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					                                              THE SPORTS   MEDICINE   PATIENT   ADVISOR                          151




                                          Low Back Pain

            What is low back pain?               connective tissues of the back    gling or numbness in the calf
                                                 become inflamed as a result of or foot mky indicate a herniat-
            Low back pain is pain and
                                                 an infection or an immune sys- ed disk ot pinched nerve. Be
            stiffness in the lower back. It is
                                                 tem problem. Arthritic disor-     sure to sJe your doctor if you
            one of the most common rea-
                                                 ders as well as some congeni-     have weJmess in your leg,
            sons people miss work.
                                                 tal and degenerative condi-       especiallt if you cannot lift
            How    does it occur?                tions may cause back pain.        your foo~,because this is a sign
                                                    Back pain accompanied by       of nerve tlamage. New bowel
             Low back pain is usually
                                                 loss of bladder or bowel con- , or bladd~r problems related to
             caused when a ligament or
                                                 trol, difficulty in moving your . your back pain may indicate
            muscle holding a vertebra in


                                                                                               t
                                                 legs, or numbness or tingling     severe injury to your spinal
            its proper position is strained,
                                                 in your arms or legs may indi- cord, and you should see your
            Vertebrae are bones that make
                                                 cate an injury to your spine      doctor.       that in~eases
            up the spinal column through
                                                 and nerves, which requires
            which the spinal cord passes.
                                                 immediate medical treat-
            When these muscles or liga-
            ments become weak, the spine
                                                 ment.                                             I
                                                                                          Low Back Pam
                                                                                                            .
            loses its stability, resulting in    What are the                                      I
            pain. Because nerves reach all       symptoms?
            parts of the body from the
            spinal cord, back problems can Symptoms include:
            lead to pain or weakness in          - pain in the back or legs
                                              __ - stiffness and limited
           ~lmo~ any.R~2i..Jhe b..:::o.::d:J...y.:..--
-----.-   -    Low back pain can occur if          motion.
            your job involves lifting and        The pain may be continu-
            carrying heavy objects, or if        ous or may occur only in
            you spend a lotof time sitting       certain positions. It
            or standing in one position or       may be aggravated by
            bending over. It can be caused       coughing, sneezing,
            by a fall or by unusually stren-     bending, twisting, or
            uous exercise. It can be             straining during a
            brought on by the tension and        bowel movement. The
            stress that cause headaches in       pain may occur in only
            some people. It can even be          one spot or may
            brought on by violent sneez-         spread to other areas,
            ing or coughing.                     most commonly down
               People who are overweight         the buttocks and into
            may have low back pain               the back of the thigh.
            because of the added stress on          A low back strain
            their back.                          typically does not pro-
               Back pain may occur when          duce pain past the knee
            the muscles, joints, bones, and      into the calf or foot. Tin-
                                                                                            Rear view of body
                                                                                               I
                                                    Low Back Pain -. Page 1 of 5
152                               THE   SPORTS   MEDICINE   PATIENT   ADVISOR




                                          Low Back Pain ---r-I I -------.....

                                                                                                       I
  despite treatment indicates a         • Having traction, if                   How lolng will the effects
  more severe problem, which              recommended by your                   last? I
  should be evaluated.                    doctor.
                                                                                The effeJts of back pain last as
                                        • Wearing a belt or corset to                     I          •
                                                                                long as the cause exists or
  How is it diagnosed?                    support your back.                    until yoJr body recovers from
  Your doctor will review your          • Talking with a counselor, if          the strain, usually a day or
  medical history and examine             your back pain is related to          two but ~ometimes weeks.
  you. He or she may order x-             tension caused by emotional
  rays. In certain situations a           problems.                             How cbn I take care of
  myelogram, CT scan, or MRI                                                                       I

