EXERCISES MAINLY FOR THE LOWER BACK AND ABDOMINAL STRENGTHENING EXERCISES

The following exercises are suitable for most people with backache; it has been found that low back pain is more common in people who are overweight, have poor posture, weak abdominal muscles, stiffness and tight hip muscles, especially the psoas, and the hamstrings. These exercises, if performed regularly and thoroughly, will help diminish all these pain-causing problems.

To get down on to the floor comfortably, go on to your knees first, then your hands; turn on to one hip and elbow and lower yourself down gently on to your back. To get up, reverse the procedure: on to one hip and elbow, turn on to hands and knees, then one knee, and stand up.

Abdominal strengthening exercises-Start by lying on the floor with knees bent.

1. Rest one hand on your abdomen. Take a deep slow breath in; as you breathe out, gently

pull in your abdominal muscles. Repeat 5 times.

Get into the habit of breathing out when tightening your abdominal muscles: this should help you avoid holding your breath while exercising, which causes an increase in intra-abdominal pressure and thus increases the stress on your spine. You do not have to think about breathing in; it happens automatically.

Practise tightening your abdominal muscles frequently during the day; strong tummy muscles give your back extra protection.

2. Flatten the hollow of your back down on to the floor, at the same time squeeze your

buttocks together so that the lower part of your pelvis lifts slightly.

This is a very important exercise which mobilises the lumbar spine, as well as strengthening

the abdominal and hip extensor muscles. Practise it in sitting as well as lying, and do it

frequently during the day.

3. Lift head and shoulders and slide hands up to knees, keep feet firmly pressed on to the

floor. Hold for a count of 4 and lower your head and shoulders.

4. Cross arms across chest; lift head and shoulders and reach with the elbow in the direction

of the opposite knee; hold for a count of 4. Repeat to the other side.

5. Lift both bent knees on to chest: straighten legs towards ceiling; hold; bend knees and put

feet back on to floor.

This exercise strengthens the abdominal muscles and stretches the hamstrings.

6. Bend knees on to chest: lift buttocks off floor and hold for a count of 4. This is a very

strong abdominal exercise.

7. Lift both bent knees on to chest. Lift head and shoulders and put hands on knees. Try to

push knees away with your hands, at the same time resisting the pressure with your knees.

This is a strong static, or isometric, exercise.

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UNDERSTANDING BACK TROUBLE: PREVENTING A RECURRENCE-WHAT YOU CAN DO TO HELP YOURSELF

It is important to identify positively the things that do not make matters worse, and to concentrate on them as a basis for an improvement of life. Assuming you can find some activity-such as short walks or swimming or even walking in a heated pool, or simple exercises which do not upset your back – do it regularly, a bit more and a bit faster or farther every day. Almost any exercise (not jogging!) will do to start with, as the basis for improvement, and help you to become generally more physically fit.

People who are physically fit are generally able to tolerate pain better than the unfit. Their sensation of pain may be no different but it affects them less and they are better able to ignore it

Some of the things you can do which should make your life easier include:

• keep a check on your weight; extra pounds mean extra stress on the spine

• eat a healthy balanced diet

• learn to relax

• learn to live according to a routine, and plan ahead, so that you never need to rush

• give careful consideration to the movements or actions which aggravate your symptoms and

try to avoid them

• when you have a ‘good’ day, do not try to catch up on all the neglected things: having further weeks of misery because you rushed to do too much on the ‘good’ day is not worth it. Increased mental stress will lower your pain-threshold

• make sure that you have a suitable chair and bed – ask advice from the physiotherapist, occupational therapist or osteopath before buying new furniture

• keep active. Rest is appropriate for acute back pain; chronic back pain tends to benefit from the right kind of exercise, preferably of the most enjoyable type and as strenuous as you can manage

• change patterns and positions as needed to ensure that your sex life can continue on as regular a basis as possible. Prolonged back pain can have a devastating effect on sexual activity. Back pain can also be used (often unconsciously) as an excuse for not engaging in sexual activity. The situation deserves understanding and sympathetic analysis from both partners. Postures can be experimented with. For example, experimenting which partner is on top; side to side positions; one partner sitting on a chair, the other astride.

