The Importance of Exercise
Back pain is a serious subject. As you recover from a back injury,
it is important that you begin to learn how to safely strengthen
your back to help prevent injuries to your back later. Your therapist
can teach you specific exercises that will help reduce your back
pain now - and help you begin a new set of habits that will help
keep your back healthy.
This presentation will help you understand what each part of your
rehabilitation program is meant to do. It will also teach you how
your back works and how to reduce or prevent further injury while
your back heals.
- First, you will learn why it is important for your spine to
be properly balanced - in the Neutral Spine Position.
- Then you will see how to use the neutral spine position in everyday
activities - such as walking and lifting. Learning to lift properly
is so important that a whole section has been devoted to the rules
of lifting.
- Finally, you will learn how you can benefit from exercise, after
an injury and as protection against further injury.
Management and prevention of back pain begin by understanding
the neutral spine position. Three natural curves are present in
a healthy spine. The neck, or the cervical spine, curves slightly
inward. The mid back, or the thoracic spine, is curved outward.
The low back, or the lumbar spine, curves inward again. The neutral
alignment is important in helping to cushion the spine from too
much stress and strain. Learning how to maintain a neutral spine
position also helps you move safely during activities like sitting,
walking, and lifting.
The natural curves of the spine are the result of the muscles,
ligaments, and tendons that attach to the vertebrae of the spine.
Without these supporting structures, the spine would collapse. They
support the spine - much like guide wires support the mast of a
ship. This guide wire system is made up mainly of the abdominal
and back muscles. The abdominal muscles provide support by attaching
to the ribs, pelvis, and indirectly to the lumbar spine. The muscles
of the back are arranged in layers, with each layer playing an important
role in balancing the spine. By using these muscles together, it
is possible to change the curves of the spine.
Controlling pelvic tilt is one way to begin helping to balance
the spine. As certain muscles of the back and abdomen contract,
the pelvis rotates. As the pelvis rotates forward, the lumbar curve
increases. As the pelvis rotates backward, the curve of the low
back straightens. Rotation of the pelvis is like a wheel centered
at the hip joint. The muscles of the upper thighs also attach to
the pelvis and contraction of these muscles can be used to change
the curve of the spine.
The abdominal muscles work alone, or with the hamstring muscles
to produce a backward rotation of the pelvis. This causes the slight
inward curve of the low back to straighten. If these muscles cause
the curve of the low back to straighten too much, this may produce
an unhealthy slouching posture.
In the other direction, as the hip flexors contract and back extensors
contract, the pelvis is rotated forward - increasing the curvature
of the lower back. If this curve is increased too much, another
unhealthy posture may result. This condition is called lordosis
in medical terminology, or swayback in common terms.
A balance of strength and flexibility is the key to maintaining
the neutral spine position. This balance is the basis for optimal
muscle function. Like a car, an imbalance may lead to wear and tear,
eventually damaging the various parts of the car.
Muscle imbalances that affect the spine have many causes. One common
cause of muscle imbalance is weak abdominal muscles. As the abdominal
muscles sag, the hip flexors become tight, causing an increase in
the curve of the low back. This leads to the swayback posture mentioned
above. Another common problem results from tight hamstrings. As
the hamstring muscles become tight, the pelvis is rotated backwards.
This produces an abnormal slouching posture.
Understanding body mechanics means understanding how we use our
body. Proper body mechanics result when we put the neutral spine
posture into action. To use proper body mechanics we need to learn
how the spine should work during activities like: rising from a
chair, walking, and lifting.
Sitting
Healthy sitting posture is based on the neutral spine position.
Positioning your hips and knees at 90 degrees can help you keep
a neutral sitting posture. Remember this position is balanced between
the extremes of lumbar movement. Remember to choose a properly designed
chair to help support the lumbar spine. The neutral spine position
is also important when getting up from a chair. Holding the spine
safely in neutral, the pelvic wheel turns forward, placing the "nose
over the toes". With the feet placed shoulder width apart,
stand upright. Use the buttock and thigh muscles to push yourself
up. Do not twist or bend too far over at the waist and put too much
strain on the lumbar spine.
Walking
Proper body mechanics are also important while walking - try to
maintain the neutral spine position while walking. In the neutral
position, the legs and arms swing naturally during forward motion.
Conditions that alter the normal way of walking, and cause a limp,
can severely stress the spine. While walking, always try to maintain
your spine in the neutral position.
Lifting
Lifting is one of the most dangerous activities for the spine.
The neutral position MUST be used to reduce the risk of injury.
With the spine held in the neutral position, the movement occurs
as the pelvic wheel turns. The hip is the axis of pelvic rotation
- not the back! Notice how the back loses the neutral position when
the pelvis does not rotate forward. This posture focuses the force
on the back muscles during a lift. Lifting in a neutral position
allows the larger and more powerful leg muscles to do the lifting.
