Treatment – Back Pain Blog

Exercises for Strengthening the Back

Plain and simple, standing up, sitting and lying down would not be possible if it weren’t for the vertebral column. Made up of the vertebrae, the nerves (including the spinal cord and nerve roots) and the soft tissues (including invertebral disks, muscles, ligaments and spinal fluid), the spine, when working properly, allows pain free activity and rest.

Exercising helps to keep the various parts of the spine working properly. Exercise also helps to keep us fit so that our spine isn’t burdened with extra weight. Stretching and strengthening conditions muscles which can help prevent back injury, or minimize the severity of injury if the spine is traumatized.

Strong muscles of the abdomen, buttocks, hips, legs and back will all support and stabilize the spinal column. The back, stomach and pelvis area muscles are referred to as the “core.” Strengthening the core and keeping the leg muscles elongated and toned help align the spine to allow for proper curvature of the spine (proper posture). Practicing good posture is probably the most important step in maintaining back health.

Legs and hips– The legs are large muscle masses that are made to carry weight. Strong hamstrings and quadriceps provide stability. Hips help keep the torso balanced. Tight or shortened hamstring muscles can pull on the muscles of the back and make the lower spine curve too far, this is called swayback. Keep the hamstrings especially lengthened and strong. Many people like yoga for a well-rounded stretching regimen.

Stomach muscles – Strong abdominal muscles are extremely important in back health. Without tight abs, the back can sway, you can lose your balance easier, and you are less agile. There are center abdominals and side abdominals; these muscle masses should not be ignored.

Back Muscles – Back muscles are often neglected. People think of working their core and they do crunches and other abdominal work, but forget about the back. With spine health, you can’t have one without the other; you have to work the muscles on both sides of the spine so that it is supported on both sides.

If there is pain being felt, starting an exercise plan should be discussed with a health care professional, however it is generally agreed that staying active can actually help back pain, as long as the activity is modified to be gentle.

There are generally two kinds of exercises for the back; those that are designed to help reduce back pain, and those that help to stabilize and strengthen the back. Stretching should include both a flex and an extension of the spine.

Pain Relief Drugs

Treating pain, whether acute or chronic can be a different experience for everyone. Allergies, other health issues and belief systems make dealing with pain a very individual discussion between a patient and health care professional. Consider talking to your doctor before taking any kind of over-the-counter-drug especially if you are already taking prescription medication of any kind or if you have other health issues, such as high blood pressure. If pain lasts longer than a few days and self-care is not reducing pain, seek advice from a professional. It is better to be safe than sorry.

In treating back pain, it is now a common belief that combining/alternating analgesics with NSAIDs is a very effective way to treat mild to moderate pain. Many over-the-counter options are available:

Analgesics (Pain killers) – Analgesics, such as acetaminophen (Tylenol) or paracetamol, treat mild or moderate pain, and can also be used to reduce fever. Narcotic analgesics, such as codeine, can be used alone or in combination with other analgesics for more severe pain. Analgesics don’t always react the same in every person, so every pain medication has its advantages and risks. Acetaminophen is good for relieving pain and fever and is less irritating to the stomach than other over-the-counter pain medications. It can, however, be toxic if the recommended dose is exceeded.
NSAIDs (Non-steroidal anti-inflammatory drugs) – NSAIDs are anti-inflammtory in nature. They are particularly effective at relieving muscular pain associated with back pain. Many forms of acute back pain are caused by tired, overused, overstretched and torn muscles, so NSAIDs work well to help reduce inflammation and relieve pain. NSAIDs work to reduce inflammation caused by injury, arthritis, or fever. Aspirin, naproxen (Aleve), and ibuprofen (Advil) are examples of NSAIDs.
Muscle relaxants – Muscle relaxants may be prescribed by a doctor to relieve muscle spasms caused by acute injury or chronic back pain conditions.
Prescription medications –Prescription pain medications may be needed in addition to or instead of over-the-counter self-care. There are specific uses and risks of prescription narcotic and non-narcotic medications and often have side effects that need to be considered. Your doctor can tell you if there is a need for a prescription.
Alternatives methods – There are alternate methods to help reduce pain that may be helpful instead of, or in addition to, pain medications. Applying heat and ice alternately to the affected area, massage, chiropractic care, and meditation or yoga.

