3 - Hold Steady - 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.

Core Exercises

Your therapist may work with you to help "flip the switch" to your multifidus and transverse abdominal (TA) muscles. Getting these muscles to coordinate their efforts may seem impossible at first. Your therapist can help by using electrical stimulation over your low back to get the multifidus muscles working again. In some cases, biofeedback may be used to help you keep your back positioned and to keep you from compensating with other muscles. The goal at first is to lightly contract these muscles and hold for 10 seconds or so. When you get the hang of it, you may be instructed to do several contractions often throughout the day.

Multifidus Muscle Activation

Rationale

The multifidus muscles cross each spinal segment, making them one of the best muscles to help stabilize the spine. People who've had back pain, even once, may lose the ability to work the multifidus muscles in the problem area. If the multifidus muscles aren't working right, the problem segment is left unprotected and is free to shift around during daily activities.

Description

Sit with your low back in the neutral position. Reach one or both hands behind your low back. Place one or more fingers up and down the sides of your lower spine, just next to the bony bumps in the center of your low back. Gently tap or press on the multifidus muscles as shown by your therapist. Attempt to lightly engage the muscle under your fingers.

Recommendations

Hold the contraction for 10 seconds. Repeat five to 10 times.

Concerns

Don't get frustrated if at first you are unable to make the muscle work. And try not to work the muscle too hard, as this may cause you to compensate with other, less important muscles. If you have trouble with this exercise, your therapist may be able to help by using other positions or treatments such as electrical stimulation or biofeedback.

TA Muscle Activation

Rationale

Recall that the TA muscles are aligned like a girdle around your waist. When they work, the TA muscles draw the abdomen in. They work with the lumbar multifidus muscles to grip and hold the spine steady. Back pain sometimes causes this muscle to either stop working altogether or to lose its ability to coordinate with the multifidus muscles. When this happens, the low back is left unprotected and at risk for further problems.

Description

Lie on your back with your knees bent and your low back positioned in neutral. Place one hand behind your back so you can feel if your back arches or flattens during the exercise. Place your other hand lightly on your lower abdomen. The key to activating the TA muscles is to remember that they draw in the lower abdomen. As you begin to lightly contract the TA muscles, concentrate on bringing your belly button toward your spine. Breathe normally as you draw your lower abdomen in. Don't allow your abdomen to "pooch" out, as this means you are compensating with other abdominal muscles. To help activate your TA muscles, imagine you are trying to zip up a pair of tight jeans. You can improve the contraction by also working the muscles deep within your pelvis, the ones that keep you from urinating.

Recommendations

Attempt to lightly engage your TA muscles. Hold the contraction for 10 seconds. Repeat five to 10 times. When you get the hang of it, you may be instructed to do several contractions often throughout the day.

Concerns

Don't get frustrated if at first you are unable to make the muscle work. And try not to work the muscle too hard, as this may cause you to compensate with other, less important muscles. If you have trouble with this exercise, your therapist may be able to help by using other positions or treatments such as electrical stimulation or biofeedback.

Dynamic Stabilization

Now it's time to put your core muscles to work as you exercise and as you do your daily activities. Using your core muscles to protect your back and to guide the spinal joints during exercise and movement is called dynamic stabilization. Feel your muscles as they work to grip and hold your spine as you move.

Abdominal Bracing

Rationale

At first, you may simply begin working on engaging your core muscles. This action, sometimes called abdominal bracing, forms a starting point as you do exercises to dynamically stabilize your spine. Bracing the abdomen causes an increase in abdominal pressure, which protects and gives stability to the spine.

Description

Attempt to set the muscles of your abdomen. As these muscles contract, you should feel your abdomen tighten.

Recommendations

Apply your awareness of how to engage the key stabilizers while keeping your back in its neutral position. As you gain control of the core muscles, the program advances to include more challenging arm and leg movements. Eventually, your therapist may have you do your exercises using weights, pulleys, therapy balls, foam rolls, or other methods to challenge your core and improve your spine stability. Be sure to breathe normally as you brace your abdominals.

