Moving When It Hurts

Over the past 13 years and 25,000 Physical Therapy sessions, I have treated many patients who are afraid to move through pain. Let's consider the patient with chronic pain who has had pain for more than five years related to a work injury or a car accident. There is no question that they are experiencing pain, and in some cases they have severe pain. But some individuals get into the habit of fearing pain and therefore fearing any movement that causes pain. These people sometimes stop moving altogether. 

Have you met people who are sedentary all day? They can't work because they are disabled or retired or any other reason, and they literally can't, won't or don't do anything. They sit down or lie down all day. They only leave the house for doctor visits. They don't go out for leisure or social time or hobbies or anything at all. 

I encouraged a patient today to just start walking, even if it is for a few minutes at a time. Of course, she voiced concern that it makes her back hurt. So I explained that a walking program is not going to make her back worse overall. She will not gain more damage to her spine by walking, but she will cause more damage by the overall lack of movement of her spine. 

To clarify, this is not referring to patients with a brand new back injury or current flare-up. Most of you know someone who has "thrown his/her back out." In that situation, there may be a few days or weeks in which he/she can barely walk and cannot stand up straight. I would not tell that patient to start a walking program today. 

However, if someone you know has chronic pain but has stopped moving for many months or years, he/she likely needs physical activity. If you are not sure where to start or what movements are safe, come see your local Physical Therapist!

Postures and Low Back Muscle Strain

Photo by Larkery

One cause of low back muscle strain is having an unhealthy spine through habitual poor posture. If you sit all day in a slumped position, your low back is loaded into a forward or flexed position, and the muscles of your back are continually stretched. As a result, you may be more likely to strain a back muscle from light tasks such as loading/unloading the dishwasher. 

Not only does slouching affect your back muscles, but it causes your disks to bulge backwards. The more pressure from bad posture, the more likely your disks cannot realign properly. This leads to pinched nerves, which shoot pain or other symptoms down your leg(s), such as sciatica. 

On the other hand, those with a healthy spine (through repetitively good posture and exercise) may tolerate light tasks but strain their backs when doing more strenuous work such as moving furniture. It is important that both individuals practice good posture and body mechanics in order to avoid straining the low back during routine daily tasks, and especially during difficult physical activities.

How To Treat Back Pain At Home

Throwing your back out is a painful scenario that is actually quite common. It is typical for someone with an acute episode of back pain to tell me:

"I bent down to..., but I could not stand back up."

"I stood up after bending down, but immediately I knew something was wrong with my back." 

"I twisted my back and quickly felt severe back pain."

"My back has been hurting since I was moving a lot of stuff around recently."

What To Do For Acute Back Pain:

Step 1. Decide if it is serious enough to see a doctor immediately.

Reasons To See a Doctor Immediately For A New Back Injury:

1. You can barely walk.

2. Your pain is so severe that no over-the-counter medicine is helping.

3. You experienced major trauma to your back.

4. The injury caused you to lose sensation in your pelvis or legs.

5. The injury has changed your ability to control your bowel/bladder function.
6. You have noticeable weakness in one or both legs as a result of your injury.

Home Treatments For A New Back Injury:

1. Ice. Ice down your back or the painful area for 10-20 minutes at a time, throughout the day.

2. Over-the-counter Pain Medicine, preferably an anti-inflammatory (Advil, Aleve, Ibuprofen).

3. Rest. Find the most comfortable positions and avoid aggravating movements.

4. Time. If it is not a major injury, it should progressively improve over the next few weeks.

Should You Immediately See a Chiropractor For a New Back Injury?
Seeing a chiropractor may be a good option if you have one that you know and trust. Ideally, go to one that has successfully treated you in the past. They can rule out red flags and tell you if/when to see a physician. If your pain is not improving with chiropractic treatment, do not continue for more than 3-4 weeks.

Should You See a Physical Therapist For a New Back Injury?
Yes! However, most Physical Therapists require a doctor's prescription before beginning treatment, so be sure to ask your doctor for this. In my experience, most patients with a new back injury will significantly improve within 1-2 weeks of PT, and many patients will get immediate pain relief within the first visit. If your pain is not improving within a month of PT, follow up with your doctor for further testing or treatment options.