Ergonomic Chairs

If you have an office job, odds are high that you sit in front of a computer for a good part of every day – even if you don’t have an office job; people of all ages spend at least an hour or two a day in front of a computer. Spending that time sitting in a comfortable and ergonomically correct chair is key in preventing minor back pain (that could eventually lead to more serious problems). There are some general rules to follow when it comes to proper body posture in a chair and aspects to the chair that can help you follow the rules.

Be aware of what your body is doing while you sit; don’t slump or slouch. A good chair can help you sit up so that your vertebrae are aligned with proper curvature of the spine. The chair should provide proper seat depth and width as well as a backrest that has lumbar support built in. Supportive padding in the seat and backrest is extremely important and if the seat is not deep enough or too deep, then the knees, hips and back will be strained. A good chair will have many different knobs and dials to adjust the lumbar support, the tilt of the seat and backrest, and the height of the chair. All of this adjustability insures the best fit possible, which also insures the most ergonomically correct chair.

Try to have right angles at the ankles, knees, hips and elbows. Bring your elbows close in to your side. Be sure that there are no angles at the wrists; the natural (neutral) way that your wrists line up with your forearms should be the way that you type and mouse. The chair should raise and lower to achieve the proper height for the individual. Your feet should be flat on the floor straight down from your knees. Adjustable armrests are optional, but it is important to do whichever helps you keep your elbows at a right angle and your wrists neutral.

Choosing a chair mobile chair is imperative. A swiveling motion will allow the whole body to turn so that the back is not twisting. Rollers on the base of the chair are also necessary to allow you to get closer to an object, such as a phone, desk drawer or stapler, so that you don’t have to reach for it. Reaching, bending and twisting movements can lead to overuse strains. Chairs that allow you to follow these rules could mean the difference between back health and many costly doctors’ visits.

Office supply stores carry lines of ergonomic chairs and many different brands and styles can be purchased online.

Chair Massagers

Sitting down and propping up your feet after a long hard day can feel wonderful. Add a gentle massaging action to that and it is heaven. Chair massagers can provide added relaxation after a long day or relief from throbbing pain from a sore back. The massaging action from the chair can increase circulation and blood flow to the area, which helps to circulate oxygen and carries away toxins. One of the great things about chair massagers is that a person can completely relax into the chair (especially if the chair also allows you to raise your feet). Some handheld types of massagers can leave residual tension in the arm that is holding up the massager; the chair doesn’t have that problem. People also like the idea in investing in a chair massager for convenience and economy – as compared to paying a massage therapist.

Often a brand will have several options at several prices levels, so it is possible to comparison shop and find something that works for you.

Here are some options to consider when purchasing (or using) a chair massagers

Variable settings – Many chair massagers come with several different settings including a vertical rolling motion or kneading action as well as a pulsation or vibration option. Settings can be changed to target the upper or lower back or a mixture of the two.
Individual needs – Different chairs will target different areas. Do you want something that targets the upper back, the seat area, and do you prefer vibration to rolling action? Check out all the options before buying.
Variable speeds – Does the device have several different speed options? Different pain can be treated in different ways, so speed variance can be important.
Heat – With proper use, infrared heat penetrates deep into muscle tissue through the skin. The heat helps to relax the muscle and get circulation going in the area.
Intensity – The kneading or rolling action of a chair massager can sometimes be intense. If you have serious back problems, or experience any discomfort, it is best to speak with your healthcare provider.
Space – Chair massagers are extremely bulky and heavy. Consider where it will fit best before purchasing.
Cost – Chair massagers can be very costly, so it is worth looking around and comparison shopping.

Massage chairs can be found at many different stores and there are two websites, massagechairs.com and comfortchannel.com, which are both great resources; both have a large selection. Directions should be followed to increase effectiveness and prevent harm.

Personal Handheld Massagers

If you suffer from back pain, it is likely that you are always looking for relief options. If you are already exercising, stretching and keeping your weight down, but still have occasional soreness, the personal handheld massager might be just the relief you are looking for. Increasing the blood flow to an area helps to circulate oxygen and nutrients and to carry away toxins, and massage increases blood flow by stimulating circulation. So massage not only feels good, but also provides physiological help as well.

When it comes to personal handheld massagers there are many different options. Some of the big names in massagers are Homedics, Heliohealth, Conair, Max and Ultrasonic, though there are many other brands. Often a brand will have several options at several prices levels, so it is easy to find something that works for you.

Many brands are thinking ergonomically. Handheld massagers are liked by people because they can massage specific areas; a drawback is that whichever hand is holding the massager (and therefore that arm and possibly the shoulder as well) can’t completely relax. Makers of ergonomic products are trying to make using their brands the most relaxing and truly healthy experience possible.

