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Low Back Pain
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On this page: General Home Measures| Exercises for Low Back Pain | Video Tutorial | References

This tutorial is not to be a substitute for professional medical advice, diagnosis, or treatment.  Do not attempt these exercises until getting approval from your doctor or physical therapist.

Overview of Low Back Pain

Low back pain is the #2 reason that Americans see their doctor, with colds and flu being the #1 reason.

The spine is surrounded by many muscles and ligaments which give it great strength and flexibility.  Most often low back pain is triggered by some nonspecific combination of overuse, muscle strain, or injury to these muscles and ligaments.   Less commonly, low back pain is caused by a spinal condition (such as spinal stenosis, sciatica, or vertebral compression fracture) or a serious illness such as cancer.(1)

Acute back pain is the most common type of back pain. It comes on quickly and often leaves just as quickly. Pain that hits you suddenly – after falling from a ladder, being tackled on the football field, or lifting a load that is just too heavy, for example – is acute pain. To be classified as acute, pain should last no longer than 6 weeks.

Chronic pain is much less common than acute pain. Chronic pain last more than 3 months. It may come on either quickly or slowly.(2)

When should I see the doctor?

In most cases, it is not necessary to see a doctor for back pain because pain usually goes away with or without treatment. However, it's a good idea to consult with your doctor if you have:

  • Numbness or tingling
  • Severe pain
  • Pain that doesn't improve with medications and rest, or
  • Pain after a fall or an injury.

    The following problems along with back pain could signal a serious problem that requires immediate medical attention:

  • Trouble urinating;
  • Weakness, pain, or numbness in your legs;
  • Fever; or
  • Unintentional weight loss.
General home measures   

Acute back pain usually gets better on its own and without treatment, although the following general measures will be helpful to relieve the pain and speed recovery.

  • Greatly reduce normal physical activity for the first few days to help relieve the acute stage of pain and reduce inflammation. Long-term bed rest is no longer recommended for most cases of back pain. In fact, after 2 to 3 days of inactivity, the muscles supporting the spine start to weaken which can actually contribute to recurrent back problems.   In most cases, you will be expected to progress back to nonstrenuous activity within 24 to 72 hours.  At this time,  controlled exercise, preferably supervised by a physical therapist should begin.

  • Apply ice for the first 48-72 hours  for 20 minutes at a time with a towel under an ice packs or 10 minutes at a time for ice directly on the injured area, for example, ice in a pillow case. This is a recommended technique used by physical therapists. With either method, apply ice approximately 4 times daily.  After the first 2-3 days, apply either ice  (as above) or warm, moist heat for 20 minutes at a time, approximately 4 times daily.  At this point, whether it's best to use ice or heat varies with the individual.  Some people do better with ice and some do better with heat.
      
  • Over-the counter pain relievers can be helpful for the pain (unless you are allergic to them, have contraindications, or have been advised to avoid these medications by your doctor. Read more)
    • ibuprofen (Advil),
    • naproxen sodium (Aleve)
    • aspirin
    • acetaminophen (Tylenol)
    • Muscle relaxants and certain antidepressants have also been prescribed for chronic back pain, but their usefulness is questionable
       
  • Avoid the following when recovering from low back pain
    • Prolonged sitting or standing--take frequent breaks, walking around slowly.
    • Heavy lifting or twisting of the back--especially lifting and twisting at the same time.
    • Weight lifting, jogging, football, golf, ballet,
    • Leg lifts when lying on your stomach, or sit-ups with straight legs (rather than bent knees).

  • Many people find that some simple changes in their posture and positioning can make a huge difference in their back pain.
    • While sitting place a lumbar support pillow, small throw pillow or a rolled up towel behind your lower back. Place your feet on a small foot rest so that your knees are at the same level as your hips.
    • Remove items from back pockets while sitting.  Men who drive for long distances with thick wallets in their back pockets can have back problems as a result.
    • Avoid high-heeled shoes  High heels pitch you forward, forcing your back muscles to arch unnaturally.
    • While sleeping, try lying in on your side in a curled-up position with a pillow between your legs. If you usually sleep on your back, place a pillow under your knees to relieve pressure.  Avoid sleeping on your stomach.
    • Assess your mattress--An old worn mattress makes and old worn back. It should be comfortable and supportive but not hard.  Many people find adding 1-2 inches of extra padding on top of a firm mattress provides comfort without losing support.    This padding is available at most stores that sell linens or mattresses.  When testing for a mattress, don't push on it or bounce up and down, as many people do. The only way to tell if the mattress is comfortable, is to lie on it for 10 minutes or so -- on your back, on your side, every way.

