Back Owner’s

Manual
A Guide to the Care of the Low Back

11836_FMECH.indd 17 1/26/09 11:28:22 AM

 A Healthy Back Keeps You Moving Forward
If back pain has you feeling down, you’re not alone. Low back pain
affects many of us. That’s because we tend to neglect our backs. But
your back is what keeps you in motion. So it’s important that you
take good care of it. This booklet shows you how to care for your
back so that you can be pain-free and always moving forward.

Pain Is a Real Problem

Low back pain is a common problem. It’s one of
the main reasons people visit the doctor. Severe
pain, sharp twinges, or constant dull aches have
many people seeking medical care for their backs.
Back pain may seem to come on suddenly. But the
truth is: Back pain often occurs after years of poor
back health.

What Causes Back Pain?

Some back pain can’t be avoided, such as pain
from an injury. Getting older can also lead to
aches and pains. But often, back pain is the
result of years of misuse. Bad habits that can
lead to back pain include:
• Poor posture
• Bad body mechanics
• Not enough exercise
• Being overweight
You can control all of these causes. With proper
care, you can help your back feel better now and
prevent back pain in the future.

When to Seek Emergency Care

It’s common to have some backaches at times. But if you
have any of these problems, seek medical care right away:
• Back pain that won’t go away
• Leg weakness, numbness, or constant leg pain
• Numbness in your groin or rectal area
• Problems controlling your bladder or bowels

This booklet is not intended as a substitute for professional medical care.

Only your doctor can diagnose and treat a medical problem.
©2007 The StayWell Company www.krames.com 800-333-3032
All rights reserved. Lithographed in Canada.
2

11836_FMECH.indd 2 1/26/09 11:27:56 AM

 Your Goal: A Pain-Free Back
There is no simple cure for back pain.
But there are things you can do to
prevent or relieve it. For example,
you can take steps to change habits
that lead to back pain or make it
worse. Improving your posture, body
mechanics, and overall health will
lessen pain or even make it go away.
Most people who make these changes
feel better. It does take time and effort.
But your goal of a pain-free back will
be well worth it.

The Road to Recovery

To improve your back health, keep
moving. Gentle activities, such as walk-
ing and swimming, can help reduce
back pain. Once pain is reduced, your
doctor will probably tell you it’s okay
to be even more active. He or she may
help you set up an exercise program.
Your program may include stretching, Keep moving with activities that help your
strength training, and activities that back stay fit and flexible, such as walking.
get the heart rate up (called aerobic
or cardio exercise). Check with your
healthcare provider before trying new
exercises. This way, you’re sure to get
safely started on the road to recovery.

Table of Contents
Anatomy of a Healthy Back. . . . . . . . . . . 4 Good Posture Is Good for You . . . . . . . 11

Common Disk Problems . . . . . . . . . . . . . 5 Choose Your Exercise Program . . . . . . 12

Causes of Pain That You Can Control . . 6 Advanced Exercises . . . . . . . . . . . . . . . . 14

Your Medical Evaluation . . . . . . . . . . . . . 7 Relieve Back Pain . . . . . . . . . . . . . . . . . . 15

Do’s and Don’ts of Body Mechanics . . . 8 Back Owner’s Maintenance Guide . . . 16

11836_FMECH.indd 3 1/26/09 11:27:57 AM

 Anatomy of a Healthy Back
A healthy back supports the body and lets it move freely. It does this
with the help of the spine’s three natural curves. Strong, flexible
muscles also help keep these curves properly aligned. Disks that
cushion vertebrae play an important role in back health, too. When
all parts are healthy, your back can support you without pain.

Three Natural Curves

Bones (vertebrae) and pads of soft tissue (disks) stack
together to create the spine. The spine follows three
curves: cervical curve (neck), thoracic curve (upper
back), and lumbar curve (lower back). When properly Annulus
aligned, these curves help you keep balance. They Nucleus
also support you while you move by distributing
your weight along the spine. Disk
Spinal
canal

Cervical Spinal Nerve

curve cord

Vertebrae and disks make up

the spine. They protect the
spinal cord and nerves.

