5 - Back Pain Basics - Skills

Goals Information Skills Drills Questions Review

 Skills to Master

Over the past few visits, you've been practicing healthy posture, body mechanics, and lifting techniques. The strategies listed in this section are designed to get you thinking about ways to apply what you know in a variety of situations. In this session, you'll also learn how to calculate your aerobic exercise intensity. Perform only the items recommended by your doctor or therapist.

Posture Strategies

Driving

Rationale

Sitting puts a lot of pressure on the discs of the back. Driving in a car compounds the problem. Proper sitting postures can help you stay comfortable and protect your back while driving.

Description

Adjust the seat in your vehicle close enough so that your knees are bent and slightly lower than your hips. If your seat has an adjustable lumbar rest, set it so that it forms a slight inward curve in your low back. If you don't have an adjustable lumbar support, you can roll up a towel and place it in the small of your low back.

Recomendation

Your doctor or therapist may suggest a lumbar roll or lumbar pillow to place in the small of your back when sitting and driving in a vehicle.

Concerns

Keeping your back in one position for a long time takes a toll on the health of your spine. You may find it helpful to routinely change the position of your low back on long drives. Do this by occasionally altering the setting of your lumbar support or by removing the towel, roll, or pillow from behind your back. Also, plan to stop at least every hour on long trips. Find a safe place to stop so you can get out of your vehicle and walk, stretch, and breathe.

Working at a Computer

Rationale

People who sit in front of a computer for long hours are at risk of back pain. Using safe postures and safe work strategies can improve comfort and protect your spine.

Description

Use a comfortable chair that supports your low back. Your shoulders should be relaxed, and your elbows, hips, and knees should be bent at right angles (90 degrees). Your feet should be flat on the floor or on a footrest. You can add support for your low back by rolling up a towel and placing it in the small of your low back.

Recommendations

Your doctor or therapist may suggest a lumbar roll or lumbar pillow to support your low back in its neutral position while you work at a computer.

Concerns

Adjust the chair to support the slight inward curve of your low back. Avoid slouching by keeping the curve of your low back against the chair. Organize your work space so you can easily reach the items you use often. Make sure the work surface is the right height. If it's too high, you'll end up leaning forward with your arms stretched out instead of relaxed along your side. Be sure to take a break every 30 to 60 minutes to relax, breathe, and stretch.

Lifting Strategies

We are constantly faced with the need to lift items. There are a variety of lifting styles that may prove useful at different times. Practice and use the choices listed here. Your therapist may determine that one style works best for you in most situations.

Lifting from a Car Trunk

Rationale

Lifting items out of a car trunk challenges the "rules of lifting." The bumper prevents you from bending your knees to lift. One way around this is to bend over at your waist and reach down to retrieve the item. But this can put your back in an unsafe position to lift. Protect your spine when lifting items out of the trunk by supporting your legs and by positioning your back in the power position.

Description

In situations where it is impossible to bend your knees to lift, you need to take special precautions. Get as close to the item as possible by supporting your knees against the car bumper. Bend at your hips, keeping your low back in the power position. Grasp the item firmly, and lift by extending your hips while keeping the slight inward curve in your low back. For heavier items, you may need to start by placing your knee on the bumper or the rim of the car trunk. Lean forward by bending your hips. Gather the item to your waist or onto your upper thigh. Then lift the item out of the trunk using your hip muscles. Keep your back in the neutral spine position.

Recommendations

You need strong hip and back muscles to perform this lift safely. Your therapist can design exercises to help you strengthen these muscles.

Concerns

Getting a heavy item out of the trunk of a car can challenge safe lifting practices. So think twice before loading a heavy item into the trunk of your car. If you must get an item from the car trunk, only do it by yourself if you can keep your back in the power position. If not, get help.

Loading and Unloading a Dishwasher

Rationale

Repeated actions of bending and twisting the spine can hurt your back. Take every effort to move and lift safely when you load or unload a dishwasher. You can protect your back during this activity by bending with your hips and by pivoting with your feet.

Description

Face the dishwasher each time you reach to load or unload dishes. Bend from your hips, not your low back. Pivot your feet in the direction you are moving, rather than twisting with your back.

Recommendations

You may tend to bend over from your back if your leg muscles are weak. Your therapist can work with you to strengthen your buttock, hip, and thigh muscles.

Concerns

Always position your back safely during this activity. Open and close the dishwasher door by bending with your hips and knees - not your back. It's easy to get in a rush and use poor habit when loading and unloading the dishwasher. Rely on your leg muscles. And keep from twisting your back by pivoting your feet.

Body Mechanic Strategies

Sweeping and Mopping

Rationale

It's hard to keep your back safely positioned while sweeping and mopping. You may tend to twist and flex your back to get the job done. But flexing and twisting your back at the same time is hazardous to the spine. The key is to engage your core muscles and to generate power from your hip and leg muscles. Practicing good technique may seem awkward at first, but it helps protect your back during these routine tasks.

Description

Keep your back in the power position, and engage your core muscles. You'll have better leverage as you work the broom or mop. If you need to lower yourself down to get under objects or to reach into tight spots, hinge at your hips so you keep from rounding your low back. Even small jobs should be done with care. Concentrate on engaging your core muscles and limiting how much you bend and twist your spine. Keep one leg forward when possible. Lean forward on your front leg with each stroke of the broom or mop. This focuses the action to your hips and legs - not your back.

