Lower Back Pain Treatments
Our doctors approach lower back pain treatments as a serious subject. As patients recover from a back injury, they begin to learn how to safely strengthen their back to help prevent injuries in the future. Also, your therapist can teach you specific exercises that will help reduce your back pain now – and help you begin a new set of habits that will help keep your back healthy.
This presentation will help patients understand what each part of a rehabilitation program does. In addition, it will also teach patients how the back works and how to reduce or prevent further injury while the back heals.
- First, you will learn why the spine requires proper balancing – in the Neutral Spine Position.
- Then you will see how to use the neutral spine position in everyday activities – such as walking and lifting. Learning to lift properly plays an important part and a whole section has been devoted to the rules of lifting.
- Finally, you will learn how you can benefit from exercise, after an injury and as protection against further injury.
Understanding the Neutral Spine Position for Lower Back Pain Treatments
Management and prevention of back pain begin by understanding the neutral spine position. Three natural curves are present in a healthy spine. The neck, or the cervical spine, curves slightly inward. The mid-back, or the thoracic spine, curves outward. The low back, or the lumbar spine, curves inward again. Therefore, the neutral alignment helps to cushion the spine from too much stress and strain. Learning how to maintain a neutral spine position also helps you move safely during activities like sitting, walking, and lifting.
The natural curves of the spine are the result of the muscles, ligaments, and tendons that attach to the vertebrae of the spine. Without these supporting structures, the spine would collapse. Also, they support the spine – much like guide wires support the mast of a ship. Furthermore, this guidewire system makes up mainly of the abdominal and back muscles. The abdominal muscles provide support by attaching to the ribs, pelvis, and indirectly to the lumbar spine. The muscles of the back are arranged in layers, with each layer playing an important role in balancing the spine. By using these muscles together, Doctors can treat the spine and actually change the curves by bracing, exercising, and surgery.
Controlling pelvic tilt helps to balance the spine. When certain muscles of the back and abdomen contract, the pelvis rotates. As the pelvis rotates forward, the lumbar curve increases. As the pelvis rotates backward, the curve of the low back straightens. The rotation of the pelvis is like a wheel centered at the hip joint. The muscles of the upper thighs also attach to the pelvis and contraction of these muscles can cause change to the curve of the spine.
The abdominal muscles work alone, or with the hamstring muscles to produce a backward rotation of the pelvis. This causes the slight inward curve of the low back to straighten. If these muscles cause the curve of the low back to straighten too much, this may produce an unhealthy slouching posture.
In the other direction, as the hip flexors contract and back extensors contract, the pelvis rotates forward – increasing the curvature of the lower back. If this curve is increased too much, another unhealthy posture may result. This condition is called lordosis in medical terminology, or swayback in common terms. A balance of strength and flexibility is the key to maintaining a neutral spine position. This balance is the basis for optimal muscle function.
Like a car, an imbalance may lead to wear and tear, eventually damaging the various parts of the car. Muscle imbalances that affect the spine have many causes. One common cause of muscle imbalance is weak abdominal muscles. As the abdominal muscles sag, the hip flexors become tight, causing an increase in the curve of the low back. This leads to the swayback posture mentioned above. Another common problem results from tight hamstrings. As the hamstring muscles become tight, the pelvis is rotated backward. This produces an abnormal slouching posture.
Good Posture is Helpful for Lower Back Pain Treatments
Understanding body mechanics means understanding how we use our bodies. Proper body mechanics result when we put the neutral spine posture into action. To use proper body mechanics we need to learn how the spine should work during activities like rising from a chair, walking and lifting.
A healthy sitting posture is based on the neutral spine position. Positioning your hips and knees at 90 degrees can help you keep a neutral sitting posture. Remember this position is balanced between the extremes of the lumbar movement. Remember to choose a properly designed chair to help support the lumbar spine. The neutral spine position is also important when getting up from a chair. Holding the spine safely in neutral, the pelvic wheel turns forward, placing the “nose over the toes”. With the feet placed shoulder-width apart, stand upright. Use the buttock and thigh muscles to push yourself up. Do not twist or bend too far over at the waist and put too much strain on the lumbar spine.
Proper body mechanics are also important while walking – try to maintain a neutral spine position while walking. In the neutral position, the legs and arms swing naturally during a forward motion. Conditions that alter the normal way of walking, and cause a limp, can severely stress the spine. While walking, always try to maintain your spine in a neutral position.