Thoracic
curve
L1

L2
Disk
Back
muscle L3
Lumbar Nerve
curve Abdominal L4
muscle

L5
Buttocks
muscle
Leg The lumbar part of the spine is
muscle made up of five vertebrae (L1
Sciatic
nerve through L5). They carry most of
the body’s weight, which makes
this part of the spine more prone
to injury than the rest of the back.
4

11836_FMECH.indd 4 1/26/09 11:27:58 AM

 Common Disk Problems
Disks are soft cushions of tissue between the vertebrae. Disks can
tear, bulge, rupture, or degenerate (wear out with age or use). When
this happens, disks no longer cushion vertebrae properly. This can
lead to back pain, stiffness, and other problems.

Torn Annulus
The annulus is the disk’s tough outer ring. A sudden
movement can cause a tiny tear in the annulus. Nearby
muscles and ligaments can also become strained or
sprained (pulled or torn). Because the annulus, muscles,
and ligaments contain nerve endings, injuries to them
Torn cause back pain.
annulus

Bulging Disk
Each disk has a spongy center (nucleus) that helps absorb
Bulging
shock during movement. When an annulus wears out
disk
or the disk is squeezed too much, the nucleus can push
on the annulus and create a bulge. The bulging disk can
then press on spinal nerves and cause back and leg pain.

Ruptured Disk
With a ruptured disk (sometimes called a slipped or
herniated disk), the annulus breaks open and allows
Ruptured the soft nucleus to squeeze out. The nucleus then presses
disk against or pinches nerves, causing pain. Pain that radiates
down the buttocks and legs is called sciatica. If pressure
continues, the nerves become damaged. Severe pain,
numbness, or muscle weakness in the legs, or problems
walking can occur.

Osteoarthritis
Bone As disks and joints wear out over time, growths of bone
spurs (bone spurs) form on the vertebrae. Bone spurs can
irritate nerves and narrow the spinal canal (stenosis),
causing back pain. In most cases, osteoarthritis occurs as
we age. But good posture and body mechanics, healthy
Worn
eating, and regular exercise can help slow the onset of
disk
osteoarthritis.

11836_FMECH.indd 5 1/26/09 11:27:59 AM

 Causes of Pain That You Can Control
Something as simple as slouching can lead to disk problems and
back pain. So can moving your back the wrong way. Even stress
can throw back muscles into a painful spasm. But you can help
control these causes of back pain. And when you do, you will
help reduce pain and improve the overall health of your back.

Poor Posture
Posture is the way you hold your body. Slouching
or over-arching the back are examples of poor
posture. Poor posture puts extra pressure on your
disks and vertebrae. It also puts you at risk of the
painful disk problems discussed on page 5.

Bad Body Mechanics

The way you move your body is called body mechanics.
There are correct ways to stand, walk, sit, and even
sleep that are best for your back (see page 8). Having
good body mechanics can reduce pain and risk of
injury by evenly distributing weight along the spine.

Lack of Exercise
Without exercise the muscles that support the
spine weaken. This can lead to poor posture and
bad body mechanics. Lack of exercise can also
lead to excess weight.

Excess Weight
Practicing proper posture is harder when carrying
excess body weight. This makes practicing good
body mechanics difficult, too. Added body weight
also puts more stress on the back and tends to
make back pain worse.

Tension and Emotional Stress

Emotional stress can worsen back pain. Money
worries, family pressures, fatigue, and other
stresses of daily life often cause back spasms.

Smoking
Smokers are more likely to have back pain than
nonsmokers. This may be because smoking reduces
nutrition to the disk. If you smoke, this could mean
weakened disks that are prone to injury and pain.
So talk to your healthcare provider about quitting.

11836_FMECH.indd 6 1/26/09 11:28:00 AM

 Your Medical Evaluation
A medical evaluation is needed to find the cause of your back
problem. This can include a health history, physical exam,
and diagnostic tests. These help your healthcare provider decide
the best treatment plan for you.

Medical History
Questions the healthcare provider may
ask you include:
• Where is your pain? How often does it
bother you?
• How and when did your pain first start?
• Does the pain stay in one place? Or,
does it radiate down your buttocks or leg?
• What relieves the pain? What makes
it worse?
• What is your occupation?
• How does back pain affect your life?