What To Do for Sciatica in my Leg

Photo: John Ragal

There are multiple causes of sciatica or back pain that radiates down the leg(s). The most serious cause of sciatica is when a nerve root in the spine is being pinched by a bulging disc or by arthritis-type changes in the spine itself. Not only can this cause shooting pain into the leg(s) but also weakness in the leg and changes in the sensation in the leg (for example numbness or tingling in a portion of the leg or foot). If this is the case, it would be diagnosed through MRI and treatment options would be recommended by your doctor. 

Physical Therapists treat many patients with such sciatica. The key to relieving this type of sciatica is to stop the compression of the nerve root in the spine where it is being pinched. This can be done through positioning and exercises. If you are completely compliant with Physical Therapy and get no relief from any sciatica symptoms, then your doctor may try injections (usually with Cortisone) to provide some pain relief. This is a steroid, which provides an anti-inflammatory response. If you do not want injections, you may be prescribed oral medications for pain relief and/or anti-inflammation. 

Other conservative treatments for sciatica are going to a chiropractor, mechanical lumbar traction (requires a MD prescription) or getting acupuncture. Also some people get relief from inversion tables. Aquatic Physical Therapy (doing therapy inside a swimming pool) is another helpful tool for patients with sciatica.

Low Back Surgery: 6 Steps To Full Recovery

Photo: Ted Hood. State Library of New South Wales.

If you have had a recent low back surgery, there are a few tips that will speed your recovery and help you to have a healthier back for the long term.

1. Practice good POSTURE. This may be difficult if you have a habit of slouching, but it is one of the most important ways to keep your spine healthy. Sit in upright, firm chairs with an extra lumbar support or rolled towel behind your low back. Avoid sitting in reclined positions.

2. AVOID BENDING FORWARD or bending down with your back. Learn how to do all your daily activities without bending your back. Many techniques can be used instead of forward bending, such as squatting, kneeling, sitting, pivoting on your hips, using a golfer's lift, or even crawling. Excessive forward bending is often the cause of back injuries, so eliminating bending decreases your risk of future back pain/injury.

3. AVOID TWISTING your back. This may be easy to do while still wearing your back brace, but once you are out of the brace, it is also important to avoid twisting. Maintaining proper spine alignment during daily activities and especially during strenuous activities will help to prevent back injury.

4. STAY ACTIVE. Find a low-impact exercise that you can start or continue, such as walking, stationary biking, or water aerobics. Depending on your stage of recovery, you may only be able to do 10 minutes at a time, but slowly progress as you are able. Mobility promotes healing, as long as you do not overdo and cause more pain.

5. FOLLOW DOCTOR'S ORDERS, such as lifting restrictions, activity restrictions, using a brace, using a cane, Physical Therapy, etc.

6. REQUEST PHYSICAL THERAPY. For the optimal prognosis after low back surgery, it is important for you to learn some strategies, exercises, postures, and functional activities from a Physical Therapist. It may take just a few visits if you are recovering quickly, or some patients need weeks or months of therapy if they are still having limitations or symptoms.

Does The Weather Really Increase Joint Pain?

Photo: Dale McDonald, State Archives of Florida

Almost all my older patients report they feel more pain when the weather is cold and/or rainy. But is it really true? Here is an example of someone who told me: "I woke up with a lot of leg and back pain, and I think it is just because of the weather." So my goal was to show that her pain could be improved, regardless of the present weather conditions.

On a scale of 0-10, pain was 7/10 at the start of our session. Her first exercise was the same one she had been doing for homework: lie face down on the mat and press up onto her hands. Doing this for a few sets decreased her pain from 7/10 to 5/10 and made her leg feel better. With a few more exercises in the same direction of movement (backwards or back extension), her pain further decreased to 1/10 and was located in the center of her low back and not her leg. Objectively, her baseline movements improved and became less stiff and less painful.

So, how much of her pain was weather-related? Some of it may have been caused or aggravated by the climate change, but most of it was movement-related. So within one hour of treatment with the proper movements, her pain decreased from 7/10 to 1/10, and the weather was still cold and wet when she left.

