Self-Care for Back Pain: Exercises to Help the Healing Process

Spotted on the Galactic Interweb! I wanted to share as this is an excellent practical application for back pain care that you can do at home.
~Stephanie 

Original Source:

To Your Health May, 2010 (Vol. 04, Issue 05)

By Marc Heller, DC

When it comes to back pain, your first thoughts may be to take over-the-counter pain medication and rest whenever possible. Two bad options. First, medication is only going to temporarily relieve the pain, if at all, and may be accompanied by various unpleasant side effects attributable to drugs. Second, rest may actually hurt more than help. While you're seeing your chiropractor, there are a few things you can do at home to help the healing process. Believe it or not, it's based on the simple principle of movement.

Whenever I see a patient with back pain, I always ask, "What do you do when you are in pain? What exercises help your pain?" I am continually surprised that very few patients know what self-care to do when they have an acute episode of pain. That includes motivated patients and patients I have seen before and carefully shown the right exercises. Maybe it is because when you hurt, you stop thinking clearly; or maybe it is fear that the pain will get worse. Both are valid excuses. Most of them just rest, ice the area, and use non-steroidal anti-inflammatory drugs (without realizing that NSAIDs actually block healing). Many of them say, "I hurt too much to exercise."

Why Movement Matters
The problem with this is that when you stop moving, when you are still, everything tightens up, circulation slows down, and pain chemicals accumulate in your muscles and joints. It's like waking up after sleeping in a cold room on a lousy mattress with a draft. If you get moving, you'll typically start to feel better.

So, here's the number-one rule to remember: Don't stop moving when you hurt. I know, you are in pain and afraid to move, and sudden movements may cause your back to "grab" or spasm. I am not telling you to ignore the pain. What I am saying is that you need to find movements that will ease your pain. In many cases, the most important thing to do when you hurt is to keep moving. The body often tightens up and limits your motion. If you find a motion that doesn't hurt you, it will probably help you. When you are hurting, you may not be able to do your usual activities, but you must keep moving. Try walking slowly, especially on flat and even ground. Try walking up a hill (you can walk up a hill without walking down, on a treadmill). Try swimming or simple motions in chest-deep water. Try basic pelvic tilts, staying within a pain-free range.

Here are some basic principles. The movement should be pain free (or at least cause minimal pain while being performed). When you have finished doing the exercise, your pain should be somewhat diminished. You should feel that you can move more freely. Your back should feel straighter and less "kinked."

Backward bending is a great exercise when you're suffering from low back pain. Start on the floor or other stable surface (top picture), then slowly raise your upper body up while keeping your lower body stationary (bottom picture). The final step involves extending your arms up (much like a push-up). Basic Exercises for Low Back Pain
Here are two basic examples of self-care exercises that have stood the test of time. Many of my patients have found variations on these and other types of movements that act as "reset" buttons for their typical pain. You are the one living in your body; you are the most likely one to know what is working for you.
Lower back diagnosis is often very difficult and confusing. For the sake of this article, let's divide low back pain exercises into two categories: exercises that make your back feel better when you bend backward, and exercises that make your back feel better when you bring your leg toward your chest.

Backward Bending (extension of the lumbar spine). An exercise called the McKenzie extension is the first thing you should try if you have sciatica (pain running down your leg). If these exercises work, your pain will diminish and may centralize, which is a good thing. Centralize means your pain goes less far down your leg, and you may feel it closer to the spine. Bending backward may not feel good at first, but you should feel better immediately afterward. If you feel worse afterward or the pain goes farther down your leg, stop, as this is not the exercise for you.

How to Do It: Lie face-down on the floor, arms bent at your sides (sort of like a starting push-up posture). Straighten your arms up slowly, lifting your upper body off the floor as you do so.

Your legs and feet should stay on the ground. Hold for 3-5 seconds, then slowly lower your upper body back down. Repeat 10 times, as often as once per hour.

If your pain or restriction is on one side, a variation on McKenzie extension (lying on a raised surface with one leg on the floor, slightly bent) may be more comfortable (keep the elevated leg straight).


Flexion Exercises (bringing the leg toward the chest). People with lower back pain can also feel better with various types of leg flexion, bringing the bent leg toward the chest, or doing contract-relax and then bringing the bent leg toward the chest. These people usually have sacroiliac joint problems. (The SI joints are located on either side of the spine in the lower back.) These are also called Tigny exercises.