When Lifting:

  • Do not bend from the back.
  • Never twist while lifting objects.
  • Keep your back straight.
Instead:
  • Think ahead--get help if the object is heavy.
  • Hold the object as close to your body as possible
  • Have a good base of support with your legs apart.
  • To lift, bend from the knees and let your legs do
    the lifting
    instead of your back.
  • Keep your back straight.
 
Physical therapy treatments are optimal for pain relief measures as well as education and exercise to improve the strength and flexibility of the muscles.  Physical therapists may employ massage, ultrasound, aquatic therapy, and controlled application of heat or ice to relieve the pain and inflammation. A specifically tailored exercise program is taught and supervised by the therapist to help patients regain full use of their back. These exercises will strengthen both the abdominal and back muscles in order to stabilize the spine which will greatly help to prevent future back injury.



Exercises for Low Back Pain Stretching and strengthening exercises are important in the long run. However, starting these exercises too soon after an injury can make your pain worse. Furthermore, some exercises can aggravate certain causes of back pain.  The best way to recover quickly from back pain and prevent further injury is to see your health care provider and a licensed physical therapist to get started on a home exercise program that is right for you.  In general, the following are some of the exercises that might be recommended by your physical therapist or physician.
Begin an exercise program with a warm up of 5 to 10 minutes Easy walking is a good warm up.
1) Pelvic Tilts:  This is an excellent exercise.  It is easy-to-do and can be very relaxing, relieving the mild stress and tightness that has built up over time, but also improves endurance of the abdominal muscles. Note: Do not do this exercise if it causes pain.
Pelvic tilts lying: Lie flat on the floor with legs bent  Pelvic Tilts LyingFlatten back against the floor by tightening stomach muscles and buttocks.  Hold this position for several seconds to start,  gradually increasing to hold this position  for 2-3 min. Don't hold your breath during this exercise--continue to breathe normally.  (Holding this position for longer lengths of time will train your muscles and improve endurance that is necessary for sustained strength in the abdominal muscles.)  Repeat this at least 10 times per session, once daily as a routine. Pelvic tilts standing:  Pelvic tilts can also be done while standing in place, such as standing in line or standing at a counter working.

With knees slightly bent, tighten stomach and flatten back by rolling pelvis down.

2) Stretching: The following exercises should be done as follows: Stretch slowly to the point where you feel a mild tension, relax and hold the stretch for a total of 30 seconds--repeat 3-5 times. The feeling of tension should diminish as you hold the position.  If it does not, ease off slightly until you find a degree of tension that is comfortable. Do not bounce or stretch to the point of pain.   
Knee-Chest Stretch: Knee-chest stretch
This stretches the lower back & hips. With both hands behind knee, pull knee into chest until a comfortable stretch is felt in lower back and buttocks.  Keep opposite leg straight and on the floor.  Keep back relaxed
Hamstring Stretch:
Hamstring stretch
Note: Do not do this exercise if this causes pain, or if you have pain radiating down the leg, or have a diagnosis of bulging disc or herniated disc.  Tension on the hamstring can increase tension on the nerve and further aggravate your symptoms if you have any of these conditions.  To do this exercise, with one leg straight, tuck the other foot near the groin.  Reach down leg that is straightened until a stretch is felt in the back of the thigh.  Keep back straight and bend at the hips.  Hold this stretch for 30 seconds then relax.  Repeat 3 times on each side.
Heel-cord stretch: 
Heel-cord stretch Stand facing a wall, about a foot away.  Place both hands on the wall for balance. Put one foot behind you.  Slightly bend the front knee. Keep the front heel down. Keep the back leg straight and the back heel down. Press your hips toward the wall.
3) Eventually an exercise program to strengthen the back should include either light walking, riding a stationary bicycle, or swimming. Your physical therapist or health care provider should tell you when it's safe to begin this program.  Start very slowly (5 minutes at a time) and work up to 30 minutes a day, five days per week.  Such aerobic activities improve blood flow to the back and promote healing. They also strengthen the muscular support in the stomach and back.
 
Educational Video Tutorial:
Low Back Pain @ Medline Plus   This link takes you to the Medline Plus Home Page. Locate the "Interactive  Tutorials" button  in the upper R hand column.  This will take you to an extensive list of available videos that are excellent patient education resources.  Scroll down to back pain and follow the directions.  You will view a comprehensive tutorial about back pain, complete with exercises for low back pain.  This site is a service of the Nat'l Library of Medicine and Nat'l Institute of Health.
References:

1) American College of Physicians and the American Pain Society Guidelines For Low Back Pain Annals of Internal Medicine, October 2007
2) Back Pain from the National Institute of Arthritis and Musculoskeletal Skin Diseases
3) Low Back Pain and Surgeryfrom the American Association of Neurological Surgeons

Assistance with this page provided by Foundation Physical Therapy--with offices in Largo (727)-518-8115 and Clearwater (727)-784-6088

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