Back and Posture Health: A Physical Therapy Perspective
BY JIM HARWOOD, P.T. | “Sit up straight. Don’t slouch.”
“Bend at the knees when you lift.”
“You need bed rest when you hurt your back.”
These are common statements we hear from well-intended friends and family — and in some cases, health care providers — when we experience low back pain (LBP).
In some cases, following this advice can actually make the situation worse. So what can the motivated person do to either minimize their chances of hurting one’s back or recover as quickly as possible when injured?
While LBP can be experienced by people in all age groups (80 percent of all Americans will experience one episode of back pain in their life), seniors face specific challenges that may predispose them to LBP. These include:
• POOR BODY AWARENESS: Weak and tight muscles from a sedentary lifestyle, poor posture and poor bending/lifting technique can create strain on the joints, ligaments and muscles of the back (and perhaps not cause pain until much later). This leads to an often-heard statement in the clinic: “I have been doing this for years without pain.”
• OSTEOARTHRITIS: Degeneration of joints can cause pain and stiffness throughout the body, including the spine.
• DEGENERATIVE DISC DISEASE: This can cause changes in the spine that may make it more susceptible to disc herniation and pressure on a nerve, sometimes resulting in “sciatica.”
• SPINAL STENOSIS: This occurs when changes to the spine cause the space through which the nerves and blood vessels exit becomes smaller making it possible for a nerve to get compressed or “pinched.”
• BAD HABITS: Cigarette smoking, poor nutrition and poor conditioning can, at a minimum, restrict blood flow to the tissues of the body causing weakened structures and decreased healing.
LBP has the potential to become a serious health issue in seniors — particularly since a decrease in mobility that can accompany pain can lead to serious consequences for an older individual’s independence and overall health.
There are strategies that can be implemented that may reduce the risk of experiencing an episode of LBP and/or speed up recovery. They include being active, minimizing bed rest when injured and learning proper body mechanics.
A recent Danish study revealed that an active lifestyle can help protect against incidents of LBP. Numerous other studies have demonstrated that exercise is significantly more effective than rest in reducing LBP. There is also evidence that no single specific exercise is superior. Therefore, the exercise guidelines for people with LBP are the same as for those who are not experiencing LBP: increasing strength, aerobic capacity and flexibility.
So why not start walking? You should strive for 30 minutes a day of uninterrupted walking. In inclement weather, find refuge in a shopping mall (it is always advisable to be evaluated by your health care provider before beginning any exercise program),
Learn Proper Body Mechanics for Common Activities:
Understand bending from the hips with a “neutral” lumbar spine; neutral being the natural position of the spine when all three curves of the spine — cervical (neck), thoracic (middle back) and lumbar (lower back) — are present and in good alignment. This is the safest and strongest position for the spine and needs to become a fundamental movement pattern in your life. This can be practiced by focusing on how your body moves as you sit and stand at a chair.
Check the weight of the object you are going to lift and, if necessary, seek help. Bend hips and knees — and keep the spine in a natural curve. Keep the object as close as possible to your body. Do not twist when lifting. Make sure you tighten your stomach muscles (but continue breathing) and lift with your legs.
When performing activities that require standing (such as cooking, doing dishes or ironing), try to break up the tasks to avoid fatigue. When possible, you can place one foot on a step or a ledge (switch feet occasionally) and try to perform the activity at a comfortable height. Do not bend in the back. Bend from your hips and knees.
When Pushing or Pulling:
When performing duties like vacuuming, sweeping, pushing a shopping cart or opening a door, keep the object you are moving close to the center of your body. When pushing or pulling, use your legs and not just your arms — while keeping back neutral and abdominal muscles tightened (keep breathing).
When Sitting for a Long Time:
When sitting for a movie or a long meal, it is important to remember that there is no “perfect” posture, and that the best advice is to change position(s) often. It is important to try to keep your spine supported in its natural curve (use a small pillow or towel in low back if necessary). When working at a computer, keep the monitor right in front of you and remember to relax your shoulders and “mouse-hand/arm” whenever possible.
Try This Posture Exercise:
If you are someone who spends a great deal of time sitting or if you feel stooped over when you are standing, you can try this posture exercise a few times a day.
• Stand facing a wall.
• Place your hands on the wall in front of you.
• Walk your hands up the wall as far as you can (make sure this causes no pain — especially in your shoulders). Walk towards the wall as your hands go up.
• Keep your chin down and tucked (you do not have to look at your hands moving up the wall).
• Try tightening your abdominal muscles.
• Hold this position for three to four breaths in and out.
• Then, relax.
• Repeat this exercise three times in a row
It is important to understand that while these few tips may not solve everybody’s back issue(s), they can be effective — if implemented properly and consistently.
If you are experiencing back pain and would like to start implementing these strategies but are not sure how (or if you have questions or need guidance to start an exercise program), you can call or stop in to see a Physical Therapist (PT) and schedule an evaluation. In the state of New York, Physical Therapists have Direct Access, meaning you do not have to see a physician and obtain a prescription before seeing a PT. This is true for all Medicare beneficiaries as well. However, if your back pain episode also includes a fever or pain/weakness in your legs or you note changes with your bowel or bladder, it is imperative that you see your doctor as soon as possible.
New York Physical Therapy (NYPT) is located in Chelsea at 359 W. 23rd Street. If you are interested in starting PT (or if you have any questions about this article or other matters concerning your physical health), feel free to call us at 212-488-7300. You can also learn more about NYPT by checking out our website at nypthealing.com.