How to Do It: Lie on your back with one leg bent and then other flat on the floor. Bring the bent leg up toward the chest. Wrap your arms around the leg and then try to lower it toward the floor for 3-5 seconds, resisting with your arms. Relax, and then pull the bent leg up farther toward the chest. Repeat the entire process three times.

Flexion exercises are another great way to relieve lower back pain. Lie on your back with one leg bent and the other leg flat on the floor. Raise the bent leg toward the chest, wrap your arms around the bent leg, and then try to lower it toward the floor as you resist with your arms. Repeat with the opposite leg. I have included a series of links at the end of this article; the first two go to videos describing the basics of McKenzie extension. The third one goes to an article I wrote describing the basic McKenzie extension exercise, and a couple of other variations. The fourth link goes to Dr. Craig Liebenson's site, LA Sports and Spine, where you can download his article and pictures on McKenzie self-treatment for sciatica. The fifth and sixth links relate to the Tigny flexion exercises, including a one-minute video demonstration.

So, here is the bottom line: When your lower back starts to hurt, find one or more simple movements or exercise that helps. Do the exercise over and over until you are back to normal. If you are not getting better quickly, call your chiropractor.

With that said, please use common sense. Stop immediately is you hurt more during or after doing any exercise. Exercise is not without risks. These or any other exercises may cause pain or injury. As with any exercise program, if at any point during your routine you begin to feel faint, dizzy, or have physical discomfort, you should stop immediately. To reduce your risk of injury, consult with your doctor before doing these exercises for the first time, particularly if your pain is new and/or you would like further explanation of how to perform the exercises correctly.

Links to Exercise Demonstrations and More Information

• Video of McKenzie lumbar extension.
• Sciatica self-care, by Dr. George Best, six-minute video.
• "Pain-Relief Exercise: The Lower Back."
• See the McKenzie self-treatment for sciatica; the other exercises are also useful.
• "Sacroiliac Joint Correction - A Different Model." A description of the Don Tigny model of the SI, with pictures of his various exercises.
• Video of flexion exercises.

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Marc Heller, DC, maintains a chiropractic practice in Ashland, Ore. He is a nationally recognized expert in treating tailbone, sacroiliac and lower back pain.

How to Get the Best Massage

Spotted on the galactic interweb! I wanted to share this - it's sage advice.
~Stephanie 
 

By Susannah Felts
From Health magazine

Massage isn’t just a me-time indulgence. Studies show it reduces stress, boosts immunity, and relieves pain from everyday wear and tear. And in tough times, just 30 minutes on the table (or even 10 minutes in a chair) can go a long way toward working out your kinks—as long as you make sure your needs are met. Here’s how to get your money’s worth.

Find the right therapist
Just as you would with an MD, select a certified massage therapist who meets your specific needs, whether you’re looking to soothe post­mara­thon aches or relieve a stiff neck. General certification in Swedish massage—long, sweeping strokes over the entire body—fits the bill when you’re simply looking to relax. (Swedish is what you’ll get if you ask for a basic massage; Shiatsu, or acupressure, features more targeted finger pressure in specific areas.) Go here to find the most experienced certified massage therapists in your area.

Speak up!
Before the massage begins, mention any areas of your body that are feeling sensitive, tight, painful, or tender (like a knot in your neck or an achy spot in your shoulder); these should be treated with particular care, according to Leena Guptha, an osteopathic doctor, a licensed massage therapist, and past president of the American Massage Therapy Association.
Most massage isn’t painful, though moderate pressure—which studies have found is necessary to provide optimal therapeutic benefits—may feel a little uncomfortable, especially if you’re new to massage. Is the pressure too intense? Don’t be shy. Guptha suggests saying something like, “That really hurts. Can you try something different or skip this area?” A good therapist should welcome (or even ask for) your input.

Pick your products
It’s acceptable to bring your own lotion or oil, especially if you have sensitive skin, a sensitive nose, or a condition like eczema or psoriasis. Another option: Ask the therapist to show you her product stash and discuss the options (many are fragrance-free). “There are dozens available for different types of massage, and your therapist should have a variety to choose from,” Guptha says.

Reschedule if you have a cold
“Postpone your massage if you feel a cold or migraine coming on,” Guptha says. “The massage will stimulate your circulation, which could leave you feeling worse.” If you’re a little stuffy or just find it difficult to breathe when lying face-down, ask to lie on your side. An experienced therapist can perform most techniques this way, or she can work on your upper back, neck, and shoulders while you’re in a sitting position.

