Injury prevention and conditioning
for your back

by Anne Kyle

In our society, back pain is the most common cause of loss of activity among adults under 45. It’s estimated that over eighty percent of all American workers suffer back pain at some time during their careers.

Most bad backs respond well to rest and conservative treatment, and most injuries can be prevented.

Your back

Your body depends on the spinal column for structural stability. You also depend on the spine for mobility—the ability to twist, bend, and flex your body for different activities.

The spine is constructed of twenty four jointed bones, or vertebrae, stacked from the pelvis to the skull in a gentle “S” curve. Between the vertebrae are spongy discs that cushion the bones and bond the stack together. Pairs of bony projections, called facets, connect the rear of each vertebra to form a series of joints. The column is wrapped tightly in ligaments and supported by muscle. Major nerves connecting the spinal cord with other parts of the body pass through spaces between the vertebrae.

The most common site of back pain and injury is the lumbar region—the lower back. Your lumbar spine bears the brunt of bending, stooping, sitting, and worst of all, lifting.

With aging, the resilient disc material between vertebrae dries out and shrinks. Under the stress of lifting, coughing, or sitting improperly, the deteriorated disc can bulge or even rupture. This herniation can press on the adjacent nerve root and cause pain, numbness, tingling, or painful muscle spasm.

Loss of disc thickness can also cause wear and arthritic enlargement on the joints, leading to abnormal pressure on the nerve.

Avoiding back injury

Everyone is vulnerable to back injury, but certain occupations present added risk. Truck drivers (sitting for long periods of time jostled by vibration) and nurses (bending over bedsides and lifting/moving patients) are just two examples of occupations at high risk. We can’t avoid every stressful activity, so the key to avoiding back injury lies in minimizing the risk inherent in any activity by applying these simple principles:

Work on your posture. Don’t slouch. Maintain the natural arch in your lower back whether standing or sitting.

Lift with your legs. Don’t bend over the object; instead bend your legs and keep your back straight with a slight arch in the low back. And most important, don’t twist as you lift.

Sit with care. Prolonged sitting in one position is a back hazard. This includes driving. Periodic breaks to move around are essential, and the use of some type of lumbar support (adjusting your chair or using a cushion or small pillow against the back) will protect the lower back.

Control your weight. Being overweight, especially around the midsection, puts stress on your low back.

Conditioning your back

Maintaining healthy back muscles is important in avoiding and recovering from an injury. Muscles around the legs, hips, and back are usually tight or weak, and this condition can predispose the back to injury. Strengthening—of the abdominal and back muscles especially—and general physical conditioning including regular aerobic exercise such as walking or swimming can provide all the exercise a healthy back needs.

Treatment for bad backs.

There is yet no simple cure for low back pain. Most experts prefer a conservative approach to treating acute back pain.

Bed rest. A person should stay in bed for forty-eight hours or until the acute period passes. A firm mattress is essential. Pillows can be placed under the knees when lying on the back, or between the knees when lying on the side. Heat or ice may be helpful.

Pain medication. Prescribed by the doctor, drugs will help the acute pain, but they will not necessarily help the cause of the pain.

Mobilization. Moving joints and muscles of the back with the assistance of a skilled professional can speed recovery. Physical therapists are trained in this, as are chiropractors (note that chiropractic does not include strengthening, and treatment need not be long term).

Positioning. Usually the injured back will feel best arched, slouched, or neutral. This position of relief should be used during activity. Traction can also be effective.

Epidural injection. Medication to reduce swelling or decrease pain can be effective if the above treatments do not achieve the desired results.

Surgery. This should be the last resort, undergone when the above treatments have failed or to control severe, chronic pain or neurological symptoms.

After healing

Keep in mind that once you’ve had a back injury, you’ll probably be vulnerable in that area for the rest of your life. Any successful treatment approach must include a program for preventing re-injury.

Activites that are easiest on the back include swimming, walking, and biking in an erect posture. They involve movements that keep the spine in an unweighted or upright position.

Activities that are more demanding on the back include jogging, golfing, all forms of skiing, climbing, and backpacking. All of these involve either spinal impact or twisting.

High impact sports and activities are the most demanding on the back. They include racquet sports, bowling, running (especially downhill),volleyball, basketball, and other similar activities.

Contrary to popular belief, exercise should not cause pain in a healthy body; at most, a person should experience only temporary muscle soreness after the activity. In order to keep a bad situation from getting worse, if you have a history of back injury consult your doctor or physical therapist.

Information in his article was reproduced with permission from the American Physical Therapy Association, “Taking Care of Your Back: A Physical Therapist’s Perspective” ©1999.

Anne Keil is a Physical Therapist with Exempla, experienced in the rehabilitation of injuries (including the back).