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LOW BACK DISORDERS

Injury Description
Back pain is very common in both athletes and non-athletes alike. It can vary from a nagging, nuisance type of ache to a severe incapacitating pain. The cause of back pain is complex and varied. The following are the four main causes of back pain.

Mechanical Low Back Pain
This is the most common type of back problem seen in the sports participant. It accounts for 70-75% of all back problems. It is caused by strain or microscopic tears of the muscles and ligaments in the back and is usually the easiest to treat.

Facet Joint Syndrome
The vertebrae in your back are connected by small joints (facet joints). These joints are about the size of the joints in your finger. They can become strained and/or inflamed when they undergo extreme forces, as with excessive twisting or arching of the back. Since you cannot splint these joints, the pain may persist for a long time as they are constantly irritated. This accounts for 10-15% of back problems in the active person.

Herniated Disc
This is usually the most severe of low back disorders. Traditionally it is called a "slipped disc." It occurs commonly in the young (under 50), but can also bother the older participant. The disc is a soft substance that acts as a shock absorber between the vertebrae. The inner center of the disc is like the liquid center of a golf ball which can push out at a point of weakness or injury. This can then press on the nerves causing pain from the back down to the foot. This condition accounts for 5-10% of back problems.

Degenerated Discs
If the discs lose moister, they may occasionally shrink and cause the facet joints to settle closer together, thus irritating the adjacent nerves. Some disc degeneration commonly occurs in people over 40 even without specific injury.

The above four conditions encompass the major causes of back pain in the active person, but there are many other possibilities. The treatment of each individual back problem varies but the principles are the same.

N.B. If your symptoms change, notify your doctor immediately for re-assessment.

Treatment

Rest
In the most severe cases, total bed rest is mandatory. You must be on a hard surface (firm mattress, floor). These are the two ideal rest positions:

• Lie on your back with pillows placed under your knees
• Lie on your side with your knees pulled up to your chest. Place pillows between the knees.

Ice, Heat, & Massage
If your muscles are in spasm, ice and/or massage can help relieve the spasm and the associated pain. To reduce stiffness, heat can be applied in the form of heating pad, baths, whirlpool, etc.

Medication
Your physician may prescribe pills depending on the nature of your back pain. The pills will help relieve muscle spasm, decrease inflammation in the joints or ligaments, and help reduce pain.

Physiotherapy
You may need physiotherapy to reduce the muscle spasm and inflammation in your back. In addition a rehabilitation program to prevent further episodes of back pain should be worked out for you, based primarily on increasing the flexibility and strength of your back.

Brace
Our team may prescribe a brace to help support your back. If sitting for long periods of time seems to aggravate your back, then special back supports may be helpful to relieve the pain.

Lifestyle
Small adjustments in the way you sit, stand, lean, and sleep can make a remarkable difference to your back. Your doctor or physiotherapist will discuss these adjustments with you.

Weight Reduction
This is most important. Often losing 10 pounds can alter your posture enough to relieve some pressure from the back.

Sports
When back pain is severe, all sports are obviously impossible. When you do return to sporting activity, the best sports are those that keep the back straight and do not involve jarring and twisting movements which aggravate the condition. Try to maintain your pelvic tilt (see exercises) during your sport.

Good Sports
These sports will be easiest on your back:

• Swimming (especially on your back)
• Cycling (stationary)
• Walking
• Skating

Questionable Sports
These may be alright for some people but bad for others:

• Jogging
• Skiing (downhill and cross-country)
• Baseball
• Hockey

Bad Sports
These sports are particularly hard on your back

• Diving (avoid at all times)
• Racquet sports
• Football
• Volleyball
• Basketball
• Running fast or downhill

Exercises
The conditioning of the stomach muscles is the key to improving your back problem. The basic back exercise is the pelvic tilt. It is important that you learn this exercise first, and then try to maintain its position during your sport activities. Initially, the pelvic tilt may feel awkward, but with practice it can become second nature.

The Pelvic Tilt
Lie flat on your back, knees bent, feet flat on the floor, and body relaxed. Tighten your abdominal muscles and press the small of your back into the floor while tightening your buttocks muscles and tilting your pelvis up. Hold 10 seconds and relax. Repeat 10 times.
A progression of the basic pelvic tilt is the knee raise. Tilt the pelvis as above and raise right knee up over chest without using your hands. Now raise your left knee to join the right. Hold both for 5 seconds and return feet flat to the floor. Repeat 10 times.

Hamstring Stretch
Sit on the floor with your leg straight, knee locked, and other leg bent in. With your back straight, bend from the hips and reach down over your leg until you feel the muscles stretch. Hold and relax. Repeat 3 times with each leg. If this exercise causes pain, discontinue.

Sit-ups
Full bent knee sit-ups can be added as pain subsides. Maintain pelvic tilt. Sit-ups should be done slowly, with a smooth, non-jerky motion (both up and down). Start with only a few, and increase the number as your strength improves.

Questions and Answers

Why do I have back pain?
There are many structures in the spine which may become strained, injured, worn, or diseased. The spinal column is made up of 33 vertebrae, which work together to provide flexibility in motion, protection for the spinal cord, support for the upper body, and force redistribution. The vertebrae are separated from each other by soft-centered discs. If these vertebrae become inflamed, get moved out of line, or press too hard on the discs, you may suffer back pain.
The spine is supported by muscles and ligaments, may become strained or weakened. This can lead to muscle spasm and resulting back pain. Most back pain can be caused by sprain, muscle weakness, tension, or arthritic conditions.

