Strengthening Low Back Pain Exercise

1. Strengthening Low Back PainExercise Yoga improves Range of Motion, Mobility, Strength results in pain reduction As well as gives ease to sore stiff muscles

2. 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.

3. Anatomy of Lower spinal • The important parts of the lumbar spine include • 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.

4. 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.

6. Anatomy of Lower back • 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. • 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. • 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.

7. Low back pain • There are many causes of pain in the back. Symptoms in the low back can be a result of problems in • 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

8. Cause of Back pain • Ruptured DiscA 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 PainDiscogenic 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

9. Cause of Back pain • Lumbar Muscle StrainMuscle 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

10. Cause of Back pain • Spinal StenosisAs 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 ArthritisArthritis 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.

11. Cause of Back pain • OsteoporosisOsteoporosis 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. • SpondylolisthesisSpondylolisthesis 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.

12. 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

13. Back Pain Treatment • 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

14. 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

15. 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

16. 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

17. Warming up • Side Bending • Backward Bending • Forward Bending • Pectorals Stretch • Trapezoids stretch • Neck stretch • Arms and Legs

18. Warming up • Leg Exercise • Hips Exercise • Lower back Twist • Back twist

19. 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.

20. 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.

21. 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.

22. 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.

23. Yoga Remedies • Child pose & Cobra pose • TV pose • Baby cobra • Full cobra • Locust • Plank • Dog and Cat • Threading needle • Tail wagging & Neck wagging • Balancing box

24. Relaxation • Bhamri (Buzzing bee) pranayam • Relaxation

25. Diet recommendation • 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.

26. Life style and other tools • Sun bathe technique • Message with sesame oil