Spinal pain is a serious subject. As you recover from a spinal injury, whether to your neck or back, it is important that you begin to learn how to safely strengthen your spine to help prevent injuries in the future. To help you strengthen your spine and learn how to protect your spine, your doctor may have you see a physical therapist who will design a rehabilitation program just for you.
Your physical therapist will evaluate your condition to determine the best way to help ease your pain and help your spine move better. You will also be given ways to take care of your spine so you can avoid pain and prevent further injury.
Your First Visit
During your first visit to a physical therapist (PT), he or she will gather information about your spine condition. You may be asked questions about when your condition started, where you hurt, and how your symptoms affect your day-to-day activities. The information you provide will help your PT to begin zeroing in on the source of your problem and to know what will be needed to help relieve it. The information you give will also be used to help measure the success of your treatment.
After reviewing your answers, your PT will do an exam that may include some or all of the following checks:
Your PT will begin by checking your posture to see whether your pain is coming from changes in your posture. Imbalances in the position of your spine can put pressure on sore joints, nerves, and muscles. Postures used for a long time at school, with hobbies, or when working can change the balance of muscle strength and flexibility. Muscles that have been stretched over time tend to be weaker, while muscles that are put in shortened positions can begin to overpower the weaker ones. This can put added strain on areas around your spine that can cause a problem or make a sore area worse. Helping you improve your posture can oftentimes make a big difference in easing pain.
Range of motion (ROM):
Your PT will check the ROM in your spine. This is a measurement of how far you can move your spine in different directions. Your ROM is written down to compare how much improvement you are making with your treatments.
Your PT may need to do some tests to check how the nerves coming from your spine are working. This includes your reflexes, sensation, and strength. The results of these tests can help your PT know which area of your spine may be causing problems for you and can guide the type of treatment that will be best for you.
Your PT may carefully move your spine in different positions to make sure that the joints are moving smoothly at each level. Muscle and soft tissue flexibility is also tested. This will help guide treatment to the joint that is tight (called a hypomobility) or where a joint may have been injured and is moving too much (called a hypermobility). Some of the movements you’ll feel are where your PT is looking at the flexibility of the muscles around your spine. This type of examination can help guide your PT in knowing where your pain is coming from and which type of treatment will help you the most.
Ergonomics involves where and how you do your work or hobby activities. By understanding your ergonomics, your PT can begin to learn whether the way you do your activities is making your condition worse. Sometimes even simple corrections of your hobby or workstation can make a big difference in easing spine problems.
Palpation involves feeling the soft tissues around your spine. This is done to check your skin for changes in temperature or texture, which could tell whether you have inflammation or nerve irritation. Palpation also checks whether there are tender points or spasms in the muscles near your spine.
Your PT will evaluate your answers and your exam results to determine the best way to help you. Your PT will then write a plan of care, which lists the treatments to be used and the goals that you and your PT decide on to do your daily activities safely and with the least amount of discomfort. Your plan will also include a prognosis, which is your PT’s idea of how well your treatments will work and how long you’ll need therapy in order to get the most benefit.
The main goal of spinal rehabilitation is to make sure you have ways to take care of future spine pain or problems. You’ll be shown ways to help control pain or symptoms if they don’t go completely away and if they return in the future. Because you’ve experienced spine pain, there is a possibility you may have soreness in the future. You may be encouraged to continue with some of the exercises to help keep your spine healthy over time.
Controlling Pain and Symptoms
Your PT may choose from one or more of the following treatments to help you control your spine pain and symptoms.
Resting painful joints and muscles can help calm soreness, giving your spine time to heal. If you are having pain with an activity or movement, it should be a signal that there is still irritation going on. You should try to avoid all movements and activities that increase your pain. In the early stages of your problem, your doctor or PT may have you wear a brace to limit movement.
Specific rest encourages safe movement of your joints and muscles on either side of a painful area, while protecting the sore spot during the initial healing phase. If a brace was prescribed, you may be instructed to take it off a few times each day so you can do some gentle and controlled exercises.
Your PT will work with you to find ways to position your spine for the greatest comfort while sleeping or resting. You may receive advice on positions that reduce stress on your spine while you are at work.
Ice makes blood vessels decrease in diameter (called vasoconstriction), which decreases blood flow. This helps control inflammation, muscle spasm, and pain.
Heat makes blood vessels increase in diameter (called vasodilation), which increases blood flow. This helps flush away chemicals that cause pain. It also helps bring in healing nutrients and oxygen.