Concerns

Don't hold your breath when you brace your abdomen, as this can cause a rise in your blood pressure. Try not to pooch out your abdomen. Instead, attempt to draw in, much like you'd feel if you were wearing a girdle around your waist.

Sit to Stand

Rationale

Standing up from a sitting position is a familiar activity. But have you ever stopped to think about the position of your spine as you stand up? What are your core muscles doing? Are they switched on as you move? The benefit of practicing the motion of standing from a sitting position is that you can begin to coordinate movement so that it comes from your hips, buttock, and thighs - not your low back. It also gives you a chance to work your core muscle during a dynamic activity.

Description

Sit with your low back in the neutral position and your feet square on the ground, shoulder width apart. Place one arm behind your back with the back surface of your hand resting on your low back. Put your other hand lightly on your abdomen. Begin to lean forward while keeping your back in the neutral position. As you lean forward and back, you're movement should be coming from the hips and not your low back. If you feel your back rounding as you lean forward, your motion is coming from your low back, which means you're not staying in the neutral position as you move. When you've leaned forward and are in the neutral position, engage your core muscles. Now stand up. Reverse these steps when returning to a sitting position.

Recommendations

Practice this exercise several times during the day and whenever you get in and out of a sitting position. At first, you may need to watch in a side-view mirror. You'll quickly be able to see if your back position stays in neutral as you stand up and sit down.

Concerns

The tendency when standing up is to throw your weight forward, allowing your back to round. You also need to remember to "set" your core muscles to grip and hold your spine steady as you perform this familiar activity.

Hinged Squat

Rationale

The hinged squat exercise is a way for you to practice moving while keeping your back positioned in neutral. It's also a good way to get a workout for your hips, buttocks, and thigh muscles.

Description

Stand with your feet positioned just slightly wider than your shoulders. Align your back in neutral. Place one arm behind your back with the back surface of your hand resting on your low back. Put your other hand lightly on your abdomen. Next, draw your abdominals in, setting your core muscles. Now "hinge" forward by bending slightly at your hips and by bending your knees. Feel your trunk with your hands as you move to make sure your back stays in neutral.

Recommendations

Practice this exercise several times during the day and any time you need to reach for objects while bending toward the floor. At first, you may need to watch a side-view in a mirror as you do the exercise. You'll quickly be able to see if your back position stays in neutral as you move. Advance the exercise by using hand-held weights as directed by your therapist.

Concerns

The aim is to engage your core muscles, while keeping your back in neutral as you bend and reach down. Use this strategy to protect your spine as you do your routine activities.

Self-Treatments

In earlier sessions, you learned to control pain through proper breathing and relaxation and by using heat or ice. Your therapist may show you how to massage areas of your back that you can reach. Or your therapist may invite you to bring a friend or family member to get a few tips on how to give you a simple and effective back massage.

Massage

Rationale

Massage can calm pain and spasm by helping muscles relax, by bringing in a fresh supply of oxygen and nutrient-rich blood, and by flushing the area of swelling and chemical irritants that come from inflammation. The idea is to help you move with less pain.

Description

Your therapist may show you or your caregiver ways to gently massage your back. Gentle strokes are best at first. These strokes can easily be done with the palms of the hands or the fingers. Use a nongreasy lotion to reduce friction during the massage. You may note the benefits of massage with a session of 10 to 30 minutes.

Recommendations

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

Concerns

Massaging too deeply into the sore tissues can produce soreness. If your pain increases afterward and lasts for more than an hour, the massage may have been too aggressive. Be sure to use some type of lotion to avoid friction on the skin.

Exercises

Modern guidelines for treating low back pain suggest the value of gradually progressing in an exercise program. Your therapist will help you safely advance the exercises for your core stabilizers.

Aerobic Conditioning

Continue to carefully increase the time you are spending during your aerobic workout. Remember that it's more important at first to progress your time, not the intensity of your aerobic workout. 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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