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| | Back | | | | Taking Care of Your Back |  By standing on their 'hind' legs, human beings freed their hands for work and gained the dexterity to create civilizations. Since ancient days, though, people have paid the price of walking erect...with their backs. In our modern, industrial society, back pain is the most common cause of loss of activity among adults under 45. It's estimated that over 80% of all American workers suffer back pain at some time during their careers. And the cost, to all of us, is staggering. American industry loses billions in productivity, and consumers and insurers pay billions more for treatment. But there's good news too. Most bad backs respond well to rest and conservative treatment. And most injuries can be prevented. This article tells how and why backs go bad, and how a licensed, professional physical therapist can help you put it right again. |
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| | Your "Bad" Back |  By far the most common site of back pain and injury is the lumbar region-the low back. Your lumbar spine bears the brunt of bending, stooping, sitting and worst of all, lifting. Low back pain usually emanates from degenerative changes to the lumbar discs. With aging, the resilient disc material dries out, shrinks and loses some of its "spring". Under the stress of lifting, coughing or sitting improperly, the deteriorated disc can bulge or even rupture, spilling its spongy pulp into the surrounding space. This herniated disc can press on the adjacent nerve root. This irritation can cause pain, numbness and tingling, or painful muscle spasms, Loss of disc thickness can also cause wear and arthritic enlargement of the facet joint, constricting the space between the vertebrae leading to abnormal pressure on the nerve. | | Avoiding Back Injury |  Everyone is vulnerable to back injury, but certain occupations present added risk. Truck drivers sit for long periods while being jostled by vibration; they lead in back injuries. Nurses are also at high risk; bending over bedsides and lifting and moving patients are hazardous to their health. Everyday activities can be dangerous, as well: even sitting puts an added load on the lumbar spine! Expectant mothers find their backs stressed in new ways. Parents lifting babies and toddlers are also at risk. We can't avoid every stressful activity. The key to avoiding back injury lies in minimizing the risk inherent in any activity by applying these simple principles. Work on your posture. Don't slouch. Maintain the natural "arch" in your lower back whether standing or sitting. Lift with your legs. Don't bend over the object, bend your legs and keep your back straight (see diagram below). And most important, don't twist as you lift! Sit with care. Prolonged sitting in one position is a back hazard you might not suspect. Lumbar support and periodic breaks to move around are essential (see driving box above). Control your weight. Being overweight, especially if you have a "pot belly", puts added stress on your lower back. The important benefits of conditioning are discussed in the next section. |
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| | Conditioning Your Back | | The muscles of your back provide structure as well as mobility-they help hold your spinal column together. That's why maintaining healthy back muscles is so important in avoiding or recovering from injury. But recent studies indicate that the most important factor in avoiding back injury may be your general conditioning, not the power of your back muscles. This suggests that regular aerobic exercise, such as walking or swimming, may provide all the conditioning a healthy back needs. After injury, the first step in getting your back healthy is gentle exercise to improve flexibility. When you've recovered and are free from pain, your physical therapist may recommend mobilization and strengthening exercises | 
| | Treatments for Bad Backs | | For thousands of years, back sufferers have sought a cure in vain. Cave drawings depict early 'patients' and attempts to treat their ailment. Medical science is still searching for more effective therapies; unfortunately, there is as yet no simple cure for low back pain. While there is disagreement about specific treatments,  most experts prefer a conservative approach to treating acute back pain. Bed Rest. For 48 hours or until the acute period passes. Stay in bed- even for meals, if possible. If your bed sags in the middle, add a board under your mattress. Heat or ice may help ease muscle spasm and aid circulation. Pain Medication. Pain medication prescribed by your physician will help get you through the period of most severe pain, but it won't help you get better. Traction. Recent studies indicate that in-hospital traction may be effective only because it confines the patient to bed rest. Most experts agree that short applications of lumbar traction in a clinical, outpatient setting can be an effective treatment. Manipulation. Manual mobilization of the lumbar region may assist recovery; restoring range of motion, reducing spasm and stimulating circulation.  Epidural Injection. Epidural injection of anti-inflammatory or pain medication has been shown to be an effective treatment for many patients with low-back symptoms.
