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  • Writer's pictureDr. Darshil Shah

Low Back Pain

Updated: Sep 12, 2020

Low-back pain is an injury to the muscles and tendons of the lower back. These muscles require great force to be able to stand upright, and the forces are tremendously increased when bending at the waist, such as to pick things up from the ground.


Common signs and symptoms


  • Pain in the back which is worse with movement, and may be felt in the hip, buttocks, or back of the thigh

  • Muscle spasms in the back

  • Loss of strength of the back muscles



Causes


  • Prolonged overuse of the muscle–tendon units in the lower back, usually from incorrect back posture

  • Possibly, a single violent injury or force applied to the back


Factors that increase risk


  • Any sport that causes twisting force on the spine or excessive bending at the waist; also, contact sports, such as football, weightlifting, bowling, golf, tennis, speed skating, racquetball, swimming, running, gymnastics, or diving

  • Poor physical conditioning (strength, flexibility)

  • Inadequate warm-up before practice or play

  • Family history of low-back pain or disk disorders

  • Previous back injury or surgery, especially fusion

  • Poor mechanics with lifting, especially heavy objects

  • Prolonged sitting, especially with poor mechanics


Preventive measures


  • Use proper mechanics when sitting or lifting, and maintain proper posture with sitting; lift using the knees and legs, do not bend at the waist.

  • Appropriately warm up and stretch before practice and competition.

  • Maintain appropriate conditioning that includes maintaining an ideal body weight, cardiovascular fitness, hamstring and back flexibility, and muscle strength and endurance training.


Expected outcome


With appropriate conservative treatment, low-back strain is usually curable within 6 weeks.



Heat and cold


Cold is used to relieve pain and reduce inflammation for acute and chronic cases. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.


Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.


When to call your Orthopaedic surgeon


If you're suffering from any of the above mentioned symptoms, kindly visit your orthopaedic surgeon or consult with Dr. Shah to get a treatment plan taking into consideration your activity level/age etc. Kindly refrain from visiting a bone setter or self-treating the injury, this may lead to worsening of symptoms and damage to your spine/spinal cord.




Exercises to avoid/reduce low back ache



Exercises


The exact range of motion and stretching exercises appropriate for you usually need to be determined on an individual basis.

The key point to remember is that if any exercise— range of motion, stretching, or strengthening—causes pain to radiate away from your back and toward your buttocks or legs, stop immediately.

A gentle stretching sensation should be felt.

If pain or other symptoms radiate away from your back toward your buttocks or legs, stop exercising immediately.


Lumbar Flexion






1. Lie on your back with both legs flat on the floor.

2. Bend one hip and knee up toward your chest.

3. Grasp the knee with your hands, and pull it gently toward your chest. Keep your other leg flat on the floor.

4. Repeat with the opposite side.



Lumbar Flexion





1. Lie on your back with both legs flat on the floor.

2. Bend one hip and knee up toward your chest and then the other.

3. Grasp your knees with your hands, and pull them gently toward your chest.

4. Hold this stretch for 30 seconds.

5. Release one knee, allowing the leg to return to the floor, then release the other.



Lumbar Extension




1. Lie on your stomach on the floor.

2. Place your arms underneath you, and prop up on your elbows as shown.

3. Allow your back to relax and sag. Hold this position for 10 - 20 seconds.

4. Return to the starting position, lying on your stomach, flat on the floor.



Lumbar Extension




1. Lie on your stomach on the floor as shown in the picture.

2. Place your palms flat on the floor. Push down on your hands, straightening out your arms and putting an arch in your back. Straighten your elbows fully, keeping your hips on the floor.

3. Return to the starting position.

4. If you are unable to fully straighten your elbows while keeping your back relaxed, place your hands farther out in front of you, and try again.




Lumbar Extension





1. Stand erect and place your hands on the back of your buttocks as shown.

2. Bend backward until you feel a gentle stretch in your back. Return to the starting position. Hold each repetition 30 seconds.




Lumbar Rotation




1. Lie on your back with your hips and knees bent and your feet flat on the floor. Keep your arms out at your sides and your shoulders flat on the floor.

2. Rotate your hips and knees to one side as far as you can, keeping your arms and shoulders flat on the floor. Hold this position for 30 seconds.

3. Reverse position and rotate your hips and knees to the opposite side.




Stretching Exercises



Lumbar Stretch




1. Position yourself on your hands and knees as shown.

2. Tighten your stomach muscles and tuck your pelvis under, arching your back as shown in the diagram. Hold this position for 15 seconds.

3. Tighten your back muscles, rotating your buttocks up and allowing your back to arch and sag as shown. Hold this position for 15 seconds.

