------------------------------------------------------------ BASIC BACK EXERCISES ------------------------------------------------------------ Everything have read in previous chapters of this tutorial has led up to this chapter which might more aptly be titled DOING SOMETHING ABOUT BACKACHES Before describing the basic exercise regimen, several paragraphs to set a precautionary tone. Always seek the advice of your physician before attempting ANY exercise program aimed at relieving backaches. Why? There are many reasons. People who have osteoporosis are strongly advised by most physicians to AVOID back flexion exercise movements. Likewise you may have a disc rupture, damaged spinal cord or undiagnosed case of spina bifida. Simply lying on an exercise mat or the living room carpet to "try a few exercises" to see if the pain is reduced is unwise! From another perspective, you may have a serious condition that warrants professional medical attention and the following exercises may provide temporary relief from pain which masks or hides a deeper organic condition. I do not mean to frighten you - the majority of back pain sufferers, perhaps 85% or higher, need only exercise and stretching movements. Statistics are on your side that exercise will produce a personal "cure" for your backache. However, play it safe and check with a doctor for clearance on the following exercises which are commonly suggested by many orthopedic surgeons and family physicians. Having said that, we should talk about the "when and how" of back exercises. For most folks exercise in any form begins with the best of intentions and then fades in both intensity and motivation as the demands of a job, family and other interests begin to pile up. Back pain exercises are different - once you start you MUST stay at it or the pain will return. Back pain exercises are like brushing your teeth: a lifelong commitment. Remember that the spinal column is by design unstable and largely held together by muscular effort especially in the lower lumbar region. The muscles which stabilize the spine and back quickly degenerate from lack of use. "Use it or lose it" is an apt warning when it comes to back exercises. These exercises should be done slowly and thoroughly without rushing and for many people the best time to do them is early in the morning just after rising and perhaps after a warm shower to further relax and prepare back and abdominal muscles for a mild workout. Upon arising in the morning, your body will feel rested and your spine will be flexible and at its greatest length due to 8 hours of rest in a prone position in the absence of gravity compression effects. This is an optimum time for a spinal exercise session. Most of the exercises are done on the floor. A carpet or towel is all you need. You need to relax and do each exercise deliberately and slowly WITHOUT bouncing! Do NOT hold your breath during any exercise! Light breathing or panting will keep you from straining muscles as a workout proceeds. If you have the time in the evening a light "mini-session" of the same exercises prior to retiring adds a bit of extra spinal flexibility, muscle tone and is an aid to restful sleep. The printed back pain guide which accompanies this tutorial illustrates in photographs and drawings many of these exercises and is suggested if you are serious about relieving your back pain. Registered users of this software receive this printed guide which also includes other rsearch and comments. Many back pain patients report surprising relief from pain within the first week during which they have begun the exercises. However it normally requires several weeks to fully restore muscle tone to abdominal, and buttock and back muscles which are weak. Evaluate results at the end of the third week and draw your own conclusions. After a day or so of exercise sessions, you may notice pain relief lasting for about 30 minutes to an hour. As time goes on and the workouts continue, pain will usually diminish further. Of course, you must augment these exercises with posture adjustments and other lifestyle changes mentioned in earlier tutorials for the whole "system" to have full effect. Go back and review the posture chapter of this tutorial for tips to protect your back as the exercise routine unfolds. Let's begin... Exercise one: Pelvic tilt. The is the most basic and ESSENTIAL exercise to learn. Lie on your back. Bend your knees and keep your feet flat on the floor. Your knees should be about six to eight inches above the carpet and in this position most back pain sufferers are quite comfortable. Keep your knees bent. Tighten your stomach muscles and squeeze your buttocks tightly together. You should notice your lower back flatten against the carpet. More importantly you should consciously notice that your lower pelvis tilts up. Take small short breaths if necessary but DO NOT try to hold your breath. Try to hold the pelvic tilt position. Another way to describe this maneuver is to attempt to flatten your back while you "thrust" your LOWER pelvis upward. The two muscle groups to involve are buttocks and stomach. Relax and repeat three to five times. Hold for the count of 5 to 15 seconds if possible on each "thrust". The "hold" is absolutely essential to the process of strengthening the necessary muscle groups. As you gain proficiency in this maneuver see if you can repeat the same exercise standing (bend your knees slightly). A further enhancement in the