Low Back Pain
Pain in the lower or low back pain is a common concern, affecting up to 90% of Americans at some point in their lifetime. Up to 50% will have more than one episode. Low back pain is not a specific disease, rather it is a symptom that may occur from a variety of different processes. In up to 85% of people with low back pain, despite a thorough medical examination, no specific cause of the pain can be identified. America spends approximately $50 billion a year on low back pain.
Back pain can have many underlying reasons, but no specific cause will often be found, and the pain will stop. This chapter will review many of the causes of back pain and proper evaluation and diagnosis. Please discuss your symptoms and the suggested treatments with your healthcare professional to determine the appropriate diagnostic and treatment plan for your circumstances.
· Low back pain is second only to the common cold as a cause of lost days at work. It is also one of the most common reasons to visit a doctor's office or a hospital's emergency department. It is the second most common neurologic complaint in the United States, second only to headache.
· For 90% of people, even those with nerve root irritation, their symptoms will improve within two months no matter what treatment is used, even if no treatment is given.
· Doctors usually refer to back pain as acute if it has been present for less than a month and chronic if it lasts longer.
Back pain is a symptom. Common causes of back pain involve disease or injury to the spine's muscles, bones, and/or nerves. Pain arising from abnormalities of organs within the abdomen, pelvis, or chest may also be felt in the back. This is called referred pain. Many disorders within the abdomen, such as appendicitis, aneurysms, kidney diseases, kidney infections, bladder infections, pelvic infections, and ovarian disorders, among others, can cause pain referred to the back. Normal pregnancy can cause back pain in many ways, including stretching ligaments within the pelvis, irritating nerves, and straining the low back. Your doctor will have this in mind when evaluating your pain.
· Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is directly irritated), often due to a herniation (or bulging) of the disc between the lower back bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, affecting a specific area, and associated with numbness in the area of the leg that the affected nerve supplies.
o Herniated discs develop as the spinal discs degenerate or grow thinner. The jellylike central portion of the disc bulges out of the central cavity and pushes against a nerve root. Intervertebral discs begin to deteriorate by the third decade of life. Herniated discs are found in one-third of adults older than 20. Only 3% of these, however, produce symptoms of nerve impingement.
Picture of a herniated lumbar disc, a common cause of sciatica |
o Spondylosis occurs as intervertebral discs lose moisture and volume with age, which decreases the disc height. Even minor trauma under these circumstances can cause inflammation and nerve root impingement, which can produce classic sciatica without disc rupture.
o Spinal disc degeneration coupled with disease in joints of the low back can lead to spinal-canal narrowing (spinal stenosis). These disc and joint changes produce symptoms and can be seen on an X-ray. A person with spinal stenosis may have pain radiating down both lower extremities while standing for a long time or walking even short distances.
o Cauda equina syndrome is a medical emergency whereby the spinal cord is directly compressed. Disc material expands into the spinal canal, which compresses the nerves. A person would experience pain, possible loss of sensation, and bowel or bladder dysfunction. This could include the inability to control urination causing incontinence, or the inability to begin urination.
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· Musculoskeletal pain syndromes that produce low back pain include myofascial pain syndromes and fibromyalgia.
o Myofascial pain is characterized by pain and tenderness over localized areas (trigger points), loss of range of motion in the involved muscle groups, and pain radiating in a characteristic distribution but restricted to a peripheral nerve. Relief of pain is often reported when the involved muscle group is stretched.
o Fibromyalgia results in widespread pain and tenderness throughout the body. Generalized stiffness, fatigue, and muscle aches are reported.
· Infections of the bones (osteomyelitis) of the spine are an uncommon cause of low back pain.
· Noninfectious inflammation of the spine (spondylitis) can cause stiffness and pain in the spine that is particularly worse in the morning. Ankylosing spondylitis typically begins in adolescents and young adults.
· Tumors, possibly cancerous, can be a source of skeletal pain.
· Inflammation of nerves from the spine can occur with infection of the nerves with the herpes zoster virus that causes shingles. This can occur in the thoracic area to cause upper back pain or in the lumbar area to cause low back pain.
