GOOD BACKS GONE BAD

Muscle imbalances are another cause for persistent back pain. A sore or tight muscle sends a signal to opposing muscles to relax even when they are supposed to contract for movement, resulting in overuse strain of related muscle groups. This pattern of reciprocal inhibition can be reversed by stretching the tight muscles immediately before retraining the inhibited ones.

DOCTOR'S NOTE: Seek evaluation by a health professional if your back pain is associated with fatigue, weight loss, fever, arm or leg weakness, or incontinence, which are symptoms of more serious causes of persistent back pain.

LOWER BACK RETRAINING



Stretching left flexors and right extensors
(WVSOM)



1. Stretch the tight hip flexor and opposite hip extensor:

1. Lie on your back with one leg hanging off the end of the bed or table;
2. Pull the other knee toward the chest as far as it will comfortably go;
3. Let the foot of the leg hang down as far as it can comfortably go;
4. Take a few deep breaths and stretch for 10-20 seconds;
5. Repeat for the other side.

2. Contract the inhibited hip extensors:

Contracting right hip extensors (WVSOM)

1. Lie on your stomach with the legs straight and toes pointing downward;
2. Slowly lift one leg 3-6 inches, hold it there 5-10 seconds, and slowly return it to the floor;
3. Repeat this leg lift and drop 5-10 times;
4. Repeat for the other leg.

3. Repeat this sequence of stretch and contraction daily and before other exercises.





 

 

UPPER BACK RETRAINING

Upper trapezius stretch
(WVSOM)

1. Stretch the tight upper shoulder muscles:

1. Hold onto the chair with one hand and hold the top of the head with the other hand;
2. Allow the head to slowly fall to the side as far as it will comfortably go, letting the weight of the arm move the head;
3. Take a few deep breaths and stretch for 10-20 seconds;
4. Repeat to the other side.



Right pectoralis stretch
(WVSOM)



 

2. Stretch the opposite chest muscles:

1. Stand with your shoulder and hip against a wall;
2. Place the arm that is against the wall straight behind you, with the hand facing the wall;
3. Push your other hand into the wall in front of you to turn the chest away from the wall;
4. Take a few deep breaths and stretch for 10-20 seconds;
5. Repeat for the other side.



Right trapezius contraction (WVSOM)

3. Contract the inhibited lower shoulder muscles:

1. Lie on your stomach with the arm straight out to the side;
2. Turn the hand to point the thumb upward;
3. With the arm straight, slowly lift the hand 3-6 inches, hold it there 5-10 seconds, and slowly return it to the floor;
4. Repeat this arm lift and drop 5-10 times;
5. Repeat for the other arm.

4. Repeat this sequence of stretch and contraction daily and before other exercises.

WHEN SWAY BACK SWAYS BACK

A common cause of chronic back pain is increased lumbar lordosis, otherwise known as sway back. What's cute in teen years often causes pain in the back muscles and ligaments when abdominal muscles become weak after prolonged inactivity, pregnancy, abdominal surgery, or aging. The resulting hyperlordosis upon standing will stretch the iliolumbar ligaments, strain the paraspinal muscles, and compress the spinal joints. In other words, OUCH!

Abdominal strengthening is the key to reducing hyperlordosis pain because the front muscles help to support a straighter spine. These exercises can be painful for an already sore back so it's better to begin with a little relief. First use the LUMBAR POSITION OF EASE to reduce back pain and the PELVIC TILT to gently stretch the back muscles before proceeding to this abdominal strengthening routine.




DOCTOR'S NOTE: Seek evaluation by a health professional if you have leg weakness or incontinence because sway back (hyperlordosis) can cause pressure on the spinal cord, resulting in these symptoms.