                                        • Beginning a program of                myself{
  may be ordered.
                                          physical therapy, or                  In additton to the treatment
                                           exercising on your own.              describ~d above, keep in mind
  How is it treated?
                                           Begin a regular exercise             these suggestions:
  The early stages of back pain            program to gently stretch
  with muscle spasms should be                                                  • Use ~ electric heating pad
                                           and strengthen your muscles
  treated with ice packs for 20 to                                                on a low setting (or a hot
                                           as soon as you can. Your .
  30 minutes everyl'!t\t06 hours                                                  wate~ bottle wrapped in a
                                           doctor or physical therapist
  for the first 2 to 3 days. You                                                          to
                                                                                  towe~1 avoid burning
                                           can recommend exercises
  may lie on a frozen gel pack,                                                   yourself) for 20 to 30 minutes.
                                           that will not only help you
  crushed ice, or a bag of frozen                                                 Don,J let the heating pad get
                                         . feel better but will                         I
  peas.                                                                           too hot, and don't fall asleep
                                           strengthen your muscles and                         I

     The following are ways to                                                    with it.You could get a burn.
                                           help avoid back trouble later.                      I
  treat low back pain:                                                          • Try Pftting an ice pack
                                        When the pain subsides, ask
  • After the initial injury,           your doctor about starting an             wrapped in a towel on your
    applying heat from a heating        exercise program such as the              back ~or 20 minutes, one to
                                                                                               I

    pad or hot water bottle.            following:                                four times a day. Set an
  • Resting in bed on a firm                                                      alarni to avoid frostbite from
                                        • Exercise moderately every
    mattress. Often it helps to lie                                               using the ice pack too long.
                                          day, using stretching and
    on your back with your                warm-up exercises                                1   I

                                                                                • Put pillow under your
    knees raised. However, some           suggested by your doctor or             knees when you are lying
                                                                                               I
    people prefer to lie on their         physical therapist.                     dowt·
    side with their knees bent.                                                 • SleeR without a pillow
                                        • Exercise vigorously for
  • Taking aspirin, ibuprofen, or         about 30 minutes two or                 under your head.
    other anti-inflammatory               three times a week by                 • Loselweight if you are
    medications; muscle                   walking, swimming, using a              overreight.
    relaxants; or other pain              stationary bicycle, or doing          • Pracfce good posture. Stand
    medications if                        low-impact aerobics.                    withlyour head up, shoulders
    recommended by your
                                        Participating regularly in an             straight, chest forward,
    doctor.
                                        exercise program will not only            weight balanced evenly on
  • Having your back massaged           help your back, it will also help         bothlfeet, and pelvis tucked
    by a trained person.                keep you healthier overall.                •       I
                                                                                   m'
                                                                                       l
                                                                                           I
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                                           Low Back Pain - Page 2 of 5
                                                   THE SPORTS   MEDICINE              PATIENT   ADVISOR                                    153




                                                         Low Back Pain ---------


                 Pain is the best way to judge        be able toha\T~,thesame range                       • Lie on your side with your
                 the pace you should set in           of motion that1iyouhad before                         knees bent when you sleep
                 increasing your activity and         your injury.ygu'Inustbe able                          or rest. It may help to put a
                 exercise. Minor discomfort,          to run, jwitpan.c:i'twist without                     pillow between your knees.
                 stiffness, soreness, and mild .      p-ain.     ~~" :.;:.~:,<,.i.:.,.
                                                                         .-   ',,-.                       • Put a pillow under your
                 aches need not interfere with                                                              knees when you sleep on
                 activity. However, limit your        What can {do to help                                  your back.
                 activities temporarily if:           prevent low back pain?                              • Raise the foot of the bed 8
                  • Your symptoms return.             You can reduce the strain on                          inches to discourage
                  • The pain increases when you       your back by doing the follow-                        sleeping on your stomach
                    are more active.                  ing:                                                  unless you have other
                  • The pain increases within 24       • Don't push with your arms                          problems that require that
                    hours after a new or higher          when you move a heavy                              you keep your head
                    level of activity.                   object. Turn around and                            elevated.
                                                         push backwards so the strain                     To rest your back, hold each of
                  When can I return to my                is taker(byxpo/legs.                               these positions for 5 minutes
                                                                 :'.,,1:'111('        ;' -.
                  sport or activity?                   • Wheneyer Yi9t1i~it, in a
                                                                          sit                               or longer:
                    The goal of rehabilitation is to       straight'"ba.q<~<;lchair and                   • Lie on your back, bend your
                    return you to your sport or            hold yourspifl~against the                       knees, and put pillows
                    activity as soon as is safely          back of the Chair:                               under your knees.
                    possible. If you return too          • Bend your knees and hips                        • Lie on your back, put a
                     soon you may worsen your               and keep your back straight                       pillow under your neck,
                     injury, which could lead to            when you lift a heavy object.                     bend your knees to a 90-
...
 -----   .....
           ---------
                 ----permanenniamage~-EveFyone-.            Avoidllffing heavy objects                    --"-de-greeangle, anapuryour--------- -----
                     recovers from injury at a dif-         higher than your waist.                           lower legs and feet on a
                     ferent r~te. Return t~ your         • Hold packages you carry                            chair.
                     sport WIllbe determined by             close to your body, with                       • Lie on your back, bend your
                     how soon your back recovers,           your arms bent.                                   knees, and bring one knee
                     not b y    ~ohwmban  y~ays or       • Use a footrest for one foot                        up to your chest and hold it
                     wee k It as een smce your
                              s                                           '.         .                         there. Repeat with the other
                      .,         .     d In      al th      when you stand or SItmane                          knee, then bring both knees
                      mJury occurre.        gener,     e          f'   1; .        Thi
                      longer you have symptoms              skPot ora' °tg:ne..        :-                      to your chest. When holding
                      before you start treatment, the                        a
                                                              eeps your ,;' ckstraigh .                        your knee to your chest,
                      longer it will take to get better. • Bend your knees when you                            grab your thigh rather than
                          It is important that you          'bend over.                                        your lower leg to avoid
                      have fully recovered from           • Sit close to the pedals when                       overflexing your knee.
                      your low back pain before you          you drive and use your seat
                       return to your sport or any           belt and a hard backrest or
                       strenuous activity. You must          pillow.



