Back and Neck Pain

Your back includes the area from below your neck to your tailbone. It is composed of the bones of the spine (vertebrae); the joints that guide the direction of movement of the spine; the discs that separate the bones of the spine and absorb shock as you move; and the muscles and ligaments that hold them all together. One or more of these structures can be injured.

A spinal disc that bulges or ruptures can put pressure on a nerve, causing pain.

Overuse or a sudden or improper movement can result in strain or sprain of the spinal ligaments, the muscles in the back, or the sacroiliac joints (the joints between the spine and either side of the pelvis). You can damage your discs the same way so that they tear, stretch, or rupture.

First Aid for Back Pain When you first feel a catch or strain in your back, try these steps to avoid or reduce pain. These are the most important Home Treatments for the first few days of back pain.

First Aid #1: Ice As soon as possible, apply ice or a cold pack to your injured back (10 to 15 minutes every hour). Cold applied for the first 3 days limits swelling, reduces pain, and speeds healing. First Aid #2: Relax Lie flat on your stomach with your arms beside your body and your head to one side. If this causes more pain, try to find a more comfortable position. Relax for 1 to 2 minutes. First Aid #3: Pelvic tilts This exercise gently moves the spine and stretches the lower back. Lie on your back with knees bent and feet flat on the floor.

Slowly tighten your stomach muscles and press your lower back against the floor. Hold for 10 seconds (do not hold your breath). Slowly relax. First Aid #4: Walk Take a short walk (3 to 5 minutes) on a level surface (no slopes) every 3 hours. Walk only distances you can manage without pain, especially leg pain.

If the tear is large enough, the jelly-like material inside the disc may leak out and press against a nerve. The nerve may also become irritated due to swelling or inflammation in other parts of the back.

Any of these injuries can result in 2 or 3 days of acute pain and swelling in the injured tissue, followed by slow healing and a gradual reduction in pain. The pain may be felt in the low back, in the buttock, or down the leg (this type of pain is called sciatica). The goals of self-care are to relieve pain, promote healing, and avoid reinjury.

Back pain can also be caused by conditions that affect the bones and joints of the spine. Arthritis pain may be a steady ache, unlike the sharp, acute pain of strains, sprains, and disc injuries. If you think your back pain may be caused by arthritis, combine the self-care guidelines for back pain with those for arthritis on See Home Treatment.

Osteoporosis weakens the bones of the spine, which can lead to compression fractures. Compression fractures cause vertebrae to collapse. This can cause misalignment of the spine, which may put pressure on the discs and spinal nerves and lead to varying degrees of pain.

Regular exercise (stretching, strengthening, and aerobic exercise) helps you maintain your overall fitness and flexibility and strengthens the muscles that support your spine. Exercising also helps you maintain a healthy body weight, which reduces the load on your lower back. If you are interested in creating a personalized fitness plan, see Fitness.

Although there is no clear evidence that specific exercises can help prevent back pain, the exercises presented here are a common, practical approach to helping you maintain strength and flexibility. You may choose to make the exercises a part of your regular fitness routine. If you never do them until you experience back pain, they will help you feel that you are doing something positive to take charge of your body.

Do not do these exercises if you have just injured your back. Instead, see "First Aid for Back Pain" on See First Aid for Back Pain When you first feel a catch or strain in your back, try these steps to avoid or reduce pain. These are the most important Home Treatments for the first few days of back pain.

Extension exercises strengthen your lower back muscles and stretch the stomach muscles and ligaments. Flexion exercises stretch the lower back muscles and strengthen the stomach muscles.

• You do not need to do every exercise. Do the ones that help you the most.

• If any exercise causes increasing or continuing back pain, stop the exercise and try something else. Stop any exercise that causes the pain to radiate away from your spine into your buttocks or legs, either during or after the exercise.

• Start with 5 repetitions, 3 to 4 times a day, and gradually increase to 10 repetitions. Do all exercises slowly.

Press-Ups

Begin and end every set of exercises with a few press-ups.

• Lie face down with your arms bent, palms flat on the floor.

• Lift yourself up on your elbows, keeping the lower half of your body relaxed. If it's comfortable, press your chest forward.

  Press-ups

• Keep your hips pressed to the floor. Feel the stretch in your lower back.

• Lower your upper body to the floor. Repeat this exercise slowly.

  Shoulder Lifts

  Shoulder lifts will strengthen the back muscles that support the spine.

  • Lie face down with your arms beside your body.

  • Lift your shoulders straight up from the floor as high as you can without pain. Keep your chin down and your eyes facing the floor. Keep your torso and hips pressed to the floor.

  Shoulder lifts (keep neck straight and chin down)

Backward Bend

Practise the backward bend at least once a day and whenever you work in a bent-forward position.