Surgery. Surgery should be considered only with the failure of conservative treatment to control severe, chronic pain or neurological symptoms. While laminectomy (a procedure that allows removal of disc material) enjoys a good success rate, there are risks. It may be wise to talk with several orthopaedic or neurosurgeons before taking this serious step. Keep in mind that once you've had a back injury, you'll probably be vulnerable in that area for the rest of your life. Any successful treatment approach must include a program for preventing reinjury. | | How Physical Therapy Can Help Your Back | | The licensed physical therapist brings a unique perspective to caring for your back: The patient is the most important participant in the healing and prevention process.  It is, after all, your back. And whatever treatment you receive from others, it can't overcome treatment you give your back, day-in and day-out.
Your physical therapist will involve you in your care, teaching you to be, in a way, your own therapist. So that as you go about the routine of daily life, you'll be healing yourself, not causing reinjury. It all starts with a careful evaluation. Evaluation. Physical therapy places greatest emphasis on this process. Your therapist will take the time to talk with you and perform a thorough physical evaluation to identify the dysfunction that causes your pain. Therapy. Your physical therapist will plan a treatment regimen suited to your individual problem, and begin working to restore flexibility and ease discomfort. Treatment may include heat, cold, massage, traction, manipulation and exercises for relaxation, conditioning, and restoring range of motion. | | | | | | | | | | |  
| Your sleeping position is another possible source of neck problems. Does your pillow cause you to sleep with your neck at an angle, either too high or too low? If so, you may want to invest in a new pillow. Feather pillows are generally preferable to foam; they conform easily to the shape of the neck. Also, remember that pillows don't last forever. After a year or so feather pillows tend to "collapse" and may need to be replaced. In addition, a bed that doesn't offer enough back support can also be a source of neck discomfort. Here are some other tips to help you avoid neck strain and pain: - Try doing stretching exercises before bed and first thing in the morning..
- Don't sleep on your stomach-this position puts great pressure on the neck.
- Don't "over-pillow" your neck; keep your neck and spine in a neutral position.
| | The neutral position rule also holds true for people who spend time working at computer terminals. Again, don't bend your neck forward. Adjust your desk, monitor, and chair to a comfortable height, so that the monitor is at eye level and your knees are slightly lower than your hips. Some people find that a footstool helps in attaining this correct position. Sit close enough to the monitor so that you don't have to bend forward in order to see well. Use the chair's armrests-your arms need support. Wear your eyeglasses if necessary. Consult your physical therapist to find the set-up that is right for you. | | You should also follow the neutral position rule when driving a car. Adjust the seat to bring you close enough to the pedals so that you don't have to extend your neck forward. | | Proper Lifting Technique |  Another cause of neck pain is poor lifting technique. People often think of the lower back as the area at risk, but the cervical region is nearly as vulnerable. Here is the correct way to lift: - Stand up straight, close to the object.
- Bend at your hips and knees, keeping your back in the neutral position and your head and shoulders up.
- Firmly grasp the object and rise up with your hip and leg muscles.
- Keep the object close to your body. Your hips and legs absorb most of the weight, and you will put less strain on your back and neck.
- The feet should be positioned shoulder-width apart, with one foot slightly ahead of the other.
In addition, you may find that placing one foot forward and one foot back may be easier than trying to lift an object from the "squatting" position. | | Avoiding Neck Stress | Other bad habits to avoid include:- Shopper's tilt"-carrying items on one shoulder for a long period.
- Carrying items that are too heavy.