Here are some options to consider when purchasing (or using) a handheld massager:

Variable speeds – Does the device have several different speed options? Different pain can be treated in different ways, so speed variance can be important.
Variable settings – Many massagers come with several different settings including percussive action, steady action or short bursts. Settings can be changed depending on if it will be large muscle groups are being massaged or smaller groups with more concentrated nerve endings.
Ergonomic – Consider how often you’ll need to use the device and for how long it will be operating. Back pain can sometimes be caused from tired muscles, so you want the massager to have easy handling and maneuverability. If your arms are weak be sure to choose an ergonomically designed device.
Cord vs. cordless – Massagers come both battery operated and with cords. Consider how and where your device will be used.
Heat – With proper use, infrared heat penetrates deep into muscle tissue through the skin without causing skin burns. The heat helps to relax the muscle and get circulation going in the area.
Noise – Massagers can be very loud when operating. Think about how loud the action is prior to purchase.

There are many stores that sell personal handheld massagers, such as Brookstone, Costco and Bed Bath and Beyond and the online resources are innumerable. However, a good place to start is comfortchannel.com or amazon.com.

Typical Back Surgeries

Compared to how many people experience back pain every year, spine surgery is rarely the initial treatment. For a majority of patients, surgery is considered only after a course of treatments that combine self and doctor-steered-care. There are emergency situation where surgery necessary or considered early on, but most conditions are resolved non-surgically. Most commonly, doctors advise somewhere between 3 to 6 months (sometimes longer) of recovery treatments before even considering spine surgery.

Once the decision is made to opt for surgery there are generally two types of lower back surgery – decompression and spinal fusion.

Decompression:
Decompression back surgery involves removing a small portion of the bone or disc material from around the nerve root or spinal cord to relieve nerve pinching and provide more room for the nerve recovery.

Herniated Disk decompression:
Herniated disk surgery is the condition that receives the most surgeries. Surgery is to reduce the pain, but also to get the bulging disk from causing nerve damage or making damage worse. Surgical methods include:

Chemonucleolysis: A non-surgical, but still invasive option where an enzyme is injected directly into the disk to dissolve the portion of the disk that is protruding
Diskectomy: Surgery under general anesthesia where a surgeon removes the protruding portions of the disk from the spinal canal or from between the vertebrae.
Microdiskectomy: Similar to a Diskectomy, but it is less invasive, since the surgeon makes a smaller incision and the surgery is performed looking through a microscope, as opposed to the standard open surgery of a Diskectomy.

Foramenotomy
A foramenotomy is another surgery used to reduce pressure on a nerve caused by a bit of bone or osteophyte. The suregery removes that portion of bone or other tissue that may be compressing as the nerve exits the spinal column.

Spinal fusion:
Spinal fusion surgery links together vertebrae that are normally separate so that motion cannot occur between the individual vertebrae. These vertebrae are individual bones that stack to form the backbone.

Laminectomy
A laminectomy is done to relieve pressure on the spinal cord. It is most commonly used to treat spinal stenosis and spondylolisthesis.

Other surgeries:

Spinal Disc Replacement
Spinal disc replacement is a treatment option for some types of low back pain. It is quite common in Europe, but not yet approved in the U.S.

Cauda Equina Syndrome
Cauda equina syndrome is an emergency situation where the complicated nerve root system in the lower spine is being compressed. This compression can cause tingling, numbness and loss of bladder or bowel control and without urgent treatment could cause permanent nerve damage.

Back Pain Treatment Options

Back pain can come in many forms and can be in the upper or lower region of the back. Upper back pain often comes from a traumatic injury such as a car accident or sports injury. However, most of the back trouble that people have is lower back pain since that is where the wear-and-tear occurs. Many different treatments are available for low back pain, depending on the cause and how long the person has been experiencing it.

Acute Pain

Acute pain from a muscle strain or sprain can be agonizing, but most people find that the agony will go away after a couple of days and significantly improves within a few weeks. Taking some basic measures on your own and without a doctor’s care clears up most cases of acute back pain. However, use good judgment; see a health care professional if your pain is out of the blue is severe even with basic self-care.