Period? No problem
There’s no medical reason to avoid a massage during your period, Guptha says. In fact, it can ease PMS symptoms like cramps and backache. But if you’re worried about heavy bleeding, just wait a few days.

Tips to Help you Fall Asleep

Below is just one of the articles included in my latest bimonthly newsletter. You can sign up for more healthy living ideas at www.stephaniehaddock.com.

Insomnia is a problem for many people, and the worry about not sleeping can become a problem of its own. Occasional insomnia is common and may be a response to excitement or temporary problems. It will do you no harm as long as you remain reasonably energetic when you’re awake. Also, you may not realize that you need less sleep as you get older, and may think you have insomnia when you can’t get the hours you were used to getting.

If you do feel over tired or too tense to relax, try the following tips. If you don’t get results, consult your physician — it’s possible you may be experiencing anxiety or depression.

Don’t work in bed. If the bedroom is used for paying bills or studying, going to bed can become a signal to become active rather than to go to sleep.

Get some exercise every day so your body feels tired at night.

Try a warm bath before bed. Add Epsom salts if you are achy, or 5–10 drops of lavender or chamomile essential oil if you are stressed.

Make sure your bed is comfortable and that you are not too hot or cold.

Avoid alcohol and caffeine in the evening.

Establish a routine, by going to bed close to the same time every night.

If you aren’t sleeping, get out of bed and stay up until you are tired. The next morning get up at your normal time and try to make it through the day without napping.

A snack before bed helps many people, but a big meal may keep you up as your digestive system works overtime.

Use relaxation techniques such as slow abdominal breathing. Before bed, sit in a comfortable position and breathe slowly, concentrating on filling your belly like a balloon. Continue for up to 5 minutes at a time, but stop if you get dizzy.

Try some gentle floor stretches before bed. Lying down with your feet on the floor and your knees up, lower your knees from side to side. Come back to center, and tilt your pelvis forward and back several times. Slowly turn your head from side to side. Stretch gently and slowly anywhere you feel tight.

Get bodywork. Bodywork can relieve persistent muscle tension. This can help you feel deeply relaxed, and can improve the quality of your sleep the evening of a session and in the following days.

Four Tips to Prevent Back Pain

Spotted on the galactic interweb! I wanted to share this - it's very sage advice.
~Stephanie 


by Nicole Cutler, L.Ac.
original source

1. Take Frequent Chair Breaks - Even though most people's work and study schedules relegate them to a chair for most of the day, the torso was not designed to be static for five or more hours at a time. According to Andre Panagos, MD, a physiatrist specializing in sports medicine and co-director of the New York Presbyterian Hospital Spine Center, "Prolonged sitting inactivates the core muscles, which are responsible for supporting the back." Taking breaks every 20 to 30 minutes gives muscles a chance to relax and releases unnecessary tension around the joints. Taking a few moments to stretch and twist the torso to invigorate circulation, then lying down with the knees bent will help relax back muscles.

2. Lift Correctly - Even though it can injure the back, many of us forget to check our body mechanics while lifting things. Remember these pointers to make sure you lift correctly: first, stretch your legs and back, begin close to the object, stand with your feet apart with one foot slightly in front of the other for greater stability, bend your knees and squat, lift straight up without twisting or bending the torso and bring the object close to the body.

3. Quit Smoking - Adding to the long list of reasons to stop smoking, cigarettes also contribute to back pain. Nicotine blocks the transport of oxygen and important nutrients to the spine's discs. Starved of oxygen, the discs are less able to repair themselves and tend to collapse at a much earlier age than is seen in non-smokers. Known as degenerative disc disease, this leading cause of chronic back pain can be prevented by kicking the smoking habit.

4. Exercise the Mid-Section - The health of the back depends on the muscular endurance of the body's core muscles. Exercises that strengthen and stretch the back and abdomen will reduce back injury risk. While a physician or physical therapist should be consulted if a back problem is present, the following types of exercise have helped many strengthen and stretch their core muscles: yoga, pilates and swimming.

Least favorite massage

A client once asked me what my least favorite massage is to give. Of course, not wanting to paint massage in any kind of negative light, my immediate response was, "Oh, I love it all! It doesn't matter to me if the client wants this, that or the other thing ... I'm happy to do any modality I know how to do!"

