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Back Care
Back pain is one
of the most common conditions affecting nearly all adults at
some stage of their life. Fortunately for most people the injury
and its problems are short lived and after it heals they return
back to normal. However, for others the injury is more severe
and its effects long-lasting. It can affect all parts of your
day, not just the times when you are active – at work or at
home.
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It is often
difficult to give a diagnosis of exactly what is wrong with your
back. This is partly because your back is made up of many
structures.
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The vertebrae are
the small bones that make up the spine. They sit one on top of
the other, are joined together at the front by a cushion-like
structure called the disc, and behind by two small joints. In
between is a canal through the bones, which forms a protective
passageway for the spinal cord.
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From the spinal
cord, nerves pass away from the spine through small gaps on the
side between each two vertebrae. The nerves to the arms come
from the neck, and the nerves for the legs come from the lower
back. |
Healing of Back Injuries
For the damaged structures
to heal, good blood supply is essential for repair, and to remove waste
products. The bones, ligaments and muscles of the back have a good blood
supply, so it can heal reasonably well. The problem is that they usually
heal with a special type of tissue called scar tissue, which is strong,
but not as flexible as normal muscles, ligaments, etc. However, discs
have a poor blood supply and this often results in slower healing.
Discs, therefore may be more easily damaged if care is not taken to
prevent this. The most common type of injury to the back is to the soft
tissue – the muscles, tendons and ligaments. Most of these soft tissue
injuries heal well, and this is why most people with back injuries
recover.
Back pain is often an
unseen injury to others. As such it is sometimes difficult to understand
the problems that a person with back injury has to live with daily. To
help yourself, it is important to keep as mobile as possible and learn
how to move your body to prevent strain on your back. This handout
outlines some general rules for caring for your back and ways these
guidelines could be applied at home in day to day living. It should be
read more than once, and invite your family to read it too. It is very
helpful to discuss the information with your physiotherapist or
occupational therapist to answer any further questions.
The advice contained in
the handout is of a general nature and it is important to apply it to
your individual situation with professional guidance.
The nerves go to the
muscles of the body and act like telephone lines from the brain;
instructing muscles to contract, thus allowing us to move. They also
carry information from the body back to the brain; telling it sensory
information about temperature, touch, pressure and pain. Bladder and
bowel function is also controlled by nerves from the lower back.
The best known of these
nerves is the sciatic nerve. It is made up of several nerve roots and
goes back from the low back, through the buttock, down the back of the
leg and into the foot. Sciatica is the inflammation of this nerve.
Pain in the back can come
from damage or irritation to any of the structures in the back – joints,
muscles, tendons, ligaments, nerves, bone and disc.
If the nerve roots in the
lower back are being irritated, this can cause pain to be felt down the
leg, or even muscle weakness. It is possible to have pain in the leg
without pain in the back, however, this is unusual.
Disc Injuries
One way the nerves can be
irritated is from pressure from a damaged disc. The disc is designed to
act like a rubber washer, cushioning movement and allowing the spine to
move in many directions. If it is damaged it can protrude backwards
where it can press against one of the nerves, which passes into the arm
or the leg. A common term for this is “slipped disc”. The disc does not
actually slip. It is made up of a very tough outer covering with a
thick, jelly-like centre. If the outer cover is damaged, the jelly-like
central substance tends to protrude. The disc can then put pressure on
the nerve
root. 
LIFTING AND HANDLING
Incorrect lifting and
handling can result in injuries most commonly to muscles and ligaments,
but also to discs and bones. Muscles can be strained, ligaments and
discs can tear, which may lead to a ruptured disc. Often the back injury
is a result of years of abuse and of incorrect lifting and handling. The
final act which causes the pain may be as simple as bending over to tie
a shoelace.
The most common area for
back pain is the lumbar or lower back region. If you lift an object
incorrectly, you can exert pressure of more than ten times the weight of
that object on your lower back. Most of us relate lifting to work or
industry, but you perform lifting all the time, even when just moving
your body by standing up. So knowing about lifting and how to do it
correctly is important.
Steps to Safe Lifting
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1.
Get a firm footing. Place feet shoulder width apart
pointing outwards.
2.
Bend at the hips, knees and ankles.
3.
Brace your stomach muscles to support your back.
4.
Use the muscles in your legs to lift. They are much more
powerful than your back muscles.
5.
Keep your head and shoulders up and your lower back
arched inwards. Move smoothly.
6.
Keep the load close to you to minimise stress on your
spine.