Why You Should Get Physical Therapy For Your Back Pain

I recently treated a patient with leg pain that radiates from his back. It goes into his thighs and even down below his knees. This pain began 3-4 months ago, and he is unsure how it started. Before his session, I knew his walking had been problematic because when he stood up in the lobby, he significantly stooped over and could barely get his balance. He was using furniture and walls to hold onto. So my initial goal was to find an exercise that would immediately improve his ability to stand up and walk. 

I treated him for 10 minutes with one or two exercises lying on the mat. Then he stood up tall and walked easily back to his chair. He could not believe he was walking that well because since his symptoms began, he has the most pain and difficulty with initially getting out of a chair to walk.

So if you have back pain, you could possibly be only a few minutes away from pain relief. Schedule your Physical Therapy today!

Best Book for Self-Treatment of Painful Joints

Do you have joint pain that you cannot afford much medical treatment for? Robin McKenzie, a world-famous Physical Therapist and bestselling author, wrote a series of books about self-treating pain in various joints. I would highly recommend any of these if you have pain but cannot afford much therapy or other treatments.

Treat Your Own Back
Treat Your Own Neck
Treat Your Own Knee
Treat Your Own Shoulder

There may be various editions of these. I would recommend looking at Amazon or other websites to find the best prices, but you should be able to purchase one for $10-$15.

For more of McKenzie's exclusively-designed products such as lumbar rolls and pillows, check out OPTP.com.

Of course, if you have serious joint pain that is not resolving, please see your physician and request a prescription for Physical Therapy.

Reading Position That Decreases Back Pain

Photo: Rachel Sian

Do you read every night before going to bed? Next time you do, lie on your tummy and prop up onto your forearms as you read. This is an ideal position because it arches your back, which is a very healthy movement that most of us rarely do. Our backs do a ton of forward bending each day, as we sit, slump, bend, stoop, and recline. But how often do we stretch our spines backwards? This is one reason why so many elderly folks, or even younger individuals, are hunched forward and cannot stand tall or even sit up straight.

If you do not achieve any backward movement of your spine in daily life, you will progressively lose the ability to fully bend backwards as a normal spine should. So lying face-down and propping on your forearms is one easy way to start moving your spine in the right direction. At first it may be a little uncomfortable, but soon you will grow to like it. Start with 3-5 minutes, and if it feels fine, increase your time up to 10-15 minutes or even more.

Not only is this healthy for your back, but it has good potential to decrease your low back pain! 70% of patients with low back pain need backward movements to get better!

Lastly, this position is the perfect adjunct to reading your Bible every night. That way you are promoting both your physical and spiritual health.

Why Sleeping In Fetal Position Is Bad For Your Back

Fetal Position: Does It Cause Back Pain?
Side sleeping can be ideal for most individuals, but curling up too much into fetal position can actually cause back pain or at least contribute to it. Fetal position puts your spine into a forward bent or flexed posture, which is similar to sitting slumped or standing and bending forward. As much as fetal position may be comfortable, it is not healthy for your spine to be in that flexed posture for hours at a time.

Forward vs. Backward Spine Positions and Back Pain:
If you have never had low back pain, you can learn this lesson from those who do: most individuals with low back pain respond best to backwards bending or back extension exercises, not flexion or forward bending. In other words, having your back in a forward bent or flexed position is not very healthy for your spine (low back, mid back or neck).

Neutral Spine Sleeping Posture To Avoid Low Back Pain:
I am not saying you should sleep in a backward bent position either. Simply find a neutral sleeping posture which puts your back into a relatively straight position. This can easily be achieved when sleeping on your side by not bringing your knees up toward your chest. Have your knees slightly bent but do not pull up your legs so that your low back becomes rounded or flexed.

Pillow Between Knees To Prevent Low Back Pain:
To further improve your neutral spine position, sleep with a firm pillow between your knees or use a body pillow. My pillow of choice is a small, firm, rectangular one. I have seen pillows made for this purpose at Bed, Bath and Beyond, but they are more expensive than simple, decorative pillows which are just as effective (check the clearance rack at your favorite discount store).

Prevent Low Back Pain With Good Posture:
While you are looking to achieve a neutral sleeping posture, also work on neutral sitting postures during the day. For example, avoid sitting in a recliner or chair/chaise with your legs extended in front of you because that also puts your low back into a rounded or flexed position. In a desk chair, sit at the back of the chair with a lumbar pillow for added support. Similarly, avoid bending forward when you are standing or sitting; instead, use your legs to squat and maintain your back in a straight position.

