Library and Important Reading:
Taking Care of Your Back
An Exercise Program for Back Care: May I recommend…
Robert F. McLain, M.D.
Of all the patients that see a spine surgeon, only about 1 in 10 ends up needing to have an operation. No matter how bad your back pain is now, your best bet for improvement in pain and function will include a combination of exercise, conditioning, and improved body mechanics. Whether you are coping with an acute back injury or long-standing pain, here are some of my favorite recommendations for dealing with pain and starting to get better.
First, start with…
Good body mechanics
Learning how to sit, stand, and move the right way is important to good back health, and very important to getting over a back injury. Good back and body mechanics reduces the strain on back muscles during normal activities, and helps you get back to normal activity without stirring up more pain than you need. Moving the wrong way can be one of the reasons you strain your back in the first place, and it can really slow down your recovery.
Sleeping and laying down
Pain at night can really interfere with rest and recovery. Both leg pain and back pain can be more aggravating at night. If you sleep on your back, put a pillow under your knees, keeping your feet elevated and your hips and knees slightly flexed. When you lay on your side try bending your knees slightly, and put a pillow between them to keep your hips even.
Sitting
Make sure your chair supports your back well. Your head should line up over your hips, and you should not feel like you’re slouching. Support your lumbar curve with a rolled up towel or lumbar roll just behind your back. Your knees should be level with your hips.
You should take time to change positions, and get up and stretch or walk around every half hour or so.
Standing
Bending your knees slightly will take the stress off your lower back. Standing with your foot on a small stool, or even resting it on the floor of an opened cabinet - while working at a counter or sink - will take some of the stress of the lumbar spine.
Remember to wear good quality shoes with a solid arch support. Change positions and move about from time to time.
Bending and lifting
Always use good back mechanics when lifting: Don't cheat! Whether it's a sock or a rock, bend at your knees and hips instead of your waist. Keep your head and shoulders balanced over your hips and feet.
Lift with your legs, not with your back. Whether you are picking something up off the floor, or a tabletop, or a counter, keep the item close to your body and avoid reaching. And remember, lifting at awkward angles is always a bad idea: Whether you are pulling groceries out of the trunk of your car, or putting your toddler in the car seat, both are much harder on you back than lifting 20 pounds off the top of a counter.
Turning
Learn how to "move as a unit". This means keeping your shoulders and your hips square as you move from place to place. Twisting a little bit to pick something up is not bad, but repetitive twisting back and forth is hard on your back. When you move things from one place to another remember to move your feet as you turn, and not twist at the waist or knees.
Reaching
Good back mechanics means learning how to protect your back whether you are lifting or not. Bending at the waist and leaning forward puts a large strain on back muscles. This is true whether you are tucking sheets on the bed, vacuuming under the couch, getting the milk out of the refrigerator, or lifting something out of your car. Remember to bend your knees, keep your back straight, and work with your legs.
Basic exercises for a better back
Whether you are trying to get back into shape, or recovering from an injury, there are some basic exercises you can do to make your Back stronger and better able to cope with the rigors of your average day.
Physical fitness
When our back hurts it is hard to get moving. Most patients with back pain worry that activity will aggravate their problem, and many fear that it may actually harm them. For the vast majority of patients, nothing to be further from the truth!
Daily activity, and a regular aerobic exercise program, are the keys to getting most people back to good function, and are important even in patients that may someday need surgery. Time invested in a physical therapy and exercise program are never wasted.
The easiest way to get started with an exercise program is by walking. Walk a bit every day, but at least 3 times a week try and get out and walk quickly for half an hour to 45 minutes. If you're doing it right you should get a little sweaty. Exercise on a treadmill, elliptical trainer, exercise bicycle or in a swimming pool are all good.
Patients with narrowing of the spinal canal - spinal stenosis - may find walking difficult. These patients may find an exercise bicycle much easier to exercise on than any upright devices such as a treadmill or elliptical. Patients with disc-related back pain may find sitting on a bicycle difficult, on the other hand, and be more comfortable either swimming or walking.
Find the exercise you can do, and do it 3 times a week.
Start with 5-10 minutes of exercise at a time, and work up to 30-45 minutes as you are able. Do not get alarmed if you get a little sore after exercising. Keep at it: Moderate exercise will not damage your spine.
Back exercises
Pelvic tilt
Lie down flat on the floor or an exercise pad and bend both knees. Start by tightening your abdominal and buttock muscles. Rotate your pelvis and hips slightly towards the ceiling, and press the small of your back against the floor. Hold this position for a moment and then relax.