ABDOMINAL CURL


Midline abdominal curl (WVSOM)

1. Lie on your back with knees bent, feet on the floor, and arms crossed;
2. Slowly lift your head and shoulders until the head is 3-6 inches from the floor;
3. Hold your head and shoulders in this position for 20 seconds, return to the floor, and rest for 5-10 seconds;
4. Repeat this head and shoulder lift by reaching your right elbow toward the left hip for 20 seconds, return to floor, and rest for 5-10 seconds;
5. Repeat by reaching your left elbow toward the right hip for 20 seconds, return to the floor, and rest for 10-20 seconds;
6. Repeat the midline, left, and right abdominal curls 3 times. If the third time is easy, increase the holding time 10-20 seconds in the next session;
7. Do this abdominal curl every other day;
8. Add the SUPINE LIMB LIFT when low back pain is no longer present.

SUPINE LIMB LIFT

Supine limb lift (WVSOM)

1. Lie on your back with legs straight, toes pointing downward, and arms straightened above your head;
2. Tighten your buttocks and slowly lift the legs, arms, and head until your hands and feet are 3-6 inches from the floor;
3. Hold your legs, arms, and head in this position for 30 seconds, return to the floor, and rest 5-10 seconds;
4. Repeat 3 times. If the third time is easy, increase the holding time 10 seconds in the next session;
5. Do this supine limb lift every other day.

INDEX OF EXERCISES

Cervical extensor stretch
Cervical joint mobilization
Cervical position of ease
Chest position of ease
Hamstring stretch
Latissimus stretch
Levator stretch
Lumbar extensor stretch
Lumbar mobilization
Lumbar position of ease
Patella mobilization
Patella position of ease
Pectoralis stretch
Piriformis position of ease
Piriformis stretch
Psoas position of ease
Psoas stretch
Radial head mobilization
Rib mobilization supine
Rib 1 mobilization
Sacroiliac mobilization
Scalene position of ease
Scalene stretch
Shoulder mobilization
Supraspinatus position of ease
Supraspinatus stretch
Thoracic flexion-extension stretch
Thoracic position of ease
Thoracic mobilization standing
Thoracic mobilization supine
Thoracolumbar mobilization
Wrist extensor position of ease
Wrist extensor stretch

SPINAL MOBILIZATION AT HOME











Tailbone to head spinal mobilization
(David R. Beatty)

       
It's normal for spinal joints to pop. They should do so when you move around after periods of prolonged immobility like sleeping, sitting at a desk, or driving. Problems only arise when this can't occur, such as when there is limited opportunity to move after immobility, or when stress and strain induced muscle spasm prevents joint motion. The following spinal mobility routine is for those who are unable to stay flexible with day-to-day movements and exercises.

DOCTOR'S NOTE: Avoid self-mobilization of joints more than twice a day. More frequent joint articulations can contribute to joint pain and hypermobility. If you feel the need to pop your own back or neck more than twice a day, instead do the spinal stretching routine in A STRETCH A DAY....

a) PELVIC TILT

Pelvic tilt (WVSOM)



1.  Lie on your back with knees bent and feet flat on the floor;
2. Roll the pelvis by pushing the low back into the floor while lifting the coccyx (tip of tailbone) slightly upward;
3. Take a few deep breaths and stretch into this position for 5-10 seconds;
4. Repeat 5-10 times;
5. Proceed to b) SACROILIAC SIDEBENDING MOBILIZATION;
6. Do this mobilization up to twice a day.



Sacroiliac sidebending mobilization

(WVSOM)

b) SACROILIAC SIDEBENDING MOBILIZATION

1. Lie on your back with knees bent and feet flat on the floor;
2. Quickly reach your left hip outward and up toward your left shoulder as far as it will go;
3. Quickly reach your right hip outward and up toward your right shoulder as far as it will go;
4. Repeat quickly from side-to-side 3-5 times;
5. Proceed to c) LUMBAR MOBILIZATION;
6. Do this mobilization up to twice a day.



c) LUMBAR MOBILIZATION 



Lumbar mobilization (WVSOM)