Self-care treatments:

Consider non-prescription strength anti-inflammatories such as aspirin, ibuprofen, or naproxen or a pain reliever such as acetaminophen (Tylenol). If you are having a muscle spasm, you may also need muscle relaxants, which a doctor can prescribe.
Stay active. Bed rest for a day or two may be absolutely necessary, but back muscles are meant to be mobile. Staying in bed can actually make your muscle stiffer or, even worse, weak. Keep active and try some basic core stretching and strengthening exercises.
Alternate icing and heating the affected area. Ice it for 12-15 minutes ever couple of hours (never put ice directly on the skin to prevent frost bite) and then apply a heating pad (set to low or medium) or take a hot shower. Some people don’t find this helpful, but it definitely can’t harm you, and it may even make you relax, which can be helpful.

Other treatments that are available for acute pain and do not fall into the self-care category are:

Chiropractic care (spinal manipulation) – A chiropractor’s aim is to align the spine and increase a joint’s range of motion. Through a series of adjustments, it is possible to align the spine, which in turn can reduce inflammation that may be the cause of the pain.
Physical Therapy – A goal for a physical therapist is to strengthen muscles so that they can effectively do their job in supporting healthy and proper posture.

Chronic Pain

If back pain becomes chronic (lasting more than six weeks) other treatments might become necessary. Causes of chronic pain include herniated disks, spinal stenosis, osteoarthritis, facet joint block, spondylosis and sometimes cancer. Chronic pain can lead to depression or sometimes anxiety from fear that what you are doing could be further damaging your back. Chronic conditions are usually treated similarly to acute pain sufferers in that core strengthening exercises are highly recommended. Treatment regimens are often more successful when stretching and aerobic and strengthening exercises is regularly practiced. Elongating and strengthening the muscles of the core can help to stabilize and support the spine so that the other treatments can be a success. Treatments for chronic conditions can vary.

Chronic pain treatments:

Drugs and Injections – Most conditions have a corresponding drug protocol that if necessary your health care professional could prescribe. Corticosteroid injections, to block pain sensation or reduce inflammation maybe be used in instances where bone is hitting bone. If your pain is severe, your doctor may recommend short-term use of an opiate painkiller, epidural steroid injection, or muscle relaxants.
Biofeedback, therapy, yoga and/or meditation – Coping with long-term pain can be stressful, upsetting and possibly even depressing. Adapting relaxation techniques into your treatment is widely recommended by doctors and other healers. Yoga can also help to stretch and strengthen muscles!
Antidepressants – if pain and anxiety leads to depression, doctors sometimes prescribe antidepressants.
Surgery – Surgery is rarely needed for low back pain (relative to how many people experience it). Most doctors will wait to until after non-surgical treatments have been attempted for 1 to 3 months without improvement.

See your health care professional immediately if you experience numbness, tingling or loss of bowel or bladder control.

Tools To Manage Back Pain

Many people experience back and neck pain. Whether a person sits at a desk for a good part of the day or performs heavy lifting, back pain is likely to knock on the door at some point in their adult lives. There are several things that can be done to help prevent back pain, like practicing good posture, going to a chiropractor, or strengthening the muscles of the back. If a person sits at a desk using a computer all day, then prevention can come in the form of an ergonomically correct desk chair. Sometimes all that is needed is the quick relief that comes with rest and relaxation, so personal handheld massagers and massage chairs can help to relieve a tired and sore back. This article takes a look at some options for self-managing minor back pain.

Ergonomic Chairs

With the onset of the computer age, more people are spending more time sitting in front of a computer. Using a comfortable and ergonomically correct chair is key in preventing minor back pain (that could eventually lead to more serious problems). Individual needs dictate which chair is right for which person, but here are some things to look for when shopping for a good ergonomic chair.

Height – can it raise and lower to suit individual height
Seat depth and width – the backs of the thighs need to be fully supported and the hips shouldn’t be squished
Backrest – correct and natural curvature of the spine needs to be supported with a high enough back and lumbar support
Arm rests – should be adjustable to accommodate the individual
Swivel and rollers – chair should easily turn and roll to help reduce the amount of bending, twisting and reaching a person does.

Office supply stores such as Office Depot or Office Max carry lines of ergonomic chairs and many different brands and styles can be purchased online.

Personal Hand-held Massagers

Massage not only feels good but has an actual positive physiological effect. Massage increases circulation to an area which increases blood flow. Increased blood flow helps to circulate oxygen and nutrients and to carry away toxins. What people like about the hand-held massagers is the “any time, anywhere” access to relief and the one-time cost, unlike going to a massage therapist. People also like the way they can massage specific areas, but this also means that whichever hand is holding the massager (and therefore that arm and possibly the shoulder as well) can’t completely relax.