Low Back Muscle Spasm

What Is Low Back Muscle Spasm?

One presentation of low back pain is muscle spasm. This can accompany a low back strain or many other lumbar spine diagnoses. Low back muscle spasm presents as sudden, severe pain in part of the low back with decreased ability to move it for a time. For example, you are in a bent position and you cannot straighten up. That muscle is hard/tight to the touch compared to the other back muscles. It may appear swollen; for example, the right side of your low back looks bigger than the left. This can be present for a few minutes-hours and can come repeatedly over a number of days to several months, depending on your activities, movements and postures.

How To Treat Low Back Muscle Spasm:

It usually requires you to change positions, and the severity decreases if you find a relieving position such as lying on your side or getting onto hands and knees. Any new injury needs to be treated with ice for at least 2-3 days to minimize swelling and inflammation. Muscle spasm can be decreased with the use of heat to relax the muscle. If there is not significant swelling or internal inflammation, you can use heat to treat the pain associated with muscle spasms.

Medical Treatments for Low Back Muscle Spasm:

For this diagnosis, you will likely be prescribed muscle relaxers, anti-inflammatory medicine and/or pain relievers. Certain movements, positions or activities may need to be limited to prevent the spasm from returning (for example walking less, decreasing housework, or not playing your sport for a time). Other treatment options are Physical Therapy, chiropractic care, massage, and acupuncture.

How To Prevent Low Back Muscle Spasm:

If you prevent all other forms of low back pain, you will prevent low back muscle spasms. This means:

1. Practice good postures.

2. Practice good ergonomics and body mechanics.

3. Exercise regularly for your overall spine health.

4. Avoid a sedentary lifestyle because all tissues, including your spine, thrive on movement.

5. Do back extension exercises (moving spine in backward direction).

Low Back Pain: Treat With One Exercise

Photo: Chakra-Jnana Yoga/Facebook

Backbends. Stand up, put your hands on your hips or low back, and bend backwards (obviously not beyond a comfortable stretch), likely around 30 degrees. Hold 1 second, then return to upright. Repeat 5-10 times. This is the single best exercise for the majority of patients with low back pain, and the following explains why.

1. Convenience. You can do this exercise anywhere to treat or prevent low back pain. It does not require equipment or even lying down. While there are various forms of back extension (lying on your tummy and pressing up onto forearms or hands, lying on your back and lifting your hips into a bridging position, various yoga poses, etc), this exercise is the easiest one to perform no matter where you are.

2. Back Extension Exercise helps 70% of patients with Low Back Pain. Moving your lower spine into a backward-bent position (arched) is one of the most effective ways to undo the force of continual forward bending and slumping that we all perform excessively every day.

3. Back Extension treats Low Back Injury which occurred in a flexed (forward bent) position. If you have Low Back Pain which began with a specific injury or traumatic event, think about the position of your back at that time. Were you lifting something? Bending forward to pick up an object? If forward movement caused your injury, back extension may be the direction of exercise to treat it. Even if you were injured in another way, this still is the direction of force that the majority of patients with low back pain need in order to minimize symptoms.


Caution: This exercise is not safe or appropriate for all individuals, so consult your physician first, especially if you have low back problems, painful medical conditions, balance problems, or anything else that may inhibit your safety. If performed in a gentle way, it is likely safe for most individuals without low back pain. No one should perform this forcefully or into an excessively far backwards position.

If you have low back issues and have not seen a Physical Therapist, ask your doctor for a referral/prescription, and find a spine PT near you!


Reference: McKenzie, Robin. Mechanical Diagnosis & Therapy: Lumbar Spine. 2009: The McKenzie Institute International, Part A.

Further reading: McKenzie, Robin. Treat Your Own Back, 9th ed. 2011: OPTP.

Back Health Survey Discussion: Risk Factors for Low Back Pain

The discussion points here respond to the questions from yesterday's post, entitled "Back Health Survey."

1. How frequently do you perform moderate-high intensity exercise? In general, back health is improved as you do regular exercise, especially cardio exercise and strength training. However, it is important not to injure your back during exercise with excessive, early high intensities or uncontrolled bending/twisting.
   