7.
Never twist with a load. Use your feet to turn, facing
the direction of your destination.
8.
If the lift is heavy, do not attempt to lift. Always seek
assistance.
If you are lifting
with someone else it is better that they are of a similar
height. Make sure you co-ordinate the lift by lifting on the
count of three. |
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LOG ROLLING AND GETTING IN/ OUT OF BED
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Log Roll
Out of Bed
1.
Lying on back, bend left knee and place left arm across
chest.
2.
Tighten your abdominals, and
3.
Roll all in one movement to the right.
4.
Reverse for rolling to the left.
5.
Always move as one unit.
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In/ Out of Bed
1.
Lower self to the bed by raising legs and lowering head
at the same time to end in side lying.
2.
Bend both knees and tighten abdominals to roll onto back
if desired.
3.
To sit up, log roll to side lying and use the same
movements in reverse.
4.
Keep trunk aligned with legs.
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LYING
Lying on your back puts
the least amount of stress on your spine. However it is important to be
comfortable when sleeping. Your mattress should be supportive yet
comfortable. A firmer mattress is best for most people.
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When you lie
on your side, it is best for the knees to be slightly bent and your top
knee to be supported by a pillow (to prevent twisting of the spine).
Keep a single pillow under the head, thick enough to fill the gap
between the point of the shoulder and the ear, keeping the spine in a
straight line.
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When on your
back, use a single pillow to support the head, making sure it is not too
high. A pillow should keep the head in line with the spine. You may find
a small rolled hand towel in the centre of your back (to support your
lumbar curve), or a pillow behind the knees aids comfort.
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When lying
on your stomach, a flattened pillow is advised. Do not attempt this six
weeks post surgery unless otherwise advised by your medical team.
STANDING
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Stand with
your feet shoulder width apart and your toes pointing out .
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Knees
straight but relaxed.
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Abdomen held
in comfortably.
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Shoulder
straight, but relaxed and chin tucked in comfortably.
Advice:
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Wear supportive
low heeled shoes, preferably with rubber soles. High heeled
shoes alter your centre of gravity and increase stress on
muscles and ligaments.
When standing for
prolonged periods alternatively place each foot on a foot stool
or telephone book. This helps to flatten the spine by rotating
the pelvis.
Stand to cough or
sneeze if possible.
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SITTING
Sitting places the
greatest stress on the spine. Avoid sitting for prolonged periods. It is
important to move and stretch every 20 – 30 minutes, particularly when
travelling in a car.
Your knees should be level
with your hips when sitting. This ensures that you are sitting on your
pelvic bones and facilitating the spine’s natural curves.
The chairs that are
usually the greatest hazard to good sitting posture are low, soft lounge
chairs. A firmer chair with a straighter back and solid arms is often
better, for example a dining room or kitchen chair.
To achieve a better
sitting posture, consider the following:
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Sit back in
the chair so you can use a back support. If the seat of the chair is too
long for your legs you will slump forward.
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Your feet
should rest flat on the floor. If not place them on a small stool or a
telephone book.
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Armrests can
be used to take some pressure off your back.
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For a better
back support, you can place a rolled up towel in the small of your back
approximately at waistline. Commercial backrests can be purchased from
your occupational therapist or your local chemist.
DRIVING
When you drive you sit;
and sitting places a great deal more stress on your lower back than does
standing or lying down. If you experience pain or discomfort when
travelling for long periods, STOP, get out of the car and move
around.
Getting in and out
Get into the car by
sitting on the side of the seat and pivoting into the car, keeping your
pelvis and shoulders facing the same way and your abdominal muscles
tight.
When seated
Support your lumbar curve.
You may find a lumbar cushion or rolled towel placed behind your bottom,
support your spine.
Things to look out for when buying a new car
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Automatic
transmission (reduces the use of foot pedals)
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Power
Steering (reduces the amount of effort to steer and turn the car)
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Car seat
design – good lumbar support, and firm seat.
Consult your Occupational
Therapist if you have any problems. Occupational therapists are
experienced with vehicle adaptations, driving assessments, equipment and
procedures.
MANAGING DAILY ACTIVITIES
Energy Conservation
After back surgery, you
may find you fatigue more easily and it is important to pace yourself.
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Organise
your schedule (i.e. Try to space your activities throughout the day,
alternate light and heavy tasks).
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Rest before
you get tired. Have short rest breaks in the middle of a task and
between tasks. Do not feel guilty about your rest breaks.