How does a muscle strain happen?
Muscle strain (stretching beyond normal limits) may result in inflammation of the muscle fibers and spasm of those fibers and adjacent fibers. Chronic muscle strain may be a result of poor posture or overuse of muscles. Lifting and turning at the same time, lifting too much weight, or twisting into an awkward position may strain the involved muscle group. Strains can occur in any area of the body - back, neck, leg, shoulder, etc.

Muscle strain can also be caused by lack of adequate warm-up exercises, certain traumatic conditions, and being overweight.

Why is bed rest recommended?
Bed rest is often recommended in order to allow the injured area to heal without any further stress. The amount of bed rest prescribed by your doctor will vary according to your condition. Your physician may also recommend dry or wet heat. Occasionally, cold, such as ice massage, may be effective in the temporary relief of acute muscle spasm.

What role does exercise play?
Supervised exercise is the most common treatment for muscle strain. Strong muscles help support your back, and proper tone can improve posture and reduce the chance of muscle strain.

An exercise program should begin once the acute muscle spasm has subsided. CONSULT YOUR DOCTOR BEFORE ATTEMPTING ANY EXERCISES. If your doctor recommends an exercise program for you, start slowly and do not overdo it. Follow your doctor's instructions carefully, and consult your doctor if pain occurs.

Posture and Lifting Techniques to Minimize Back Strain
The way you stand and sit, the way you lift objects can be critical to your health, especially if you have back problems. Take a look at the "right" and "wrong" shown here. Make a habit of being "right." Take it easy on your back

Lifting

Wrong
Stand securely. Don't lean forward with stiff knees or twist suddenly as you lift the load or set it down.

Right
Bend at the knees, grip the load securely, and thrust up with your legs.

Riding

Wrong
Riding for long periods without rest can be harmful for your back.

Right
Sit with your knees than your hips. On long rides, stop occasionally to stand and stretch.

Basic Low Back Syndrome Conditioning Exercises
These exercises are designed to strengthen a back that has been weakened by a strain, defect, disease, or a simple lack of exercise. CONSULT YOUR DOCTOR BEFORE ATTEMPTING THESE EXERCISES. If your doctor recommends any of these exercises for you, start them slowly. Do not overdo it! Follow your doctor's instructions carefully. Consult your doctor if pain occurs.

Starting position for all exercises: lying on the floor, knees and hips bent with back flat and neck comfortably supported, arms to the side, and feet flat on the floor.

With both hands on one knee, bring the knee up as near to the chest as possible. Return it slowly to the starting position. Relax. Repeat, alternating with each leg, 10 times.

Tighten the abdominal muscles and hold the back flat, then bring both knees up to the chest, grasp the knees with the hands, and hold the knees against the chest about 30 seconds. Return slowly to the starting position. Relax. Repeat 5 times.

Bring one knee to the chest; straighten the knee, extending the leg as far as possible; bend the knee and return to original position. Relax. Alternate with the opposite leg. Repeat 5 times. This exercise is NOT recommended for patients with sciatic pain.

Exercises for Better Back Care

General Instructions
Your best back support is derived from your own back muscles! Faithful performance of back exercises often avoids the necessity of an external brace or corset. Back muscles can give you all the support needed if you strengthen them by routine performance of prescribed exercise.

Exercises
Follow the exercise routine prescribed by your doctor. Gradually increase the frequency of your exercises as your condition improves, but stop when fatigued. If your muscles are tight, take a warm shower or tub bath before performing your back exercises. Do not be alarmed if you have mild aching after performing exercises. This should diminish as your muscles become stronger.

Exercise on a rug or mat. Put a small pillow under your neck. Wear loose clothing; no shoes. Stop doing any exercise that causes pain until you have checked with your doctor.

Helpful Hints for a Healthy Back

Standing and Walking
Try to toe straight ahead when walking; put most of your weight on your heels; hold your chest forward and elevate the front of the pelvis as if walking up an incline. Avoid wearing high heels. Stand as if you are trying to touch the ceiling with the top of your head, eyes straight ahead. All the elements of good posture will flow from these simply maneuvers.

Sitting
Sit in a hard back chair with spine pushed back; try to eliminate the hollow in the lower back. If possible, elevate the knees higher than hips while sitting in an automobile. Secretaries should adjust posture chairs accordingly. Sit all the way back in the chair with your back erect.

Lifting
Bend your knees; squat and lift with your thigh muscles, not your back. Never bend with your knees straight and lift with the upper torso. Move slowly and avoid sudden movements. Try to avoid lifting loads in front of you above the waist line. Avoid bending over to lift heavy objects from car trunks, as this places strain on low back muscles.

Sleeping
Sleep on a firm mattress; a 3/4 inch plywood bed board is helpful and should be used with all but a very firm orthopedic mattress. With acute back pain, sleep with a pillow or blanket rolled under the knees and a pillow under the head. Keep your knees and under the head. Keep your knees and hips bent when sleeping on your side.

Driving
Use a firm seat with a padded plywood or special seat support. Sit close to the wheel with knees bent. On long trips, stop every one to two hours and walk to relieve tension and relax muscles.

Working
Try to avoid fatigue cause by work requiring long standing. Flex hips and knees by occasionally placing a foot on a stool or bench. Take exercise breaks from desk work by getting up, moving around, and performing a few back exercises in the standing position.

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