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.
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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.
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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.
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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:   Spine Health. PROCEDURE 6 — EXTENSION IN STANDING

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 4 — EXTENSION IN LYING WITH BELT FIXATION The patient’s position and the exercise are the same as in the third procedure, but now a fixating belt is placed at or just below the segments to be extended. The safety belt is the first simple external aid, used to enhance maximum extension. It does so by preventing the pelvis and lumbar spine lifting from the couch. Other methods of restraint may be used effectively, for example the body weight of a young son or daughter when exercising at home. Fig. Extension in lying with belt fixation. Effects: This procedure creates a greater and more localised passive extension stress than the previous ones. It is particularly suitable for stretching in the case of extension dysfunction, and is more often required in dysfunction than in derangement. In dysfunction some pain will be experienced in the small of the back while exercising, because contracted tissues are being stretched. In derangement the rules pertaining to the centralisation phenomenon must be observed, and the proce...
Spinal manipulation techniques There are many differing philosophies and concepts surrounding the practise of spinal manipulation and its effects on the pathologies which may exist in the spine. To satisfy all these philosophies an equal number of institutions has developed, teaching those wishing to learn. No matter what school presents its case or which philosophy is adhered to, all manipulative specialists claim to have a high success rate. They all use techniques which vary in nature, application and intent; they proclaim that their own methods are superior to those used by others; and yet, somehow they all obtain uniformly good results. Self-limitation of low back pain plays, of course, a significant role in this happy situation. Apart from this there are definite benefits which are obtained quickly by using manipulative techniques. Throughout the years I have practised many forms of mobilisation and manipulation, including osteopathic and chiropractic techniques and those taught by Cyriax. I have come to be...
ASSESSMENT OF PAIN Pain gives the body warning and often is accompanied by anxiety and the need to relieve the pain. Pain is both sensation and emotion. As noted earlier, it can be acute or chronic. Health-care professionals may find the following mnemonic tool useful for assessing a client in pain: P = place (client points with one finger to the location of the pain) A = amount (client rates pain on a scale from 0 to 10 ) I = interactions (client describes what worsens the pain) N = neutralizers (client describes what lessens the pain) The scale of 0 to 10, as described in the mnemonic, is a useful method of assessing pain. Further pain assessment skills include observing the client’s appearance and activity. Monitoring the client’s vital signs may be of value in assessing acute pain but not necessarily chronic pain. To assess the pain of children or those with some cognitive dysfunction or dementia, a “smiley face” model often proves beneficial. The first smiley face shows a happy face...
Back pain. The Cause of Pain THE NOCICEPTIVE RECEPTOR SYSTEM Most tissues in the body possess a system of nerve endings which, being particularly sensitive to tissue dysfunction, may be referred to as nociceptive receptors. The free nerve endings of the nociceptive system provide the means by which we are made aware of pain. Wyke describes the distribution of the nociceptive receptor system in the lumbar area: it is found in the skin and subcutaneous tissue; throughout the fibrous capsule of all the synovial apophyseal joints and sacro-iliac joints; in the longitudinal ligaments, the fiaval and interspinous ligaments and sacro-iliac ligaments; in the periosteum covering the vertebral bodies and arches, and in the fascia, aponeuroses and tendons attached thereto; and also in the spinal dura mater, including the dural sleeves surrounding the nerve roots. The nociceptive innervation of the spinal ligaments varies from one ligament to another. The system is found to be most dense in the posterior longitudinal l...
Recovering From Acute Low Back Pain. General Instructions You have recovered from the acute episode because of your ability to master the exercises which relieved your pain. These exercises must be repeated whenever situations arise which have previously caused pain. You must perform the corrective movements before the onset of pain. This is essential. If you carry out the following instruction, you can resume your normal activities without the fear of recurrence. SITTING When sitting for prolonged periods the maintenance of the lordosis is essential. It does not matter if you maintain this with your own muscles or with the help of a supportive roll, placed in the small of your back. In addition to sitting correctly with a lumbar support, you should interrupt prolonged sitting at regular intervals. On extended car journeys you should get out of the car every hour or two, stand upright, bend backwards five or six times, and walk around for a few minutes. BENDING FORWARDS When engaged in activities which require prolonged fo...