When lifting - first find the neutral position. Bend at the hips
by rotating the pelvic wheel at the hip joint axis. Keep the safe
posture, hold the object securely, and use the large leg muscles
to generate power. Tighten the abdominal muscles during the lift
to create a stabilizing corset around the trunk.
Many back injuries occur during lifting. Making a complete checklist
for safe lifting can reduce the risks of injury.
- First, plan and prepare for the lift. It only takes a moment
to insure safety. The consequences of a back injury can be long
lasting!
- Insure a safe and clear path.
- Before beginning, think through the lift.
- Obtain good footing with a wide base of support, by placing
the feet a minimum of shoulder width apart. This lowers the center
of gravity and increases stability.
- Keep the load close! Keeping the load close to the body can
reduce stress on the spine and back muscles. Think of how a lever
and fulcrum works. The back muscles, the spine, and the arms are
the parts that form this lever system. The force needed to lift
an object is lower if the load is nearer the fulcrum point. If
the load is too far away from the body, the muscles of the spine
have to work harder to help with the lift. This leads to too much
stress on the muscles of the spine, and can cause injury.
- Maintain the neutral spine position! By moving the pelvic wheel
around its axis, the upper body hinges forward, but the spine
stays in neutral. Remember the neutral spine position at all times!
- Remember to lift with the large muscles of the legs!
- Avoid twisting AND bending of the lower back at the same time!
This is one the most damaging movements to the spine. To avoid
twisting, pivot the feet to complete the lift.
- Get help if necessary! If the load is too bulky or heavy, do
not hesitate to get help or use a hand truck! Do not be too tough
or too busy to get help. Will power does not take the place of
a reasonably safe lift.
Exercise is beneficial during all stages of recovery from a back
injury.
Different types of exercises will be used by your physical therapist
as you progress. In the early stages, when your back is still quite
painful, specific exercises to reduce your pain may be suggested.
These exercises are helpful in easing pain through relaxation. Positioning
exercises place the spine at rest. These exercises can give relief
to sore muscles and joints.
Back pain can be physically and emotionally draining. Relaxation
exercises may not correct your problem, but they can help control
pain and its accompanying stress. Movement is also important, even
when the back is still painful. Careful movements suggested by your
therapist can safely ease pain by providing nutrition and lubrication
to injured areas. Movement of joints and muscles also signals the
nervous system to block incoming pain.
As your back becomes less painful, the exercises will be changed
to focus on improving the overall health of your back. These changes
will focus on:
- Flexibility
- Strength
- Posture
- Coordination
- Aerobic Conditioning
Flexibility
Exercises that increase flexibility reduce pain, making it easier
to keep the spine in the neutral position. Tight muscles cause imbalances
in spinal movements. This can make injury of these structures more
likely. Flexibility exercises for the trunk and lower limbs are
helpful in establishing safe movement. A slow progression of stretching
exercises can increase flexibility in these structures and reduce
the chance of re-injury.
Strength
The next stage of exercise focuses on the strength of the muscles
that support the spine. These muscles help bring the spine into
the neutral position and keep it there. Trained abdominal, back,
and hip muscles assist in forming a natural corset. Strength training
is simple to do at home and does not require any expensive equipment.
Posture
Posture exercises help train movement between the pelvis and low
back.
Learning how to find and hold the neutral position of the spine
is the basis for safe and healthy posture. Remember that the position
of the pelvis determines the curve in the low back. Forward rotation
increases the curve.
Backward rotation straightens the curve. By practicing these exercises,
you will become comfortable using the neutral spine position in
daily activities.
Coordination
Strong muscles need to be coordinated. As the strength of the
spinal muscles increases, it becomes important to train those muscles
to work together.
Learning any physical activity takes practice. Muscles must be
trained so that the physical activity is under control. Muscles
trained to control safe movement of the spine reduce the chance
of injury. You will be taught exercises that will help you train
your back muscles to work together to protect the spine.
Aerobic Conditioning
Finally, attention will be directed to increasing your overall
fitness. The word "aerobic" means "with oxygen".
By using oxygen as they work, muscles are better able to move continuously,
rather than in spurts. Fitness training allows the muscles to become
more efficient at obtaining nutrients and oxygen from the blood.
As the muscles use up the nutrients and oxygen, chemical waste products
are created that cause pain. Training also increases the muscles
ability to get rid of these waste products.
Exercise has other benefits as well. Exercise causes chemicals
called endorphins to be released into the blood. These chemical
hormones act as natural pain relievers. It will be important
for you to pick an aerobic activity that you enjoy and stick with
it!