1. Lie on your back with knees bent, feet on the floor, and arms outstretched;
2. Drape one knee over the other and allow the legs to fall to the floor while keeping the shoulders down;
3. Repeat to the other side;
4. Proceed to d) THORACOLUMBAR MOBILIZATION;
5. Do this mobilization up to twice a day.

d) THORACOLUMBAR MOBILIZATION


Thoracolumbar mobilization (WVSOM)

1. Sit with your legs straight and hands on the floor behind you;
2. Bend one knee and place the opposite arm against the outside of the bent leg;
3. Slowly turn your trunk toward the bent leg as far as it will comfortably go while pushing the arm into the leg;
4. Add a short quick push of the arm into the leg to twist the trunk slightly farther. If the upper low back doesn't pop, move the hand on the floor a little farther away from or closer to the back of the hip and repeat the short quick trunk twist;
5. Repeat to the other side;
6. Proceed to e) SUPINE THORACIC MOBILIZATION;
7. Do this mobilization up to twice a day. 

e) SUPINE THORACIC MOBILIZATION

Supine thoracic mobilization (WVSOM)

1. Lie on your back on a firm surface with the knees bent and fingers interlocked behind your head;
2. Push your elbows together and use your arms to pull the head forward while simultaneously lifting the pelvis until a single vertebra is touching the floor;
3. Rock the pelvis up and down to roll the vertebra over the floor until a joint mobilization is felt;
4. Repeat step 3 for other achy vertebrae;
5. Proceed to f) CERVICAL JOINT MOBILIZATION;
6. Do this mobilization up to twice a day.

f)

Right cervical joint mobilization (WVSOM)

CERVICAL JOINT MOBILIZATION

1. Lie on your back and use one hand to grip both sides of the back of your neck just below the tight area;
2. Use your other hand to gently and repetitively move the head into sidebending around the hand at the back of the neck;
3. Repeat for the other side if needed;
4. Do this mobilization up to twice a day.

A STRETCH A DAY...

... keeps the back, neck, and head pain away! This daily routine will help you to stay flexible and pain-free.





LUMBAR EXTENSOR STRETCH

1. Lie on your back and grasp both knees with your hands. If knee pain occurs, instead grasp the back of the thighs just above the knees;

   

   Lumbar extensor stretch (WVSOM)

2. Use your arms to slowly pull the knees toward the chest as far as they will comfortably go;
3. Take a few deep breaths and stretch for 10-20 seconds;
4. Do this stretch daily.

THORACOLUMBAR STRETCH



Thoracolumbar stretch (WVSOM)

1. Sit with your legs straight and hands on the floor behind you;
2. Bend one knee and place the opposite arm against the outside of the bent leg;
3. Slowly turn your trunk toward the bent leg as far as it will comfortably go while pushing the arm into the leg;
4. Take a few deep breaths and stretch for 10-20 seconds;
5. Repeat to the other side;
6. Do this stretch daily.

THORACIC FLEXION/EXTENSION STRETCH

  

Flexion stretch (WVSOM)

1. Kneel with your arms straight and hands shoulder width apart;
2. Arch your back slowly upward while tucking the head and tailbone downward;
3. Take a few deep breaths and stretch for 5-10 seconds;



Extension stretch (WVSOM)

4. Arch your back slowly downward while curling the head and tailbone upward;
5. Take a few deep breaths and stretch for 5-10 seconds;
6. Repeat the flexion and extension stretches 3-5 times;
7. Do this stretch daily.



Cervical extensor stretch
(WVSOM)

CERVICAL EXTENSOR STRETCH

1. Sit with your feet flat on the floor and the back straight;
2. Place your hands on the back of the head;
3. Keeping the back straight, let the chin drop down toward your chest, allowing the weight of the arms to pull your head downward;
4. Take a few deep breaths and stretch for 10-20 seconds, avoiding pulling on the head with the arms;
5. Do this stretch daily.