Ultrasound can reach tissues that are over two inches below the surface of your skin. The ultrasound machine directs high-frequency sound waves toward the sore area. As the waves pass through your body’s tissues, they vibrate molecules. The vibration causes friction and warmth. The remaining sound waves are converted to heat in the deeper tissues of your body. This heating effect helps flush the sore area and brings in a new supply of blood that is rich in nutrients and oxygen.
Phoresis means to “carry or transmit.” There are two methods of phoresis that PTs can use to transmit substances across your skin. Phonophoresis uses the high frequency sound waves of ultrasound to “push” a steroid medication (cortisone) through your skin. Iontophoresis uses a small machine that produces a mild electrical charge, which is used to carry medicine, usually a steroid, through the skin. The steroid is a very strong antiinflammatory medication that actually stops the pain, causing a chemical reaction within the cells of the sore tissue in your body. Either type of phoresis may be used in place of a cortisone injection.
Electrical stimulation is a gentle treatment used to stimulate nerves. The current passes through pads applied on your skin. Some people say it feels like a Massage on their skin. Electrical stimulation can ease pain by sending impulses that are felt instead of pain. Once yo9ur pain eases, muscles that are in spasm begin to relax, letting you move and exercise with less discomfort.
Soft Tissue Mobilization/Massage:
PTs are trained in many different forms of massage and mobilization. Massage has been shown to calm pain and spasm by helping muscles relax. Massage brings in a fresh supply of oxygen and nutrient-rich blood, and can help flush the area of chemical irritants that come from inflammation. Soft tissue treatments can help tight muscles relax, getting them back to a normal length. This will help you begin to move with less pain and greater ease.
Graded pressures and movements for joint mobilization may be performed by skilled therapists. Gentle graded pressures help lubricate joint surfaces, easing stiffness and helping you begin to move with less pain. As your pain eases, more vigorous grades of mobilization may be used to lengthen tissues around the joint in order to restore better movement in your spine.
Sore joints and muscles often feel better when traction (pull) is used. PTs apply traction manually or with a traction machine. There are also traction devices that can be issued to you for use at home. The amount of pull that is used will depend on your condition. A gentle on/off pressure may be better early on to help control arthritis pain. More vigorous traction can help take away pain if a spinal joint is mildly sore or tight.
Specialized treatments and exercises can help maximize your physical abilities, including flexibility, stabilization, coordination, and fitness conditioning exercises.
Exercises that increase flexibility help to reduce pain and make it easier for you to keep your spine in a healthy position. Flexibility exercises are helpful for establishing safe movement. Tight muscles cause imbalances in spinal movements. This can make injury of these structures more likely. Gentle stretching increases flexibility, eases pain, and reduces the chance of re-injury.
Depending upon what part of your spine is affected, one of the therapeutic exercises you will likely focus on in physical therapy is strengthening your “core” muscles. The “core” muscles you’ll be working on are closer to the center of your body and act as stabilizers. These key muscles are trained to help you position your spine safely and to hold your spine steady as you perform routine activities. These muscles form a stable platform, letting you move your limbs with precision. If the stabilizers aren’t doing their job, your spine may be overstressed with daily activities.
Strong muscles need to be coordinated. As the strength of your spinal muscles increases, it becomes important to train these muscles to work together. Learning any physical activity takes practice. Muscles must be trained so that the physical activity is under control. Spine muscles that are trained to control safe movement help reduce the chance of re-injury.
Improving your overall fitness level aids in recovery of spine problems. Fitness conditioning involves safe forms of aerobic exercise. The term aerobic means “with oxygen.” When using oxygen as they work, muscles are better able to move continuously, rather than in spurts.
Exercise has other benefits as well. Vigorous exercise can cause chemicals, called endorphins, to be released into your blood. These chemical hormones act as natural pain relievers in reducing your pain. Examples of aerobic exercise include:
- Swimming laps
- Walking on a treadmill
- Using a cross country ski machine
- Using a stair stepper
If you decide you want some extra conditioning, always check with your doctor or PT before beginning a program on your own. It is important that you choose an aerobic activity you enjoy. This will help you stick with it, ensuring you the long-term benefits that come with a well-rounded fitness program.
Once your pain is controlled, your range of motion is improved, and your strength is returning, you will be progressed to a final home program. Your PT will give you some ideas to help take care of any more soreness at home. You’ll be given some ways to keep working on your range of motion and strength, too. Before you are done with physical therapy, more measurements will be taken to see how well you’re doing now compared to when you first started in therapy.
PTs use functional training when you need help doing specific activities with greater ease and safety. Examples include posture, body mechanics, and ergonomics.
Using healthy posture keeps your spine in safe alignment, reducing strain on the joints and soft tissues around your spine. The time and effort you take to use good posture are vital to spine care, including prevention of future spine problems. As you gain strength and control with your stabilization exercises, proper posture and body alignment will be easier to remember and apply with all your activities.