· As can be seen from the extensive, but not all inclusive, list of possible causes of low back pain, it is important to have a thorough medical evaluation to guide possible diagnostic tests
Causes of back pain:
1. Work-related/job
2. Physically inactive lifestyle/immobility
3. Mechanical causes
4. Underlying diseases
5. Work and Back Pain
Work-related
Back Pain and Driving
The driver and the passenger both, due to long-term sitting position, are vulnerable of getting back pains. If you are spending a lot of time in your car, there are a few tips to improve your health and to avoid back aches.
1. Choose the car according to your needs
2. Take regular breaks while driving long distance
3. Take your seat forward to avoid stretching your leg to depress the clutch
4. Adjust your mirrors properly.
5. Try to avoid twisting when getting into the car
6. Keep a small pillow to support your lower back
Mechanical Causes of Back Pain
These are by far the most common cause of back pain. Mechanical problems and pain rising due to such issues could be related to joint ligaments or discs in the spine. Strains, knocks, accidental injuries to the spine and a number of diseases can give rise or aggravate mechanical causes of back pain.
Examples: Growing older and aging of the vertebrae, Herniated discs, Facet joint problems, spinal stenosis (abnormal narrowing of the spinal canal)
Underlying diseases
It is much less common than the mechanical causes of back pain. However, the diseases which lead to back pain are likely to need long-term treatment as a management step.
Examples: Arthritis – (osteoarthritis, rheumatoid arthritis), Ankylosing spondylitis, Fibromyalgia, osteoporosis.
Low Back Pain Symptoms
Pain in the lumbosacral area (lower part of the back) is the primary symptom of low back pain.
· The pain may radiate down the front, side, or back of your leg, or it may be confined to the low back.
· The pain may become worse with activity.
· Occasionally, the pain may be worse at night or with prolonged sitting such as on a long car trip.
· You may have numbness or weakness in the part of the leg that receives its nerve supply from a compressed nerve.
o This can cause an inability to plantar flex the foot. This means you would be unable to stand on your toes or bring your foot downward. This occurs when the first sacral nerve is compressed or injured.
When to Seek Medical Care
The Agency for Healthcare Research and Quality has identified 11 red flags that doctors look for when evaluating a person with back pain. The focus of these red flags is to detect fractures (broken bones), infections, or tumors of the spine. The presence of any of the following red flags associated with low back pain should prompt a visit to your doctor as soon as possible for a complete evaluation.
· Recent significant trauma such as a fall from a height, motor vehicle accident, or similar incident
· Recent mild trauma in those older than 50 years of age: A fall down a few steps or slipping and landing on the buttocks may be considered mild trauma.
· History of prolonged steroid use: People with asthma, COPD, and rheumatic disorders, for example, may be given this type of medication.
· Anyone with a history of osteoporosis: An elderly woman with a history of a hip fracture, for example, would be considered high risk.
· Any person older than 70 years of age: There is an increased incidence of cancer, infections, and abdominal causes of pain.
· Prior history of cancer
· History of a recent infection
· Temperature over 100 F
· IV drug use: Such behaviour markedly increases the risk of an infectious cause.
· Low back pain worse at rest: This is thought to be associated with an infectious or malignant cause of pain but can also occur with ankylosing spondylitis.
· Unexplained weight loss
When To Seek Medical Help?
1. If the pain is after an accident
2. Pain lasting more than a week
3. High temperature
4. Redness or swelling of the back
5. Pain down the legs and below knees
6. Numbness or weakness in one or both legs
7. Loss of bladder or bowel control
The presence of any of the above would justify a visit to a hospital's emergency department, mainly if your family doctor cannot evaluate you within the next 24 hours.
· any acute nerve dysfunction should also prompt an immediate visit. These would include the inability to walk or the inability to raise or lower your foot at the ankle. Also included would be the inability to raise the big toe upward walk on your heels or stand on your toes. These might indicate an acute nerve injury or compression. Under certain circumstances, this may be an acute neurosurgical emergency.
· Loss of bowel or bladder control, including difficulty starting or stopping a stream of urine or incontinence, can be a sign of an acute emergency and requires urgent evaluation in an emergency department.
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Low Back Pain Exams and Tests
Medical history
· Because many different conditions may cause back pain, a thorough medical history will be performed as part of the examination. Some of the questions you are asked may not seem pertinent to you but are very important to your doctor in determining the source of your pain.