There are many different options when it comes to personal hand-held massagers. Massagers come small, large, battery operated, with cords, etc., so finding something for your individual preference is easily achievable.

Massage Chairs

Massage chairs are effective and helpful since a person can relax fully into the chair. Massage stimulates blood flow which increases oxygen to the area. A full chair can be purchased that has the massage unit built in or an insert can be placed on any upright or reclining chair.

Common options in massage chairs include:

Vertical rolling or kneading motion
Pulsation
Concentration on lower back, upper back or both
Heat

Personal hand-held massagers and massage chairs can be found at many different stores including Bed Bath and Beyond, Brookstone and Costco. A good resource online is comfortchannel.com where a full selection of massage therapy products and types are available. Directions should be followed to increase effectiveness and prevent harm.

Back Rotation Stretch

When thinking of your core, consider the area around your trunk and pelvis. When you have good core stability the muscles in your legs, hips and buttocks, lower back and stomach work together. Strong core muscles make it easier to do most everything – stand, sit, recreate, run up stairs. Core exercises help you strengthen the muscles in your trunk and pelvis. They also help your balance, since the core is also your center of gravity.

Poor use or overuse of the lower back muscles, such as lifting and bending for a long period of time, can weaken the core. Weak core muscles leave you at risk for lower back pain and muscle injury. Long periods of stress, whether environmental or emotional can weaken the muscles in the back. So not only is strengthening the core imperative in back health maintenance, but releasing tension is also an important step.

This rotation stretch not only releases tension in the lower back but if done slowly should also give a little boost of abdominal strength:

Lie on your back with your knees bent and your feet and head on the floor. Tilt your pelvis slightly up so that you remove any hollow between your lower back and the floor. Tighten your abdominal muscles and breathe. Keep your shoulders on the floor and let your knees fall slowly to your left side. The bottoms of your feet can come up as your knees drop. Keeping your arms at your side can help to stabilize you and remind you to keep your shoulders on the ground. Go only as far as is comfortable. You should feel a stretch, but no pain. If you ever feel pain, consult with your health care provider. Hold for 15-20 seconds. Slowly bring your knees back up to their starting position remembering to breathe. Repeat on the right side, and repeat the set if desired.

Slow & Gentle Crunches

Keeping muscles strong enough to support the body’s weight is the main goal in preventing back injury. A large but sometimes underused muscle mass are the abdominals. Weak stomach muscles can lead to slouching or swayback. In order to stand upright and keep the back in proper alignment, the muscles of the abdomen need to remain able to support a great deal of weight.

The abdominals consist of several muscle groups: the rectus and transversus abdominis (generally – muscles in the middle) and the internal and external obliques (generally – the side muscles). Keeping these strong can help to lift the trunk upward while both sitting and standing.

Crunches are the oatmeal of the abdominal strengthening breakfast. They are a mainstay. It is one of the best exercises to target the middle to lower abdominal muscles. If crunches are done with a full regimen of core strengthening exercises, back pain could possibly be a thing of the past.

Lie on your back with your knees bent and your feet on the floor. Tilt your pelvis slightly up so that you remove any hollow between your lower back and the floor. Put your hands on your knees or reach toward your knees. Engage your abdominal muscles and breathe. In a crunch you don’t lift your torso all the way off the ground. Keep your chin up and tension out of your neck. Imagine your lower back anchored to the ground. Slowly curl your chest up toward your knees trying to use your abdominals as much as possible and breathe out. Raise yourself up until your shoulders leave the floor entirely. Hold at the top for three seconds and then slowly lower yourself back down breathing in. Relax for several moments. Repeat this exercise 7-10 times. Try to build up to three sets and stop if there is ever any pain.

Stabilizer for the Back

Performing exercises to elongate and strengthen the support muscles of the spine can help prevent back pain and injury. When muscles in the legs and back are tight and/or weak it can cause lower back pain. Muscle strain (muscles that are torn or overstretched) is a problem that most adults experience at some point in their lives.

Another important step in injury prevention, and one that people don’t think of, is balance. Staying agile and stable on your feet can prevent a person from unintentional twisting or jerking in the muscles that can cause muscle strains or even ligament sprains (ligaments that are torn when there is a quick movement in the spine and the muscles cannot react quickly enough to stabilize).