Partial sit up
Laying on your back with both knees bent and your feet flat on the floor, fold your arms across your chest or over your tummy. Tighten your abdominal muscles to raise your chest and shoulders just off the floor.
Don't strain your neck; keep it straight.
Hold your back and shoulder blades off the floor for a count of 3, then relax and let yourself back down. Take a couple of deep breaths, and repeat.
Full Sit-ups
For patients with better starting muscles desiring better conditioning of the abdominal wall and pelvic girdle musculature, a full sit-up from the flat position, with the knees bent and the feet anchored, works the deep muscles of the hip flexors as well as the abdominal muscles that help support the spine.
You can do these with your hands reaching for your knees or crossed over your chest.
Do three sets of ten – fifteen, and see how your back feels before trying to do more.
Hamstring stretch
Starting flat on your back, with your knees slightly bent, gently flex your hip and bring one of your knees up towards your chest. Holding the knee with your hands, gently pull it towards you until you can feel a stretch. Holding the leg flexed up in that position, straighten the knee out as much as you can, feeling the muscles stretch behind the knee. Lower that leg slowly back to the floor then stretch the other side.
Wall slide
Find a nice, smooth section of wall, with a stable place to put your feet. Do not try this on a throw rug or something that might slide.
Start with your feet shoulder-width apart, about a foot out from the wall. Lean back until your shoulder blades and buttock are resting comfortably against the wall. Now bend your knees and hips and slowly slide down the wall into a half-sitting position. Pause, then slide back up to your starting position. As you slide, feel your back pressed against the wall. Tightening your abdominal muscles as you move. Your hips should stay higher than your knees, and your knees should not go out beyond your toes.
Press ups
Start by lying on your stomach. Put your hands on the floor on either side of your shoulders. Raise your head up and looked towards the far wall.
Straight your arms and push your upper body off the floor. Keep your hips in contact with the floor and arch your back. Pause, then slowly bend your elbows and relax your tummy and chest back down to the floor.
Arches
Start in the same position that you did with the press ups.
This time tuck your arms by your sides, and do not use them to push up. Tightening your back muscles, and lift your chest and shoulders up off the floor, again raising your head to look towards the far wall. Hold this position for a count of 5-10, then relax back to your starting position and take a few, well earned deep breaths.
These exercises will take you 10 – 15 minutes to do each day. Do them each day if you can, but at least four times each week. Do each exercise move 5 times to start, and 10 times each after you get used to it. Move slowly, deliberately, and feel your muscles tighten as you do them. For the Stretches and Press-ups, you should feel stretching, but not sharp pain.
If you feel sore after exercise, use some ice on the sore-spot and go easy the next day. If you experience sharp pain, stop your exercises and note which one seemed to aggravate things. Touch base with my office or your primary doctor if the pain doesn’t calm down over 48 hours.
Robert F. McLain, M.D.
Of all the patients that see a spine surgeon, only about 1 in 10 ends up needing to have an operation. No matter how bad your back pain is now, your best bet for improvement in pain and function will include a combination of exercise, conditioning, and improved body mechanics. Whether you are coping with an acute back injury or long-standing pain, here are some of my favorite recommendations for dealing with pain and starting to get better.
First, start with…
Good body mechanics
Learning how to sit, stand, and move the right way is important to good back health, and very important to getting over a back injury. Good back and body mechanics reduces the strain on back muscles during normal activities, and helps you get back to normal activity without stirring up more pain than you need. Moving the wrong way can be one of the reasons you strain your back in the first place, and it can really slow down your recovery.
Sleeping and laying down
Pain at night can really interfere with rest and recovery. Both leg pain and back pain can be more aggravating at night. If you sleep on your back, put a pillow under your knees, keeping your feet elevated and your hips and knees slightly flexed. When you lay on your side try bending your knees slightly, and put a pillow between them to keep your hips even.
Sitting
Make sure your chair supports your back well. Your head should line up over your hips, and you should not feel like you’re slouching. Support your lumbar curve with a rolled up towel or lumbar roll just behind your back. Your knees should be level with your hips.
You should take time to change positions, and get up and stretch or walk around every half hour or so.
Standing
Bending your knees slightly will take the stress off your lower back. Standing with your foot on a small stool, or even resting it on the floor of an opened cabinet - while working at a counter or sink - will take some of the stress of the lumbar spine.
Remember to wear good quality shoes with a solid arch support. Change positions and move about from time to time.