Understanding the Neutral Spine Position:
Management and prevention of back pain begin by understanding the neutral spine position. Three natural curves are present in a healthy spine. Your neck, or cervical spine, curves slightly inward. Your mid back, or thoracic spine, is curved outward. Your low back, or lumbar spine, curves inward again. The neutral alignment is important in helping to cushion your spine from too much stress and strain. Learning how to maintain a neutral spine position also helps you move safely during activities like sitting, walking, and lifting.
The natural curves of your spine are the result of the muscles, ligaments, and tendons that attach to the vertebrae of your spine. Without these supporting structures, your spine would collapse. They support the spine, much like guide wires support the mast of a ship. This guide wire system is made up mainly of your abdominal and back muscles. Your abdominal muscles provide support by attaching to your ribs, pelvis, and indirectly to your lumbar spine. The muscles of your back are arranged in layers, with each layer playing an important role in balancing your spine. By using these muscles together, it is possible to change the curves of your spine.
Controlling pelvic tilt is one way to begin helping to balance your spine. As certain muscles of your back and abdomen contract, your pelvis rotates. As your pelvis rotates forward, the lumbar curve in your spine increases. As your pelvis rotates backward, the lumbar curve straightens. Rotation of your pelvis is like a wheel centered at your hip joint. The muscles of your upper thighs also attach to your pelvis, and contraction of these muscles can be used to change the curve of your spine.
Your abdominal muscles work alone, or with your hamstring muscles to produce a backward rotation of your pelvis. This causes the slight inward curve of your lumbar spine to straighten. If these muscles cause the curve of your low back to straighten too much, this may produce an unhealthy slouching posture.
In the other direction, as your hip flexors contract and your back extensors contract, your pelvis is rotated forward. This increases the curvature of your lower back. If this curve is increased too much, another unhealthy posture may result. This condition is called lordosis in medical terminology, or swayback in common terms.
A balance of strength and flexibility is the key to maintaining the neutral spine position. This balance is the basis for optimal muscle function. Like a car, an imbalance may lead to wear and tear, eventually damaging the various parts of your spine.
Muscle imbalances that affect your spine have many causes. One common cause of muscle imbalance is weak abdominal muscles. As your abdominal muscles sag, your hip flexors become tight, causing an increase in the curve of the low back. This leads to the swayback posture mentioned above. Another problem results from tight hamstrings. As your hamstring muscles become tight, your pelvis rotates backwards. This produces an abnormal slouching posture.
Think of body mechanics as putting the safe, neutral spine posture into action. It’s one thing to sit or stand with good posture. It’s another to keep safe posture as you actually move with activity. You want to keep your body in its safest alignment as you go about your daily tasks, such as:
- Getting out of a chair
- Taking out the trash
- Getting clothes out of the dryer
- Brushing your teeth
Tips for putting safe posture into practice:
Healthy sitting posture is based on the neutral spine position. Positioning your hips and knees at 90 degrees can help you keep a neutral sitting posture. Remember this position is balanced between the extremes of lumbar movement. Remember to choose a properly designed chair to help support your lumbar spine. The neutral spine position is also important when getting up from a chair. Holding your spine safely in neutral, the pelvic wheel turns forward, placing your “nose over your toes”. With your feet placed shoulder width apart, stand upright. Use your buttock and thigh muscles to push yourself up. Do not twist or bend too far over at the waist and put too much strain on your lumbar spine.
Proper body mechanics are also important while walking. Try to maintain the neutral spine position while walking. In the neutral position, your legs and arms swing naturally during forward motion. Conditions that alter the normal way of walking, and cause a limp, can severely stress your spine. While walking, always try to maintain your spine in the neutral position.
Lifting is one of the most dangerous activities for your spine. The neutral spine position MUST be used to reduce your risk of injury. With your spine held in the neutral position, movement occurs as the pelvic wheel turns. Your hip is the axis of pelvic rotation, not your back! Notice how your back loses the neutral position when your pelvis does not rotate forward. This posture focuses the force on your back muscles during a lift. Lifting in a neutral position allows your larger and more powerful leg muscles to do the lifting.
When lifting, first find the neutral position. Bend at your hips by rotating the pelvic wheel at the hip joint axis. Keep the safe posture, hold the object you are lifting securely, and use your large leg muscles to generate power. Tighten your abdominal muscles during the lift to create a stabilizing corset around your trunk.
