THE SPORTS MEDICINE PATIENT ADVISOR

Low Back Pain

connective tissues of the backbecome inflamed as a result ofan infection or an immune sys-tem problem. Arthritic disor-ders as well as some congeni-tal and degenerative condi-tions may cause back pain.

Back pain accompanied byloss of bladder or bowel con-trol, difficulty in moving yourlegs, or numbness or tinglingin your arms or legs may indi-cate an injury to your spineand nerves, which requiresimmediate medical treat-ment.

What is low back pain?Low back pain is pain andstiffness in the lower back. It isone of the most common rea-sons people miss work.

How does it occur?Low back pain is usuallycaused when a ligament ormuscle holding a vertebra inits proper position is strained,Vertebrae are bones that makeup the spinal column throughwhich the spinal cord passes.When these muscles or liga-ments become weak, the spineloses its stability, resulting in What are thepain. Because nerves reach all symptoms?parts of the body from thespinal cord, back problems can Symptoms include:lead to pain or weakness in - pain in the back or legs

~lmo~ any.R~2i..Jhe b..:::o.::d:J...y.:..--__ - stiffness and limited-----.- - Low back pain can occur if motion.

your job involves lifting and The pain may be continu-carrying heavy objects, or if ous or may occur only inyou spend a lotof time sitting certain positions. Itor standing in one position or may be aggravated bybending over. It can be caused coughing, sneezing,by a fall or by unusually stren- bending, twisting, oruous exercise. It can be straining during abrought on by the tension and bowel movement. Thestress that cause headaches in pain may occur in onlysome people. It can even be one spot or maybrought on by violent sneez- spread to other areas,ing or coughing. most commonly down

People who are overweight the buttocks and intomay have low back pain the back of the thigh.because of the added stress on A low back straintheir back. typically does not pro-

Back pain may occur when duce pain past the kneethe muscles, joints, bones, and into the calf or foot. Tin-

gling or numbness in the calfor foot mky indicate a herniat-ed disk ot pinched nerve. Besure to sJe your doctor if youhave weJmess in your leg,especiallt if you cannot liftyour foo~,because this is a signof nerve tlamage. New bowel

, or bladd~r problems related to. your back pain may indicate

severe injury to your spinalcord, and you should see yourdoctor.t that in~eases

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Rear view of bodyI

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despite treatment indicates amore severe problem, whichshould be evaluated.

How is it diagnosed?Your doctor will review yourmedical history and examineyou. He or she may order x-rays. In certain situations amyelogram, CT scan, or MRImay be ordered.

How is it treated?The early stages of back painwith muscle spasms should betreated with ice packs for 20 to30 minutes everyl'!t\t06 hoursfor the first 2 to 3 days. Youmay lie on a frozen gel pack,crushed ice, or a bag of frozenpeas.

The following are ways totreat low back pain:• After the initial injury,

applying heat from a heatingpad or hot water bottle.

• Resting in bed on a firmmattress. Often it helps to lieon your back with yourknees raised. However, somepeople prefer to lie on theirside with their knees bent.

• Taking aspirin, ibuprofen, orother anti-inflammatorymedications; musclerelaxants; or other painmedications ifrecommended by yourdoctor.

• Having your back massagedby a trained person.

ILow Back Pain ---r-I -------.....

IHow lolng will the effectslast? IThe effeJts of back pain last as

I •long as the cause exists oruntil yoJr body recovers fromthe strain, usually a day ortwo but ~ometimes weeks.

How cbn I take care ofI

myself{In additton to the treatmentdescrib~d above, keep in mindthese suggestions:• Use ~ electric heating pad

on a low setting (or a hotwate~ bottle wrapped in atowe~1to avoid burningyourself) for 20 to 30 minutes.Don,J let the heating pad get

Itoo hot, and don't fall asleep

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with it.You could get a burn.I

• Try Pftting an ice packwrapped in a towel on yourback ~or 20 minutes, one to

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four times a day. Set analarni to avoid frostbite fromusing the ice pack too long.