KNEECAPS NEED RELIEF

Palpating the patella
(WVSOM)

The patella is different. Most bones meet other bones via joints but not the kneecap. It floats in the tendon of the quadriceps femoris muscle that straightens the knee. Most tendons connect a muscle to a bone but not the patellar tendon. Much of it stretches from the kneecap to the tibial tuberosity. Most bone and joint problems are not easily treated by self-administered manipulation but not patellofemoral syndrome. It responds quite well to the sequence of position of ease, stretch, and joint mobilization provided below.






DOCTOR'S NOTE: Seek evaluation by a health professional if your knee pain occurred following a knee injury or if you are unable to stand on that leg.








PATELLA POSITION OF EASE

Right patella position of ease (WVSOM)

1. Lie on your back with the legs straight;
2. Place your foot on a pillow and allow the leg to relax. If knee pain is no better, add a second pillow;
3. When comfortable, take a few deep breaths and rest in that position for 2-5 minutes;
4. Slowly remove your foot from the pillow and proceed to the HAMSTRING STRETCH, or roll to one side before getting up;
5. Use this position of ease 2-4 times a day before stretching or as often as needed for pain relief.



Left hamstring stretch (WVSOM)

HAMSTRING STRETCH

1. Sit with one leg straight and the hand on the same side on the floor behind you;
2. Keeping the leg straight, reach with the other hand toward the foot as far as you can comfortably go;
3. Take a few deep breaths and stretch for 10-20 seconds;
4. Repeat for the other side if needed and then proceed to the PATELLA MOBILIZATION;
5. Do this stretch 2-4 times a day.









Right patella mobilization
(WVSOM)

PATELLA MOBILIZATION

1. Sit with your legs straight and a hand on the floor behind you;
2. Use the web of your other hand to push the kneecap down toward the big toe as far as it will comfortably go and hold it there;
3. Gently push the lower leg on that side up toward the ceiling until knee pain occurs;
4. Slowly release and repeat 2-5 times;
5. Do this self-mobilization 2-4 times a day.

TENNIS ELBOW ANYONE?

Wrist extensor muscle tenderness (WVSOM)

Whether or not from the sport, lateral elbow pain from strain of the wrist extensor muscles is a common and self-treatable problem if you can restore normal movement and avoid the repetitive arm use that caused it.









DOCTOR'S NOTE: Seek evaluation by a health professional if your elbow pain is associated with banging the arm, hand numbness, or arm weakness.









Wrist extensor position of ease
(WVSOM)

WRIST EXTENSOR POSITION OF EASE

1. Sit with the involved arm resting on a table or counter and your palm facing upward;
2. Place a small pillow or rolled up towel under the wrist and allow your hand to fall back over it;
3. If still painful, add a second pillow under the forearm;
4. When comfortable, take a few deep breaths and rest in that position for 2-5 minutes;
5. Slowly turn the hand over and proceed to the WRIST EXTENSOR STRETCH;
6. Repeat this position of ease 2-4 times a day or as needed for pain relief.



Wrist extensor stretch
(WVSOM)

WRIST EXTENSOR STRETCH

1. Sit with the involved elbow resting on a pillow, the arm straight, and your hand hanging off the table or chair arm with palm facing downward;
2. Use your other hand to slowly bend the hand downward as far as it will comfortably go;
3. Take a few deep breaths and stretch for  10-20 seconds;
4. If no increase in pain and the elbow is still stiff, proceed to the RADIAL HEAD MOBILIZATION;
5. Do this stretch 2-4 times a day.

RADIAL HEAD MOBILIZATION

(WVSOM)

(WVSOM)

1. Stand with the involved elbow bent with the fist facing your upper chest;
2. Rapidly straighten the elbow as far as it will go by throwing the hand forward as you turn the fist to face upward;
3. Repeat 2-3 times if needed;
4. Do this self mobilization up to twice a day.