Recommendations

Practice engaging your core muscles and using your arms and legs to sweep or mop. You may be shown a partial lunge exercise to simulate the actions needed to complete these tasks safely.

Concerns

Avoid the tendency to twist from side to side when sweeping or mopping. And don't twist or bend your trunk to get under objects or to reach into tight spots. If you don't engage your core muscles, you'll be forced to flex and twist your back. Be cautious when using a dust pan or mop bucket. Remember to bend with your hips and knees rather than keeping your legs straight, which forces you to bend at your waist.

Vacuuming

Rationale

People with back pain often have difficulty vacuuming. Poor technique takes a toll on the long-term health of the spine and actually requires more energy than using good technique. As when sweeping and mopping, you may find it awkward at first to keep your back safely positioned while vacuuming. But by using your core muscles and by generating power from your hips and legs, you'll protect your back. And you'll need less energy than when you use only your arms to push and pull the vacuum.

Description

Keep your back in the power position, and engage your core muscles. You'll have better leverage as you work the vacuum back and forth. When you push the vacuum forward, keep one leg in front of the other, and lean forward on your front leg. Then lean back onto your back leg as you pull the vacuum toward you. This focuses the action to your hips and legs - not your back. If you need to lower yourself down to get under objects or to reach into tight spots, hinge at your hips to keep from rounding your low back. You might find it easiest to get down onto one knee in these situations.

Recommendations

Practice engaging your core and using your hip and leg muscles as you vacuum. You may be shown a partial lunge exercise to simulate the actions needed to complete this task safely.

Concerns

Keep the vacuum directly in front of you at all times. Avoid trying to reach around corners or objects. This will force you to bend and twist your low back. Don't twist or bend your trunk to get under objects or to reach into tight spots. Use the rules of safe lifting (described in Session Four) when lifting and transporting the vacuum.

Exercises

Follow your therapist's guidance about the types of exercises you do. Continue your daily stretching routine. As you build strength and control in your core muscles, use this new and improved strength as you go about your daily activities.

Aerobic Conditioning

Continue to step up your aerobic exercise program. People who stay active and improve their cardiovascular fitness tend to get better, faster. Aerobic exercise also helps people cope with back pain.

Calculating Intensity

Rationale

You've been gradually increasing the amount of time (duration) you spend on your aerobic workout. Now it's time to increase the intensity of your exercise. Intensity is how hard you work during exercise. Knowing ways to calculate the intensity of your workout can ensure that you don't overdo it. It also provides a starting point for setting exercise goals.

Description

You can monitor your heart rate to know how hard you're working out. The easiest way to do this is by wearing a heart-rate monitor, which shows your heart's beats per minute (bpm). You can also check your heart rate without a special device by taking your pulse. To take your pulse, place the pad of one finger lightly over the front of the opposite wrist, just below the thumb. Count the pulses for 15 seconds and multiply them by four. (For example, 20 pulses in 15 seconds is 80 bpm.) You'll use this number to track how hard you're working out. If you're not able to feel your pulse at your wrist, you can place the two pads of fingers on the carotid artery, located on the side of your neck.


Calculating an Exercise Target

  • For a 50-year-old woman, the equation for MHR looks like this: 220 - 50 = 170 bpm.
  • Her MHR is 170 bpm. She multiplies her MHR by the intensity target. If we assume she's physically fit, she could multiply her MHR by 80 percent. 170 x .8 = 136 bpm
  • So during her exercise routine, she should feel 34 pulses when checking her pulse for 15 seconds. It looks like this: 34 x 4 = 136 bpm.

To target the intensity of your workout, obtain your maximum heart rate (MHR) by subtracting your age from 220. Then multiply by a percentage between 50 and 85 percent. If you're just starting out, shoot for 50 to 60 percent of your MHR. Eventually you can progress toward a high-energy workout by targeting between 75 and 85 percent. (Refer to the target heart rate example for calculating an exercise target.)

Another way to check how hard you're working is to rate how you feel when you're working out. This method uses a rate of perceived exertion (RPE) scale. While exercising, choose a number between zero and 10, where one means you're hardly doing anything (no exertion), and 10 means you're at your maximum exertion. Shoot for an RPE between four and six. Your RPE represents the amount of work you feel in your muscles and how hard you're breathing.

Recommendations

Your doctor or therapist will help you determine your exercise heart rate. Check your pulse often at first while exercising to check that you are meeting your intensity target. Also, rate your intensity from zero to 10 (your RPE) and track it when you check your heart rate. Your RPE should equate closely to your exercise heart rate. In other words, at 60 percent of your maximum heart rate, you may feel that you're working with an RPE of five. Advancing to 80 percent of your maximum heart rate will cause your RPE to rise, perhaps to a seven or eight.

After a while, you may find that you only need to keep an eye on your RPE, as it will give you a good idea about what your heart rate is doing. Use your current exercise levels to set goals. Goals can help make your aerobic exercise program meaningful and fun.

Concerns

Beginners, sedentary people, and older patients should target between 50 and 60 percent of their maximum heart rate. This percentage can safely go up as your body adjusts to a longer workout with greater intensity. Check with your doctor or therapist if you have problems tracking the intensity of your aerobic workout.

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