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Medical Edge Newspaper Column from Mayo Clinic
WHEN IT’S BEST TO WATCH YOUR BACK
DEAR MAYO CLINIC: I have had a ruptured disk and was given epidural injections to ease the pain. Can you tell me which stretches and exercises are now good or bad for me? I’ve heard that lunges and squats are bad for disk problems. — Tucson, Ariz.
ANSWER: No exercises (including stretches) are absolutely good or bad for dealing with a ruptured disk. The choice and timing of an exercise program depends on your condition, your age and the daily activities to which you aim to return.
Disks are “shock absorbers” or cushions between the vertebrae of the spine. They are made of a tough outer layer and a gel-like center. As we age, the center begins to dry out, which not only reduces its cushioning effect but can also contribute to its becoming displaced (that is, herniated or ruptured). If this disk material protrudes far enough, it may press on a nerve, causing pain in your back and leg as well as numbness, tingling and possibly weakness.
Though surgery might be indicated for the most serious cases, the vast majority of patients improve without it. Nonsurgical treatment has two components: pain control and restoration of function, in that order. The former is to provide relief in the here and now. The latter — consisting of exercises that address any deficiencies in your flexibility, strength, posture or body mechanics — is performed to prevent the problem from recurring.
Of course, it makes no sense to try to prevent future problems while your back is presently killing you. So it’s likely that your epidurals —injections of corticosteroids into the area around the spinal nerves — were given to reduce inflammation, provide pain relief and hasten recovery.
Oral pain relievers such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen (Advil, Motrin) are usually tried first. In your case, they may not have been enough.
Other options for pain-control treatment, typically administered by a physical therapist, may include cold or heat therapy, electrical stimulation, ultrasound, hydrotherapy and lumbar (lower-back) support. With adequate instruction, some of these options may be self-administered at home.
A physical therapist is also important in evaluating your current condition and developing an exercise program that makes you less likely to relapse in the future. For example, because tightness in certain muscle groups such as the hamstrings (along the back of the thigh) or hip flexor (which connects the hip to the spine) can cause or exacerbate back problems, stretches may be prescribed to loosen them up.
Coordinated strengthening exercises that target the back and abdominal muscles aim to achieve a normal, balanced-spine posture. This goal is analogous to two wires holding up a pole: We want strength in both so that the pole remains erect and stable. Similarly, for a balanced or “neutral” spine, we want neither too much arch nor too much forward leaning, both of which increase stress on the back.
We also aim for good body mechanics (healthful positioning of the body when in motion). Awareness of your posture when walking or running, how you get out of a car or how you hit a golf ball, for example, can help prevent back problems in general and herniated disks in particular.
A sound exercise program starts with simple movements and builds progressively toward the more complex motions of daily life at home, in the workplace and during recreation. So if you are a bowler, we would include lunges as an advanced part of your exercise program; and if you play catcher for a softball team or regularly do heavy lifting at work, we’d include squats.
— Steven J. Hust, PT, CSCS, Rehabilitation Services Supervisor, Mayo Clinic Family Medicine, Glendale, Ariz.
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
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Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2006 TRIBUNE MEDIA SERVICES, INC.
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