knees supported over a pillow, or by lying on your side with a pillow between your knees.

Recommendations

Follow the advice of your doctor and therapist for best results.

Concerns

Sleeping on a soft surface may partly explain unwanted back stiffness when rising in the morning. If you've tried to support your back as described above but are still awakening with back pain and stiffness, ask your doctor or therapist for other helpful tips.

Safe Postures

Proper posture is essential to spine health. When possible, keep a slight inward curve in your low back. Avoid awkward postures, such as bending or twisting the spine. Try not to stay in one position for too long. Take breaks often to get up, stretch out, and move around. The idea is to avoid too much strain on your back. In Session One, you were shown proper sitting posture. In this session, apply your understanding of spine alignment when you are standing to keep your back pain to a minimum and to give you ways of preventing future back problems.

Standing

Rationale

A slouched standing posture is seen when the knees are kept straight, the shoulders droop or round forward, and the head and neck jut forward. Combined with the effects of gravity, this slouched posture forces the back muscles to work extra hard to keep the upper body upright. Balancing the head atop the spine and keeping a slight inward curve in the low back reduces this strain and protects against back pain and future back injury.

Description

Good standing posture doesn't mean that you stand like a soldier at attention. Rather, it is a relaxed upright position. It begins by "thinking tall." Place a hand on your chest, just below your neck. Feel your chest move from a slouched to an upright position. Find a midway point. Now roll your shoulders back slightly. Don't thrust yourself back at the waist. Instead, get into a position where you feel a slight inward curve in your low back. This standing posture balances the spine for improved efficiency and comfort. If you must stand for a prolonged period, you can keep your back relaxed by placing one foot on a step or stool. For example, when washing dishes at a sink with a lower cabinet, swing the lower cabinet door open, and place your foot on the ledge inside the cabinet.

Recommendations

Follow the advice of your doctor and therapist for best results.

Concerns

Wear comfortable and supportive shoes. Avoid shifting all your weight onto one foot. Instead, stand with equal weight on both feet. Also, don't get stuck in one position. Change positions; do some stretches; move around.

Safe Movements

You were introduced in Session One to the "log roll" as a way to help you get in and out of bed safely. And you learned tips on how to cough or sneeze to avoid further back pain or injury. Taking extra care as you move during routine activities is important when controlling back pain. It is also key to long-term spine health. Keeping the spine safely positioned as you move helps protect the parts of the spine from awkward, painful, and repeated stresses. Use the neutral position when sitting and standing.

Sitting and Standing

Rationale

You may tend to lean too far forward when sitting down or standing up. Keep your spine in neutral to avoid flexing the spine forward.

Description

As you prepare to stand up from a chair, place your feet shoulder width apart. Keep your spine aligned in neutral. Place your nose over your toes by hinging forward at the hips. Use your buttock and thigh muscles to push yourself up. Don't twist or bend too far over at the waist, which puts added strain on the lumbar spine. Reverse this process when preparing to sit down.

Recommendations

Follow the advice of your doctor and therapist for best results.

Concerns

Keep your back in neutral. Lean forward at the hips - not your back - when you sit or stand. If your thigh and hip muscles are weak, choose a chair with armrests so you can use your arms for additional leverage.

Self-Treatments

In Session One, you learned to control pain through proper breathing and relaxation. Applying ice or heat is another measure you can use to manage your condition, especially if symptoms are particularly bad.


Applying Ice

Rationale

Ice makes blood vessels narrow (called vasoconstriction). This is ideal for stopping the pain that often comes with inflammation. It can easily be used as part of a home program. Ice is especially helpful in the early hours and days after onset of back pain. Ice may also help reduce swelling, which in turn takes pressure off pain sensors within the tissues of the spine. The goal is to ease discomfort so you can rest, move, and exercise easier.

Description

Ice packs or a bag of ice are the most effective forms of cold therapy. Cold treatments usually involve applying ice to the sore area for 15 to 20 minutes. You may find you have less pain and better mobility after applying ice.

Recommendations

Follow the advice of your doctor and therapist for best results.

Concerns

Avoid injury to your skin by placing a wet towel between your skin and the cold pack or ice bag. Also, avoid heavy exercise or activity after applying cold treatments to your back. The drop in temperature can momentarily slow the responsiveness of nerves and muscles in the area, setting you up for an injury. Alert your doctor or therapist to any unusual increase in back pain.

Applying Heat

Rationale

Heat makes blood vessels expand (called vasodilation), which helps flush away chemicals that make your back joints and muscles hurt. It also helps your back muscles relax. The goal is to ease discomfort so you can rest, move, and exercise easier.