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• Put 1pillow under yourknees when you are lying

Idowt·

• SleeR without a pillowunder your head.

• Loselweight if you areoverreight.

• Pracfce good posture. Standwithlyour head up, shouldersstraight, chest forward,weight balanced evenly onbothlfeet, and pelvis tucked• Im'l

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THE SPORTS MEDICINE PATIENT ADVISOR

• Having traction, ifrecommended by yourdoctor.

• Wearing a belt or corset tosupport your back.

• Talking with a counselor, ifyour back pain is related totension caused by emotionalproblems.

• Beginning a program ofphysical therapy, orexercising on your own.Begin a regular exerciseprogram to gently stretchand strengthen your musclesas soon as you can. Your .doctor or physical therapistcan recommend exercisesthat will not only help you

. feel better but willstrengthen your muscles andhelp avoid back trouble later.

When the pain subsides, askyour doctor about starting anexercise program such as thefollowing:

• Exercise moderately everyday, using stretching andwarm-up exercisessuggested by your doctor orphysical therapist.

• Exercise vigorously forabout 30 minutes two orthree times a week bywalking, swimming, using astationary bicycle, or doinglow-impact aerobics.

Participating regularly in anexercise program will not onlyhelp your back, it will also helpkeep you healthier overall.

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Low Back Pain ---------

Pain is the best way to judgethe pace you should set inincreasing your activity andexercise. Minor discomfort,stiffness, soreness, and mild .aches need not interfere withactivity. However, limit youractivities temporarily if:• Your symptoms return.• The pain increases when you

are more active.

be able toha\T~,thesame rangeof motion that1iyouhad beforeyour injury.ygu'Inustbe ableto run, jwitpan.c:i'twist withoutp-ain. ~~" :.;:.~:,<,.i.:..,

.- ',,-.

What can {do to helpprevent low back pain?You can reduce the strain onyour back by doing the follow-ing:

• Don't push with your armswhen you move a heavyobject.Turn around andpush backwards so the strain

When can I return to my is taker(byxpo/legs.:'.,,1:'111(' ;' -.

sport or activity? • Wheneyer Yi9t1i~it,sit in aThe goal of rehabilitation is to straight'"ba.q<~<;lchairandreturn you to your sport or hold yourspifl~against theactivity as soon as is safely back of the Chair:possible. If you return too • Bend your knees and hipssoon you may worsen your and keep your back straightinjury, which could lead to when you lift a heavy object.

...----- .....-------------permanenniamage~-EveFyone-. Avoidllffing heavy objectsrecovers from injury at a dif- higher than your waist.ferent r~te. Return t~ your • Hold packages you carrysport WIllbe determined by close to your body, withhow soon your back recovers, your arms bent.not b

ky~ohwmbany~ays or • Use a footrest for one foot

wee s It as een smce your '. .., . d In al th when you stand or SItmanemJury occurre. gener, e f' 1; . Thilonger you have symptoms skPotora' °tg:ne.. :-before you start treatment, the eeps your ,;'ackstraigh .longer it will take to get better. • Bend your knees when you

It is important that you 'bend over.have fully recovered from • Sit close to the pedals whenyour low back pain before you you drive and use your seatreturn to your sport or any belt and a hard backrest orstrenuous activity. You must pillow.

• The pain increases within 24hours after a new or higherlevel of activity.

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• Lie on your side with yourknees bent when you sleepor rest. It may help to put apillow between your knees.

• Put a pillow under yourknees when you sleep onyour back.

• Raise the foot of the bed 8inches to discouragesleeping on your stomachunless you have otherproblems that require thatyou keep your headelevated.

To rest your back, hold each ofthese positions for 5 minutesor longer:

• Lie on your back, bend yourknees, and put pillowsunder your knees.

• Lie on your back, put apillow under your neck,bend your knees to a 90-

--"-de-greeangle, anapuryour--------- -----lower legs and feet on achair.

