Acute Low Back Pain. General Instructions

You must retain the lordosis at all times (lordosis is the hollow in the lower back). Bending forwards as in touching the toes will only stretch and weaken the supporting structures of the back and lead to further injury. Losing the lordosis when sitting will also cause further strain.

SITTING

  • When in acute pain you should sit as little as possible, and then only for short periods only.
  • At all times you must sit with a lordosis. Therefore you must place a supportive roll in the small of the back, especially when sitting in a car or lounge chair.
  • If you have the choice you must sit on a firm, high chair with a straight back such as a kitchen chair. You should avoid sitting on a low, soft couch with a deep seat; this will force you to sit with hips lower than knees, and you will round the back and lose the lordosis.
  • The legs must never be kept straight out in front as in sitting in bed, in the bath or on the floor; in this position you are forced to lose the lordosis.
  • When rising from sitting you must retain the lordosis; move to the front of the seat, stand up by straightening the legs, and avoid bending forwards at the waist.
  • Poor sitting postures are certain to keep you in pain or make you worse.
READ:   WHAT IS PAIN?

DRIVING A CAR

  • When in acute pain you should drive the car as little as possible. It is better to be a passenger than to drive yourself.
  • When driving, your seat must be close enough to the steering wheel to allow you to maintain the lordosis. If in this position your hips are lower than your knees you may be able to raise yourself by sitting on a pillow.

BENDING FORWARDS

  • When in acute pain you should avoid activities which require bending forwards or stooping, as you will be forced to lose the lordosis.
  • You may be able to retain the lordosis by kneeling — for example, when making the bed, vacuuming, cleaning the floor, or weeding the garden.
READ:   EFFECTIVE PAIN MANAGEMENT

LIFTING

  • When in acute pain you should avoid lifting altogether.
    If this is not possible you should at least not lift objects that are awkward or heavier than about thirty pounds.
    You must always use the correct lifting technique: during lifting the back must remain upright and never stoop or bend forwards; stand close to the load, have a firm footing and wide stance; bend the knees and keep the back straight; have a secure grip on the load; lift by straightening the knees; take a steady lift and do not jerk; shift your feet to turn and do not twist your back.
READ:   Spine Health. PROCEDURE 12 — ROTATION MANIPULATION IN FLEXION

LYING

  • A good firm support is usually desirable when lying. If your bed is sagging, slats or plywood supports between mattress and base will firm it. You can also place the mattress on the floor, a simple but temporary solution.
  • You may be more comfortable at night when you use a supportive roll. A rolled up towel, wound around your waist and tied down in front, is usually satisfactory.
  • When rising from lying you must retain the lordosis; turn on one side, draw both knees up and drop the feet over the edge of the bed; sit up by pushing yourself up with the hands and avoid bending forwards at the waist.
READ:   Back pain Prevention

COUGHING AND SNEEZING

  • When in acute pain you must try to stand up, bend backwards and increase the lordosis while you cough and sneeze.

REMEMBER

  • At all times you must retain the lordosis; if you slouch you will have discomfort and pain.
  • Good posture is the key to spinal comfort.
Spine Health. PROCEDURE 7 — EXTENSION MOBILISATION The patient lies prone as for procedure 1. The therapist stands to one side of the patient, crosses the arms and places the heels of the hands on the transverse processes of the appropriate lumbar segment. A gentle pressure is applied symmetrically and immediately released, but the hands must not lose contact. This is repeated rhythmically to the same segment about ten times. Each pressure is a little stronger than the previous one, depending on the patient’s tolerance and the behaviour of the pain. The procedure should be applied to the adjacent segments, one at a time, until all the areas affected have been mobilised. Fig. Positioning of hands prior to extension mobilisation. Extension mobilisation. Effects: In this procedure the external force applied by the therapist enhances the effects on derangement and dysfunction as described for the previous extension procedures. In general, symmetrical pressures are used on patients with central and bilateral symptoms. Therapist-...
Spine Health. PROCEDURE 11 — SUSTAINED ROTATION/MOBILISATION IN FLEXION The patient lies supine on the couch, and the therapist stands on the side to which the legs are to be drawn, facing the head end of the couch. The patient’s far shoulder is held firmly on the couch by the therapist’s near hand, providing fixation and stabilisation. With the other hand the therapist flexes the patient’s hips and knees to a rightangle and carries them towards himself, causing the lumbar spine to rotate. With the patient’s ankles resting on the therapist’s thigh the knees are allowed to sink as far as possible and the legs are permitted to rest in that extreme position. The lumbar spine is now hanging on its ligaments in a position which combines side bending and rotation. By pushing the knees further towards the floor the therapist applies overpressure to take up the remaining slack in the lumbar spine. Depending on the purpose for which the procedure is used, the position of extreme rotation is maintained for a shorter or longer period. Fig. Sustained rotation/mob...
Spine Health. PROCEDURE 14 — FLEXION IN STANDING The simple toe touching exercise in standing does not need much elaboration. The patient, standing with the feet about thirty centimeters apart, bends forward sliding the hands down the front of the legs in order to have some support and to measure the degree of flexion achieved. On reaching the maximum flexion allowed by pain or range, the patient returns to the upright position. The sequence is repeated about ten times, should be performed rhythmically, and initially with caution and without vigour. It is important to ensure that in between each movement the patient returns to neutral standing. Fig. Flexion in standing. Effects: Flexion in standing differs from flexion in lying in various ways. Naturally, the gravitational and compressive forces act differently in both situations. In flexion in standing the movement takes place from above downwards, and the lower lumbar and lumbo-sacral joints are placed on full stretch only at the end of the movement. In addition, the lumbo...
Spine Health. PROCEDURE 10 — ROTATION MANIPULATION IN EXTENSION The patient lies prone as for procedure 1. The therapist stands to one side of the patient and, having selected the correct segment, places the hands on either side of the spine as for the technique of rotation mobilisation in extension (procedure 9), which is always applied as a premanipulative testing procedure. The information obtained from the mobilisation is vital and determines on which side and in which direction the manipulation is to be performed. If following testing the manipulation is indicated, the therapist reinforces the one hand with the other on the appropriate transverse process. The manipulation is then performed as in procedure 8. Fig. Rotation manipulation in extension. Effects: The effects of the external force and the reasons for its use are the same as for procedure 9. When the desired result is not obtained with the mobilising technique, manipulation is indicated under certain circumstances. Regarding the direction in which the manipulation is to be...
Back pain Prevention The majority of patients responding to basic extension and flexion principles of treatment have been educated in the means of achieving pain relief and restoring function. They have carried out the self-treatment procedures and have to a large extent become independent of therapists. Following successful treatment it requires little emphasis to convince patients that if they were able to reduce and abolish pain already present, it should also be possible to prevent the onset of any significant future low back pain. Of all the factors predisposing to low back pain only postural stresses can be easily influenced and fully controlled. We must develop this potential ingredient of prophylaxis to the full. The patient must understand that the risks of incurring low back pain are particularly great when the lumbar spine is held in sustained flexed positions; and that when the lordosis is reduced or eliminated for prolonged periods, he must at regular intervals and before the onset of p...