Monday, August 17, 2009

Newsletter: Back Pain, part 4

The decompression exercise seems to help a bit, even more than you thought it might. You want to accelerate the healing (i.e. eliminate pain) now. It's time to begin gentle stretching moves. You'll want to tie this into the decompression exercise as well, doing the stretches after the decompression.
Stretch #1 - lay prone (on your back), and pull one knee to your chest, holding the knee with both hands. This is a very basic hip/lower back stretch. Hold this stretch until you feel the tension in your back subside. Why do I say this? You will notice that the typical 15 -30 second hold you hear about so often does not apply to you because in that time period, you will notice that your back is still tense. Think yoga here. Slowly pull the knee as far to the chest as you can, and try to relax your lower back as much as possible. Wait until you feel it "give" before you end the stretch. Repeat with the other leg. You start this stretch in that sit-up position you had for the decompression exercise. When you're ready to advance the stretch, just extend one leg out while you're pulling the other knee to the chest.
Stretch #2 - lay prone, and pull both knees to the chest. The goal here is to get the hips off the ground. This will be difficult in the beginning because the lower back muscles won't want to release enough to allow that to happen. Keep working at it. The same rule applies here as to the length of time you hold the stretch.
These two stretches are the ones you will get if you go to physical therapy. You can do these on your own very easily. Get in and out of the stretch positions the same way I told you to get in and out of the decompression exercise.
Stretch #3 - More advanced. Sit on something soft, like a pillow (Bosu, if you're in the gym), and spread your legs as wide as you can. Reach forward as far as possible, making sure to support yourself with your hands by putting them on the ground. This stretch will focus on both your hamstrings and your lower back (a good combo since both tend to cause back pain when tight). Hold the stretch as long as you want, sticking to the rule on length of time for holding the stretch. By the time you're able to do this stretch, your lower back muscles will release, but they will be tender, so returning to your starting position must be done slowly. Your muscles will thank you for it. After going down the middle of your legs with this stretch, try reaching out over each leg, putting one hand on either side of that leg. Move to the other leg, and then finish back in the middle. Do not fight this stretch! If you can't reach the ground with your hands, then it is too soon to do it. You may try this stretch with assistance from another person, but make sure that person knows what he or she is doing!
Stretch #4 - More advanced. Lie prone, pulling both knees to your chest. Kick one leg out straight and rest it on the ground, while holding other knee to chest. If you have your left knee up, drop your left hand off that knee and lay it on the ground, straight out, palm on the floor. Use your right hand to pull your left knee across your body as far as possible. The goal is to get the knee to the ground. Start by trying to get your foot to the ground. Breathe out and relax as much as possible as you rotate over. You will take somewhat more shallow breaths as you rotate further, but keep focusing on relaxing your lower back with each exhale. Do not be afraid if you feel a "pop" in your lower spine. That's just your verterbral joints releasing from their compressed state. This stretch should not be attempted until you can roll your hips off the ground in stretch #2. Important: After you stretch to one side, pull both knees to the chest to realign your spine before stretching the other side.
Stretch #5 - More advanced. Sitting in a chair, or on a bench, cross one leg over the other so that only the ankle of one leg is resting just above the knee of the other leg. Sit straight (neutral spine), and push down the knee of the crossed leg so that it is parallel to the ground. If you can do this, then while holding that position, lean forward as far as possible keeping the neutral spine (do not round it yet). Hold this position for about 1 minute. Then, relax your spine as much as possible, rounding it, and reach over the crossed leg with both hands like your trying to tie your shoelace on the shoe of the supporting foot. Repeat on the other side. Do this stretch twice each side. This stretch can be done as often as you'd like, and I highly recommend it!

Monday, August 10, 2009

Newsletter: Back pain, part 3

Click on the link below to get some helpful information and client reviews about back pain and options for treatment. It also includes videos, and pictures of what spinal disc herniations look like through an MRI (magnetic resonant imaging).
Decompression again, as I stated earlier, is the first order of business. This doesn't mean hanging upside down right away, as even getting to a position where you can hang upside down may be too painful. No, it's best to start with focused decompression - localizing just one part of the body, making it easier to get in and out of the position. Use a foam roller for this, or even a couple pillows. Lay on your back, delicately bring your knees up, keeping your feet on the ground, so you look like you're in a sit-up position. Lift your butt up off the ground being careful not to arch your back. Slide the pillows, or foam roller, under your butt just below the pelvic crest. Gently relax on to the pillows or roller. Let your lower back relax and "fall" into the space provided between the pillows or roller, and your shoulders. Stay in this position until you feel most of the pain subside (it may even go away completely!). Repeat this drill as often as you'd like (I did it in the morning, at lunch during work, and at night before bed). When you're done, slide the roller or pillows out to one side, and roll to your side, bringing your knees up toward your chest. Relax for a second in this position (which should be a sleeping position for you during this time). Then, to get up, rotate your chest to the ground, and use your arms to press you up on to your hands and knees. Bring a foot forward, put your hands on that knee, and press up to a standing position. Easier said than done, I know, but you'll get the hang of it. Eventually, you'll want to get up that way all the time, healthy back or not!

Saturday, August 8, 2009

Newsletter: Back pain, part 2

Diagnosis. All right, what happened? Was it a sharp wincing type of pain that came from one side of the back, or was it a headache type of pain (more dull than sharp, but still debilitating) that seemed to emanate from inside your spine? It's very important to think about this, because if you do see a doctor, you'll need to describe in detail what happened, what you felt, and what you did about it. More often than not, the sharp pain from either side of the spine means muscle strain (slight tearing of the muscle), followed by a cramping of that muscle - it's a protective mechanism built into your body that you have little control over. Believe it or not, this is the lesser of the two evils of back pain. This problem is much easier to treat. Muscle -or soft tissue - injury will require less recovery time, in general.
Structural injury is a more serious problem. You're probably dealing with a bulging -or herniated- disc. What's the difference? A bulging disc is just that -bulging out from the space it occupies between the two vertebrae above and below it. It means it's compressed, and the soft nucleus pulposus center has pushed out either through a tear in the connective tissue surrounding the disc, or pushing the connective tissue itself out. The bulge can either directly impinge on a spinal nerve, or cause a narrowing of the space where the spinal nerve comes out (foramen)between the two vertebrae, and the bones of the vertebrae (facets) are pinching the nerve.
Secondly, a question to ask yourself is this: "did I experience any discomfort or pain down either of my legs prior to the pain hitting me?" If so, you may have sciatica, which is a pinching of the sciatic nerve that runs down the back of both legs, and is fed by the spinal nerves in the lower lumbar area as well as the sacral area. Pinching of this nerve, and the resulting pain down the legs, lets you know that you have a bulging disc, and that the problem is a structural one. Muscle cramping around the sciatic nerve will most often ensue, so attacking the soft tissue problem first will help alleviate some of the discomfort of sciatica until you can treat the structural one.
Decompression is the first order of business for the structural problem. Rest and Ice is the first order of business for the soft tissue problem. (Actually, Rest and Ice will help with the structural problem as well, but only initially. You will still have the structural problem after the rest and ice, and that needs to be addressed.)
Next: treatment options