Back Pain

What is low back pain?

Low back pain is pain and stiffness in the lower back. It is one of the most common reasons people miss work.
How does it occur?
Low back pain is usually caused when a ligament or muscle holding a vertebra in its proper position
is strained. Vertebrae are bones that make up the spinal column through which the spinal cord passes. When these muscles or ligaments become weak, the spine loses its stability, resulting in pain. Because nerves reach all parts of the body from the spinal cord, back problems can lead to pain or weakness in almost any part of the body.

Low back pain can occur if your job involves lifting and carrying heavy objects, or if you spend a lot of time sitting or standing in one position or bending over. It can be caused by a fall or by unusually strenuous exercise. It can be brought on by the tension and stress that cause headaches in some people. It can even be brought on by violent sneezing or coughing.

Symptoms

Symptoms include:

• Pain in the back or legs
• Stiffness and limited motion
• The pain may be continuous or may occur only in certain positions. It may be aggravated by coughing, sneezing, bending, twisting, or straining during a bowel movement. The pain may occur in only one spot or may spread to other areas, most commonly down the buttocks and into the back of the thigh.
• A low back strain typically does not produce pain past the knee into the calf or foot. Tingling or numbness in the calf or foot may indicate a herniated disk or pinched nerve.

Be sure to see your health care provider if:

• You have weakness in your leg, especially if you cannot lift your foot, because this may
• be a sign of nerve damage.
• You have new bowel or bladder problems as well as back pain, which may be a sign of severe injury to your spinal cord.
• You have pain that gets worse despite treatment.

How is it diagnosed?
Your health care provider will review your medical history and examine you. He or she may order x-rays. In certain situations a myelogram, CT scan, or MRI may be ordered.

Treatment

Initial treatment for back pain includes the following easy to remember acronym, LUSKIN:

Stretching

Single Knee to Chest Stretch
Lie on your back with one knee bent. Hold thigh behind knee and bring one knee up to chest. Hold 30 seconds. Relax. Repeat three times on each side.

Hamstring Stretch
Lie on your back and bring affected leg towards your chest. Grab the back of your thigh and try to extend your leg. Hold this position for 30 to 60 seconds, feeling a stretch in the back of your thigh. Repeat three times. You may also try this with a towel around your foot if it is more comfortable.

• Do not perform if stretch increases symptoms

Extended Child Pose
Begin sitting on your heels with your toes together underneath you and your knees apart. Then fold your body forward over your thighs, reaching your arms overhead. Your hands, forearms and forehead rest on the ground. Tip: keep your hips as close to your heels as possible while reaching your arms forward. Hold for 30 seconds. Repeat the stretch by reaching both arms forward and over to the right while shifting your hips slightly to the left. Hold for 30 seconds. Repeat again on the opposite side (hands reaching towards the left and hips shift slightly to the right).

Cat Cow
Start on your hands and knees. While breathing, slowly in round your back like a scared cat and hold for 1 to 2 seconds. While breathing out, arch your back to cow position. These should be slow gentle movements. Repeat this cycle 10 times.

Pelvic Tilts
Lie on your back with both knees bent and feet planted on the floor. Gently tuck your buttocks under and front of hips slightly up and think of pulling your belly button in towards your back as you do this. Hold for 10 seconds and repeat 10 times.

Heel Raises
While standing, on the floor or on a small step balance yourself on both feet and hold onto a wall for balance. Rise up on your toes, hold for five seconds, and then lower yourself back down. Repeat 10 times, and do 3 sets of 10. Once you are comfortable with this, try on one leg. 3 sets of 10.

Opposite Arm and Leg
Lie down facing the floor. You may use a rolled up towel under your forehead for comfort. Lift up the opposite arm and leg two inches above the floor. Hold this position for five to ten seconds. Repeat 10 times on each side. Do three sets.

Dead Bugs
Lie on your back and place both hands under your buttocks. Bring both legs up to point to the ceiling with knees slightly bent. Gently lower one leg towards the ground then slowly back up. Try to keep your lower back on the floor. Repeat with opposite leg. Complete 3 sets of 10.

How long will the effects last?
The effects of back pain last as long as the cause exists or until your body recovers from the strain, usually a day or two but sometimes weeks.

How can I take care of myself?

In addition to the treatment described above, keep in mind these suggestions:

• Use an electric heating pad on a low setting (or a hot water bottle wrapped in a towel to avoid
• burning yourself) for 20 to 30 minutes. Don’t let the heating pad get too hot, and don’t fall asleep with it. You could get a bum.
• Try putting an ice pack wrapped in a towel on your back for 20 minutes, one to four times a day. Set an alarm to avoid frostbite from using the ice pack too long.
• Put a pillow under your knees when you are lying down.
• Sleep without a pillow under your head.
• Lose weight if you are overweight.
• Practice good posture. Stand with your head up, shoulders straight, chest forward, weight balanced evenly on both feet, and pelvis tucked in.

Pain is the best way to judge the pace you should set in increasing your activity and exercise. Minor discomfort, stiffness, soreness, and mild aches need not interfere with activity. However, limit your activities temporarily if:

• Your symptoms return.
• The pain increases when you are more active.
• The pain increases within 24 hours after a new or higher level of activity.

When can I return to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If
you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport will be determined by how soon your back recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better.
It is important that you have fully recovered from your low back pain before you return to your sport or any strenuous activity. You must be able to have the same range of motion that you had before your injury. You must be able to run, jump and twist without pain.

Prevention

You can reduce the strain on your back by doing the following:

• Don’t push with your arms when you move a heavy object. Turn around and push backwards so the strain is taken by your legs.
• Whenever you sit, sit in a straight-backed chair and hold your spine against the back of the chair.
• Bend your knees and hips and keep your back straight when you lift a heavy object.
• Avoid lifting heavy objects higher than your waist.
• Hold packages you carry close to your body, with your arms bent.
• Use a footrest for one foot when you stand or sit in one spot for a long time. This keeps your back straight.
• Bend your knees when you bend over.
• Sit close to the pedals when you drive and use your seat belt and a hard backrest or pillow.
• Lie on your side with your knees bent when you sleep or rest. It may help to put a pillow between your knees.
• Put a pillow under your knees when you sleep on your back.
• Raise the foot of the bed 8 inches to discourage sleeping on your stomach unless you have other problems that require that you keep your head elevated.
• Lie on your side with your knees bent when you sleep or rest. It may help to put a pillow between your knees.
• Put a pillow under your knees when you sleep on your back.
• Raise the foot of the bed 8 inches to discourage sleeping on your stomach unless you have other problems that require that you keep your head elevated.

To rest your back, hold each of these positions for 5 minutes or longer:

• Lie on your back, bend your knees, and put pillows under your knees.
• Lie on your back, put a pillow under your neck, bend your knees to a 90-degree angle, and put your lower legs and feet on a chair.
• Lie on your back, bend your knees, and bring one knee up to your chest and hold it there.
• Repeat with the other knee, then bring both knees to your chest. When holding your knee to your chest, grab your thigh rather than your lower leg to avoid over flexing your knee.