                                                                                                                            © HBO &: Company
        ,
     154                                THE SPORTS   MEDICINE   PATIENT    ADVISOR




      ----              Low Back PainRehabi/~t,at;on Exercises ----......

                                                                     .u.   .


        The goal of these exercises is to strengthen your abdo~~muscles,   stretch your lower back, hip
          flexors, and hamstrings. These exercises may help reduce lower back pain by correcting muscle
          imbalances in strength and flexibility of the trunk andhips.

        1. Hamstring stretch: Place the heel of one leg on a stool about 15 inches
           high. Lean forward, bending at the hips until you feel a mild stretch in
           the back of your thigh. Make sure you do not roll your shoulders and
           bend at the waist when doing this or you will stretch your lower back
           instead. Hold the stretch 30 to 60 seconds. Do the same exercise with the
           other leg. Repeat 3 times.

                                        2. Cat and camel: Get down on your hands
                                           and knees. Let yourstomach sag, allowing                    Hamstring stretch
                                           your back to curve downward. Hold this
                                           position for 5 seconds, then arch your back.
                                           Repeat 10 times. D02 sets ..

                    Cat and camel      3. Pelvic tilt: Lie on your back with
                                          your knees bent and your feet
                                          flat on the floor. Tighten your
            stomach muscles to flatten your lower back against the floor.
            Hold for 5 seconds, then relax. Repeat 10 times. Do 3 sets.                          Pelvic tilt


       4. Partial curl: Lie on your back with your knees bent and your feet
                    tl}e
_____ .__ flil..t..9n flggr. Tighi~!lY.9_urstOl!!~cb.}.!lusc~~9DgJ].atten your
          back against the floor. Tuck your chin to your chest. With your
          hands stretched out in front of you, curl your upper body for-
          ward until your shoulders clear the floor. Hold this positiori for 3
          seconds. Don't hold your breath. It helps to breathe out as you                      Partial curl
          lift your shoulders up. Relax. Repeat 10 times, Build to 3 sets of
          10. To challenge yourself clasp your hands behind your head
          and keep your elbows out to the side.

        5. Prone hip extension: Lie on your stomach with your legs
           straight out behind you. Tighten your buttock muscles
           and lift your right leg off the floor, keeping your knee
           straight. Hold this position for 5 seconds. Then lower your               Prone hip extension
           leg and relax. Repeat the same with your left leg. Hold 5
           seconds and then lower the leg and relax. Repeat 10 times
           on each side. Build up to 3 sets of 10.