Safe body movement is especially important during lifting. To avoid extra spine strain when lifting, use these safety tips:
Ergonomics looks at the way people do work. It’s possible that even minor changes in the way you do your work or hobby activities could keep your pain and symptoms in check while protecting your spine from further injury.
In some cases, it is best to have someone trained in ergonomics, like a PT or occupational therapist, check your work station and the way you do your work. The first step will be for them to ask you some questions about your work, which makes good sense. Since you’re the one doing the job, you will have an expert opinion about what seems to be working, what could be done differently, and what tasks seem to be causing the most problems for you.
Once these questions are answered, the evaluator will want to watch you do your work tasks. Areas that will be noted include the postures you use, repetitions to complete the task, rest time between tasks, and the amounts of weight you are dealing with. For office workers, the examiner will look at alignment of the computer monitors, chairs, desk heights, etc. Other areas that may be evaluated include work heights, tools of the trade, lighting, and temperature. It’s also helpful to look at your work postures and work tasks to see whether what you are doing can be done with less stress and strain on your body.
When the work site evaluation is over, you or your supervisor will probably be given some recommendations, some of which may even be recommendations you came up with! Ergonomics doesn’t always have to involve expensive changes. Even minor adjustments can make a huge difference in easing your pain and preventing further problems.
Work Place Strategies:
These strategies are ideas of how to work with greater safety and even better productivity. Have you ever felt stress or tension at work? Chances are good that you wouldn’t have a pain or worry if you didn’t. The reality is that people are often called on to do even more with fewer resources. They are faced with more responsibility and more deadlines to get their tasks done. The health of your spine may be at risk with these mounting pressures. But scientists have helped us learn that we have a defense against these mounting pressures. They have shown the importance of using the “Three R’s” to help ease tension and reduce spine pain at work. Here are the three Rs:
Whether at work or at home you can use these ideas to help prevent back and neck pain and injury. Here are some additional tips to use at work to avoid tension and keep your neck healthy:
- Plan and prepare for the lift.It only takes a moment to ensure safety. The consequences of a back injury can be long lasting!
- Make sure you have a safe and clear path.
- Before beginning, think through the lift.
- Obtain good footing with a wide base of support.Place your feet a minimum of shoulder width apart. This lowers your center of gravity and increases your stability.
- Keep the load close!Keeping the load close to your body can reduce stress on your spine and back muscles. Think of how a lever and fulcrum works. Your back muscles, spine, and arms are the parts that form this lever system. The force needed to lift an object is lower if the load is nearer the fulcrum point. If the load is too far away from your body, the muscles of your spine have to work harder to help with the lift. This leads to too much stress on the muscles of your spine and can cause injury.
- Maintain the neutral spine position!By moving the pelvic wheel around its axis, your upper body hinges forward but your spine stays in neutral. Remember the neutral spine position at all times!
- Remember to lift with the large muscles of your legs!
- Avoid twisting AND bending of your lower back at the same time!This is one the most damaging movements to your spine. To avoid twisting, pivot your feet to complete the lift.
- Get help if necessary!If the load is too bulky or heavy, do not hesitate to get help or use a hand truck! Do not be too tough or too busy to get help. Will power does not take the place of a reasonably safe lift.< >Rest:This includes taking frequent breaks during the work hour. It also means choosing alternate activities to get your mind ready for a new job task. Activities include deep breathing, walking, napping, or exercising.Relaxation:Take a load off. Lie back. Turn down the lights, and listen to your favorite tape or CD. Attempt to breathe slowly and deeply, allowing your abdomen to rise and fall rhythmically. Using visual imagery can also aid in relaxation. Try to visualize each muscle relaxing one after another.Recovery:Our bodies need a chance to heal. Repeated and prolonged activities can take their toll if your body doesn’t get a chance to recover. Recovery helps repair these sore and achy tissues along the way, keeping them healthy.Be Relaxed.Try to work with your muscles relaxed. To stay relaxed, look relaxed.
- Pace Yourself.Keep an even keel. Avoid sudden changes in your workload. Try to avoid last minute “panics” to meet deadlines.
- Take a Break.Take a thirty second “microbreak” every twenty to thirty minutes to do some deep breathing and a few exercises. Take a few minutes each hour to do some exercises, get a drink, or go bug a coworker. Use your lunch break to take a nap or a walk.
- Change Positions.Avoid holding your neck, trunk, or limbs still for a long time. Plan ways to get the job done using different positions. Sit for a bit, then stand for a bit. Or simply readjust your approach to the task.
- Rotate Duties.Rotating or sharing your tasks can be fun by offering a new work setting while giving your body a chance to recover.
- Avoid Caffeine and Tobacco.These can heighten stress, reduce blood flow, and elevate the awareness of pain.