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PHYSIOTHERAPY: MANIPULATIVE PROCEDURES-TRACTION

This is a longitudinal stretching force applied along the axis of the tissues and is a form of regional mobilisation. It has been known for centuries that back pain can sometimes be relieved in this way. It is not known, however, why traction works when it does. Some practitioners have claimed that pulling the vertebral bodies slightly apart eases the pressure on a prolapsed disc. But this in itself would not make the extruded disc material shrink back, nor repair the ruptured outer casing. One theory was that the vacuum produced in the intervertebral space would withdraw the extruded disc material away from the nerve, but bio-engineering experiments have now shown this to be unlikely. Studies have suggested that the amount of traction necessary to achieve actual separation of vertebral bodies is far greater than that ever applied by way of pelvic traction in a physiotherapy department. Possibly traction works by increasing input into the spinal nerves ‘blocking’ the pain pathways or by reducing tension or spasm in the back and hip muscles, or by easing the strain on the facet joints. There is no conclusive evidence. Many people have found relief in this way, but if you are one of the people for whom it does not work, there is no point in persisting with it.

There are several ways of applying traction involving, in many cases, the use of special apparatus. The magnitude of the pulling force, the position in which it is given and the time for which it is applied will determine the effects of the traction. If the traction makes the pain worse at the time, the treatment is stopped. If the pain is worse after traction, the treatment should be discontinued. Patients with severe back pain may be admitted to hospital for traction.

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WHEN THE PAIN STRIKES

An attack of back pain can take several forms. It may occur as a sudden, acute pain at a particular site, and be so severe that you cannot move; it may begin as a dull ache that becomes more severe during the following 24 hours; it may appear as a less painful sensation of stiffness in the muscles down one side of the body.

Back pain may follow a bout of unaccustomed exertion, such as digging a garden bed, or moving heavy furniture at spring cleaning. Or you may bend down awkwardly or with a sudden jerk, and feel that something has ‘gone’ in your back, but not experience really severe discomfort till the next morning, when inflammation will have built up in the damaged tissues. An attack may come on after a spell of mild, nagging backache which you had ignored in the hope that it would go away.

If you have had back trouble before, quite mild and accustomed exertion can cause it to recur; for example, reaching across the car from the driver’s seat to open the passenger’s door.

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PROLAPSED DISC

If the protrusion or the bulge does not press on any sensitive structures there are no symptoms, because the disc has almost no nerve supply of its own. If the bulge presses against one of the ligaments which bind the spine together, or against a nerve root, the pain can be intense. This condition, called a prolapsed disc, is what is popularly, but incorrectly, called a slipped disc. A disc cannot, in fact, slip out of place, because its fibres are knitted into the bone of the adjacent vertebral bodies.

Any disc may suffer a prolapse but, for reasons that are not well understood, those most frequently affected are the last two in the lumbar spine – the one that lies between the fourth and fifth lumbar vertebrae and the one between the fifth and the sacrum. One reason why discs at those sites become affected may be because those are the points of maximum movement for the lumbar spine.

The commonest direction for a prolapse is backwards and sideways. The symptoms arise from the irritation of the sensitive structures and the associated inflammation, similar to the inflammation following any injury. This develops over a day or so, and spreads to involve other tissues at the same vertebral level. It may cause back pain or sciatic pain (down the leg), depending on whether it affects the tissues of the spine or of the nerve root, or both.

Prolapsed discs resulting from violent injury are probably likeliest to occur in young people who are most apt to go in for strenuous games, ‘working out’, disco dancing, and so forth; young nurses also have a fairly high rate of disc injury, through lifting and turning patients.

In middle-aged people, however, it is gradual degeneration of the casing of the disc, rather than violent exercise, that is the commonest cause of disc prolapse. The fibrous outer casing of the disc gradually weakens and grows stiffer, developing cracks through which the nucleus can leak out.

As a small compensation, disc prolapse becomes much less common once middle age is past and this, too, is due to degenerative changes. The nucleus, losing much of its moisture, shrinks considerably, and though it may spread out, it is less apt to leak out of the casing. However, this change brings its own problems, as the disc loses some of its shock-absorbing ability.

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