July 19, 2009
Over the years, I have worked with literally thousands of people who suffer from mechanical lower back pain. During that time, I have identified several self management tips that are worth knowing. These tips fall into the category of “management of biomechanics” during activities of daily living.
First of all, most people who suffer lower back pain experience the pain episodically. Each episode is worse, last longer and over time, starts to come on more frequently. This is typical, and is the main reason why management of lower back pain is worthwhile.
My tips are these:
- The pain is worse in the morning, and there is more risk in the morning. It is important then, to take care of the back first thing out of bed. This is true because during the night, the disc imbibes water creating increased intradiscal pressure in the disc before you get out of bed. You are indeed taller when you wake up than when you go to bed! So the first tip is to be cautious in the morning. I have advised people who have significant morning pain to actually get up in the middle of the night and walk around for several minutes as a way to mitigate the morning pain.
- Walking is great medicine. The literature points out that maintaining your activity is of no harm, and I believe necessary to overcome episodic back pain. Sub maximal exercise gets your blood circulating, relaxes your muscles and generally promotes good health. The weight bearing also compresses the disc and squeezes some of the water out, meaning less pressure on the nerves. So a good walk every day is helpful.
- Biomechanics is key. Be thoughtful about what you do. Face the things you do, keep lifting to a minimum, but when you do lift, keep the object as close to your center of gravity (around your belly button) as possible.
- Avoid prolonged sitting. And when you do sit, a firm chair with back support and arm rests is ideal. Try to use lumbar support when you sit. For instance, when getting on an airplane, put one of those little pillows behind your back.
- Use prolonged ice daily. I mean ice plus water in a plastic bag right on the skin for at least 30 minutes. The cold penetrates at about one cm every 10 minutes. It takes a half hour to numb the muscles and dull the pain. Be careful not to use gel ice packs because they tend to be too cold (if your freezer is below freezing) and not stay cold for long enough.
- Finally, get fit. Fit people have a much lower incidence of lower back pain than the population at large. This is more of a long term strategy, but if you are stronger, your muscles do a lot to support you. Along with this of course goes flexibility and core stability. Develop your core and don’t forget your back side when you do so. Core exercises include hamstring exercises, and back muscle exercises as well.
Back pain tends to be episodic, the episodes tend to be more frequent over time, they tend to last longer each time and also to be more severe each time. Reversing these trends is the goal of managing your back pain. Follow my advice and you will be able to do so!
Filed under: abdominal exercise
,acute back pain
,facet joint pain
,low back pain
,lower back pain
,lower cross syndrome
,nerve root compression
,pain in the butt
,physical therapy for back pain
,return to function
,SI joint belt
,SI joint Sacro-iliac joint
,SI joint stabilization
| by Neil Chasan, PT, MMT @ 11:23 am | |
February 20, 2009
Turn up your computers volume and click the play button:
One of the things I see in people who suffer long standing SI joint dysfunction is the “reluctance” of the Si joint to remain stable once the dysfunction has been reduced. It seems that almost regardless of the subluxation (up slip, down slip, anterior torsion, posterior torsion etc), the joint wants to “return” to the subluxed position.
To help stabilize the joint after reducing a subluxation, I employ two strategies that are muscular and one that is not.
The nature of the SI joint is that there are no muscles that cross the Si joint that are useful for stabilization purposes. The Piriformis originates on the inside of the Sacrum and should be perfect for stabilization purposes, but because it inserts on the Greater Trochanter of the femur, it is useless for stabilizing the SI joint.
Instead, we have to look forward to the Adductors which insert onthe inferior pubic ramus and also the Abdominals which insert on the pubis. These muscles are better suited to maintain the stability of the pubic symphesis and indirectly, the SI joint.
Try these two exercises to stabilize the SI joint:
- Sit on the edge of a firm chair, lean over, your knees apart, and put your elbow on the inside of one knee and your hand onthe inside of the other. Squeeze as hard as you can while also at the same time trying to be as relaxed as you can. Repeat this about 8 or 10 times. You are looking or a palpable click to occur in the groin indicating that the pubic symphesis has reduced. this does not always occur though, so if it does not occur, not to worry.
- Lie on your back, both knees flexed up toward your chest. Place a hand on either thigh near the knees and push as hard as you can with both the knees and hands so that you do not let your thighs actually move. You should feel your stomach muscles working hard.
The other stabiliation idea is to use an external fixation, like an SI Stabilization Belt. I like one you can purchase here. It is caled the BOA Sacro-Iliac Belt. Be sure to size it properly, and when you wear it, keep it snug. Also, as an alternative this one is also a good suggestion.
The thing about reducing an SI Jointsubluxation is that after I have sucecssfully reduced the joint, it often wants to return to its former subluxed state, and after each successive reduction, it often takes longer and longer sublux again. My advice is to be very patient. Allow weeks to successfully treat the joint so that it stays reduced. And while you are undergoing treatment, use the belt and do the exercises I suggested for longer lasting relief.
Finally, I think that you should use ice religeously. By that I mean 30 -45 minutes of ice plus water (not those blue ice packs that you throw inthe freezer, not frozen corn or peas, actual ice) right on the skin. Make sure to include water, or risk frost bite.