Physical Exam
Your healthcare provider can learn a lot by
looking at your back when you’re in different
positions. He or she may check your posture,
and muscle strength and flexibility. Your
reflexes and the sensation in your legs may
also be tested. Depending on your symptoms,
a more thorough physical exam may be
needed to find the cause of your back pain.

Diagnostic Tests
Your healthcare provider may also use one or
more of the following tests to diagnose pain:
• X-ray: takes images of bones
• MRI (magnetic resonance imaging):
takes highly detailed images of bone
and soft tissues
• CT (computerized tomography) scan:
takes a series of special x-rays of bones
and soft tissues
• EMG (electromyogram): checks electrical
activity in muscles
• Myelogram: makes images of problems in
the spinal canal using injected dye
7

11836_FMECH.indd 7 1/26/09 11:28:02 AM

 Do’s and Don’ts of Body Mechanics
There are wrong ways and right ways to move your back. Bad body
mechanics can damage your spine. To reduce your risk of injury
and pain, practice the “do’s,” and avoid the “don’ts.”

Lifting

✗ Don’t bend over with legs straight. ✓Do bend your knees, not your back.
✗ Don’t twist while lifting. ✓Do be sure of your footing.
✗ Don’t lift above shoulder level. ✓Do lift with your legs.
✗ Don’t lift heavy loads without help. ✓Do hold objects close to your body.

Sitting

✗ Don’t sit in a chair that’s too high ✓Do sit with both feet flat on the floor.
or too low. ✓Do keep your knees at or slightly below
✗ Don’t arch or round your back. the level of your hips.
✗ Don’t lean forward. ✓Do protect your low back with a
✗ Don’t slump or slouch. lumbar support or rolled-up towel.
8

11836_FMECH.indd 8 1/26/09 11:28:03 AM

 Driving

✗ Don’t sit too far back from the wheel. ✓Do use a lumbar support cushion.
Stretching for the pedals and wheel ✓Do sit upright and drive with both
strains the back. hands on the wheel.
✗ Don’t drive with your knees higher ✓Do shift weight often.
than the level of your hips.
✓Do keep back pockets empty.

Working at the Computer

✗ Don’t slump or slouch. ✓Do sit firmly against the chair back.
✗ Don’t sit in a chair that’s too high or ✓Do protect your back with a lumbar
too far from your workstation. support or rolled-up towel.
✗ Don’t lean forward to read the screen. ✓Do use an adjustable footrest.

11836_FMECH.indd 9 1/26/09 11:28:06 AM

 Do’s and Don’ts of Body Mechanics (Continued)
Here are more ways you can improve the way you move your body
to help protect your back.

Standing or Walking

✗ Don’t stand too long in one position. ✓Do stand with one foot up; change
✗ Don’t bend forward with legs straight. positions often.
✗ Don’t walk with poor posture. ✓Do correct your posture when necessary.
✗ Avoid wearing high-heeled shoes. ✓Do wear comfortable, low-heeled shoes.

Sleeping

✗ Don’t sleep or lounge on soft, sagging, ✓Do sleep on a mattress that supports
nonsupportive mattresses or cushions. your back’s natural curves.
✗ Don’t sleep on your stomach. ✓Do sleep on your side with a pillow
between bent knees, or on your back
with a pillow under your knees.
10

11836_FMECH.indd 10 1/26/09 11:28:09 AM

 Good Posture Is Good for You
Poor posture throws off the spine’s natural curves. This can lead to
back pain and injury. For example, poor posture can cause disks
to wear out. But when you practice proper posture, you help keep
the spine healthy and well aligned. This decreases your risk of pain.

Checking Your Posture

To test your posture, stand with your back against a wall. There should
be only a small space between your back and the wall. Check to see if you
hold your back too swayed (like in the “military” stance) or if you slouch
forward. Military and slouched stances put added stress on your back.

Improving Your Posture

It’s not too late to change your
posture. Follow these steps to
improve your posture:
• Breathe deeply.
• Relax your shoulders, hips,
and knees.
• Think of the ears, shoulders,
hips, and ankles as a series
of dots. Now, adjust your
body to connect the dots in
a straight line.
• Tuck in your buttocks a bit
if your back is swayed.