4. Find a neutral position. Tighten your stomach and back muscles. Hold this position for 15 seconds.



Strengthening Exercises


Do the exercises as initially prescribed by your physi- cian, physical therapist, or athletic trainer. Progress slowly with each exercise under their guidance, gradually increasing the number of repetitions and weight used.

If pain or other symptoms radiate away from your back toward your buttocks or legs, stop the exercises immediately.



Pelvic Tilt





1. Lie on the floor as shown. You may do this exercise with your knees bent or straight, but it is harder with the knees straight.

2. Tighten your stomach and buttocks, and push back flat onto the floor. If you do this properly, your pelvis will rotate in the direction shown in the diagram. Hold each repetition for 30 seconds.

3. Count out loud and do not hold your breath.



Leg Lifts





1. Lie on the floor as shown. You may do this exercise with your knees bent or straight, but it is harder with your knees straight.

2. Tighten your stomach and buttocks, and push back flat onto the floor. If you do this properly, your pelvis will rotate in the direction shown in the diagram.

3. Keeping your back flat on floor, slowly lift one leg off the floor 6 inches, keeping your knee straight. Count out loud to 30, and do not let your back arch.

4. Repeat with the opposite leg.



Partial Sit-ups





1. Lie flat on your back with your hands resting on your thighs, and tuck your chin to your chest.

2. Slowly sit up until you touch the top of your knees.

3. Hold this position for a count of 20. Count out loud, and do not hold your breath.

4. Return to the starting position.


Double-Leg Hold




1. Lie on your back with your hips and knees bent toward you as shown.

2. Tighten your stomach muscles, and press your back flat into the floor.

3. Keeping your back flat on the floor, slowly let your legs back down. When you feel your back start to arch, stop and hold that position. Count out loud to 30, and do not hold your breath.

4. Return to the starting position.



Quadruped Lift




1. Position yourself on your hands and knees.

2. Keep your back flat and parallel to the floor. Do not allow your back to arch or move during this exercise.

3. Lift your left arm up to shoulder height. Hold this position, and lift your right leg to the same height.

4. Balance and hold this position for 30 seconds.

5. Return to the starting position, and repeat with the opposite arm and leg.

6. Count out loud, and do not hold your breath.


Posture and Body mechanics


Maintaining the most appropriate posture and using correct body mechanics can have a significant effect on back pain. The following are basic suggestions regarding proper posture and body mechanics. These should be specifically discussed with your physician, physical therapist, or athletic trainer. Please remember:


Good posture minimizes the stress and strain on any portion of your spine.

You can incorporate these posture principles into all of your daily and recreational activities.



Resting Positions





Sleep or rest on a firm surface, and find a comfortable position. The most commonly suggested positions are side lying with a pillow between your knees or on your back with a pillow under your knees.



Proper Sitting Posture





Do not slouch! Sit with a small rolled-up towel, foam cushion, or pillow in your low-back area, just above your belt. Sit with your buttocks all the way back in the chair.



Lifting





Do not round out your back when lifting any object. You should make sure that you bend your knees, and attempt to maintain a normal curve in your spine.


Correct Lifting Techniques


DO





Lift with your legs, keeping your back straight.

Use a footstool for objects that need to be placed in or retrieved from high locations.

Get help lifting heavy or awkward objects.


Incorrect Lifting Techniques


DO NOT




  1. Do not lift with your legs straight and your back flexed/ bent.

  2. Do not lift objects that are too heavy over your head.

  3. Do not lift and twist at the same time.

  4. Do not lift an object that is too heavy or awkwardly shaped without help.




Prolonged standing




When you must stand in a position that requires a prolonged period in slight flexion, consider finding a footstool or other object to place one foot on. This will minimize the load on your back.


Prolonged activity in slight flexion





Try to avoid doing any activity in a flexed position for a prolonged period. Put one leg up if possible, which will minimize stress on your back.


Correct Standing Postures




Stand upright and erect whenever possible. You should also attempt to keep a normal spinal posture when doing any activity.


Incorrect Standing Postures




Do not slouch or maintain flexed standing postures for prolonged periods.



Correct Sitting Postures





Sit erect. Use a lumbar roll, cushion, or pillow and a chair that has a high enough back to support your back up to your shoulder blades.



Incorrect Sitting Postures


Slouching



Avoid slouching when you walk or stand. Stand up straight, and walk erect and tall.

Do not slouch or slump. Maintain a proper position in the chair.







The above article is written to provide general information to the common public. Please consult your orthopaedic surgeon before beginning any sort of treatment. Do not attempt to self-medicate as this may lead to undesirable side effects.




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