Then I realized I had only thought about giving massage to a client on a massage table. And I truly don't have a most favorite or least favorite. But, I had forgotten about the massage chair. So after my all-massage-is-so-great-to-give attitude, a few seconds later I added, "Well, I guess, actually, chair massage is my least favorite."

The truth is, giving massage to a client in the chair is different than giving one to a client on the table. You're holding your arms up higher than you might be used to. Your leverage is different. It puts more pressure on your hands. You still use your legs to create pressure, but you have to more actively lean into someone to get deep into the soft tissue. On the other hand, when a client is on a table, you can let gravity do some of the work for you. I find I tire more easily when giving chair massage. I enjoy going to health fairs and expos and giving demo massages in the chair to potential clients, but I find I have to take frequent breaks and am usually more drained after giving 4 hours of chair massage than if I gave 5 or even 6 hours of table massage.

Chair massage is still great, though. From a business perspective, its overhead is low. All you need is the chair. For clients, it's quick and less intimidating to someone who wants bodywork but doesn't want to be undressed and under a sheet. It just tends to wipe me out as a therapist.

A New Look

I've updated the look of my blog. Please tell me what you think. Is there anything you love? Anything you hate?

Reflexology: More than just a foot massage

I am often asked, "What is reflexology?" and that is sometimes followed up with, "Is it just a foot massage?"

The Reflexology Association of Canada defines reflexology as: A natural healing art based on the principle that there are reflexes in the feet, hands and ears and their referral areas within zone related areas, which correspond to every part, gland and organ of the body. Through application of pressure on these reflexes without the use of tools, crèmes or lotions, the feet being the primary area of application, reflexology relieves tension, improves circulation and helps promote the natural function of the related areas of the body. (From "Standards of Practice, Code of Ethics & Code of Conduct." Click to view the document.)

Reflexology seems to be a mystery to most people. My answer to their questions is that reflexology is the belief that the feet (and for some practitioners the hands and ears) mirror the body and that by working the feet, you are, in effect, working the entire body. Reflexologists believe every part of the body from the organs and glands to the spine to the sinuses has a reflex point on the feet and that you can effect these by applying deep pressure to those points. I always say that reflexology is a great modality for anyone who wants to try bodywork but is uncomfortable receiving massage as reflexology is done fully clothed with only your feet exposed and touched.

A brief history
Many civilizations worked on the feet to promote health. It is widely believed that reflexology originated in China about 5000 years ago, but there is evidence that it was also practiced in some form by Egyptians, Russians, Japanese, and Indians. The Cherokee nation of North America practices a form to this day that is passed down to each new generation.

The precursor of modern reflexology was introduced to the United States in 1913 by William H. Fitzgerald, M.D. (1872–1942), an ear, nose, and throat specialist, and his colleague, Dr. Edwin Bowers. Fitzgerald argued that parts of the body correspond to others and that applying pressure in one area had an anesthetic effect on other areas and called it "zone therapy". Bowers would demonstrate this theory by first applying pressure to the point in a person's hand that corresponded with a specific area of the face. Then, he would stick a pin into the same area of that person's actual face without that person feeling any pain.

Reflexology was further developed in the 1930s and 1940s by Eunice D. Ingham (1889–1974), a nurse and physical therapist who used zone therapy on her patients. She concluded that since zones ran throughout the body and could be accessed anywhere, some areas might be more effective than others. Ingham believed that the feet and hands were especially sensitive, and mapped the entire body into "reflexes" on the feet. It was at this time that "zone therapy" was renamed reflexology.

A mirror of the body
Below is a foot reflexology map from the book Feet First: A Guide to Foot Reflexology by Laura Norman. I like Norman's book because the language is simple. Anyone can pick it up and grasp the concept of reflexology and how to give a reflexology treatment, not just bodyworkers or those with a deeper knowledge of anatomy. I also think her maps are clearer than others and more logically laid out, making them easier to remember and follow. (I've found that not all reflexology maps are the same. Some chart the points in very different places. More on that to follow.)

 

See how all of the organs are arranged just as they are in your body? The brain is on the top of the toes, just like it's at the top or your head. The heart is in between the lungs and more left than right. The liver is on the right, the stomach on the left and they are below the diaphragm and above the intestines. There is one kidney on each side, etc. Click here for an interactive map.

The reflex points aren't just on the plantar surface, either. There are points on both medial (inner) and lateral (outer) arches, around the ankles and on the dorsal (top) surface. For example, the medial arch is considered "the spine" of the foot because its curvature mimics that of the spine.