This Stabilizer exercise is a quadruple threat in back maintenance – working the back, abdominal and leg muscles and balance at the same time:

On the floor in a hands and knees position place your knees shoulder width apart and align your hips so that your back and legs are at a right angle. Place your hands in front of you and make sure your shoulders are positioned so that your back and arms are also at a right angle. Your arms should be should width apart. Put your palms flat against the ground; your arms should be engaged to support your weight but don’t lock your elbows. Engage your abdominal muscles and make sure that there is very little arch or dip in your lower back. Lift your right arm and extend it in front of you imagining a level line from your back and along your arm. Hold the head up, but look directly down at the floor. On the opposite side, lift and straighten your left leg, also creating a level line. Hold this position for 10-15 seconds while breathing regularly. Slowly lower your arm and leg. Alternate sides by lifting the left arm and then the right leg. Don’t continue if you feel pain.

Pelvic Tilt and Lift

Core strength – people sometimes think that the term core strength means strong abdominal muscles. Actually, core strength not only means strong abs, but the back as well. There are many different muscle groups involved in keeping us upright and well-aligned. Practicing core strength produces good posture. This means that the vertebrae are sitting properly on top of one another and the nerves of the back (including the spinal cord and the nerve roots) are not being pinched or otherwise irritated therefore reducing or eliminating back pain and injury. Simply, strengthening the core means toning and lengthening the stomach, back, hip and leg muscles.

The Pelvic Tilt can help to tighten the muscles of the lower stomach and back. The Pelvic Lift can help to tighten the muscles of the lower stomach, back, buttocks and upper thigh.

Start with the pelvic tilt: Lie down on your back with your knees bent and your feet and head on the floor arms at each side. Engage your stomach muscles and tilt your pelvis down toward the floor. Imagine your lower back being pressed into the ground. Hold this position for 5-10 seconds and then relax. Repeat 5-8 times.

Next is the pelvic lift: Stay on your back with your knees bent and your arms to the side. Engage your stomach muscles and breathe. Lift your pelvis directly up to the sky until your chest hips and legs are lined up and not angled. Support this lift primarily with your feet that are firmly planted on the ground, but the lift should be coming from the raised pelvis. Check occasionally that the pelvis hasn’t sagged, keep it raised! Do not continue if you start to feel pain. Hold the lift for 20-30 seconds and continue breathing. Slowly lower your pelvis and relax. Repeat 3-5 times. As you become stronger try to lift the pelvis higher. Look up toward the ceiling during this exercise, since turning your head while your pelvis is lifted could possibly cause a strain.

Knee Tuck Back Exercise

The lower back is the area that has the burden of carrying most of the weight of the body. As muscles are overused they can become fatigued and less able to provide the support necessary to keep the back in its proper alignment. Muscles and ligaments both support the boney structure of the back called the spinal column. Overused muscle can lead to back strains (torn or overstretched muscle) or back sprains (torn ligaments). In many cases, inflammation will occur to protect the strained/sprained area. Inflammation can lead to muscle spasms and other back pain. Weakened muscles leave other parts of the back susceptible to injury.

Muscle strain can come from overuse, such as lifting and bending for a long period of time, or it can also come from built up tension. Long periods of stress, whether environmental or emotional can weaken the muscles in the back. Strengthening muscle and releasing tension are both important steps in preventing injury. This knee tuck feels good and releases tension in the lower back:

Lie down on your back with your knees bent and your feet and head on the floor. Tilt your pelvis slightly toward the ceiling to reduce the lumbar curve (remove any large hollow there might be between your back and the floor). Keep your knees bent and slowly raise them and pull them toward your chest. Put your arms around your knees and hug them close to your chest. Make sure to keep your head on the ground and keep breathing. If you like you can gently rock from side to side while your knees are elevated. You should feel a release of tension in your lower back. Release your knees and slowly bring your feet back to the ground. This stretch can also be done with the knees separated and the arms hugging each knee separately.

Hip/Leg Extension Back Exercise

Proper spine alignment (proper posture), whether it be sitting, standing or lying down, can reduce the severity of an episode of back pain or eliminate it altogether. Proper posture means lining up the vertebrae so that the natural curve in the spine is realized. This is also called neutral alignment. Neutral alignment can be obtained by evenly strengthening the core. People often think of abdominals as the core, but a good core workout will include work on both the stomach and back. Strong muscles are the body’s defense against the strain of gravitational pull and defense needs to come from both at the front and the back.