lying position is to see if you can slightly raise your buttocks off the floor. As you stand and go about your activities during the day, try to consciously tilt your pelvis forward using the buttock and stomach muscles. This is how the lumbar region is SUPPOSED to be supported in the first place! Here's another tip: remember in a previous chapter we talked about putting a small stool under one foot if you have to stand for long periods of time? Try this and then study how this maneuver automatically encourages a pelvic tilt. The basic pelvic tilt is the key to controlling lumbar (lower back) pain. Exercise two: Hamstring stretch. Lying on your back assume a pelvic tilt position with both knees bent as in the previous exercise. Next bring ONE knee up and finally straighten that leg towards the ceiling and finally stretch your heel - point your heel - towards the ceiling. If you cannot straighten out or point towards the ceiling - and most folks initially cannot - take your time and try to at least extend in that direction. You will feel a stretching and mild pulling behind your knee as your hamstring wakes up. Hold for the count of five then lower the leg. Switch to the other leg. Repeat 5 to 10 times. Exercise three: Knees to chest. Start in the basic pelvic tilt position. Slowly and evenly pull both bent knees to your chest - or as close to your chest as is comfortable. Hold for the count of five then release and repeat five additional times. Keep breathing slowly and gently - don't strain. This exercise is EXTREMELY important. Exercise four: abdominal crunch/sit-ups. Go back to the pelvic tilt position. Gradually tilt and roll your head and chest up and towards your knees. Try to touch your knees with your hands but do NOT allow your back to become fully erect in a sitting up position. Do not attempt a full sit-up since this usually results in rapid bouncing up and down without much real muscle effort. Concentrate on holding the "crunch" position for a few seconds and then down. Repeat five times. The purpose of this modified sit-up is to work on those abdominal muscles. Exercise five: Leg cross overs and trunk rotation. Back to a pelvic tilt position. Extend your right leg flat on the floor. Keep left leg bent slightly. Now lift your extended right leg up and over the left leg and try to stretch it to the left side as far as you can go but try to KEEP your upper and middle back flat on the floor. As your pelvis lifts gradually you will feel a twisting rotation and STRETCHING in your back. Do not extend your leg too far, you just want a gradual rotation you can hold for four or five seconds. Repeat with the other leg extending in the opposite direction. As you limber up you may be able to touch the extended leg to the floor. Exercise six: Spinal twist. A slightly stronger spinal twist than the last. Lay on back, knees bent. Pelvic tilt position. Hands behind the head. Elbows touching floor. Cross your bent right knee over the left bent knee - pretend you are sitting cross-legged on a chair - and then slowly let both legs drop to the side with a resulting twisting motion to the spine. Try to keep upper back and torso relatively flat on the floor as you twist the lower back. You may not be able to let both knees touch the floor but you will feel a stretching and twisting sensation which you should do slowly. Hold for the count of five and then reverse the legs and twist to the other side. Exercise seven: Back arch. Roll over on your stomach and get into a position as if you were going to give a small child a pretend horseback ride. Your weight rests on your two knees and two hands. Now arch your back up like a cat as far as is comfortable and hold for the count of five. Use stomach and buttock muscles to help. Then relax your back and sag for a second like an old swayback horse. Repeat five or six times. This will increase flexibility and continue back muscle exercises. A very worthwhile exercise. Exercise eight: trunk stretch while seated. A good exercise to try in the morning but VERY good to USE throughout the day during work. Sit near the edge of a chair. Legs spread apart. Cross arms over chest. Make sure chair will not slip or slide backwards and then tuck chin down and curl your trunk downwards as if you are trying to touch your head to the floor. Hold for the count of five and repeat five or six times. Stretches the spinal column and muscles. Exercise nine: rotational sit-up. A tough but profitable exercise. Lying on floor on your back do a pelvic tilt. As you begin a traditional sit-up/abdominal crunch described previously, instead rotate to the right or left side letting your weight rest on right or left shoulder. Raise opposite shoulder off the ground. Curl head forward and hold. This produces a twisting effect on the spine and works on abdominals at the same time. A tough exercise but highly recommended. This tutorial is merely a starting point! For further information on back care and back pain, be sure to register this software ($25.00) which brings by prompt postal delivery a printed, illustrated guide to back pain written by a physician plus two software disks. From the main menu select "Print Registration Form." Or from the DOS prompt type the command ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO Box 1506, Mercer Island, WA 98040. If you cannot print the order form, send $25.00 to the above address and a short letter requesting these materials. End of chapter.