  

Unlike massage, reflexology is not a manipulation of the soft tissue. Rather, the thumbs and fingers are use to apply static pressure. The practitioner may manipulate the foot to flex, rotate, or pivot it onto the thumb or a finger for deeper pressure. When the practitioner finds an area that is tender, they might work that reflex more by taking their thumb and applying pressure all around that area, and from several different directions and angles to be as accurate and effective as possible. It usually takes several sessions for recipients to notice any difference in how they feel if they have a chronic condition. Relaxation and serenity, though, can be achieved immediately.

Also, tender areas do not always mean that something is wrong in the body. Just because someone has a tender heart reflex does not mean they have a heart defect. A tender area could be a foot problem, too, such as a bunion, bruise or scar tissue. Only doctors can diagnose. Reflexologists should only ever tell their clients what they are feeling in their feet, and it is up to the client to seek further attention from a physician. In Norman's book, I think she does a good job of explaining what reflexology is and isn't:

In plain language, it is not a foot massage and it not a medical treatment. First and foremost, reflexologists do no diagnose illness, nor do they practice medicine ... Neither does a reflexologist treat specific diseases. Even though most of my clients tell me what their problems are ... we never proceed as if a reflexology session is going to cure these problems. We spend extra time working the reflex area on the foot that corresponds to the body part that is troubled, but our work cannot be classified as medical treat as such ... reflexology works with subtle energy flows, revitalizing the body so that the natural internal healing mechanisms of the body can do their own work. As a matter of fact, people do attest to better health, even sometimes a marked reduction or even disappearance of the ailment. But it was not the reflexologist nor the session that cured. Only the body cures ... When practiced in conjunction with sound medical advice form your physician, reflexology facilitates healing.

She also encourages her clients to inform their physicians that they are receiving reflexology treatments because a relaxed body functions better. She mentions that she has had diabetic clients who, in consultations with their doctors, where able to reduce their insulin.

So, does it really work?
Reflexology, like any complimentary or alternative practice (CAM), has its detractors. Most doctors think it's New Age Quackary. They don't think any substantial evidence exists that proves efficacy. And, to be honest, it's hard to say, "Oh yes, this works" when different reflexologists or reflexology associations practice different methods and follow different foot or hand maps. Also, reflexology isn't regulated by a governing body. For massage therapy, almost every state has a different board that licenses, registers, or certifies practitioners. I am licensed by the state of Maryland. I cannot practice massage for pay without it. However, if I wanted to practice reflexology and only reflexology, I don't need any such credential.

But, a recent study at the Florence Nightingale School of Nursing and Midwifery, in London, England, set out to determine the effectiveness of reflexology in treating idiopathic constipation in 19 women. The result was 94% believing that their constipation was improved. Regis Philbin tells how Laura Norman saved him from having surgery to remove a kidney stone and helped him relieve a goiter.

And there are boards that provide certification, such as the American Reflexology Certification Board. The ARCB serves to educate the public and provide professional and ethical standards for practitioners. A reflexologist who is certified by the ARCB took an exam to prove their knowledge of the theory and practice of reflexology, lending credibility to what they do.

My answer to the question is that different things works for different people. I believe in massage and chiropractic because they have worked for me personally, but I don't think ear candling works. And I don't think traditional Western medicine always works, either. Medications are constantly discontinued because in the end they do more harm than good. Surgeons have a reputation of always ever recommending surgery, because that's what they do. I think that massage therapists, reflexologists, internists, surgeons, chiropractors and other health related professionals are the same as all other professional fields: some are great at what they do, and some just aren't. If you go to someone who isn't in it because they love it, then your experience will be negative.

If you really want to know if an alternative therapy works, you should try it. Maybe it will. Maybe it won't. They key is to go at it with an impartial mind. If you really, really, really want that reflexology session you are about to receive to clear your sinuses forever, you will convince yourself that it does. If you really, absolutely, no-doubt-about-it believe that the tincture your herbalist made up for you isn't going to do you a lick of good, then it will seem to you that it doesn't. And the same applies to traditional medicine: If you don't think you're going to feel better if you take this or that drug, you probably won't.

The human body is a mystery, and every one responds differently to the outside environment or stimulus. The only way to know what your body likes is through experience. So don't be shy. Put those feet forward and say, "Okay, I'm game!" If anything, your feet will feel great and you'll have a serene, blissful nap.