Many machines at the gym concentrate on strengthening the upper portion of the back. The lower back is actually where much of the body’s weight is carried, so it needs its share of strengthening. This Hip/Leg Extension exercise strengthens the lower back muscles (and as an added bonus strengthens the glutes and stretches the hip):

Lie down on your stomach and stretch out your legs. The legs should be straight and pulled together. Place your arms on each side of you, bent, with elbows up to the ceiling and palms flat on the ground lined up evenly with your upper chest. Pull your shoulders down and back – don’t let them creep up around your ears. With your face down toward the ground, tilt your head up to look toward the ceiling just until the bottom of your chin is resting on the ground. Engage your abdominal muscles and buttocks. Breathe and lift the right leg about 6 inches off of the ground and hold it there for 5-10 seconds. Keep your leg straight and your foot flexed. Slowly lower the leg and repeat on the other side. You can rest between legs if necessary, don’t forget to breathe and discontinue if you begin to feel pain. Repeat the exercise 3-6 times.

Hamstring Stretch

The legs are large muscle masses that are meant to take on a lot of weight. When the legs are strong, they are able to take on much of the weight that the back would otherwise have to carry. The hamstrings are the muscles on the back of the thigh that if tight, can actually exacerbate back pain. Elongated hamstrings allow the legs their full range of motion which allows the body to stand upright and in proper posture. Tight hamstrings can lead to swayback.

Keeping the muscles of the legs elongated and toned plays an integral part in maintaining back health. Back pain can radiate down through the buttocks and into the legs. Severe back pain can cause numbness or tingling in the legs.

The Sciatic nerve also runs through the same area of the leg as the hamstring. When the sciatic nerve is being pinched by inflammation it can radiate pain down the back through the buttocks and into the legs. When people experience sciatica, they want to overcompensate and be too gentle on the back and legs. However, once inflammation has been reduced, stretching the hamstring can relieve the tension in the legs and the back, which then eases the pressure being put on the sciatic nerve. Here is a stretch that will help elongate the hamstring and can also ease the tension on the lower back:

Lie down on your back with your knees bent and your head on the ground. Tilt your pelvis slightly toward the sky so that there is very little hollow between the low back and the floor. (You can put a small, rolled up towel under your back if it is especially tender.) Bring up your right knee and lace your fingers behind the upper middle part of your calf. Pull the leg toward your chest. Slowly straighten the raised leg. The stretch will increase as you pull back and straighten the leg. Stop the stretch if you begin to feel pain. Stretch the hamstring for 15-30 seconds trying to straighten the leg a little more every several seconds. Slowly lower the leg. Repeat on the left leg. This stretch can be done several times a day.

Hamstring / Glute Raise Back Exercise:

Strengthening the back muscles is just as (if not more) important as abdominals when it comes to maintaining back health. The spinal column runs along the inside and has muscles at both the front and the back to support it, so naturally both sets of muscles should be toned. The lower back takes on the brunt of the body’s weight while sitting and standing. The vertebrae in that part of the back are larger to accommodate this weight, but there is still a higher risk of lower back injury because of this burden. Every day use, such as lifting, twisting and bending can fatigue back muscles and, over time, be the cause of short term problems (acute pain), such as a back strain or sprain, or long-term conditions (chronic pain), such as herniated disks, osteoarthritis, or less frequently spinal stenosis. While most all American adults experience back pain at some point, maintaining good back health can decrease or eliminate it altogether.

This Hamstring Raise is an exercise that will not only strengthen the lower back muscles and the glutes, but will stretch the hips and can help with balance as well:

Stand facing the back of a weighted chair. Stand up straight with abdominals engaged, pelvis neutral (not tucked under or pushed back), and chest up and shoulders down. Let your head balance on top of your neck.

Hold the back of the chair. Lift your right leg out behind you while keeping it straight with your foot flexed. Don’t forget to breathe and stop if you feel any pain. Lift your leg away from you about 12 inches and hold for 5-10 seconds. As you lift your leg, try to stay vertical and don’t tip to the opposite side. Slowly lower the leg and repeat with the left leg. Repeat this exercise 3-6 times. As your back become stronger, try to lift the leg farther back.

Wall Slide Back Exercise

Preventing back pain or maintaining an already strong back can mean fewer doctor visits, less medication and less missed activity. Back pain is the second highest reason Americans call in sick to work after the common cold. Having the strength needed in back muscles is just one step in a healthy back. Knowing the biomechanics of the back can also help keep a back injury-free. What is proper posture? How does the back interact with the neck, buttocks, or legs?