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Use
assistive equipment where needed to avoid unnecessary bending and
twisting eg. long handled brush and dustpan.
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Eliminate
unnecessary motions and tasks.
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Organise
work areas to eliminate bending and overhead reaching.
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Allocate
difficult tasks to others e.g. carrying shopping, vacuuming.
Please consult your
Occupational Therapist for more advice on your individual needs. If
return to work is an issue, the Occupational Therapist is able to assist
with this. There are many agencies within companies and in the private
sector that are able to support your return to work. They can perform
site visits, liaise with employers, vocational retraining etc.
PERSONAL CARE
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Showering
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Preferably use a shower, with a shower chair if needed.
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Use
a bath seat and a shower hose if getting in and out of the bath
is a problem and you don’t have access to a walk-in shower.
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Sitting down to dry yourself is preferable.
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Aids
such as soap-on-a-rope, a long handled washer, or a soap mix
help to reduce bending over while washing.
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While ……may help to put one foot up on a small stool to ease the
load……..
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Putting on socks
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Sit
on a chair of suitable height, keep back straight.
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Cross one foot over the other leg.
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Then
put the sock onto your foot.
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Putting on trousers
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Sitting on a chair, back straight
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Bend
knees up towards chest and put feet through trousers one leg at
a time.
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Putting on shoes
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Slip
on shoes are the easiest to put on but make sure they are flat,
supportive and non-slip. |
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It is best to
dress sitting down post-surgery and ensuring that your back is
well supported when trying to dress your lower body. If you are
unable to do this, please discuss your problems with your
Occupational Therapist. They can advise you on correct ways of
moving and can provide small aids to trial to allow you to be
independent (such as ezi-reach, sock gutter, long handled
shoehorn, elastic shoelaces etc). |
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GENERAL HOUSEHOLD CHORES
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Laundry
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Use
a trolley to minimise bending
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Clothes line should be between waist and shoulder height.
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Alternatively, dry clothes in a clothes drier. If drier is on
the floor, fill and empty it seated |
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Ironing
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Stand using lunge position (one foot in front of the other) with
board at correct height, or with one foot resting on a low
stool.
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Alternatively sit on a chair and adjust the board’s height.
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HEAVY DOMESTIC CHORES
Avoid transporting heavy
or large objects from one place to another after your surgery (eg.
leaving ironing board in a suitable place rather than taking it in and
out of a cupboard, arrange someone to take out the rubbish).
Avoid heavy physical tasks
(e.g. Washing the car), particularly jobs that involve twisting and
bending post-surgery.
Gardening
Gardening need not be hard
work or stressful on your back. All the previous advice on moving and
handling is applicable in the garden.
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Lawns
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Use
a light weight mower and keep as upright as possible when
mowing.
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Hedges
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Not
all hedge need clipping, choose suitable varieties. |
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Weeding
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Use
a weeding stool, available at most hardware stores.
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Weed
only within arms’ length.
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Plan
to spend only short periods in this activity.
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Consider ground cover or mulching to cut weeds. |
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Watering
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Plan
a watering system
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Use
a long handled watering wand for hanging baskets and difficult
areas. |
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Tools
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Most
gardening tools have handles that are too short and can only be
used with a bent back. Tools which pull through the soil and let
your stand upright are easier to use and safer for your back.
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Rakes
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Rake
from the side to the centre of your body using a gentle pulling
action.
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Wheelbarrows
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If
you can, get a ….wheelbarrow. They are light, easy to push and
up ……to allow rubbish to be swept into ………..
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LEISURE
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It is important to
continue with your sporting and hobby interests; and with good
knowledge on the care of your back and some minor alterations in
technique and equipment, many activities are still open to you.
Most active
sporting hobbies which are generally suitable for people with
back pain are swimming and walking.
Some sporting
hobbies involve a lot of bending. It is important to protect
your back when picking up a ball or heavy object by adhering to
the previously discussed rules for lifting.
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RELAXATION
Relaxation is a useful
tool for people with back pain (or anyone in general) for several
reasons:-
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It
can prevent or alleviate aches and pains caused by excessive
muscle tension.
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It
can help to minimise unnecessary fatigue and is useful in aiding
recovery after strenuous exercise.
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It
can raise the threshold for tolerance to pain.
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The
main aim of relaxation is to achieve a complete state of physical rest.
Although this sounds easy, it is not something that comes naturally to
us and must be learned and practised. Talk to your medical team for more
information. |
