Back Pain Part 4

Pregnancy:Back pain is among the most common discomforts during pregnancy. Back pain during pregnancy can be due to a number of factors, usually resulting in strain on the back muscles:
• In mid-pregnancy the uterus becomes heavier, changing the woman’s center of gravity, resulting in postural and movement changes. Most women begin to lean backwards in later pregnancy, causing the back muscles to work harder.
• Weakness of abdominal muscles can also contribute to back pain during pregnancy. The abdominal muscles usually support the spine, playing an important role in keeping
the back in good health.
• Additionally, the hormones of pregnancy cause the muscles to relax and become loose, which may cause some back pain and can contribute to making one more injury prone during physical activity (American College of Obstetricians and Gynecologists, 1997).
Bad Posture
Bad posture in any circumstance - while standing or sitting for long periods,
or while lifting, exercising, or doing any other type of activity - can contribute to
back pain and problems.
Lifestyle
Lifestyle factors, such as stress and smoking are thought to play a part in some cases of back pain. The mechanisms for this association, however, have not yet been proven


Prevention, diagnosis, treatment -

chronologically, this is the best way to treat back pain:
1 Try to prevent it.
2 Know when to see a doctor for diagnosis.
3 Understand and implement treatment options.
Preventing back pain. The first strategy for dealing with back pain is to try to prevent it. There are three primary areas one can focus on to keep a healthy back:
1 Exercise
2 Posture
3 Diet.

Exercise:
“Regular exercise is the most potent weapon against back problems (Mayo Clinic, 1997).” Exercise has the potential to strengthen the back, increase aerobic capacity, improve
overall fitness, reduce stress, and help shed excess pounds that put more pressure on the
back (Mayo Clinic, 1997). By increasing strength and flexibility of back muscles, weight is better distributed, and less force is placed on the spine (Cluett, 2001). Strengthening of back muscles is also one of the most important steps in treating most causes of back pain (Cluett, 2001).


The following are a few examples of back exercises:

Partial sit-up
Lie down on your back with bent knees. Slowly raise head and shoulders off the floor, and hold for 3 minutes. Knee-to-chest raise Lie down on your back. Slowly pull knees to chest, relaxing neck and back. Hold for 10 seconds; repeat 10 times.

Press-up
Lie down on your stomach. Place hands near shoulders and keep pelvis on floor. Press up painlessly. Hold for 10 seconds; repeat 10 times (National Library of Medicine, 2001). It is recommended that these exercises be done 2-3 times a week (National Library of Medicine, 2001). Be sure to always stretch before doing any type of exercise (Pace, 2000), and always consult your doctor before beginning any new exercise activity.
For more exercise ideas, see the following
websites:
• About back pain (UW) at: http://www.orthop.washington.edu/arthritis/
types/backpain.
• Back pain exercises (AAOS) at: http://orthoinfo.aaos.org/fact/
thr_report.cfm?thread_ID=17&
topcategory=Spine.
• Low back exercises (AAOS) at: http://orthoinfo.aaos.org/booklet/
thr_report.cfm?thread_id=18&
topcategory=spine.

Posture:

Maintaining good posture can keep the back healthy. Postural techniques can also help relieve back pain. Here are some tips to follow for good posture:
When sitting
• Sit in a firm chair with armrests.
• Keep the back straight and shoulders relaxed.
• Keep the stomach pulled in, and maintain the proper curve in the back - this can be done by tightening the stomach and buttocks.
• If it is more comfortable, place the back of the chair at a 15-20 degree angle. A small cushion behind the lower back to maintain the natural curve of the back can also be helpful.
• Keep the knees slightly higher than the hips - use a footstool or book under the feet if necessary.
• Keep your feet flat on the floor, stool, or book.
• Do not sit for long periods of time. Stand up occasionally to stretch tight muscles and give them a chance to relax.

When standing:

• Stand with weight equal on both feet.
• Avoid locking your knees.
• Place one foot on a footstool to ease tension in your back.
• Wear flat or low-heeled shoes if you must stand for long periods of time.
• Keep your back straight by tightening your stomach muscles and buttocks.

When sleeping:

• Use a firm mattress.
• Lie on your side with your knees bent.
• Place a pillow between your knees if it is more comfortable.
• If you sleep on your back, consult your doctor to find out if placing a pillow under your knees would help or worsen lower back pain for you.
(Adapted from University of Washington Department of Orthopaedics and Sports Medicine, 2002).