Military stance Slouched stance Straight stance

makes the spine makes the spine aligns the spine’s
arch too much. round too much. natural curves.

Reducing Stress on Your Spine

Your spine supports your body’s weight.
Certain positions put more pressure
on your back than others. For example,
sitting puts more stress on the back than
walking. So do your best to limit the Walking Standing Sitting Bending
50 lbs 75 lbs 135 lbs 240 lbs
amount of time you spend in the positions
that put the most stress on your spine.
If you weigh 110 lbs, sitting puts 135 lbs of pressure
on your back, but walking puts only 50.
11

11836_FMECH.indd 11 1/26/09 11:28:12 AM

 Choose Your Exercise Program
A good exercise program helps you stretch and strengthen the muscles
that support your back. These muscles let the back be flexible and move
naturally. Beginning on this page are examples of exercises you can do
to strengthen and stretch your muscles. Be sure to speak with your
healthcare provider before starting any exercise program. Find
exercises that work for you. Move from basic to advanced exercises.
And remember: Don’t overdo it!

Play It Smart: Tips for a Safe Exercise Program

• If you’re recovering from a back problem, do only the exercises suggested by
your healthcare provider. If instructed, do the exercises in this booklet daily.
You might take 15 minutes in the morning and 15 minutes at night.
• Avoid occasional, excessive exercising because it can hurt your back. Instead,
do regular, moderate activity.
• Always warm up your muscles for 2 to 3 minutes before you exercise. Try gently
marching in place while moving your arms.
• Don’t hold your breath while doing exercises. Focus on breathing in and out.
• Expect a little discomfort, but stop any activity that causes back or leg pain.
Then, talk to your healthcare provider.
• If you prefer, put a pillow under your neck or back for comfort.

❑ Knee-to-Chest Raise ❑ Hamstring Stretch

1. Lie on your back with your knees bent. Keep 1. Lie on your back. Lift your leg. Place your hands
your feet flat on the floor. around your thigh, just above the knee. (Use a
2. Grasp your thigh behind the knee and slowly towel if you have trouble reaching around your
pull it to your chest. Keep your back flat against thigh.) Then tighten your abdominal muscles.
the floor. You will feel pulling in your buttocks 2. Pull your leg toward your chest until you feel
and low back. pulling in the back of the leg. Gently straighten
3. Hold for seconds. Switch legs. your leg as much as you can.
Repeat exercise times. 3. Hold for seconds. Switch legs.
Repeat exercise times.
12

11836_FMECH.indd 12 1/26/09 11:28:13 AM

 ❑ Pelvic Tilt ❑ Half Sit-Ups

1. Lie down and bend both knees. 1. Lie on your back with both knees bent, feet
2. Press your low back into the floor and tighten flat on the floor, arms by your sides.
your abdominal muscles. 2. Use your abdominal muscles to raise your
3. Hold for seconds. Relax. head and shoulders slightly off the ground.
Repeat exercise times. Reach for your knees.
3. Hold for seconds. Relax.
Repeat exercise times.

❑ Calf Stretch ❑ Wall Slide

1. Position yourself with your arms braced against 1. Stand with your shoulder blades against the
a wall. Put one foot approximately 1½ feet wall. Place feet about 4 to 6 inches in front of
behind the other. you, shoulder-width apart. Tuck in your buttocks.
2. Bend your front leg, while keeping both heels on 2. Slide down about 2 feet. Keep your back against
the floor. Lean forward until you feel pulling in the the wall. Don’t let your knees go past your toes.
back of your back leg. Do not bounce. 3. Hold for seconds. Slide back up the wall.
3. Hold for seconds. Switch legs. Relax. Repeat exercise times.
Repeat exercise times.
13

11836_FMECH.indd 13 1/26/09 11:28:14 AM

 Advanced Exercises
Talk to your healthcare provider before trying advanced exercises.