Bending and lifting
Always use good back mechanics when lifting: Don't cheat! Whether it's a sock or a rock, bend at your knees and hips instead of your waist. Keep your head and shoulders balanced over your hips and feet.
Lift with your legs, not with your back. Whether you are picking something up off the floor, or a tabletop, or a counter, keep the item close to your body and avoid reaching. And remember, lifting at awkward angles is always a bad idea: Whether you are pulling groceries out of the trunk of your car, or putting your toddler in the car seat, both are much harder on you back than lifting 20 pounds off the top of a counter.
Turning
Learn how to "move as a unit". This means keeping your shoulders and your hips square as you move from place to place. Twisting a little bit to pick something up is not bad, but repetitive twisting back and forth is hard on your back. When you move things from one place to another remember to move your feet as you turn, and not twist at the waist or knees.
Reaching
Good back mechanics means learning how to protect your back whether you are lifting or not. Bending at the waist and leaning forward puts a large strain on back muscles. This is true whether you are tucking sheets on the bed, vacuuming under the couch, getting the milk out of the refrigerator, or lifting something out of your car. Remember to bend your knees, keep your back straight, and work with your legs.
Basic exercises for a better back
Whether you are trying to get back into shape, or recovering from an injury, there are some basic exercises you can do to make your Back stronger and better able to cope with the rigors of your average day.
Physical fitness
When our back hurts it is hard to get moving. Most patients with back pain worry that activity will aggravate their problem, and many fear that it may actually harm them. For the vast majority of patients, nothing to be further from the truth!
Daily activity, and a regular aerobic exercise program, are the keys to getting most people back to good function, and are important even in patients that may someday need surgery. Time invested in a physical therapy and exercise program are never wasted.
The easiest way to get started with an exercise program is by walking. Walk a bit every day, but at least 3 times a week try and get out and walk quickly for half an hour to 45 minutes. If you're doing it right you should get a little sweaty. Exercise on a treadmill, elliptical trainer, exercise bicycle or in a swimming pool are all good.
Patients with narrowing of the spinal canal - spinal stenosis - may find walking difficult. These patients may find an exercise bicycle much easier to exercise on than any upright devices such as a treadmill or elliptical. Patients with disc-related back pain may find sitting on a bicycle difficult, on the other hand, and be more comfortable either swimming or walking.
Find the exercise you can do, and do it 3 times a week.
Start with 5-10 minutes of exercise at a time, and work up to 30-45 minutes as you are able. Do not get alarmed if you get a little sore after exercising. Keep at it: Moderate exercise will not damage your spine.
Back exercises
Pelvic tilt
Lie down flat on the floor or an exercise pad and bend both knees. Start by tightening your abdominal and buttock muscles. Rotate your pelvis and hips slightly towards the ceiling, and press the small of your back against the floor. Hold this position for a moment and then relax.
Partial sit up
Laying on your back with both knees bent and your feet flat on the floor, fold your arms across your chest or over your tummy. Tighten your abdominal muscles to raise your chest and shoulders just off the floor.
Don't strain your neck; keep it straight.
Hold your back and shoulder blades off the floor for a count of 3, then relax and let yourself back down. Take a couple of deep breaths, and repeat.
Full Sit-ups
For patients with better starting muscles desiring better conditioning of the abdominal wall and pelvic girdle musculature, a full sit-up from the flat position, with the knees bent and the feet anchored, works the deep muscles of the hip flexors as well as the abdominal muscles that help support the spine.
You can do these with your hands reaching for your knees or crossed over your chest.
Do three sets of ten – fifteen, and see how your back feels before trying to do more.
Hamstring stretch
Starting flat on your back, with your knees slightly bent, gently flex your hip and bring one of your knees up towards your chest. Holding the knee with your hands, gently pull it towards you until you can feel a stretch. Holding the leg flexed up in that position, straighten the knee out as much as you can, feeling the muscles stretch behind the knee. Lower that leg slowly back to the floor then stretch the other side.
Wall slide
Find a nice, smooth section of wall, with a stable place to put your feet. Do not try this on a throw rug or something that might slide.
Start with your feet shoulder-width apart, about a foot out from the wall. Lean back until your shoulder blades and buttock are resting comfortably against the wall. Now bend your knees and hips and slowly slide down the wall into a half-sitting position. Pause, then slide back up to your starting position. As you slide, feel your back pressed against the wall. Tightening your abdominal muscles as you move. Your hips should stay higher than your knees, and your knees should not go out beyond your toes.
Press ups
Start by lying on your stomach. Put your hands on the floor on either side of your shoulders. Raise your head up and looked towards the far wall.