        6. Single knee to chest: Now do a pelvic tilt and pull one knee up
           to your chest. Hold for 5 seconds and return to the starting
           position. Alternate sides, and repeat it 10:-20 times.
                                                                                          Single knee to chest


                                               Low Back Pain -pag~;~;)bf5
                                                                                                   r
                                          THE SPORTS.MEDICINEPATIENT                             ADVISOR                             155
                                                                              ~
                                                                          '.;~;~



         ---'                Low Back Pain:Rehabilitation                                                  Exercises ---......
                                                      .         '~,:      ·;b--·· "
                                                                       ..:~! ; .. ,
                                                                          i[';
                                                                          /.:.
                                                                 ,. . );~~~.<
                                        7. Double knee     to
                                                            chesfAgam; doa
                                           pelvic tilt and now p@poth
                                           knees up to y~~iche~t Hold for
                                           5 secondsandrm.e~~:tti~~tO        .'
                                                                              .':
                                           times.Y01.:(may;~~~ti~f\9:.llit:!on~

                Doubl.   knee W FOesI                .
                                          ~~:.1tf~~f;~~:~&-;
          8. Lower trunk rotation: Do a pelvic tilt.Keepi?g~p:6Ulders
             down flat, gently rotate the knees to one side, tli~nthe other,
             as far as you can. Repeat 10-20 times.             ;:: .



                                                                                                              Lower trunk rotation
                                                                         ..              .



                                                             9. Pirif~rmis stretch: Lie on your back as shoin. Pull
                                                                ..one;~l:!e up and across your trunk so you feel a
                                                           . ..>!~p~p'#.b~estr~tch in the top buttocks and back.
                                                                                         and
                                                          .: ::-·1f:Iolp.:;.to,(~~J5s~conds repeat 5-10 times on

                                                          ,[~~~~~r""iiiii'i'
                                                           :.,.;\,lX9yJ, ;, ..
                                                                            ,p~this    exercise by reaching for your
                                                                                   .
                                                           ·····'··ll':~;'"iII-i··''".·''·.'''···I.       .
                                                        .·.'~~I~~~llWW·Weopposite          hand and keeping your
                                                   ...·.....,;!shomflendlat      on the floor. Pull your knee over as
-----f---------l"ir~formls-stretch
                                                                'far'ils'you can allowing your trunk to rotate.    --------




                                                                                                                        © HBO & Company




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Description: 20120329_Apr2012-Guidelines-LowBackPain Acute acute_lbp Acute Low Back Pain acute_lbp Acute Low Back Pain Back Pain Back Pain back_pain_ff What Is Back Pain Back_Pain_French_FINAL Mal de dos Back_Pain_French_FINAL Mal de dos Backpain_July_2011 Chapter 2 Spine Low Back and Neck Pain Chronic low back pain KCE reports vol. 48 C Chronic Low Back Pain Diagnosis and classification of chronic low backpain disorders Maladaptive movement and motor control impairments as underlying mechanism Diagnosis and classification of chronic low backpain disorders Maladaptive movement and motor control impairments as underlying mechanism doc_22 Early management of persistent non-specific low back pain Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function Evidence-based Management of Acute Musculoskeletal Pain Evidence-informed management of chronic low back pain with opioid analgesics file Low Back Pain file Low Back Pain files_100729lowbackpain Healing_Back_Pain_The_Mind HEALING BACK PAIN in the clinic LBPGUIDELINESNov25 Low Back Pain (1) Low Back Pain BASIC EXERCISES FOR THE LOW BACK Low back pain early management of persistent non-specific low back pain Low Back Pain What is low back pain Low back pain low-back-pain-frazier Low Back Pain Rehabilitation Exercises Lumbar Supports for Prevention and Treatment of Low Back Pain Managing_acute_-_subacute_low_back_pain MPOC Acute Low Back Pain Acute Lower Back Pain National practice guidelines for physical therapy in patients with low back pain neckpain ﺍﻻﻧﺰﻻﻕ ﺍﻟﻐﻀﺮﻭﻓﻰ ﻭ ﺍﻻﻡ ﺍﻟﻈﻬﺮ New Zealand Acute Low Obesity and Low Back Pain (Derek Tobin; Tom Shaw Oswestry Low Back Pain Scale Please rate the severity of your pain by circling a number below Perceived disadvantages caused by low back pain Primary Care Interventions to Prevent Low Back Pain A Brief Evidence Update for the U.S. Preventive Services Task Force Radiography for low back pain a randomised controlled trial and observational study in prim