Lifting is one of the most dangerous activities for the spine. The neutral position MUST be used to reduce the risk of injury. With the spine held in the neutral position, the movement occurs as the pelvic wheel turns. The hip is the axis of pelvic rotation – not the back! Notice how the back loses the neutral position when the pelvis does not rotate forward. This posture focuses the force on the back muscles during a lift. Lifting in a neutral position allows the larger and more powerful leg muscles to do the lifting. When lifting – first find the neutral position. Bend at the hips by rotating the pelvic wheel at the hip joint axis. Keep a safe posture, hold the object securely, and use the large leg muscles to generate power. Tighten the abdominal muscles during the lift to create a stabilizing corset around the trunk.
The Rules of Lifting
Many back injuries occur during lifting. Making a complete checklist for safe lifting can reduce the risks of injury.
- First, plan and prepare for the lift. It only takes a moment to ensure safety. The consequences of a back injury can last a lifetime!
- Ensure a safe and clear path.
- Before beginning, think through the lift.
- Obtain good footing with a wide base of support, by placing the feet a minimum of shoulder width apart. This lowers the center of gravity and increases stability.
- Keeping the load close to the body can reduce stress on the spine and back muscles. Think of how a lever and fulcrum work. The back muscles, the spine, and the arms are the parts that form this lever system. The force needed to lift an object is lower if the load is nearer the fulcrum point. If the load is too far away from the body, the muscles of the spine have to work harder to help with the lift. This leads to too much stress on the muscles of the spine and can cause injury.
- Maintain the neutral spine position. By moving the pelvic wheel around its axis, the upper body hinges forward, but the spine stays neutral. Remember the neutral spine position at all times!
- Remember to lift with the large muscles of the legs!
- Avoid twisting and bending the lower back at the same time! This is one of the most damaging movements to the spine. To avoid twisting, pivot the feet to complete the lift.
- Get help if necessary! If the load is too bulky or heavy, do not hesitate to get help or use a hand truck! Don’t think you do not have the time to get help. Will power does not take the place of a reasonably safe lift.
The Importance of Exercise for Lower Back Pain Treatments
Exercise is beneficial during all stages of recovery from a back injury. Your physical therapist will provide different types of exercises as you progress. In the early stages, when your back is still quite painful, specific exercises will reduce the pain through relaxation. Positioning exercises place the spine at rest. These exercises can give relief to sore muscles and joints.
Back pain can become physically and emotionally draining. Relaxation exercises may not correct your problem, but they can help control pain and its accompanying stress. Movement is also important, even when the back is still painful. Careful movements suggested by your therapist can safely ease pain by providing nutrition and lubrication to injured areas. The movement of joints and muscles also signals the nervous system to block incoming pain.
As the lower back pain treatments begin to lessen your pain, the exercises will be changed to focus on improving the overall health of your back. These changes will focus on:
- Aerobic Conditioning
Becoming more Flexible helps Lower Back Pain Treatments
Exercises that increase flexibility reduce pain, making it easier to keep the spine in a neutral position. Tight muscles cause imbalances in spinal movements. This can make the injury of these structures more likely. Flexibility exercises for the trunk and lower limbs are helpful in establishing safe movement. A slow progression of stretching exercises can increase flexibility in these structures and reduce the chance of re-injury.
The next stage of exercise focuses on the strength of the muscles that support the spine. These muscles help bring the spine into a neutral position and keep it there. Trained abdominal, back, and hip muscles assist in forming a natural corset. Strength training is simple to do at home and does not require any expensive equipment.
Posture exercises help train movement between the pelvis and low back. Learning how to find and hold the neutral position of the spine is the basis for a safe and healthy posture. Remember that the position of the pelvis determines the curve in the low back. Forward rotation increases the curve. Backward rotation straightens the curve. By practicing these exercises, you will become comfortable using the neutral spine position in daily activities.
Strong muscles need to be coordinated. As the strength of the spinal muscles increases, it becomes important to train those muscles to work together. Learning any physical activity takes practice. Muscles must be trained so that physical activity is under control. Muscles trained to control the safe movement of the spine reduce the chance of injury. You will be taught exercises that will help you train your back muscles to work together to protect the spine.
Finally, attention will be directed to increasing your overall fitness. The word “aerobic” means “with oxygen”. By using oxygen as they work, muscles are better able to move continuously, rather than in spurts. Fitness training allows the muscles to become more efficient at obtaining nutrients and oxygen from the blood. As the muscles use up the nutrients and oxygen, chemical waste products are created that cause pain. Training also increases the muscle’s ability to get rid of these waste products. Exercise has other benefits as well. Exercise causes chemicals called endorphins to be released into the blood. These chemical hormones act as natural pain relievers.
It will be important for you to pick an aerobic activity that you enjoy and stick with it!