Physiotherapy Services

Transcription

1 Physiotherapy Services Low Back Pain Information and Exercises Date issued:. Name of patient:.. Name of therapist:... Information for patients KGH is a nonsmoking environment If you wish to make any comments or require a copy of this information in another format or language, please contact the PALS Office: Telephone or PALS@kgh.nhs.uk

2 Spinal Anatomy Three main areas of spine consisting of bones separated by discs: Cervical: 7 vertebrae Thoracic: 12 vertebrae Lumber: 5 vertebrae Spinal Curves Cervical outwards Thoracic inwards Lumber outwards Lumber Spine Bears body weight Most common area for back pain Bottom joint has limited movement and therefore most easily strained Facet Joints Either side of each disc (No. 4 on diagram) Discs (No. 2 on diagram) 80% water, which reduces with age Many of these injury occurs over period of years Pain due to repeated heavy lifting, twisting and bending, poor posture, lack of rests between tasks Repeated stress on discs can cause disc protrusion. Nerves Irritated by swelling of soft tissue or stiffness of joints Can be trapped by disc protrusion Nerve pain felt in legs, can cause pins and needles, numbness and burning Ref: 10.PI.0267 Low Back Pain exercise & info Point of issue: LBP classes Page 2 of 7

3 Muscles Either stabilise or move the back Spasm as a protective mechanism Weaken with lack of use Pain AIM: help with healing and prevent further damage Acute: recent onset, definite cause Chronic: unknown cause, lasts longer than injury takes to heal People with pain often become less active. This can make the problem worse. It can lead to general loss of fitness and develop into a vicious cycle (Figure 1). Pain and muscle spasm More pressure on structures Inactivity Functional restrictions Stiffness and muscle shortening Less strength and fitness Figure 1 - Pain vicious cycle The way to break this cycle is to gradually build up strength and fitness Coping Skills Key Points 1. Prioritise 2. Plan 3. Pace yourself and keep to your activity limits 4. Change position frequently 5. Think about doing things differently 6. Take regular rests Ref: 10.PI.0267 Low Back Pain exercise & info Point of issue: LBP classes Page 3 of 7

4 REMEMBER.. Stop and think : Little and often : DO NOT DO 5 minutes more The 3 P s Pacing Links closely with activity cycles Pacing is undertaking steady levels of activity distributed with regular periods of rest This should be the case WHETHER IT IS A GOOD OR BAD DAY It is about doing things throughout the day for periods of time that do not make your pain worse The purpose of pacing is to make it possible for you to be active every day. To help with pacing you need to work out your activity limits, this is the level at which an activity can be performed on good and bad days. 1. Choose an activity e.g. sitting 2. Time the length of time you are able to sit comfortably at several different times during the day 3. Take your average of these limits 4. Halve this time and this is your activity limit for sitting Stick to this On a good day DO NOT FALL INTO THE JUST FIVE MINUTES MORE SYNDROME Your general health can affect your activity limits You should always measure your progress by your previous experience NOT by others Activity limits can be increased gradually as stamina and exercise tolerance improve. Otherwise you will be playing a game of snakes and ladders. Prioritising Do not do things that are not necessary. Ask yourself the following questions: 1. Can I get someone to help me? 2. Does it need to be done at all? 3. Does it need to be done today? Planning Think ahead. What do you need to do the job? Can you break the job down into smaller jobs/different stages? take regular breaks Be aware of your activity limits. Pace this in the activity Allow time Distraction This is all about focusing your attention on stimuli other than the pain sensation. This will not make the pain go away but can make it more bearable e.g. relaxation, reading, Television. Please remember these activities can be very self absorbing so remember your activity limits, so don t overdo it. Ref: 10.PI.0267 Low Back Pain exercise & info Point of issue: LBP classes Page 4 of 7

5 Regaining Control Activity Cycling Do you have days when you push yourself and do too much and then your pain is worse and you are unable to do much at all? With pain it is very common to get into a cycle of over activity and under activity, in other words on a good day you overdo things but this results in pain and inactivity You may even get to the stage where you are cautious about doing things because of the consequences afterwards Over time the periods of activity become shorter and the rest periods lengthen Achievements become smaller and disability can increase resulting in a progressive pattern of demoralisation The purpose of pacing is to regulate daily activity and gradually increase the activity This pattern of cycles of activity and inactivity can be made worse if people take extra medication to help them cope with difficult tasks Using medication regularly in this way prevents people with pain learning how to pace activity Exercise Inactivity Not using muscles muscles tighten, weaken and fatigue Muscles stiffen Painful to stretch Increased strain on joint due to weakness Ligaments weaken Joint stiffness premature degeneration Other effects: More prone to illness Reduced efficiency of heart and lung Reduced brain activity Benefits of exercise Increased suppleness Increased stamina Increased strength Improved posture Weight control Increased co-ordination Reduced pain information Helps cope with stress Reduced muscle tension Ref: 10.PI.0267 Low Back Pain exercise & info Point of issue: LBP classes Page 5 of 7

6 Lower blood pressure Strengthens the heart and lungs Exercise programme 5 minute warm up Main programme: combination of stretching, strengthening and mobility (see back of booklet) Stretches to finish Core stability Consists of deep abdominal and bottom muscles Increase spinal stability Stretching and strengthening helps with muscle imbalance Aim: restore normal movement Back Care Posture Tense posture increased joint pressure Poor muscle use ligament strains Prolonged poor posture structural changes and muscle weakness Correct posture/balance needed for efficient use of arms and legs DO NOT bend forwards or stoop bend at knees Sit as little as possible Sitting Firm upright chair Bottom at back of chair Avoid crossing your legs DO NOT sit with your legs up Standing When standing keep back straight Lying Firm mattress or board under mattress Use pillows to help comfort Getting out of bed Roll onto side Push up on elbow Ref: 10.PI.0267 Low Back Pain exercise & info Point of issue: LBP classes Page 6 of 7

7 Short regular walks beneficial Avoid bending forwards when coughing or sneezing if possible Lifting Avoid over stretching and lifting Repetitive lifting place load above knee height Plan lift Get close to load (More effort if arms are outstretched) Stand with stable base Face the direction you want to move Lift in one smooth movement Bend knees and hips, and consciously brace abdominals when lifting. Ref: 10.PI.0267 Low Back Pain exercise & info Point of issue: LBP classes Page 7 of 7