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.
READ:   Spine Health. PROCEDURE 7 — EXTENSION MOBILISATION

BENDING FORWARDS

  • When engaged in activities which require prolonged forward bending or stooping — for example, gardening, vacuuming, concreting — you must stand upright, restore the lordosis and bend backwards five or six times before pain commences.
  • Frequent interruption of prolonged bending by reversing the curve in the low back should enable you to continue with most activities you enjoy, even with some you do not enjoy.

LIFTING

  • If the load to be lifted weighs over thirty pounds, the strain must be taken with the low back in lordosis and you must lift by straightening your legs.
  • If the object weighs under thirty pounds less care is required, unless you have been in a bent or sitting position for some time prior to lifting. In the latter case you must lift as if the weight exceeds thirty pounds.
  • In addition to correct lifting technique, you must stand upright and bend backwards five or six times after lifting.
READ:   Examination of Back Pain

RECURRENCE

  • At the first signs of recurrence of low back pain you should immediately start the exercises which previously led to recovery, and follow the instructions given for when in acute pain.
  • If this episode of low back pain seems to be different than on previous occasions, and if your pain persists despite following the instructions, you should contact a manipulative therapist.

REMEMBER

  • If you lose the lordosis for any length of time, you are risking recurrence of low back pain.
Examination of Back Pain Having digested the information supplied by the referring doctor, extracted as much relevant information as possible from the patient, and checked the radiologist’s report, we may proceed to the examination proper. If the patient is able to do so, we should make him sit on a straight backed chair while taking his history. During this lime he will reveal the true nature of his sitting posture. When the patient rises to undress after the interrogation we should observe the way he rises from sitting, his gait, the way he moves, and any deformity that may be obvious. We will record the following: I. POSTURE SITTING If the patient has been sitting during history taking, we already have a good impression of his posture. We now ask him to sit on the edge of the examination table with his back unsupported. In the majority of cases the patient will sit slouched with a flexed lumbar spine. Some patients are more aware of the relationship between their posture and pain. They have discover...
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...
Spine Health. PROCEDURE 6 — EXTENSION IN STANDING The patient stands with the feet well apart and places the hands (fingers pointing backwards) in the small of the back across the belt line. He leans backwards as far as possible, using the hands as a fulcrum, and then returns to neutral standing. The exercise is repeated about ten times. As with extension in lying it is necessary to move to the very maximum to obtain the desired result. Fig. Extension in standing. Effects: Extension in standing produces similar effects on derangement and dysfunction as extension in lying, but it is less effective in the earlier treatment stages of both syndromes. Whenever extension in lying is prevented by circumstances, an extension stress can be given by extension in standing. In derangement, extension in standing is designed to reduce accumulation of nuclear material in the posterior compartment of the intervertebral joint, provided this accumulation is not gross. In the latter case extension in lying will have to be performed first. Th...
WHAT IS PAIN? Definition of Pain In dictionaries, pain (ICD-9: 780.96) is defined as a sensation of hurting or of strong discomfort in some part of the body, caused by an injury, a disease, or a functional disorder and transmitted through the nervous system. A nurse, Margo McCaffery, who worked for years with clients in pain and conducted extensive research in the field of pain, defines pain as whatever the experiencing person says it is, existing when he or she says it does. This definition is perhaps the most useful because it acknowledges the client’s complaint, recognizes the subjective nature of pain, and implicitly suggests that diverse measures may be undertaken to relieve pain. The IASP and the American Pain Society (APS) define pain as an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage. Again, this definition further confirms the multiple components of pain in a person’s psychological and physiological exist...
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...