Straight your arms and push your upper body off the floor. Keep your hips in contact with the floor and arch your back. Pause, then slowly bend your elbows and relax your tummy and chest back down to the floor.
Arches
Start in the same position that you did with the press ups.
This time tuck your arms by your sides, and do not use them to push up. Tightening your back muscles, and lift your chest and shoulders up off the floor, again raising your head to look towards the far wall. Hold this position for a count of 5-10, then relax back to your starting position and take a few, well earned deep breaths.
These exercises will take you 10 – 15 minutes to do each day. Do them each day if you can, but at least four times each week. Do each exercise move 5 times to start, and 10 times each after you get used to it. Move slowly, deliberately, and feel your muscles tighten as you do them. For the Stretches and Press-ups, you should feel stretching, but not sharp pain.
If you feel sore after exercise, use some ice on the sore-spot and go easy the next day. If you experience sharp pain, stop your exercises and note which one seemed to aggravate things. Touch base with my office or your primary doctor if the pain doesn’t calm down over 48 hours.
Caring for you Neck, before and after surgery
Taking care of your neck
Your neck is supported by the bones of the cervical spine, and is moved and maintained by a group of muscles that run from the back of your shoulder blades, the middle of your spine and up the neck to the base of your skull. The muscles of the back of the neck and upper spine are the largest group, but the small muscles on the front of the neck help support the skull as you turn, twist, and move. Muscles give the spine stability, and maintain flexibility and support.
When problems occur within the cervical spine, or with injuries to the ligamentous or soft tissues, the muscles can often be injured as well. If they are not injured directly, muscles often will become sore and painful from having to cope with the underlying injury. This can result in spasm and severe pain. In fact, some patients can experience severe, disabling pain simply because the muscles go into spasm on their own. And, as anyone who has suffered with neck pain knows, when it involves your neck and arms the pain can be disabling.
The fundamental keys to keeping your neck in good shape are the same keys that we focus on when trying to recover from an injury or strain. First of all, patients needs to keep themselves in good overall health! That means taking time out for yourself and focusing on getting YOU healthier!
3 things can help with that:
Weight control and fitness
Controlling your weight and maintaining a good diet will contribute to your overall well-being and will help with reduction of pain in your neck and your lower back. Maintaining a healthy diet, avoiding overeating and snacks, and maintaining a good balance of protein and carbohydrates, will help you heal an injury, and maintain a good healthy fitness level.
Smoking
Cigarette smoking is very indicative and hard to quit. Nonetheless stopping smoking can be one of the most important things to do for the fitness of your spine. Patient's with severe neck problems really need to stop smoking, as the affective nicotine on surgical treatment can be very disruptive.
Exercise
Diet alone will not keep you from gaining weight, or help you lose it. A good exercise program is always important. Whether or you use an exercise bike, elliptical trainer, treadmill, worse when, walking remains one of the easiest and most effective weighs to lose weight and maintain fitness.
Daily exercises for your neck
Exercises For Your Neck
Common causes of neck pain include irritation or arthritis of the small joints in the neck, or degeneration of the discs that support the neck, but often they include the muscle strain and muscle spasm that take place in the spinal column or the shoulder girdle involving the muscles that help support the neck.
Stretching
Stretching exercises can help relieve pains and maintain range of motion and flexibility of the neck. As the neck muscles recover from injury or irritation they become more flexible and more tolerant of motion, and they can eventually regain their fitness and ability to do a full day's work without hurting.
The following exercises can go a long way towards helping you regain mobility and restore the strength and vitality of your neck and shoulder muscles. This can help you get over pain and avoid problems in the future. These exercises should be done on a daily basis, usually twice a day (morning and night), and should be done gently and repetitively to gain benefit.
An exercise program like this doesn't take the place of professional care to maybe night and needed in some patients, but it is a good place to start for your own neck and is often sufficient to get to through a episode of pain
Stretching exercises
Is usually not necessary to work hard on stretching the neck to regain motion. After an injury or after a bout of muscle spasm, most patients can regain range of motion by working very gently on 3 times of stretching activities:
First of all patients can sit gently in a chair and work on letting their shoulders relax and letting their neck stretch forward, letting the chin fall forward and the shoulders fall forward, and relaxing them in a slumped posture. Let this go for 10-20 seconds before sitting upright and stretching the neck back into normal position.
You can stretch your neck backwards by laying flat on your back at the edge of the bed and letting your neck hang over the edge. By gently letting the head roll backwards, you can stretch the muscles in the front of the neck and relieve painful tension.