· Your doctor will first ask you many questions regarding the onset of the pain. (Were you lifting a heavy object and felt an immediate pain? Did the pain come on gradually?) He or she will want to know what makes the pain better or worse. The doctor will ask you questions referring to the red-flag symptoms. He or she will ask if you have had the pain before. Your doctor will ask about recent illnesses and associated symptoms such as coughs, fevers, urinary difficulties, or stomach illnesses. In females, the doctor will want to know about vaginal bleeding, cramping, or discharge. Pain from the pelvis, in these cases, is frequently felt in the back.
Physical examination
· To ensure a thorough examination, you will be asked to wear a gown. The doctor will watch for signs of nerve damage while you walk on your heels, toes, and soles of the feet. Reflexes are usually tested using a reflex hammer. This is done at the knee and behind the ankle. As you lie flat on your back, one leg at a time is elevated, both with and without the doctor's assistance. This is done to test the nerves muscle strength, and assess the presence of tension on the sciatic nerve. Sensation is usually tested using a pin, paper clip, broken tongue depressor, or other sharp object to assess any loss of sensation in your legs.
· Depending on what the doctor suspects is wrong with you, the doctor may perform an abdominal, pelvic, or rectal examination. These exams look for diseases that can cause pain referred to your back. The lowest nerves in your spinal cord serve the sensory area and muscles of the rectum, and damage to these nerves can result in inability to control urination and defecation. Thus, a rectal examination is essential to make sure that you do not have nerve damage in this area of your body.
Imaging
· Doctors can use several tests to "look inside you" to get an idea of what might be causing the back pain. No single test is perfect in that it identifies the absence or presence of disease 100% of the time.
· If there are no red flags, there is often little to be gained in obtaining X-rays for patients with acute back pain. Because about 90% of people have improved within 30 days of the onset of their back pain, most doctors will not order tests in the routine evaluation of acute, uncomplicated back pain.
· Plain X-rays are generally not considered useful in the evaluation of acute back pain, particularly in the first 30 days. In the absence of red flags, their use is discouraged. Their use is indicated if there is significant trauma, mild trauma in those older than 50, people with osteoporosis, and those with prolonged steroid use. Do not expect an X-ray to be taken.
· Myelogram is an X-ray study in which a radio-opaque dye is injected directly into the spinal canal. Its use has decreased dramatically since MRI scanning. A myelogram now is usually done in conjunction with a CT scan and, even then, only in special situations when surgery is being planned.
· Magnetic resonance imaging (MRI) scans are a highly detailed test and are very expensive. The test does not use X-rays but very strong magnets to produce images. Their routine use is discouraged in acute back pain unless a condition is present that may require immediate surgery, such as with cauda equina syndrome or when red flags are present and suggest infection of the spinal canal, bone infection, tumour, or fracture.
o MRI may also be considered after one month of symptoms to rule outmore underlying severe problems.
o MRIs are fine. Bulging of the discs is noted on up to 40% of MRIs performed on people without back pain. Other studies have shown that MRIs fail to diagnose up to 20% of ruptured discs that are found during surgery.
· A CT scan is an X-ray test that is able to produce a cross-sectional picture of the body. CT scan is used much like MRI.
Nerve tests
· Electromyogram or EMG is a test that involves the placement of very small needles into the muscles. Electrical activity is monitored. Its use is usually reserved for more chronic pain and to predict the level of nerve root damage. The test is also able to help the doctor distinguish between nerve root disease and muscle disease.
Blood tests
· Sedimentation rate or C-reactive protein are blood tests that can indicate whether or not inflammation is present in the body.
Chronic Back Pain and Sleep
When chronic back pain affects you or a family member, you might despair of sleeping well. Pain can disturb the sleep your family needs, night after night. However, experts say that with proper treatment, the chances are very good that you or your loved one can get relief from chronic back pain and enjoy normal sleep. Below, find out about treatments and lifestyle tips for better sleep.
Why Sleep Is Important When You Have Chronic Back Pain
The inability to get a good night's sleep hurts -- literally. Chronic back pain prevents you from sleeping well. You can wake up hurting even more.
Pain can interfere with the normal cycles of sleep, creating a non-specific pattern of alpha delta sleep waves found in other painful conditions such as arthritis and fibromyalgia, but also in healthy people.