• Lie on your back, bend yourknees, and bring one kneeup to your chest and hold itthere. Repeat with the otherknee, then bring both kneesto your chest. When holdingyour knee to your chest,grab your thigh rather thanyour lower leg to avoidoverflexing your knee.

4. Partial curl: Lie on your back with your knees bent and your feet_____ .__ flil..t..9ntl}e flggr. Tighi~!lY.9_urstOl!!~cb.}.!lusc~~9DgJ].atten your

back against the floor. Tuck your chin to your chest. With yourhands stretched out in front of you, curl your upper body for-ward until your shoulders clear the floor. Hold this positiori for 3seconds. Don't hold your breath. It helps to breathe out as you Partial curl

lift your shoulders up. Relax. Repeat 10 times, Build to 3 sets of10. To challenge yourself clasp your hands behind your headand keep your elbows out to the side.

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---- Low Back PainRehabi/~t,at;onExercises ----......

.u. .

The goal of these exercises is to strengthen your abdo~~muscles, stretch your lower back, hipflexors, and hamstrings. These exercises may help reduce lower back pain by correcting muscleimbalances in strength and flexibility of the trunk andhips.

1. Hamstring stretch: Place the heel of one leg on a stool about 15 incheshigh. Lean forward, bending at the hips until you feel a mild stretch inthe back of your thigh. Make sure you do not roll your shoulders andbend at the waist when doing this or you will stretch your lower backinstead. Hold the stretch 30 to 60 seconds. Do the same exercise with theother leg. Repeat 3 times.

2. Cat and camel: Get down on your handsand knees. Let yourstomach sag, allowing Hamstring stretch

your back to curve downward. Hold thisposition for 5 seconds, then arch your back.Repeat 10 times. D02 sets ..

Cat and camel 3. Pelvic tilt: Lie on your back withyour knees bent and your feetflat on the floor. Tighten your

stomach muscles to flatten your lower back against the floor.Hold for 5 seconds, then relax. Repeat 10 times. Do 3 sets. Pelvic tilt

5. Prone hip extension: Lie on your stomach with your legsstraight out behind you. Tighten your buttock musclesand lift your right leg off the floor, keeping your kneestraight. Hold this position for 5 seconds. Then lower yourleg and relax. Repeat the same with your left leg. Hold 5seconds and then lower the leg and relax. Repeat 10 timeson each side. Build up to 3 sets of 10.

Prone hip extension

6. Single knee to chest: Now do a pelvic tilt and pull one knee upto your chest. Hold for 5 seconds and return to the startingposition. Alternate sides, and repeat it 10:-20 times.

Single knee to chest

Low Back Pain -pag~;~;)bf5r

---' Low Back Pain:Rehabilitation Exercises ---....... '~,: ·;b--·· "

.. .

9. Pirif~rmis stretch: Lie on your back as shoin. Pull..one;~l:!e up and across your trunk so you feel a

. ..>!~p~p'#.b~estr~tch in the top buttocks and back..: ::-·1f:Iolp.:;.to,(~~J5s~condsand repeat 5-10 times on

,[~~~~~r""iiiii'i':.,.;\,lX9yJ, ;, .. ,p~this exercise by reaching for your·····'··ll':~;'"iII-i··''".·''·.'''···I. . ..·.'~~I~~~llWW·Weopposite hand and keeping your

...·.....,;!shomflendlat on the floor. Pull your knee over as'far'ils'you can allowing your trunk to rotate. --------

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THE SPORTS.MEDICINEPATIENT ADVISOR'.;~;~~

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7. Double knee to chesfAgam; doapelvic tilt and now p@pothknees up to y~~iche~t Hold for5 secondsandrm.e~~:tti~~tO .'times.Y01.:(may;~~~ti~f\9:.llit:!on~.':

Doubl. knee W FOesI ~~:.1tf~~f;~~:~&-;.8. Lower trunk rotation: Do a pelvic tilt.Keepi?g~p:6Ulders

down flat, gently rotate the knees to one side, tli~nthe other,as far as you can. Repeat 10-20 times. ;:: .

-----f---------l"ir~formls-stretch

Lower trunk rotation

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