• Stand upright with your feet slightly apart. Back up to a countertop for greater support and stability.

• Place your hands in the small of your back and gently bend backward. Keep your knees straight (not locked) and bend only at the waist. See illustration. Hold the backward stretch for 1 to 2 seconds.

  Backward bend (keep neck straight and chin down)

Curl-Ups

Curl-ups strengthen your abdominal muscles, which work with your back muscles to support your spine.

• Lie on your back with knees bent (60° angle) and feet flat on the floor, arms crossed on your chest. Do not hook your feet under anything.

• Slowly curl your head and shoulders up until your shoulder blades barely rise from the floor. Keep your lower back pressed to the floor. To avoid neck problems, remember to lift your shoulders, and do not force your head up or forward. Hold for 5 to 10 seconds (do not hold your breath), and then curl down very slowly.

  Curl-ups (keep neck straight and chin tucked in)

Knee-to-Chest Stretch

The knee-to-chest exercise stretches the lower back and hamstring muscles (in the back of the thigh) and relieves pressure on the joints where the vertebrae come together.

• Lie on your back with knees bent and feet close to your buttocks.

• Bring one knee to your chest, keeping the other foot flat on the floor (or the other leg straight, if that feels better on your lower back). Keep your lower back pressed to the floor. Hold for 5 to 10 seconds.

• Relax and lower your knee to the starting position. Repeat with the other leg.

  Knee-to-chest stretch

Many common exercises actually increase the risk of low back pain. Avoid the following:

• Straight-leg sit-ups.

• Bent-leg sit-ups when you have acute back pain. (These may be safe to do if you make sure to keep your lower back pressed against the floor.)

• Leg lifts (lifting both legs while lying on your back).

• Lifting heavy weights above the waist (military press, biceps curls while standing).

• Any stretching done while sitting with the legs in a V.

• Toe touches while standing.

Immediately after an injury and for the next few days, the most important Home Treatment includes the following:

• Follow the "First Aid for Back Pain" guidelines on See First Aid for Back Pain When you first feel a catch or strain in your back, try these steps to avoid or reduce pain. These are the most important Home Treatments for the first few days of back pain. Also see Home Treatment on page 114..

• Sit or lie in positions that are most comfortable and reduce your pain, especially any leg pain.

• Do not sit up in bed, and avoid soft couches and twisted positions. Avoid sitting for long periods of time. Follow the body mechanics guidelines discussed earlier.

• Bed rest can help relieve back pain but may not speed healing. Unless you have severe leg pain, 1 to 3 days of bed rest should relieve pain. More than 3 days of bed rest is not recommended and could actually delay healing.

For bed rest, try one of the following positions (see illustrations on Try placing pillows between or under your knees to relieve back pain while lying in bed.):

• Lie on your back with your knees bent and supported by large pillows, or lie on the floor with your legs on the seat of a sofa or chair.

• Lie on your side with your knees and hips bent and a pillow between your legs.

• If it doesn't increase your pain, lie on your stomach.

• Take aspirin or ibuprofen regularly as directed. Call your doctor if these medications cause stomach pain or make your stools look black. Acetaminophen may also be used. Take these medications sensibly; the maximum recommended dose will reduce the pain. Masking the pain completely might allow movement that could lead to reinjury.

• Relax your muscles. See Progressive Muscle Relaxation for progressive muscle relaxation.

After 2 to 3 days of Home Treatment:

• You can apply heat to your sore back 72 hours after injury occurs. Apply heat for 20-minute periods. Moist heat (hot packs, baths, showers) works better than dry heat.

• Some people find comfort in alternating between heat and ice packs, or using ice only.

• Continue daily walks (increase to 5 to 10 minutes, 3 to 4 times a day).

• Try swimming, which is good for your back. It may be painful immediately after a back injury, but lap swimming or kicking with swim fins often helps prevent back pain from recurring.

• When your pain has improved, begin easy exercises that do not increase your pain. One or 2 of the exercises described on See Exercise See Hip Flexor Stretch may be helpful. Start with 5 repetitions 3 to 4 times a day and increase to 10 repetitions as you are able.

After the initial first aid treatments, a physical therapist with training in orthopaedic treatment can:

• Identify specific muscle or disc problems.

• Provide other therapies, such as manual therapy, if you aren't improving.

• Develop a customized exercise program for your recovery and long-term protection.

Chiropractors and osteopaths can provide relief from some types of back pain through spinal manipulation. Spinal manipulation usually works best if you have had symptoms for fewer than 4 weeks. If your symptoms don't improve after 1 month of spinal manipulation treatment, stop the treatment and have your pain reevaluated.

Acupuncturists, massage therapists, and others can also provide treatments that may give short-term relief. For more information, See Complementary Medicine.

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