2. How many hours/day do you sit on most days of the week? Likely, you have minimal control over how much you sit at work, but the rest of your day is yours to stand and walk more! Too much sitting puts your spine in a rounded or flexed position for long periods of time (unless you practice perfect sitting posture with additional lumbar support). Also, sitting does not promote cell growth and circulation as well as standing/walking, so it can lead to spine issues later in life.

3. How often do you perform back strengthening exercise or core strengthening? I recommend you do this at least 2-3x weekly, even if only for 5 or 10 minutes each time. Good back strengthening includes back extensions (backwards bending or arching of the back). Abdominal strengthening is also good (crunches are better for your back than full sit-ups). Core strength exercises of all varieties are great for your spine health, as they strengthen the deep abdominal and spine muscles, which will give natural spine support when you do strenuous daily tasks.
   
4. What is your usual sitting posture? First, check the chair you sit in to ensure it is ergonomic. Then add a lumbar roll (rolled up towel or round pillow) behind your low back. Sit at the back of the chair, then add your additional lumbar support.
   
5. What is your present weight status? Extra weight puts more strain on all your joints, including your spine.

6. How many episodes of major low back pain have you had in your lifetime (enough to limit your usual functional activities)? Low back pain comes in repeating episodes, so if you have had several, you likely will have more in the future. But it is not too late to get treatment, of which Physical Therapy can help significantly! Not only will you learn exercises but also things to avoid and how to self-manage your symptoms.

7. How far down did your low back pain symptoms radiate? Symptoms that radiate further down the leg are worse than those in the back only. That is because nerve(s) are being pinched in the spine, causing the symptoms to shoot downward. The key to treatment is to find what eliminates the leg symptoms and moves them more centrally, to the spine (AKA centralization).
   
8. How did your low back pain resolve? Your risk of future back pain is increased if your prior back pain has never resolved or has become chronic. In this case, you and your medical team have not yet found the ideal treatment plan, so all options should be considered, perhaps multiple times.

9. How often do you practice proper body mechanics during daily activities (such as squatting instead of bending, avoiding twisting, and good lifting techniques)? This may be the single most important factor to decrease your risk of future low back injury! Simply begin to implement body mechanics changes in your daily life. Soon they will become habitual.

10. How much heavy lifting do you regularly perform? Heavy lifting can increase your risk for back pain unless it is always performed correctly (spine straight and using the legs only to do the work of lifting).

11. How often do you participate in high risk sports/activities (such as skiing, skydiving, skateboarding, 4-wheeling, etc)? Trauma obviously can cause major back injuries or worse (becoming paralyzed or even death), so proceed only with extreme caution, and practice utmost safety measures.
   
12. How often do you perform standing forward bending exercises (such as touching the toes)? This is one of the single worst exercises you could perform. Your spine does not need to be stretched into a forward bent (flexed) position. What is your reason for doing this exercise? If it is for hamstrings stretching, use an alternate technique. If you do this out of habit or from something you learned in your past, change it because this can majorly damage your spine.

Back Health Survey: Am I At Risk For Low Back Pain?

1. How frequently do you perform moderate-high intensity exercise?
     a. 5-7x/week
     b. 2-4x/week
     c. 1x/1-2 weeks
     d. rarely

2. How many hours/day do you sit on most days of the week?
    a. <4 hours/day
    b. 4-6 hours/day
    c. 7-10 hours/day
    d. >10 hours/day

3. How often do you perform back strengthening exercise or core strengthening?
    a. >3x/week
    b. 1-2x/week
    c. occasionally
    d. what do you mean by back or core strengthening exercise?

4. What is your usual sitting posture?
    a. upright, with extra lumbar support (lumbar roll, rolled towel, etc)
    b. upright, without lumbar support (decent chair but no additional lumbar roll or cushion)
    c. mildly slumped
    d. severely slumped or rounded

5. What is your present weight status?
    a. ideal body weight
    b. mildly overweight
    c. moderately overweight
    d. severely overweight

6. How many episodes of major low back pain have you had in your lifetime (enough to limit your usual functional activities)?
    a. no major episodes
    b. 1 major episode or injury
    c. 2-3 episodes
    d. >3 episodes

7. How far down did your low back pain symptoms radiate?
    a. no major low back pain in my past
    b. low back only
    c. low back and buttock(s)
    d. down to thigh (not below knee)
    e. down below the knee