Worse, studies have shown that not getting enough sleep may make you more sensitive to pain. It's a vicious cycle. Back pain can make it harder to sleep -- and your back pain can be worse when you can't sleep.
Other Causes of Sleep Problems When You Are in Pain
Anxiety and depression can make it hard to fall asleep or stay asleep, and the consequent sleep loss can lead to worse pain. Anxiety and depression themselves can also increase a person’s sensitivity to pain.
Some breathing-related sleep disorders are associated with obesity -- and obesity is also linked with back pain. Sleep disorders like obstructive sleep apnea interfere with normal sleep patterns leading to insufficient sleep and poor sleep quality. Sleep apnea can also be caused or exacerbated by opioid painkillers, which some people are prescribed for severe back pain.
Limb movement disorders like restless legs syndrome might further disrupt the normal sleep pattern.
Fibromyalgia can cause pain throughout the body. It's also linked with fatigue, anxiety, and sleep problems.
Self-medicating with alcohol might numb your back pain and help you fall asleep at first. But it's also likely to wake you up a few hours later. In the morning, you're bound to get out of bed tired, cranky, and hurting because the quality of sleep is poor.
Many prescription medications can impair the quality of your sleep. For instance, medications for conditions such as high blood pressure, epilepsy, and ADHD may also cause sleep problems.
First aid for low back pain
When you first feel back pain, try these steps to avoid or reduce pain:
· Relax. Find a comfortable position for rest. Some people are comfortable on the floor or a medium-firm bed with a small pillow under their head and another under their knees. Some prefer to lie on their side with a pillow between their knees. Don't stay in one position for too long.
· Walk. Take a short walk (10 to 20 minutes) on a level surface (no slopes, hills, or stairs) every 2 to 3 hours. Walk only distances you can manage without pain, especially leg pain.
· Take pain medicine if needed, such as acetaminophen (Tylenol) or medicines that reduce pain, swelling, and irritation, including ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve or Naprosyn). These medicines usually work best if you take them on a regular schedule instead of waiting until the pain is severe.
· Try heat or ice. Try using a heating pad on a low or medium setting for 15 to 20 minutes every 2 to 3 hours. Try a warm shower in place of one session with the heating pad. Or you can buy single-use heat wraps that last up to 8 hours. You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours. You can use an ice pack or a bag of frozen vegetables wrapped in a thin towel. There is not strong evidence that either heat or ice will help, but you can try them to see if they help. You may also want to try switching between heat and cold.
Taking care of your back at home
A common misconception about back pain is that you need to rest and avoid activity for a long time. In fact, bed rest is NOT recommended. If you have no sign of a serious cause for your back pain (such as loss of bowel or bladder control, weakness, weight loss, or fever), then you should stay as active as possible. Here are some tips for how to handle back pain and activity early on:
- Stop normal physical activity only for the first few days. This helps calm your symptoms and reduce any swelling (inflammation) in the area of the pain.
- Apply heat or ice to the painful area. One good method is to use ice for the first 48 to 72 hours, then use heat after that.
- Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
- Sleep in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.
- Do NOT perform activities that involve heavy lifting or twisting of your back for the first 6 weeks after the pain begins.
- Avoid exercise in the days right after the pain begins. However, after 2 to 3 weeks, slowly begin to exercise again (it's helpful to get advice from a physical therapist). You can start getting back to regular activities after a few days.
EXERCISE AND YOUR BACK PAIN
Exercise is important for preventing future back pain. Through exercise you can:
- Improve your posture
- Strengthen your back and improve flexibility
- Lose weight
- Avoid falls
A complete exercise program should include aerobic activity (such as walking, swimming, or riding a stationary bicycle), stretching, and strength training. Always follow the instructions of your doctor or physical therapist.
Begin with light cardiovascular training. Walking, riding a stationary bicycle, and swimming are great examples. Such aerobic activities can help improve blood flow to your back and promote healing. They also strengthen muscles in your stomach and back.
Stretching and strengthening exercises are essential in the long run. However, starting these exercises too soon after an injury can worsen your pain. A physical therapist can help you determine when to begin stretching and strengthening exercises and how to do them.
