SPINE DOCTOR - Exercise

Physical Therapy is a place where people with spinal injuries learn how to manage their symptoms, minimize further injury through activity management, learn self care, body mechanics, and gain the strength and flexibility to return to their previous activities.

Answers to and further information for commonly asked questions follow:

"Why do I need to see a Physical Therapist?"

The role of Physical Therapy in Spinal Care

Physical Therapy is an important part of your recovery and rehabilitation from a neck or back injury. Many Physical Therapists specialize in manual techniques to reduce pain and restore mobility, which is often lost by those suffering from spine injuries. Therapists also work directly with their patients to develop safe exercise programs and prevent future injuries.

Some of the benefits of Physical Therapy which you can expect include:

learning to move and exercise without causing further injury
learning to manage your symptoms and avoid high risk activities
learning safe working techniques
receiving hands-on treatment to promote healing and restore movement

"I hurt my back! What can I do?"

First Intervention and Positioning

1. Rest Within Reason

Treating an acute back injury is a balancing act between appropriate rest and keeping active without aggravating your symptoms. On the one hand, rest is often necessary to allow an irritable condition to settle and begin healing. On the other hand, the joints and discs in our spine rely on movement for nourishment and will usually heal more quickly if we remain active.

Depending on the severity of your injury, appropriate rest can mean anything from several days bed rest to not rock climbing for a time. As is often the case, moderation is the key to success. Here are some ideas to help guide you:

a) Rest — Take frequent breaks and rest in a comfortable position (see below)

b) Walk — Remember, movement nourishes the spine and may help you feel better. Start with a short walk of 1 to 10 minutes and progress as able.

c) Listen to your body — You must modify or eliminate activities which aggravate your symptoms, e.g. sitting, lifting, driving. Stop before your symptoms make you stop.

2. Rest Positions

Look for positions where you symptoms are reduced or eliminated. Try lying on your back with your legs elevated on a chair or sit back in a recliner with a towel roll under your low back or buttocks. Whatever your rest position, remember, it must not increase your symptoms and you should feel better after taking a break.

3. Hot or Cold?

Use ice or cold packs for intense pain, a new injury, or swelling.
Heat works well for tight muscles, older injuries, and joint aches.
Apply either for 10 to 20 minutes, several times a day, being careful not to irritate or burn the skin.

4. Medications

Consult with your physician regarding medications which can help control pain and swelling.

"Lift with your knees, not with your back!"

Body Mechanics for All Activities

Body Mechanics

When lifting and bending, it is important to maintain a neutral spine and lift with the leg and buttock muscles. This protects the spine by using the powerful leg muscles to do the work. It also lowers the stress on the disc, reducing the chance of injury.

There are four basic lifts:

1. Squat

Use:To lift larger and heavier object from low surfaces

Technique: Maintain an upright posture and bend the knees to lower yourself to the ground, as if sitting in a chair. Try keeping your heels on the ground as long as possible.

2. Genuflect or 1/2 kneeling

Use: To lift medium objects from the ground, especially when a squat lift doesn't get you low enough.

Technique: Maintain an upright posture and kneel down onto one knee, pull the object up to your belly, and stand.

3. Straight back bend

Use: To bend over objects such as a sink to brush your teeth or wash your hands, and for reaching.

Technique: You maintain a neutral spine and pivot forward from the hips (top of the legs), not the waist (i.e., low back). It often helps to bend the knees slightly.

4. Golfer's lift

Use: To pick up light and small objects. This is good for getting canned goods out of a shopping cart.

Technique: You must have a stick, cane or other object to lean on in order to perform this lift. Lean one hand on your stick, maintain a neutral spine, and pivot forward from the hips, while allowing the opposite leg to raise up behind you.

"But I have to sit at work!"

Sitting Ergonomics

Sitting is often the most painful posture to maintain. It loads the disc and often becomes painful after a short time. You need to pay attention to your body and determine how long you are able to sit prior to the onset of pain. If you wait until you feel symptoms, you've already overstressed the injured structure, and will have a more difficult time alleviating your pain. Once you know your limit, set a timer to remind you to get up before you need to.

Adjusting a Chair

1. Adjust seat height so feet reach the floor (may need a foot riser).

2. Tilt seat bottom for upright posture and to make it easy to reach your telephone, keyboard, etc.

3. After you are positioned comfortably on the seat, adjust the backrest to support your lumbar curve. (Do not use the backrest to force your back forward)

4. Consider using a towel roll or wedge under your buttocks when your chair does not have a tilt adjustment.

5. Make the desk/work surface accommodate you. This may require raising or lowering the height of the desk.

"How can I perform my regular activities?"

Activity Management

The central principle of spine stabilization is to find the "neutral" position for the section of the spine that is causing the symptoms and then maintain that throughout activities of daily living, including exercising. For some conditions, the flexed position is appropriate, and for other conditions the extended position is appropriate, and for still other conditions a neutral position is most appropriate. Many patients will have a range of motion that is tolerated, and when that range is exceeded, symptoms begin to worsen. Ideally, we want to allow the irritated or diseased spinal segment to rest while one is still able to carry out activities of daily living in general in the most normal way possible. This can frequently be done by focusing on the degree of curve (lordosis) in the lumbar spine, finding the degree of curve or position that is most comfortable, and then learning to maintain this position in sitting, standing, walking, and all other activities that are engaged. To put it simply, the rule of thumb is don't cause the pain.

Since the spinal structures are viscoelastic and change their position somewhat over time when one maintains a static position, symptomatic patients frequently do not tolerate holding certain positions for too long. In other words, one may be able to sit for 20 minutes and then get pain on a predictable basis. In this situation, in order to allow the diseased segment to heal as quickly as possible, it would be recommended to change the position prior to the usual onset of symptoms. That is, one would sit for 15 minutes and then get up, and not wait for 20 minutes until pain usually becomes apparent. In this way, chronic inflammation from small repetitive microinjuries is prevented and the abnormal area can maximize its healing potential.

These exercises are frequently used by physical therapists. You must have enough trunk strength to execute them properly or you may injure yourself. Get professional instruction before attempting them.