"Shopper's tilt" can be avoided by using a back pack-style bag to more evenly distribute the weight you're carrying. (Be sure to wear the back pack correctly, with both arms through the shoulder loops, or the benefit will be lost.) A variation on "shopper's tilt"-"traveler's droop"- is a familiar experience to anyone who has ever tried to lug a heavy suitcase across an airline terminal. Again, a back pack can be helpful, or consider purchasing a compact "rolling suitcase" with wheels and a retractable handle. | | Believe it or not, simply talking on the phone can create neck problems. Some people are in the habit of cradling the telephone receiver between the shoulder and the neck. Not only does this put stress on the neck, but over a long period it can cause the cervical discs to place pressure on the nerves. If you spend a great deal of time on the phone, you might try one of the products designed to make it a more comfortable experience-neck cradles, speaker phones, or a "hands-free" headset. | | TMJ Disorders | | The TMJ- temporomandibular joint- is the joint at which the jaw is hinged to the skull. Painful TMJ problems occur in people who overuse or abuse this joint through teeth grinding, constant clenching and unclenching of the jaw, or excessive gum chewing. Sometimes people are born with a misalignment of the jaw that can bring on similar symptoms. | | Because the neck and the TMJ are so closely connected, the TMJ can cause neck pain-and vice versa. In some cases a dentist may need to create an oral retainer to allow the joint to rest and let healing begin. After that, a physical therapist can help minimize the pain in the jaw or neck through a custom-designed exercise program. | 
| | Migraine Headaches | | True migraine headaches are most likely the result of problems affecting the blood vessels in the head, or of an allergic reaction. However, many other types of headaches can mimic migraines and are often misdiagnosed. Some of these originate in the neck or jaw, such as the TMJ disorders mentioned above. | | If you don't have all the symptoms of migraines- nausea, problems with vision, and pain-get a second opinion, particularly if the pain is triggered by motion of the neck. If you don't have a true migraine, a physical therapist can help diagnose the actual source of the pain. Once an evaluation is made, your physical therapist will help you create a comfortable and appropriate home and work environment and will design a program of rest (if needed) and exercise. If the source of your headache is in the TMJ (jaw) area, your physical therapist may consult with your dentist who may create a special oral retainer in order to discourage "bad habits" such as teeth grinding. | | Other Kinds Of Headaches | | Most people know from experience that emotional stress can cause headaches. These "simple" headaches can be treated in a variety of ways, from taking nonprescription pain relievers to practicing meditation. Most simple headaches will go away by themselves; however, if the headache is persistent or recurring, make sure that neck strain, poor posture, or eyestrain isn't the culprit. If your headache is severe or persists for more than a few days, it is important to seek professional attention right away. Sometimes muscles in the back of the neck can irritate nerves in the head, causing a headache. If you are having headaches, a physical therapist will first make a careful evaluation of your problem (often in consultation with a physician). After pinpointing the problem, he or she will design a program of rest, exercise, stretching, and other treatments that are very effective in eliminating the cause of your headaches. | | Osteoarthritis | | Osteoarthritis is inflammation of the joints caused by wear and tear. All of us experience some degree of osteoarthritis as we grow older, but the condition can also be caused by injuries. Osteoarthritis in the neck is characterized by stiffness and limited range of motion. | | Physical therapy can be a great help in treating osteoarthritis. Through exercise, stretching, massage, and other therapeutic techniques, the physical therapist can gently and slowly help the patient ease the stiffness and increase range of motion. | | Whiplash | | Whiplash -a violent back-and-forth motion of the neck- is probably the most common traumatic injury to the neck region. It is frequently associated with automobile accidents, although it occasionally occurs in other situations (such as skiing accidents or amusement park rides). In acute cases, a device known as a cervical collar may be appropriate in order to "rest" the neck and calm the inflammation. Once the tissue has been rested, a physical therapy program designed to regain strength, function, and range of motion can begin. | | Is It Only A "Pain In The Neck"? | | Pain in the cervical region can cause arm pain as well as the "pain in the neck." Why? In the case of the arms, it's because the nerves that branch out from the neck go all the way down into the arms and into the hands. Sometimes it's difficult to tell