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Mechanical Low Back Pain

Prevention

These recommendations apply to persons with posterior or posterior lateral derangement, a flexion dysfunction, or a slumped postural condition.

Prevention:
General Instructions When in Acute Low Back Pain

You must retain the lordosis at all times (lordosis is the hollow in the lower back). Bending forwards as in touching the toes will only stretch and weaken the supporting structures of the back and lead to further injury. Losing the lordosis when sitting will also cause further strain.

Sitting

• When in acute pain you should sit as little as possible, and then only for short periods.
• At all times you must sit with a lordosis. Therefore you must place a supportive roll in the small of the back, especially when sitting in a car or lounge chair.
• If you have the choice you must sit on a firm, high chair with a straight back such as a kitchen chair. You should avoid sitting on a low, soft couch with a deep seat; this will force you to sit with hips lower than knees, and you will round the back and lose the lordosis.
• The legs must never be kept straight out in front as in sitting in bed, in the bath or on the floor; in this position you are forced to lose the lordosis.
• When rising from sitting you must retain the lordosis; move to the front of the seat, stand up by straightening the legs, and avoid bending forwards at the waist.
• Poor sitting postures are certain to keep you in pain or make you worse.

Driving a Car

• When in acute pain you should drive the car as little as possible. It is better to be a passenger than to drive yourself.
• When driving, your seat must be close enough to the steering wheel to allow you to maintain the lordosis. If in this position your hips are lower than your knees you may be able to raise yourself by sitting on a pillow.

Bending Forwards

• When in acute pain you should avoid activities which require bending forwards or stooping, as you will be forced to lose the lordosis.
• You may be able to retain the lordosis by kneeling--for example, when making the bed, vacuuming, cleaning the floor, or weeding the garden.

Lifting

• When in acute pain you should avoid lifting altogether.
• If this is not possible you should at least not lift objects that are awkward or heavier than about thirty pounds.
• You must always use the correct lifting technique; during lifting the back must remain upright and never stoop or bend forwards; stand close to the load, have a firm footing and wide stance; bend the knees and keep the back straight; have a secure grip on the load; lift by straightening the knees; take a steady lift and do not jerk; shift your feet to turn and do not twist your back.

Lying

• A good firm support is usually desirable when lying. If you bed is sagging, slats or plywood supports between mattress and base will firm it. You can also place the mattress on the floor, a simple but temporary solution.
• You may be more comfortable at night when you use a supportive roll. A rolled up towel, wound around your waist and tied down in front, is usually satisfactory.
• When rising from lying you must retain the lordosis; turn on one side, draw both knees up and drop the feet over the edge of the bed; sit up by pushing yourself up with the hands and avoid bending forwards at the waist.

Coughing and Sneezing

• When in acute pain you must try to stand up, bend backwards and increase the lordosis while you cough and sneeze.

Remember

• At all times you must retain the lordosis; if you slouch you will have discomfort and pain.
• Good posture is the key to spinal comfort.

General Instructions When Recovered from Low Back Pain

You have recovered from the acute episode because of your ability to master the exercises which relieved your pain. These exercises must be repeated whenever situations arise which have previously caused pain. You must perform the corrective movements before the onset of pain. This is essential.

If you carry out the following instructions, you can resume you normal activities without the fear of recurrence.

Sitting

• When sitting for prolonged periods the maintenance of the lordosis is essential. It does not matter if you maintain this with you own muscles or with the help of a supportive roll, placed in the small of your back.
• In addition to sitting correctly with a lumbar support, you should interrupt prolonged sitting at regular intervals. On extended car journeys you should get out of the car every hour or two, stand upright, bend backwards five or six times, and walk around for a few minutes.

Bending Forwards

• When engaged in activities which require prolonged forward bending or stooping - for example, gardening, vacuuming, concreting - you must stand upright, restore the lordosis and bend backwards five or six times before pain commences.
• Frequent interruption of prolonged bending by reversing the curve in the low back should enable you to continue with most activities you enjoy, even with some you do not enjoy.

Lifting

• If the load to be lifted weighs over thirty pounds, the strain must be taken with the low back in lordosis and you must lift by straightening your legs.
• If the object weighs under thirty pounds less care is required, unless you have been in a bent or sitting position for some time prior to lifting. In the latter case you must lift as if the weight exceeds thirty pounds.
• In addition to correct lifting technique, you must stand upright and bend backwards five or six times after lifting.

Recurrence

• At the first signs of recurrence of low back pain you should immediately start the exercises which previously led to recovery, and follow the instructions given for when in acute pain.
• If this episode of low back pain seems to be different than on previous occasions, and if your pain persists despite following the instructions, you should contact a physical therapist.

Remember

• If you lose the lordosis for any length of time, you are risking recurrence of low back pain.