Strengthening Low Back Pain
Exercise
Yoga improves
Range of Motion, Mobility, Strength
results in pain reduction
As well as gives
ease to sore stiff muscles
Pathophysiology of back pain
• Pathology, broadly speaking, is the "study of the
nature and cause of disease” or the results of
disease in the body.
• Physiology is the study of normal, healthy bodily
function (as opposed to anatomy, which is the
study of normal structure).
– When something disrupts normal physiological
processes, it enters the realm of pathophysiology.
• Pathophysiology looks at the detailed
malfunctioning that comes from or - alternately causes disease.
Anatomy of Lower spinal
• The important parts of the lumbar spine include
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bones and joints
nerves
connective tissues
muscles
spinal segments
• Bones and Joints
– The human spine is made up of 24 spinal bones, called vertebrae.
Vertebrae are stacked on top of one another to form the spinal column.
– The spinal column is the body's main upright support.
– The lumbar spine is made up of the lower five vertebrae. These
vertebrae referred as L1 to L5.
– The lowest vertebra of the lumbar spine, L5, connects to the top of the
sacrum, a triangular bone at the base of the spine that fits between the
two pelvic bones.
Anatomy of lower back
• Each vertebra is formed by a round block bone, called a vertebral
body
• A bony ring attaches to the back of each vertebral body. This ring
has two parts.
– Two pedicle bones connect directly to the back of the vertebral body.
– Two lamina bones join the pedicles to complete the ring.
– The lamina bones form the outer rim of the bony ring. When the
vertebrae are stacked on top of each other, the bony rings form a hollow
tube that surrounds the spinal cord and nerves.
– The laminae provide a protective roof over these nerve tissues.
Anatomy of Lower back
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The facet joints are located on the back of the spinal column. There are two
facet joints between each pair of vertebrae, one on each side of the spine.
– A facet joint is made of small, bony knobs that line up along the back of the
spine. Where these knobs meet, they form a joint that connects the two
vertebrae. The alignment of the facet joints of the lumbar spine allows freedom of
movement as you bend forward and back.
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The surfaces of the facet joints are covered by articular cartilage.
– Articular cartilage is a smooth, rubbery material that covers the ends of most
joints. It allows the ends of bones to move against each other smoothly, without
friction.
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On the left and right side of each vertebra is a small tunnel called a neural
foramen. (Foramina is the plural term.)
– The two nerves that leave the spine at each vertebra go through the foramina,
one on the left and one on the right
– A facet joint sits in back of the foramen
– The intervertebral disc (described later) sits directly in front of the opening.
Low back pain
• There are many causes of pain in the back. Symptoms in
the low back can be a result of problems in
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Bony lumbar spine,
Discs between the vertebrae,
ligaments around the spine and discs,
spinal cord and nerves,
muscles of the low back,
internal organs of the pelvis and abdomen,
and the skin covering the lumbar area.
• Bone spurs that form on the facet joint can project into
the tunnel, narrowing the hole and pinching the nerve
Cause of Back pain
• Ruptured Disc
A ruptured intervertebral disc, also called a herniated
disc, is another common cause of back pain. How to
treat the back pain from a herniated disc depends on the
particular individual and situation.
• Discogenic Back Pain
Discogenic back pain is the result of damage to the
intervertabral disc, but without disc herniation. Diagnosis
of discogenic back pain may require the use of a
discogram.
• A bulged or herniated disc can narrow the opening and
put pressure on the nerve
Cause of Back pain
• Lumbar Muscle Strain
Muscle strains are the most common cause of low back
pain. Patients may or may not remember the initial event
that triggered their muscle spasm, but the good news is
that most episodes of back pain from muscle strains
resolve completely within a few weeks
Cause of Back pain
• Spinal Stenosis
As we age, the spinal canal can become
constricted, due in part to arthritis and other
conditions. If the spinal canal becomes too tight,
back pain can be the result.
• Lumbar Spine Arthritis
Arthritis most commonly affects joints such as
the knees and fingers. However, arthritis can
affect any joint in the body, including the small
joints of the spine. Arthritis of the spine can
cause back pain with movement.
Cause of Back pain
• Osteoporosis
Osteoporosis can cause a number of orthopedic
problems and generalized discomfort. Back pain from
osteoporosis is most commonly related to compression
fractures of the vertebra. Osteoporosis causes weak
bones and can lead to these fractures.
• Spondylolisthesis
Spondylolisthesis causes back pain because adjacent
vertebra become unstable and begin to "slip." The most
common cause of spondylolisthesis is due to
degenerative changes causing loss of the normal
stabilizing structures of the spinal column. If the spine
becomes unstable enough, back pain can become a
problem.
Sign & Symptoms
• Have significant back pain lasting more than 3 weeks
• Have back pain that becomes worse when you rest,
or wakes you up at night
• Get numbness or weakness in legs while walking
• Low back pain extended down to leg
• Leg pain increase if you lift knee to your chest or
bend over
– If so, there is a good chance a disc is irritating a nerve.