8. How did your low back pain resolve?
    a. no major low back pain in my past
    b. completely resolved
    c. partially resolved
    d. never resolved

9. How often do you practice proper body mechanics during daily activities (such as squatting instead of bending, avoiding twisting, and good lifting techniques)?
    a. All the time; with both difficult and easy tasks
    b. Most of the time, especially difficult tasks
    c. Sometimes
    d. Rarely

10. How much heavy lifting do you regularly perform?
     a. occasionally-rarely. Always with good technique
     b. frequently. Always with good technique
     c. occasionally-rarely. Without considering technique
     d. frequently. Without considering technique

11. How often do you participate in high risk sports/activities (such as skiing, skydiving, skateboarding, 4-wheeling, etc)?
      a. rarely and not likely to in the future
      b. once every few years
      c. multiple times per year
      d. very frequently

12. How often do you perform standing forward bending exercises (such as touching the toes)?
      a. never. not since elementary school calisthenics
      b. occasionally, when I need to stretch my back
      c. frequently, during my usual workouts
      d. daily or multiple times daily


Score: Count your score by assigning points to each letter answer.
Legend
a: 0 points
b: 1 point
c: 2 points
d: 3 points
e: 4 points


Results:
>30 points: Get to know your Physical Therapist and spine surgeon. You will be seeing us a lot.
20-30 points: Moderate risk unless you make major changes immediately.
13-20 points: Mild-moderate risk. Consider ways to improve!
6-12 points: Mild risk. But beware and don't become complacent in these areas.
0-6 points: You have a healthy back and are at low risk as long as you continue good habits!

Tune in next time for more discussion about these questions/answers!

Post your answer in the comments section. There will be three prizes awarded!
 

Low Back Muscle Strain

Causes of Low Back Strain: 

One very common form of low back pain is due to a low back muscle strain. This usually occurs because of improper lifting, sports activities, twisting of the back, car accidents, or improper strengthening. General workout activities can contribute, such as a challenging exercise class, machine weights or free weights.  In these cases, one or several muscles of the low back are strained through over-stretching, over-contracting, moving too quickly, twisting or pulling. The muscles have a strain placed on them when they are in an awkward position or there is a traumatic force on them if they are in a neutral position.

Postures and Low Back Pain:

Another cause for low back muscle strain is having an unhealthy spine through habitual poor posture. If you sit all day in a slumped position, your lumbar spine (low back) is loaded into a forward or flexed position, and the muscles of your back are continually stretched (elongated). As a result, you may be more likely to strain a back muscle from light tasks such as loading/unloading the dishwasher. On the other hand, those with a healthy spine (through repetitively good posture and exercise) may tolerate light tasks but strain their backs when doing more strenuous work (ex: heavy yardwork). It is important that both individuals practice good posture and body mechanics in order to avoid straining the low back during routine daily tasks, and especially during difficult physical activities.

Treatment of Low Back Strain

Low Back Muscle Strain should first be treated with ice for at least 2-3 days. If you see a doctor, you will likely be prescribed a muscle relaxer, anti-inflammatory, and/or pain reliever. Other treatments are rest, ice/heat, massage, and Physical Therapy. Depending on the severity of the muscle strain, you may have pain for a few days to several months. This type of LBP can be prevented by maintaining proper posture/body mechanics, proper lifting, regular exercise, caution with sports activities, and maintaining a strong core.

Laptop Ergonomics Video

This video gives you some ideas for how to improve your posture and positioning when working on the computer. It is very brief (2 minutes).

Back Pain Prevention: Avoid Twisting

Never twist your body when holding something. It is common for me to ask a patient with low back pain how he hurt his back and he responds that he was holding a heavy box and twisted his back. This is one common way to cause a disc in the low back (lumbar spine) to bulge or herniate, which is a very common diagnosis in PT clinics. The complication associated with disc problems is that if a lumbar disc bulges out of its normal position, it can compress the nerves in the spine, causing pain and other symptoms into the leg or legs. It is much easier to prevent a disc herniation than to treat one after it occurs!