Description

Moist hot packs, heating pads, and warm showers or baths are the most effective forms of heat therapy. Heat treatments usually involve applying heat to the sore area for 15 to 20 minutes. You may find you have less pain and better mobility after applying heat.

Recommendations

Follow the advice of your doctor and therapist for best results.

Concerns

Because heat vasodilates blood vessels, it is generally not used in the first 48 hours after the onset of back pain. Be cautious when using heat. Even when heat is the best treatment for your back discomfort, hotter is not always better. Your skin can overheat and even burn. Use layers of towels between the heat source and your skin to avoid the risk of a burn. Sleeping with an electric hot pad is a bad idea. The prolonged heat can actually burn your skin. Watch for areas of redness that don't go away within 20 minutes. This can be a sign that the temperature of the heat source is too high. Alert your doctor or therapist to any unusual increase in your back pain.

Exercises

Continue with the exercises you received in Session One. Discuss with your healthcare provider any problems or concerns you have about your exercise program. To help you apply what you've learned about anatomy and the neutral spine, practice the two exercises outlined below.

Pelvic Tilt

Rationale

The pelvic tilt exercise helps you feel the change in low back posture that occurs with pelvic movement. It is also a gentle way to stretch the low back, while coordinating movement between the muscles of your back and abdomen.

Description

Lie on your back with your knees bent. Gently roll your pelvis back and forth. Feel how the amount of space between the mat and the small of your low back changes. As you roll your pelvis forward, you should feel the space getting larger. Your back is extending. As you roll your pelvis backward, your back flexes, making the space in the small of your back smaller. Your low back may even contact the mat as your low back flattens into flexion. Next, roll your pelvis in gradually smaller amounts until you find the middle position, between the extremes of flexion and extension. This is the neutral position. Hold this position as you close your eyes and sense what this neutral position of your spine feels like.

Recommendations

Repeat pelvic tilts 10 to 20 times slowly and gently. Practice locating and keeping the neutral position of the spine.

Concerns

Stay relaxed as you practice the pelvic tilt exercise. Keep light on your heels; otherwise your hamstring muscles on the back of your thighs will do all the work. Only roll your pelvis back and forth within a pain-free amount of movement. If you feel pain when rolling your pelvis all the way in one direction, back off slightly.

Cat and Camel

Rationale

The cat and camel exercise helps you feel the change in low back posture that occurs with pelvic movement. It is also a gentle way to stretch the low back, while coordinating movement between the muscles of your back and abdomen.

Description

Get on your hands and knees, as though you were going to crawl. Position your hips over your knees, and your shoulders over your hands. Now gently roll your pelvis back and forth. Feel how the curve in your low back changes. As you roll your pelvis backward, your back hunches into a rounded (flexed) position much like the back of a mad cat. As you roll your pelvis forward, you should feel your low back arch like that of a camel's back. Your back is extending. Next, roll your pelvis in gradually smaller amounts until you find the middle position, between the extremes of flexion and extension. This is the neutral position. Hold this position as you close your eyes and sense what this neutral position of your spine feels like.

Recommendations

Repeat cat and camel 10 to 20 times slowly and gently. Practice locating and keeping the neutral position of the spine.

Concerns

Stay relaxed as you practice the cat and camel exercise. Only roll your pelvis back and forth within a pain-free amount of movement. If you feel pain when rolling your pelvis all the way in one direction, back off slightly.

Stretches

Continue to do the stretches you were given in Session One. Flexibility does not happen immediately. It takes time and effort to attain muscle balance. You may find that stretching eases your pain. Discuss with your healthcare provider any problems or concerns you have about your stretching program.

Aerobic Conditioning

Current guidelines for low back pain include recommendations to begin aerobic conditioning soon after the onset of low back pain, usually within two weeks. Aerobic exercise may be recommended to help you avoid potential debilitating effects of back pain, such as spine inflexibility, muscle weakness, and weight gain.

There are many ways to get a good aerobic workout. Aerobic exercises include walking on a treadmill, riding a stationary bike, or swimming. These activities can relieve the stress that often goes along with low back pain, and they help your body to release endorphins into your blood stream. Endorphins are the body's own natural painkillers.

Follow your healthcare provider's advice about beginning an aerobic exercise program. At first, the goal is to gradually increase the amount of time you're doing aerobic exercise, not how hard you're working out. When you've comfortably worked up to 20 or 30 minutes during an aerobic workout, then you may be encouraged to increase the intensity of the exercise.

Goals Information Skills Drills Questions Review






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