• Have persistent bladder or bowel problems
Back Pain Treatment
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Do not alleviate back pain
Avoid strain to the spine
Often help from ice and heat theraphy
Physical Therapy Back exercises, aquatherapy,
ultrasound, electrical stimulation.
Epidural Steroid Injections
Anti-inflammatory medications
Muscle Relaxers
Spine Surgery
Safety : Yoga
• Yoga is for fun
• Listen to your body
• Feel freedom, Feel Relax
– Do not hurt yourself
• Keep breathing
– Tune in relax rhythm of breathing
• Yoga is not just posture
– It is more than posture- Steady breathing & steady
mind
• Throw all negative feelings and stress
Safety : Yoga
• Always warm up before Yoga
• Yoga should not cause pain, mild discomfort is
acceptable.
• Never bounce or havr jerky motion
• Never lock joints arm/leg while doing yoga
• Do not compete
• Happy thought, smiley face, thus relax your body
and cortex
• Do each stretch 3 to 5 times
• Hold stretch for 5 to 30 seconds
Yoga remedies: Three sessions
• Perform Yoga exercise in sequence :
– Warming up
– Yoga for back pain
– Relaxation
• Do no compromise with Warming up and
Relaxation due to lack of time
– Cut down on number of yoga postures
– Do not cut down on time of yoga posture
• Progress gradually in your Yoga exercise
Warming up
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Side Bending
Backward Bending
Forward Bending
Pectorals Stretch
Trapezoids stretch
Neck stretch
Arms and Legs
Warming up
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Leg Exercise
Hips Exercise
Lower back Twist
Back twist
Warming up
• Pelvic Tilt
– Starting Position: Lie on your back on a table or firm surface.
Your feet are flat on the surface and the knees are bent.
Action: Push the small of your back into the floor by pulling the
lower abdominal muscles up and in. Hold your back flat while
breathing easily in and out. Hold for five seconds. Do not hold
breath.
• Pelvic Lift
– Starting Position: Lie on your back on a table or flat surface.
Your feet are flat on the surface and your knees are bent. Keep
your legs together Cross your arms over your chest.
Action: Tilt your pelvis and push your low back to the floor as in
the previous exercise, then slowly lift your buttocks off the floor
as far as possible without straining. Maintain this position for 5
seconds. Lower your buttocks to the floor Do not hold breath.
Yoga Remedies
• Bellow posture (Knee to Chest )
– Starting Position: Lie on your back on a table or firm surface.
Action: Clasp your hands behind the thigh and pull it towards your
chest. Keep the opposite leg flat on the surface of the table Maintain the
position for 30 seconds. Switch legs and repeat.
• Bellow posture (Knee to Chest ) followed by leg Raised up.
– Lie on firm surface. Knees bent and feet flat on the table. Flatten
your back to the floor by pulling your abdominal muscles up and
in.
Action:
– Bring one knee toward your chest. Hold this position
– Raise your leg keeping your knee straight. Hold for ____ seconds.
Slowly lower the leg to the floor. Repeat on the opposite leg.
Yoga Remedies
• Hip Rolling (8 variation)
– Starting Position: Lie on your back on a
table or firm surface. Both knees bent, feet flat
on the table.
Action: Cross your arms over your chest.
Turn your head (trunk) to the right as you turn
both knees to the left. Allow your knees to
relax and go down without forcing. Bring
knees back up, head to center. reverse
directions.
Yoga Remedies
• Boat posture (3 variation)
– Starting Position: Lie on your back on a table or flat surface.
Your feet are flat on the surface and your knees are bent.
Maintain your pelvic tilt for the curl up exercises.
Action:
– Slowly reach your arms in front of you as much as possible,
curling your trunk. Slowly keep the neck muscles relaxed.
Breathe normally. Slowly return to the starting position. Do Not
Cause Pain.
– Fold your arms on your chest. Tuck your chin to your chest and
slowly reach your elbows to your knees, curling your trunk. Keep
neck muscles relaxed and breathe normally Return to the
starting position.
– With your hands behind your head, slowly curl your head to your
chest and then your trunk. Relax, breathe and then slowly return
to the starting position.
Yoga Remedies
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Child pose & Cobra pose
TV pose
Baby cobra
Full cobra
Locust
Plank
Dog and Cat
Threading needle
Tail wagging & Neck wagging
Balancing box
Relaxation
• Bhamri (Buzzing bee) pranayam
• Relaxation
Diet recommendation
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Eat fresh cooked food
Hot herbal (ginger) tea with Honey
Sleep before mid night
Avoid:
– Cold foods
– White sugar & sweet
– Cooling fruits like banana, mango.
Life style and other tools
• Sun bathe technique
• Message with sesame oil