Avoid these exercises during recovery, unless your doctor or physical therapist says it is okay:
- Jogging
- Contact sports
- Racquet sports
- Golf
- Dancing
- Weight lifting
- Leg lifts when lying on your stomach
- Sit-ups with straight legs (rather than bent knees)
PREVENTING YOUR BACK PAIN FROM COMING BACK
Low Back Pain - Why Exercise Helps
Exercise and staying active may relieve lower back pain and help speed your recovery. Stretching and strengthening your stomach, back, and leg muscles helps make them less susceptible to injury that can cause back pain. Strong stomach, back, and leg muscles support your spine better, reducing pressure on your spinal discs. This may help prevent disc injury.
Aerobic exercises—such as walking, swimming, or walking in waist-deep water—also help you maintain a healthy back. Aerobic exercise makes your heart and other muscles use oxygen more efficiently. Muscles that frequently receive oxygen-rich blood stay healthier.
Exercises that may help reduce or prevent low back pain include:
· Aerobic exercise to condition your heart and other muscles, maintain health, and speed recovery.
· Strengthening exercises, focusing on your back, stomach, and leg muscles.
· Stretching exercises to keep your muscles and other supporting tissues flexible and less prone to injury.
Some exercises can aggravate back pain. If you have low back pain,avoid:
· Straight leg sit-ups.
· Bent leg sit-ups or partial sit-ups (curl-ups) when you have acute back pain.
· Lifting both legs while lying on your back (leg lifts).
· Lifting heavy weights above the waist (standing military press or bicep curls).
· Toe touches while standing.
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To prevent back pain, it is also very important to learn to lift and bend properly. Follow these tips:
- If an object is too heavy or awkward, get help.
- Spread your feet apart to give you a wide base of support.
- Stand as close to the object you are lifting as possible.
- Bend at your knees, not at your waist.
- Tighten your stomach muscles as you lift the object or lower it down.
- Hold the object as close to your body as you can.
- Lift using your leg muscles.
- As you stand up with the object, DO NOT bend forward.
- DO NOT twist while you are bending for the object, lifting it up, or carrying it.
Other measures to prevent back pain include:
- Avoid standing for long periods of time. If you must stand for your work, try using a stool. Alternate resting each foot on it.
- DO NOT wear high heels. Use cushioned soles when walking.
- When sitting for work, especially if using a computer, make sure that your chair has a straight back with an adjustable seat and back, armrests, and a swivel seat.
- Use a stool under your feet while sitting so that your knees are higher than your hips.
- Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods of time.
- If you drive long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Don't lift heavy objects just after a ride.
- Quit smoking.
- Lose weight.
- Do exercises to strengthen your abdominal muscles on a regular basis. This will strengthen your core to decrease the risk of further injuries.
Bone Spurs (Osteophytes) and Back Pain
Many patients are told that they have bone spurs in their back or neck, with the implication that the bone spurs are the cause of their back pain. However, bone spurs in and of themselves are simply an indication that there isdegeneration of the spine; the presence of bone spurs does not necessarily mean that they are the actual cause of the patient's back pain.
The term "bone spurs" is a bit of a misnomer, as the word "spurs" implies that these bony growths are spurring or poking some part of the spinal anatomy and causing pain. However, contrary to this implication, bone spurs are, in fact smooth structures that form over a prolonged period.
The medical term for bone spurs is osteophytes, which represent a normal bony structure enlargement. Osteophytes are a radiographic marker of spinal degeneration (ageing), which means that they show up on X-rays or MRI scans and are by and large a normal finding as we age. Over the age of 60, bone spurs on the spine are actually quite common.
Bone Spurs and Spinal Anatomy
The human spine comprises thirty-two separate vertebral segments separated by intervertebral discs made of collagen and ligaments. These discs are shock absorbers, allowing limited flexibility and motion at each spinal segment. The cumulative effect allows a full range of movement around the axis of the spine, especially the neck (cervical spine) and lower back (lumbar spine).
Motion between each segment is limited by the tough outer disc ligaments and the joints that move (articulate) at each spinal level (the facet joint). Under each joint, just behind the disc, is a pair of nerve roots that exit the spinal canal. The exiting hole (foramina) surrounding the nerve (disc in front, joints above and below) is relatively small and has little room for anything besides the exiting nerve.
