Contents What causes chronic lower back pain? . . . . . 3

What treatment can I receive? ...... 5

What should I do? ...... 6 YOUR GUIDE TO Exercises ...... 7 Phase 1 ...... 7

Phase 2 ...... 11

CHRONIC Phase 3 ...... 14

LOWER BACK Introduction Please take note of the following something that you have read in this PAIN before starting any of the exercises guide. in this guide: G Many people have found quick and G IPRS are committed to helping you lasting relief from their chronic lower to recover in the shortest and safest back pain by acting upon the possible time. information provided, but everyone decides for themselves what to do G The information contained in this An IPRS Guide to provide you with this information. Should you L guide is intended to assist in doubt a particular in your managing your recovery. A with exercises and advice to situation, please consult your health

T ease your condition G This guide is based on the latest professional. medical research in the field and E When consulting your health contains the best advice available to L professional, it is wise to take this the best of our knowledge.

E guide with you to show them. G This guide is complementary to K G If you have any uncertainties or other medical services and is not

S queries regarding the information, intended as a substitute for a health please do not hesitate to contact us O care provider’s consultation. on our free phone number L G Never disregard medical advice or 0800 072 1227 or email us at

U delay in seeking advice because of [email protected]. C S U M What is chronic lower back pain? Chronic lower back pain (LBP) is OSTEOPOROSIS defined as pain that persists longer Osteoporosis is a condition that arises than 12 weeks and is often attributed to from a decrease in your bone density degenerative or traumatic conditions (your body is failing to produce new of the spine. The evolution of chronic bone and is absorbing too much of the LBP is complex, with physiologic, existing bone). This will lead to your psychological, and psychosocial bones becoming thinner and weaker, influences. and therefore prone to fracturing (breaking). Conditions that may be causing your back pain BULGING (HERNIATED) DISC Most bulging discs are known to occur in the lower back, known as the lumbar spine. This condition occurs when the discs, between the vertebrae, weaken KYPHOSIS AND LORDOSIS or start to slowly degenerate. This can Kyphosis is an increased curvature of cause the cartilage to bulge, or be the normal upper back curve, also pushed into an area containing the SCIATICA known as the thoracic spine . Lordosis spinal chord or another nerve. This can This condition results from the is an increased curvature of the lead to the pain that you may be irritation of the sciatic nerve, which is normal lower back curve, also known experiencing. the large nerve that carries nerve as the lumbar spine. Changes away fibres down to the right and left leg, from the normal curviture of the spine and runs from the lumbar spine to the can result in pain as there is a greater lower leg. There are a number of pressure exerted on the vertebrae, factors that can irritate the nerve, but discs, and musculature that supports the most common cause occurs when SCOLIOSIS these areas. a bulging, or herniated, disc starts to This involves a curvature of the spine push against the sciatic nerve. The and can come in the form of a ‘C’ curve symptoms that you are likely to feel (one curve) or an ‘S’ curve (two curves). are a burning type pain in the lower This picture is an example of what back that may then extend into the scoliosis may look like. Bear in mind and either leg. In some that some cases will not be as severe as severe cases the symptoms may shown here. Exercises are available to differ and you will experience the people, who are diagnosed with the numbness and a feeling as if you have condition of scoliosis. lost some control over your legs. This is due to the pressure being placed on the nerve. Medical Illustration Copyright © 2008 Nucleus Medical Art, All rights reserved. Medical Illustration Copyright © 2008 Nucleus Medical Art, All rights reserved. 3 www.nucleusinc.com www.nucleusinc.com 4 What treatment can I receive?