Finally, while sitting in a chair, you can let your chin fall forward and your head flex forward as far as is comfortable then gently roll it from side to side, trying to let your ear almost touch your shoulder as you get to each side. You can continue this rotation all the way around the back until your neck extends back and you are looking at the ceiling. Then let the spine roll to the other ear and back around in a circle. This gentle range of motion will help stretch all the muscles; it should be done as comfortably as possible with no attempt at actually straining or causing pain. He don't need to push your comfort level.
Isometric strengthening exercises
Here are a series of gentle isometric exercises that will also help strengthen the neck.
These exercises are intended to help you strengthen the muscles that support the neck every day. They should be done gently to start with, and her never intended to involve great strain or produce pain in the neck. If the exercises make use or, and the soreness is better by the next day, the new are working the muscles. If the soreness persists more than a day, however, than you need to back off as the strain may be too much.
Isometric exercises are intended for you to strengthen the muscles without motion. In other words by placing the hand against the side of the head and pressing against a head the hands should not push the head over, nor should the head push the hand away, but both should stay still and push against each other equally. This will help the muscle strength in, but won't strain the neck or require great range of motion.
Side bending exercises.
Start off by placing the palm of the hand against the side of your head around the level of the ear were a little higher. Press against the side of your head with the hand, not trying to twist it or bend it, and push back against the hand with your head.
You will feel the muscles along the side of your neck and in the front of your neck tighten as you push. Count to 10 than rest and relaxed.
Do this about 5 times to the left-hand side and then 5 times to the right-hand side and then rest and relaxed. This will help strengthen the muscles both in the front and the back of her neck.
Forward bending exercise
Just as you used your hand to press on the side of the head, this exercise simply requires that you push against your forehead with your hand. Pushing back against the for head as you push forward with your head you'll tighten the muscles in the front of your neck, and you can feel of those tighten along the front of your throat as you push.
Do this exercise for a count of 10, resting between sets, and do about 5 sets before you quit.
Extension exercises
Use a small bath towel or rolled towel and place it like a sling behind the back of your head, just at the base of your skull.
Pull the towel up against the back of your head with both hands and pull forward firmly. Push back into the towel with your head so that you do not either bend your head forward or push the towel away.
As you push back into the towel you will feel the muscles on the back of your neck and into her shoulders start to tighten and firm up. This is another exercise that you should do for about 10 seconds at a time using 5 sets as a normal set of exercises.
Shoulder exercises
When you have done your isometric exercises for the neck muscles, you may start doing exercises for the shoulder girdle itself. When we talk about the shoulder girdle we are talking about the muscles attached to the neck from the shoulder blades along either side and from the middle of the back. These muscles include the trapezius muscle, spinal muscles that run right along the spine, and muscles that support the shoulder blade, or scapula, on either side of the neck.
Start by standing upright with your shoulders level and let your shoulders relax at your sides.
Once you have relaxed, with your chin up and neck in neutral position, shrug your shoulders up towards your ears as far as you can, and tighten them and hold them for a count of 10 before resting, letting them come back to their normal position.
You can do this exercise while holding weights in your hand, but I would start with nothing in the hands and workup very lightly with weights if you want to.
A second exercise that will help build the shoulders up is to squeeze the shoulder blades together as though you were trying to pinch a piece of paper between the shoulder blades behind your back.
Squeeze the shoulder blades together and hold on there for a count of 10 then rest and relax.
These simple exercises will help to get your neck and upper back muscles in better shape, and this will help you get over neck pain problems and neck strain more quickly and reliably than anything else we tend to offer in medicine.
If your pain persists, if you have pain running down your arm or numbness in your arm and hand, or if the symptoms just aren’t getting better, we'll always be glad to see you at the Cleveland Clinic Center for Spine Health, in our medical or spine surgery clinics. Please feel free to contact us anytime if you're having more problems than you think you can handle.
But, if you do well with these exercises and this simple program, you will have a great chance of having a healthy neck and keeping active throughout your life.
Robert F. McLain, MD
2012
When Neck Pain and Degeneration Become Severe
Sometimes, in spite of the best effort and non-operative care, neck pain, and arm pain, may progress to an intolerable point. In some cases multiple levels of the cervical spine are involved, and sometimes, the neck becomes unstable, putting the spinal cord at risk. This is when we talk about surgery. Because there are a lot of technical terms and anatomic points that may be hard to digest during a clinic visit, I've included this Presentation (click here) which covers many of the issues you may need to think about.