The lower back is more susceptible to back injury. Although the spinal column is made so that the largest vertebrae are located the lower back, there is still a lot of pressure and weight carried in that area. Weakened muscles can lead to muscle strain (muscles that are torn or overstretched). Carrying some of the weight in the legs can reduce the amount of pressure that the back experiences, so strengthening leg muscles is an important part in the prevention of back pain. Strong, flexible legs can take their share of the body’s weight.

This Wall Slide can strengthen the legs and hips and will also work on the back a bit:

Lean against a wall with your feet facing forward and placed about a foot away from the wall. Your feet should be a little less than shoulder width apart. Align yourself with shoulders back and your head balanced on top of your neck. Tilt your pelvis slightly away from the wall, so that the curve at the lower part of your back isn’t great. Engage your abdominal muscles and breathe. Slowly slide down the wall until your knees are bent at a ninety degree angle. Hold the position for 5-10 seconds and then slowly slide yourself back up the wall. Repeat this 1-3 more times, making sure to breathe the whole time. Discontinue and consult a health care professional if you start to feel pain.

Cat and Camel Stretch:

The back carries the weight of the head, neck and body. Strong and properly elongated back muscles allow for good posture, which in turn can help to prevent back pain and injuries. Additionally, because the back carries the weight of the body, tension can gradually build that could lead to chronic conditions such as herniated disks. Disks that provide cushioning for the vertebrae can bulge out from between and cause inflammation or muscle spasms. Emotional distress can also lead to subconscious tension being held in the muscles. Releasing tension can not only prevent back injury, but it can also ease pain from already injured areas by strengthening and lengthening the muscles. The Cat and Camel stretch is great for releasing tension in the lower back:

On the floor in a hands and knees position place your knees shoulder width apart and align your hips so that your back and legs are at a right angle. Place your hands in front of you and make sure your shoulders are positioned so that your back and arms are at a right angle. Your arms should be shoulder width apart. Put your palms flat against the ground; your arms should be engaged to support your weight but don’t lock your elbows. Start with the Camel stretch: bend your back up towards the sky while rounding your neck and head toward your chest. Make sure your abdominal muscles are engaged and that your upper back is higher than your rounded shoulders. Your pelvis should naturally tilt toward your arms. Feel release in your lower back as you breathe in and out. Slowly move into the Cat stretch: As you arch your back toward the ground, pull your shoulders back and bring your chin up toward the sky. As you slowly and fluidly arch your back, your pelvis should tilt out away from you and your buttocks should rise into the air. Open your chest, engage your abdominals and breathe. Repeat several times.

TENS Machines

In the treatment of back pain there isn’t just one remedy; treating the symptoms by several different means can be very effective. Besides the more well-known remedies, like pain killers, icing and exercise, electrical stimulation has also been successful in pain management. Transcutaneous (or “through the skin”) Electrical Nerve Stimulation (TENS) works by transmitting electrical impulses via electrodes placed on the skin. The electrode pads are carefully placed to target the areas which are causing pain. A physiotherapist or healthcare professional can advise on the most effective placement of the pads. The chronic musculoskeletal pain of the back is one type of pain that responds very well to the TENS machine.

The idea behind the TENS machine is that pain messages sent to the brain are overridden by the electrical messages of the machine. Just as when you hit your funny bone and immediately reach down to rub the area, the electrical stimulus can help with chronic pain. The machine can be set to several different settings: constant, modulation and burst. The first sends a constant signal that is better for acute pain. The frequency on the modulation mode changes so that the nerve doesn’t adapt. The burst mode is what it sounds, a burst of frequency happens that has proven to be good with people with chronic pain.

Some TENS users find experience immediate relief and some find that they have to wait a few weeks before obtaining effective results. The good news is that, if used properly, there are no adverse side effects, which is not necessarily the case with other treatments. Transcutaneous Electrical Nerve Stimulation (TENS) has also shown to stimulate the body’s production of endorphins, which has also been proven to relieve pain. They are relatively inexpensive to buy and run.

In order for the machine to be the most effective, and the safest possible, electrodes should never be placed:

Do not place electrode pads on broken or damaged skin, over the front or side of the neck, on each temple, close to eyes or in the mouth.
On areas of decreased sensation (numb skin)
In or near water such as in the bath or shower.

TENS should not be used by people with epilepsy, or people who have an artificial cardiac pacemaker, or with people with certain types of heart disease. TENS should also be used with great caution in pregnant women (affect on the developing fetus are not known). Before using the machine a doctor should be consulted.