If you are suffering from chronic lower MANUAL THERAPY LIFESTYLE back pain it is important to visit your Physical therapy is often required to There are ways in which you can look 3.When carrying parcels in both GP, registered chiropractor or decrease muscle spasm, reduce after your back and work more at hands, try and carry similar loads on physiotherapist, so that a full inflammation, provide mobilisation prevention of your injury rather both sides. examination can be performed and a techniques, massage and other than cure: 4.Try and use satchels that can strap diagnosis reached as to the cause of modalities which will all help to on both shoulders, to share the weight your lower back pain. If necessary your decrease the pain and get you back to 1. Be aware of your everyday posture and prevent leaning to one side. GP may arrange for X-rays to get a full function as soon as possible. The i.e. try not to slouch when sitting or better view of the bones, or an MRI extent to which these techniques will standing. Periodically stand up and 5.Watch your weight, extra weight scan to get a clearer view of the soft help is very dependant on your walk around the house/office. When can increase the chances of you tissue, discs etc in your spine. diagnosis. standing, try to balance your weight developing a back injury, as it CHOICE OF TREATMENT G Ice/heat therapy is often used by evenly between the right and left leg. encourages abnormal postures. It can also prolong the recovery process. This will depend entirely on the therapists, and can be used as a home 2.Be aware of your lifting technique. diagnosis/cause of the lower back therapy to relieve pain, reduce Keep objects close to your body, and 6.Understand your diagnosis and pain. Some types may benefit from inflammation and reduce muscle use your knees, keeping your back make sure that you look after your physical therapy, massage, and/or spasms. straight when lifting an object. Use back in the future, by through medications (e.g. non-steroidal anti- EXERCISE your feet to turn, try not to twist your including good habits into your inflammatory drugs), whilst others Exercise can play a significant role in back. every day life. may require injections, bracing or easing the pain of chronic lower back surgery. pain and preventing its reoccurance. DRUG TREATMENT The main goals of rehabilitation for G Paracetamol based pain killers are indivduals with chronic lower back What exercises should I do? usually prescribed by doctors to help pain are to prevent further weakness G Range of movement 2. Avoid over stretching, therefore with pain management. and pain, and to maximise strength, stability, flexibility, endurance and (ROM)/stretching exercises only take the stretch to a comfortable G Anti-inflammatory drugs are mobility. The maintenance of a G Strengthening exercises pain/stretch level. usually prescibed by doctors to G Aerobic exercises: cycling, regular exercise routine is essential to 3. If necessary, accumulate exercise control the inflammatory process. swimming, water-aerobics, walking. preventing future episodes of lower dose throughout the day. For G Steroids such as cortisone It is suggested you do aerobic back pain. example three sets of 10 minute (injections and tablets) are also used exercise for 20-30 minutes, three exercises may be preferred to 30 to manage pain and inflammation. times a week. minutes of continuous exercise. DIET SPECIAL CONSIDERATIONS It is important that you maintain a 1. Stretching and stability exercises 4. Some post-exercise soft tissue healthy, balanced diet in order to avoid should be performed daily, even on discomfort may be expected. excessive weight gain. Added weight the days when there is no pain. will put increased strain on your lower back and may greatly aggravate your condition.

5 6 GLUTE STRETCH Exercises phase 1 Lying on your back, rest your right When first starting an exercise when you have ‘bad’ days or if you have ankle on your left knee. Using programme, start slowly and only do done something to cause a flare up. your hands lift your left leg into as much as you are comfortable with. the air, bending your knee at 90°. If you have pain, other than slight For example: only do the stretches Pull your left leg gently towards muscle stiffness after exercise, then and stability exercises, as in phase one. your body. You should feel the you have done too much or are doing If this happens when you have stretch in the upper part of your the exercises incorrectly, and need to progressed to phase 2, do not be right leg (i.e. buttock region). adjust your programme or consult scared to regress for a day or two until your therapist. you feel better and are able to Adapt your exercise programme continue the strengthening exercises. QUADRICEPS STRETCH Lying on your side, pull your heel in towards your buttocks until a S T R E T C H I N G E X E R C I S E S comfortable stretch is felt in the G Repeat each of these stretches G You can use a towel to aid you in front of your thigh. Bend your 2-3 times, holding the stretch for the stretches if you are unable to lower knee to 90° in front of you to at least 30 seconds. reach your leg. stabilise your position. Use a towel if you are G Hold a steady stretch and do not G You should only feel a stretch, bounce. not pain. unable to reach your leg.

SPINAL TWIST SINGLE KNEE TO CHEST Lying down on your back, your arms STRETCH outstretched and your knees bent. Pull one knee in towards your Gently roll your legs over to one side. chest until a comfortable stretch is Hold for 20-30 seconds and then roll felt in your lower back and over to the other side. If you cannot buttocks. Repeat with the opposite feel the stretch along your spine, knee. bring your legs up closer to your body.

