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:   The Intervertebral Disc

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:   Examination of Back Pain

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:   Recovering From Acute Low Back Pain. General Instructions

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...
Low Back Pain. Contraindications Although it has been accepted throughout that all patients have received adequate medical screening, occasionally patients with serious pathology or mechanical disorders unsuited to mechanical treatment are encountered during routine examination. If in the examination no position or movement can be found which reduces the presenting pain, the patient is unsuited for mechanical therapy, at least at this time. The existence of serious pathology should be considered when the history states that there has been no apparent reason for the onset of symptoms; that the symptoms have been present for many weeks or months, and have during that time increased in intensity; and that they are constant; and the patient feels that he is gradually getting worse. On examination the pain remains exactly the same, irrespective of positions assumed or movements performed. Usually there is little loss of function if any, and postural deformity is not often seen. In addition to the examination finding, th...
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...
Spine Health. PROCEDURE 3 — EXTENSION IN LYING The patient, already lying prone, places the hands (palms down) near the shoulders as for the traditional press-up exercise. He now presses the top half of his body up by straightening the arms, while the bottom half, from the pelvis down is allowed to sag with gravity. The top half of the body is then lowered and the exercise is repeated about ten times. The first two or three movements should be carried out with some caution, but once these are found to be safe the remaining extension stresses may become successively stronger until the last movement is made to the maximum possible extension range. If the first series of exercises appears beneficial, then a second series may be indicated. More vigour can be applied and a better effect will be obtained if the last two or three extension stresses are sustained for a few seconds. It is essential to obtain the maximum elevation by the tenth excursion and once obtained the lumbar spine should be permitted to relax into the most extreme ...
Spine Health. PROCEDURE 9 — ROTATION MOBILISATION IN EXTENSION The position of patient and therapist is the same as for procedure 7. By modifying the technique of extension mobilisation so that the pressure is applied first to the transverse process on the one side and then on the other side of the appropriate segment a rocking effect is obtained. Each time the vertebra is rotated away from the side to which the pressure is applied — for example, pressure on the right transverse process of the fourth lumbar vertebra causes left rotation of the same vertebra. The technique should be repeated about ten times on the involved segment and, if indicated, adjacent segments should be treated as well. Fig. Rotation mobilisation in extension. Effects: Also here the external force applied by the therapist enhances the effects on derangement and dysfunction as described for the previous extension procedures. The reasons for adding therapist-technique are the same as for procedure 7. In general, unilateral techniques are likely to effect unilateral...