whether the pain is actually originating in the neck, or the arms, or both. | | Symptoms in the arms include numbness, tingling, cold, aching, and "pins and needles." These symptoms can be confused with carpal tunnel syndrome (CTS), a condition found in people who work at computer keyboards or perform other repetitive motion tasks for extended periods. In CTS, the nerve sheath that runs down the center of the forearm becomes inflamed and restricts the gliding movement of the nerve. It is possible, however, for a nerve impingement to start much further "up the chain," in the neck region. It's also possible for the nerve impingement to be taking place both in the neck and in the arm. | | What To Do When Your Neck Is Hurting |  When your neck hurts, and no major trauma is involved, rest is the first order of business. But don't stuff too many pillows under your neck- that will only make things worse. The goal is to keep your spine and neck in a neutralposition. Make sure that the "gap" between the back of your neck and the bed is filled in by a pillow (or foam support) that keeps your neck in a neutral position.You can also apply ice or heat. Many physical therapists prefer ice because of its effectiveness in reducing pain and inflammation. (To use ice, fill a plastic bag with crushed ice, place a towel over the affected area, then apply the ice-filled bag to the area.) Heat also provides relief to some people, but should be used with caution because it can sometimes make an inflamed area worse. Apply heat or ice for 15-20 minutes at a time, and give yourself a 40-minute rest between applications. If you use both heat and ice, make sure to alternate between the two. | | How Physical Therapy Can Help With Neck Pain and Headaches | | Physical therapy always begins with a detailed history and evaluation of the problem. Your physical therapist will take many things into account, including your age, general health, occupation, and lifestyle. If major trauma or disease is involved, your physical therapist will work with you in consultation with a physician. After a diagnosis has been made, your physical therapist may choose from a range of treatment options, including exercises for flexibility, strength, stability, and restoration of range of motion. Other options include ice, heat, electrical stimulation, traction or mobilization, and massage. Your physical therapist may also analyze your home and work environment in order to ensure that you're not re-injuring yourself.. Much evidence suggests that low-impact aerobic exercise such as swimming, walking, low-impact aerobics, and stationary bicycling may also be helpful in decreasing neck pain. A physical therapist can design a pain-free exercise program just for you. Once your physical therapy goals are met, your physical therapist will help you continue therapy on your own with a home program designed to fit your needs. The goal of physical therapy is to return you to normal activity as quickly as possible, with the knowledge you need to minimize or eliminate your problem. | 
| | Neck And Head Pain Questions And Answers | Is arm pain, numbness, tingling, and weakness related to neck pain? Will I need surgery?| Because the nerves in the cervical region radiate down through the arms, these symptoms can sometimes be related to neck pain. While surgery is sometimes required to reduce pressure on the nerves, many cases can be treated effectively through physical therapy. |
| Is surgery beneficial for chronic neck pain?| Surgery may be the treatment of choice in isolated cases-for example, if you have a condition known as spinal stenosis (in which the openings for the nerve roots or spinal cord become smaller, often due to osteoarthritis). In most cases conservative treatment, including physical therapy and/or medication, is preferable. |
| Is it alright to take medication such as aspirin for my neck pain and headache?| Yes, although anti-inflammatories such as NSAIDS (non-steroidal anti-inflammatory drugs) or aspirin can cause stomach upset or ringing in the ears. Be aware that acetaminophen can help with pain but not inflammation. Consult your pharmacist about the medication you are taking. Do not take medication that is old or previously prescribed for someone else. |
| How long before I get better?| The nature of your injury will determine how long it takes to heal. In general, recovery from neck sprains or strains can take anywhere from a few weeks to a few months, depending on the severity of the injury, your age and ability to heal, and other factors. Your recovery will be faster if you follow the program designed by your physical therapist. Your program will probably include exercises and other treatments designed to ensure that the neck heals properly and regains its normal range of motion. Without proper treatment, prolonged stiffness and discomfort may result. | | | Home • Up • PT Upper Legs • PT Fitness • PT Carpal Tunnel • PT Hands • PT Head & Neck • PT Back • PT Shoulder • PT Knee • PT Foot & Ankle |
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