MID BACK ROTATION ACTIVE STRETCH Sit back on your heels in a Lying on your back, lift your leg up kneeling position. Stretch forwards straight. Hold behind your knee and with both hands as far as you can, starting with your knee bent, attempt keeping your chest as low to the to straighten your knee until a floor as possible. Now repeat the comfortable stretch is felt in the back same on either side. of your thigh. A towel can be used to supportyour leg if you cannot. 7 Exercise images licensed from Visual Health Information 8 PELVIC LIFTS ON FLOOR Exercises phase 1 (continued) Lying on your back, bend both knees to 90° with your feet flat on the floor. Tighten stomach muscles (TA) and lift S TA B I L I T Y A N D M O B I L I T Y E X E R C I S E S pelvis and lower back off the floor. Hold this position for 10 seconds and then G Do three sets of ten (on both sides). lower down slowly to the start position, G Do each exercise within your maintaining the TA contraction painfree zone. throughout. Repeat 10 times.

FINDING NEUTRAL on the ground. You will now feel SINGLE ARM LIFT ON ALL FOURS Lie on your back with your knees your hip bones are pointing towards On all fours, hands under shoulders bent. Put your hands on your hip your knees. Find the middle and knees under hips, ensure that bones and flatten your back into the position between the two extremes your pelvis is in neutral (i.e. hips ground. You will feel your hip bones and your hip bones should be facing the ground) and back is flat. are pointing towards you. Now arch pointing towards the ceiling. Raise one arm out in front of you. your back up keeping your buttocks This is neutral Do not arch your neck, keep it in line with the rest of your body. Be sure to keep your back flat. Hold for 5-10 seconds for 10 times on each side.

SINGLE LEG LIFT ON ALL FOURS Intheaboveposition,raiseoneleg CORE STRENGTHENING AND SINGLE LEG LIFT behindyouuntilyourlegisstraightand inlinewithyourbody. Do not arch your Find the above position. Pull your Make sure that you can still breathe neck or back. Try to hold for 5-10 belly button towards your spine, normally. You should only feel a seconds. without changing the position of slight contraction in your lower your pelvis. This will contract your abdominals. Hold for 10 seconds Transverse Abdominis (TA). and repeat 10 times. Now try to raise one leg slowly up and down GLUTEAL SETS without moving your pelvis. Repeat Lying on your stomach, find your on the opposite leg. You can neutral position and pull your belly alternate this by raising an arm and button into your spine. At the same then try to raisethe opposite arm time squeeze your bottom ensuring and leg at the same time. not to alter your pelvic position. You can progress this by raising one leg in the air. Repeat 3 sets of 10 repetitions on each leg.

9 10 ALTERNATIVE ARM AND LEG Exercises phase 2 EXTENSION ON ALL-FOURS Phase 2 should be started once you some of the exercises, do not be afraid In the all four position, now raise your are able to perform the exercises in to use some exercises from each phase opposite arm and leg without moving phase 1 pain free and with control at the same time and progress yourself your hips and keeping your spine in a (expecially in the stability/mobility slowly as you feel comfortable. neutral position. Do not arch your neck. exercises). This will probably be after a Continue with the stretching Repeat 5 times on each side and hold week or two of starting with this programme from phase 1 at the each for 5-10 seconds. You can try this programme. If you progress to phase 2 beginning and end of each session. over an exercise ball as a progression. and find that you are unable to do S T R E N G T H E N I N G E X E R C I S E S G Perform 2-3 sets of 10 on each side S TA B I L I T Y A N D M O B I L I T Y E X E R C I S E S G Ensure that the movement is controlled and that a neutral position is PRONE BENT KNEE LIFT Lying on your stomach, bend your knee maintained throughout and slowly raise your heel towards the ceiling. Maintain a neutral position in your pelvis. Avoid arching your lower DOUBLE LEG LIFT back. You should feel this in the Keep your pelvis in neutral, your buttock, not the back. Therefore if sore stomach contracted at all times and in the back contract your glutes and move your legs slowly. Repeat 5 sets stomach muscles. of 10 repetitions.