Normal life stressors, possibly compounded by traumatic injuries to the spinal architecture, cause degeneration in the spine's discs and joints. With factors such as age, injury, and poor posture, there is cumulative damage to the bone or joints of the spine. For example:
1. As disc material slowly wears out, ligaments loosen and excess motion occurs at the joint
2. The body naturally and necessarily thickens the ligaments that hold the bones together
3. Over time, the thick ligaments tend to calcify, resulting in flecks of bone or bone spur formation
4. As the central spinal canal and the foramina thicken their ligaments, compression of the nervous system causes clinical symptoms.
Degenerative changes to normal vital tissue begin in early adulthood, but usually this slow process only presents with nervous system compression once we are in our sixth or seventh decades. Factors that can accelerate the degenerative process and bone spur growth in the spine include:
· Congenital or heredity
· Nutrition
· Lifestyle, including poor posture and poor ergonomics
· Traumatic forces, especially sports-related injuries and motor vehicle accidents.
Frequent Factors of Low Back Pain and What You Can Do
All the various problems connected to low back discomfort are costly for many Western countries. in fact, it is realistic that nearly every person has experienced some kind of mild variety of low back pain. Accidents and pain in the lower back, or medically known as the lumbosacral region, is one of the leading causes of job-related impairment and missed work. When it pertains to difficulties that are neurologically related in the US, only headaches beat back pain. It is common knowledge that low back pain can be temporary or produce more serious and chronic problems. As you can imagine, many diverse factors may be found with a low back pain situation. A person can strain back muscles, ligaments, or something worse, affecting the vertebrae and discs. Unnecessary stress can be subjected to the back from physical imbalances that basically put too much strain and tension on the lower back, or any other back area. the common result is that the back cannot take it anymore, and subsequently problems start to surface. We have all been aware of, or maybe experienced, back injuries caused by the smallest actions. back pain can reveal itself in alternative ways, and it really has to do with the distinct situation. There is the kind that is acute pain felt instantly. Chronic pain lasts and may begin at a low grade and afterward maybe remain that way for a very long time. As is evident, serious low back pain usually stems from some type of trauma. in that predicament, mechanical abnormality or genuine damage creates the acute pain. the general symptoms for this form of pain can be a piercing painful feeling that really gets your particular attention. Additionally, it is quite prevalent to have a lowering in motion or range of actions. probably all of us have noticed someone who has to tilt forward just slightly because that is more comfortable for their back. One type of continual exposure to frequent vibrational motion makes a person vulnerable to a herniated spinal disc. On the other hand, it is even conceivable for an extreme load on the back to develop this, too. Plenty of things help with back health such as being too tight, on the whole, due to not enough good exercise and stretching. What tends to make matters worse with a herniated disc is that it often results in various nerves being pinched. You should never fool around with any kind of back ache since you can worsen the condition. Unexpected pain that is acute in nature is critical and should be evaluated by a doctor promptly. in that kind of circumstance, you can quickly make matters more painful and cause additional damage if you continue to act like there is no problem. Constantly remember to lift using your legs and not your back, and at all times keep your back straight when you lift. for those who enjoyed reading this post then you may wish to look at alternative topics from this article writer linen tea towels, retirement investment strategy and tama drum kits.
Low Back Pain - Why Exercise Helps
Exercise and staying active may relieve low back pain and help speed your recovery. Stretching and strengthening your stomach, back, and leg muscles helps make them less susceptible to injury that can cause back pain. Strong stomach, back, and leg muscles support your spine better, reducing pressure on your spinal discs. This may help prevent disc injury.
Aerobic exercises—such as walking, swimming, or walking in waist-deep water—also help you maintain a healthy back. Aerobic exercise makes your heart and other muscles use oxygen more efficiently. Muscles that frequently receive oxygen-rich blood stay healthier.
Exercises that may help reduce or prevent low back pain include:
· Aerobic exercise, to condition your heart and other muscles, maintain health, and speed recovery.
· Strengthening exercises, focusing on your back, stomach, and leg muscles.
· Stretching exercises, to keep your muscles and other supporting tissues flexible and less prone to injury.
Some exercises can aggravate back pain. If you have low back pain, avoid:
· Straight leg sit-ups.
· Bent leg or partial sit-ups (curl-ups) when you have acute back pain.
· Lifting both legs while lying on your back (leg lifts).
· Lifting heavy weights above the waist (standing military press or bicep curls).
· Toe touches while standing.