            One common way for this to happen is while doing the laundry. Many people twist their bodies when putting clothes from the washer into the dryer. This is worsened because they are holding wet clothes while twisting their backs, causing more injury than if nothing were held. Instead, step over to the dryer, then squat to throw the clothes in. It takes a conscious effort every time, but just remember "step, squat, and toss." It only takes one wrong twist to cause low back pain which could last for months or years, so avoid twisting—every time!
         Here is a video showing what not to do. I posted it a year ago, but it's funny and worth another viewing.

Ergonomics Rap with Sustainable John - Lawrence Berkeley Lab

Click on the title to view this video about workplace ergonomics! Good reminders for those of you who sit at a desk all day.

Back Pain Prevention: Proper Lifting Techniques

Photo: New York Public Library

Never lift an object if you are in a forward bent position. The picture here shows a proper squat in order to reach down to the floor. Your spine is a perfectly stable system of bones (vertebrae) with discs in between each one. This system is designed to support your body weight and has the capacity to support much more weight (for example, carrying furniture) if the spine is maintained in its neutral position. (Note, it is not designed to support excessive body weight). The neutral position of the spine is when each vertebra is stacked on the one above it, which happens when you are demonstrating proper posture. You lose the stability and strength of the spine when you are twisted or bent, which removes the vertebrae from their properly stacked resting position. When this occurs, the muscles of your back have to be used in a way they were not made for. Why not use the stability of your spine when you lift instead of straining weak back muscles? 

Back muscles can be strengthened, but strong back muscles alone cannot prevent back injuries when your spine is in a compromised position, such as bent forward. Instead, it is best to lift when your back is straight and you use your legs to do the work. This involves squatting down but maintaining a straight back position. Our leg muscles are very strong and large and are made to do the work of lifting heavy objects, if we use our legs instead of our backs. If you are familiar with weight lifting, squatting is the exercise in which one can lift the most weight, compared to dead lifts, bench press, etc. This is because the thighs and buttocks have huge, powerful muscles, which are much less prone to injury. I rarely see patients for quadriceps (anterior thigh muscle) or gluteus maximus (buttocks muscle) strains whereas low back strains are very common in outpatient PT clinics.

What Should I Do For Chronic Back Pain?

First, you should see your primary care physician. He/she will decide if you need a referral to a specialist. 

Second, consider your most conservative treatment options, such as medication and Physical Therapy (PT). There are several types of Physical Therapy options. If you have seen a Physical Therapist before and still have chronic back pain, maybe you need to find a therapist that specializes in the spine. 

There are three main forms of specialty PT that are most effective for chronic back pain. Mechanical Diagnosis and Therapy (MDT), Manual Therapy, and Aquatic Therapy. Your primary doctor, spine specialist or pain specialist may prescribe PT for you and refer you to a specific PT clinic. But do not hesitate to do your own research on local PTs in order to find the clinic that will best meet your needs. It is your choice where to get your Physical Therapy once it is prescribed (just like you choose your pharmacy). Just remember that not all PTs are the same. Some clinics specialize in orthopedic rehab, neurological rehab, pediatric rehab, spine rehab, aquatic therapy, geriatrics, etc, so select carefully in order to maximize your time, effort and cost. Getting the proper Physical Therapy could help you to prevent injections or even surgery. 

Third, if you are still not getting better, follow up with your doctor/specialist. You may be a candidate for injections or other treatments. Injections are effective for some back patients. Some get short-term relief, some get long-term relief and some get no relief, depending on your diagnosis and other factors.

Fourth, increase your fitness level. Get on a weight loss program if you are overweight or obese. Start exercising regularly. This, by itself, could drastically decrease your back pain. It is urgent that you start to do cardio exercise 5-7x per week. Work up to at least 30 minutes per day of moderate to heavy cardio exercise (a walking program may be the easiest, cheapest and most convenient option).

Fifth, if you have done all of the above and still have chronic back pain, see your specialist again, or get a second or third opinion. You should at least know your diagnosis, prognosis and treatment options. If you do not know these yet, ask more questions until you get the answers you seek.

As a PT, I obviously recommend PT over other treatment options. I recently saw a patient with chronic back pain for >20 years and radiating leg pain for >1 year. Within 1 PT session his leg pain was gone and within 3-5 sessions, his back pain was gone! A PT will help to find the cause of your pain, the proper treatment(s), and the best ways to prevent future episodes.