❑ Press-Up ❑ Back Extension

1. Lie on your stomach with a pillow under your 1. Lie on your stomach with a pillow under
pelvis. Place your hands on the floor near the your pelvis. Put your hands by your sides.
sides of your head. 2. Slowly raise your chest off the floor, arms behind
2. Press up on your elbows, slowly arching your you. Go only as high as feels comfortable.
back. Hold this position for seconds. 3. Hold for seconds. Relax.
3. Return to the first position and relax. Repeat exercise times.
Repeat exercise times.

❑ Hip Extension ❑ Lower Back Rotation

1. Lie on your stomach with a pillow under your 1. Lie on your back with your knees bent. Put your
pelvis. feet on the floor. Extend your arms out and place
2. Straighten your left leg and tighten your buttocks. your palms on the floor.
Then slowly raise the left leg from the hip. Return 2. Slowly drop both knees to one side while turning
the leg to the floor. your head to the other side; keep your shoulders
3. Repeat exercise times. Switch legs. to the floor.
3. Hold for seconds. Return to start.
Repeat exercise times on each side.

14

11836_FMECH.indd 14 1/26/09 11:28:17 AM

 Relieve Back Pain
Aches and pains are your body’s way of telling you to pay more
attention to your back. Your back may need to be stretched or
rested. Or, you may need to ice it, apply heat, or take over-the-
counter medications to help stop back pain.

Rest Your Back

Certain positions help relax the back. They stretch the spine and
the muscles that support it. Rest positions can also take pressure
off the back. So give your back a rest in these positions.
NOTE: Do these positions only if instructed by your healthcare provider.

Lie on your back on the floor with your legs Lean forward in your chair. Stand with your hands on the
up on a stool. Put a pillow under your neck Lower your head to the low back. Bend slightly back for
for comfort. Hold for 15 minutes. knees. Hold for 1 minute. 15 seconds. Repeat 2 or 3 times.

Treat Pain A Physical Therapist May Help

To treat your back pain, consider using: A physical therapist is trained to evaluate
and treat your back pain. He or she will
• Ice to reduce swelling. Place an ice pack
also plan an exercise program to help you
wrapped in a thin towel where your
treat yourself. A physical therapist may
back hurts most. Keep it on for 15 to
practice mobilization (gentle movement
20 minutes. Repeat this each hour. If
of the vertebrae). Other treatments may
you don’t have an ice pack, a bag of
include using machines that produce cold,
frozen peas will also work. If ice hasn’t
heat, or electrical stimulation to help treat
relieved pain after 2 days, try heat.
your back pain or injury.
• Heat to relax muscles. Put moist heat,
such as a towel heated with warm water,
on the sore area for 10 to 15 minutes
each hour. Taking a warm bath or
shower may also help.
• Over-the-counter medicines to reduce
pain. Try using aspirin, ibuprofen, or
naproxen. Talk to your healthcare
provider before taking any medications.

15

11836_FMECH.indd 15 1/26/09 11:28:19 AM

 Back Owner’s Maintenance Guide
• Exercise daily to build strong, supportive
muscles. Walking and swimming are
great ways to strengthen muscles.
• Think before you lift. Always lift with
your legs, not with your back. Do this by
squatting and bending your knees. Hold
the object close to your body when lifting.
And ask for help with heavy loads!
• Maintain your back’s natural curves by
practicing proper posture.
• Avoid slouching or leaning forward while
sitting or driving.
• If you sit for long periods, take time to
get up and walk around. If you stand
a lot, place one foot up on a box or stool.
• Sleep on your back or side on a mattress
that supports your back’s natural curves.
• Relieve added back strain by losing
excess body weight.
• Quit smoking to reduce your risk of back
pain and injury.
• Always talk to your healthcare provider
about concerns you may have about the
health of your back.

Consultants:
James B. Reynolds, MD, Orthopaedic Surgery
John Ceglia, PT, ATC, Physical Therapy
With contributions by:
Amy J. Allen, DC
David F. Apple, Jr., MD, Orthopaedic Surgery
Leon I. Gilner, MD, FACS, Neurological Surgery
George B. Hamil, Jr., PT, Physical Therapy
Alan T. Hunstock, MD, FACS, Neurological Surgery Also available
Robert T. Tenny, MD, Neurological Surgery in Spanish

11836 0902

11836_FMECH.indd 16 1/26/09 11:28:21 AM