PRONE STRAIGHTEN In the above position, keep both knees straight, and raise your leg at your hips into the air. Be careful to avoid arching PELVIC LIFT WITH LEG EXTENDED your lower back. Repeat 2 sets of 10 Lying on your back, bend both knees repetitions on each side. to 90° with feet flat on the floor. With your pelvis in neutral and stomach CURL UP contracted, lift pelvis and lower back With your arms at your sides, start in a off the floor. Now lift one foot off the neutral pelvic position (as in phase 1). floor and straighten your leg in the Raise your shoulders and head from air, hold for 5 seconds, put back the floor, using your arms to support down, repeat with the other foot, and you if necessary. Keep your neck in a then relax completely. Keep your neutral position and if it is hurting, try pelvis stable throughout, without to put your tongue to the roof of your dropping to one side. Repeat 5 times mouth when sitting up (this will on each leg. stabilise your neck). 11 12 Exercises phase 2 (continued) Exercises phase 3 S T R E N G T H E N I N G E X E R C I S E S Progress to this phase when you feel exercises while still doing phase 2 if G Perform 2-3 sets of 10 on each side that you have improved in both your you are unable to do all of the strength and control. Again you can progressions. start with some of the phase 3 Continue with stretches as in phase 1. DIAGONAL CURL-UP With your arms at your sides, tilt your S T A B I L I T Y E X E R C I S E S pelvis to flatten your back. Raise your G Maintain neutral throughout and repeat 5-10 times head and shoulders, rotating to one side as yourshoulder blades clear the floor. LOWER ABDOMINAL STABILITY Start in the same position as phase 2. Now straighten both legs away from your body along the floor, maintaining neutral and ensuring movments are WALL SLIDES slow and controlled. Repeat 5-10 times Keep your head, shoulders, and back (you may only be able to do one or two against a wall with your feet out in front to start, but try and progress). of you and slightly wider than shoulder width apart. Slowly lower your buttocks while sliding down the wall, until your thighs are parallel to the floor. Keep your back flat.

RESISTED LUMBAR ROTATION IN SITTING In a seated position with theraband S T R E N G H T E N I N G E X E R C I S E S attached to a door handle. Make sure G Repeat two sets of 10-12 repetitions of each exercise on each side that your pelvis is in a neutral position. G Ensure that the movements are controlled and that you are aware of your Gently rotate away from the door in a pelvic position at all times pain free range of motion.

RESISTED LUMBAR DIAGONAL ROTATION IN STANDING Stand with feet shoulder width apart, and pelvis in a neutral position. Attach one end of tubing to a low fixed point and hold the other end with both hands. Extend and rotate your back as demonstrated in the picture.

13 14 Exercises phase 3 (continued)

CURL-UP STANDING LEG EXERCISES Keeping your arms folded across your Tie a piece of theraband around the chest, tilt your pelvis to flatten your leg of a table or bed, and place your back. Raise your head and shoulders foot through the loop. Now perform from the floor. Use a ball to progress various movements, ensuring that this. your pelvis is stable (neutral and TA contracted) and that you are not leaning. DIAGONAL CURL-UP Abduction: Take your leg away from Keeping your arms folded across your you chest, tilt your pelvis to flatten your Adduction: Turn around and bring back. Lift your head and shoulders your leg in towards you from the floor while rotating to one Hip flexion: Facing away from the side. Use a ball to progress this. table, bring your leg straight out in front of you LUNGES Hip Extension: Face the table and Start with your feet together and kick your leg backwards keeping a pelvis in a neutral position. Step straight knee forward into a position but do not allow your back knee to touch the floor. When you lunge make sure that both knees are at a 90° angle and Contact us then return to the start position. Keep both feet facing forwards. Try to keep Thisguideisdesignedtoassistyouinthe a flowing movement up and down, do self-managementofyourinjury/condition. not hold the lunge position. Repeat 10 Weareheretoassistyourrecoveryinthe times on each leg. Progress this to shortestbutsafestpossibletime.Ifyou walking lunges. haveanyuncertaintiesorqueries regardingtheinformation,pleasedonot hesitatetocontactuson: TPhoneel: 087 0178904009990 756 5020 / 07870166861 Ewww.mdphysiotherapy.co.uk-mail: [email protected] DM Ref.: MSkel 038

15 16