Back to Basics for Moms-to-Be - A Sore Subject
By Andrea Braslavsky, WebMD Feature Archive

Exercise and Back Pain
By Chris Woolston for blueprint.bluecrossmn.com

Failed Back Surgery Syndrome: What it is and how to avoid it
By Peter F. Ullrich, Jr., M.D. (From Spine-Health.com)

Foot-Controlled Movement While Seated
Prepared by Kirsti Florenes Vandraas for HÅG

Healthy Seating in the Workplace
Prepared by Dr. Philip L. Witt for HÅG

Movement for the Seated Worker
Prepared by Dr. David J. Miller for HÅG


Sports and your spine

"Sleeping posture is also very important. What I have found is that subconsciously you are going to move into the position that is most comfortable for you anyway, but a lot of times a total body pillow that you can roll around on and hug is very effective in keeping you in a good posture throughout sleep," says Colliton.

The best sleep positions depend on the type of pain a woman is having. A good general rule of thumb is not to sleep flat on your back, as it may reduce blood flow to the baby. To avoid that position, Colliton recommends putting a pillow beneath one hip or raising the head of the bed a couple of inches.

All Sorts of Support: Friends and Hosiery

"We always encourage women to start using abdominal support when they start having back pain," says certified nurse-midwife Patricia A. Powell, CNM, MPH. "Certain undergarments, like elastic stockings that have reinforced spandex, help with the lower abdomen support. When you support the lower abdomen, that gives less pull to the back and back muscles."

"There can also be a psychological component to back pain," says Powell. "Women with less support tend to elicit more complaints about things. If you are alone, you tend to focus on [your pain] because there is no one there to share it or help you work through it. Anything can be exaggerated by isolation."

Women without a partner can look for support within her family and her community.
A partner or a support person can also help with household tasks that might aggravate back pain; this is especially true for women who already work at physically demanding jobs.

"Pregnancy itself is a challenge to the ... body; women can handle that, but if they have to work at lifting, stretching, reaching, and pulling, that can certainly add to some of the normal aches and pains of pregnancy," says Powell. "Even that can be tolerated if a woman has support, [so] I encourage support persons, fathers, anyone, to can help even with small tasks."

Relief can also come in the form of heat massages, regular massages, warm baths, warm water bottles, and/or acetaminophen, says Powell.

Both Powell and Colliton highly recommend gentle exercises that strengthen and stretch. One type of exercise that worked wonders for me was prenatal yoga class.
"If you get off you feet, if you lie down, if you stretch out, you are going to feel better," says yoga instructor Barbara Nardi, who teaches yoga at the Pierce Program in Atlanta. "Yoga works on keeping the abdominals and the back strong without stressing them. But probably the most important thing that yoga does is it just makes a woman take time to take care of herself."

Another alternative is chiropractic care.

"It's not contraindicated during pregnancy -- as long as it is in the right hands with someone who is aware of the ligament, hormonal, and biomechanical changes that occur during pregnancy," says Colliton. "The right person knows that there are some adjustments you don't want to make during pregnancy, and knows you well prior to your pregnancy."

Pain, Pain Go Away

If you expect your back pain to disappear after childbirth, you may have an unwelcome surprise in store. For many, the old pain doesn't clear up right away, and for some, new pain may develop in entirely different and unexpected places.
"This [area] hasn't been well studied," says Colliton. "Some studies say that the relaxin levels decrease to prepartum levels early on, and other studies say that they stay high, especially if you breastfeed. We do know that a lot of that ligament [overstretching] can stick around for up to eight months postpartum. So someone who had lumbar or sacroiliac pain could have it for up to eight months."

"It is really important for those women to get into a physical therapy program where they learn good biomechanics: how to lift and carry their baby, how to put their baby in the crib and take the baby out, and what exercises they can do while holding the baby," she adds.

Relaxin or no relaxin, it is important for all new moms to learn proper posture.
"Pain can also develop because you are not carrying the child right, or picking him up right, or only carrying the car seat with your left arm -- that's where working with a therapist is helpful," says Colliton. "They can watch you and say, 'This is a better way to do it.' "

Many of the pregnancy good-posture tips still apply, but there are also new tricks.
"You cannot pack everything and the kitchen sink in those baby bags, put it on one shoulder, then grab the baby and the toddler," says Powell. "You can't carry it all, so try to anticipate where you have to go what you need to take. It's also better to have something to push ... so you don't have to carry it."

Even new moms who have perfected the art of holding, nursing, bathing, and burping a baby while maintaining correct posture can also run into problems. Colliton says women should work to strengthen the neck muscles and those in between the shoulders.

"Strengthening and stabilizing those muscles is important, because those are the core of what we use for our upper extremities," she says.

Once again, yoga came to my rescue.

"Postpartum yoga is even more important, because your body has been through something incredible and you really need to get things back, and you have to start slowly," says Nardi. "You would start with the same types of poses that you did during pregnancy. The big difference is that you don't have a baby so you can do stronger abdominal poses and poses on your stomach."

Nardi says she sees many new moms with pain in the upper back. "It is very common -- especially if you are nursing, because your breasts are bigger and heavier and you are hunched over the baby all the time," she says. "Lying on the floor and doing arm movements is great [for] opening up and relaxing, instead of fighting gravity and having everything push down."

"The most wonderful thing about doing yoga, particularly postpartum yoga, is that it helps you keep your sanity. ... It helps you take care of yourself and gives you some peace, and connects you to others," she says.

Sanity, a moment of peace, and a connection to others -- those are things any new mom can use.

While anyone can suffer from back pain, people who get regular exercise have a distinct advantage over everyone else. The strength and flexibility that comes from exercising regularly offers powerful protection against strained or sprained muscles and ligaments, the number-one cause of back pain. Working out can also help improve posture and increase bone density -- that's enough to make even a stomach crunch sound appealing!

Exercise can work wonders, but it isn't a cure-all. If you're fighting through a sudden bout of pain, you probably can't speed relief by hitting the gym. Your doctor will probably encourage you to stay as active as you can, but any new exercise program should wait until your back starts to feel better. If back pain is a constant problem, there's no reason to wait. According to a recent report in the New England Journal of Medicine, exercise that strengthens the back muscles is one of the most effective remedies for chronic back pain.

While no single approach works for everyone, most successful exercise programs combine stretching and weight training with low-impact aerobic exercises such as swimming, walking, and riding a stationary bike. As reported by the Mayo Clinic, water workouts are an especially good choice for people with back pain. Swimming and water aerobics put virtually no strain on the back, and a good soak in warm water almost always feels good. In contrast, jarring activities that require a lot of twisting, stopping and starting -- like tennis or basketball -- might strain the back and bring on more pain.

For maximum protection against pain, you should also try special exercises that stretch and strengthen the muscles and ligaments that support the back. Your doctor or physical therapist can suggest workouts that match your ability and needs. According to the American Academy of Orthopaedic Surgeons, most people recovering from back problems should start by doing simple exercises and work up to three times a day, 10 to 30 minutes at a time.

The first round of exercises will be gentle and easy. For example, your doctor might recommend a heel slide: While lying on your back, slowly slide your foot toward you, bending and straightening your knee 10 times. Repeat with your other knee.
Another good exercise is to lie on your back while pointing and flexing your feet 10 times. Or you might try a stomach squeeze: Lie on your back with your knees bent and your hands on your stomach, as if you were about to do a sit-up. Tighten your stomach muscles while breathing out, and hold for five seconds. Relax and repeat 10 times.

Other easy sets could include standing with your weight on both feet, then slowly raising your heels up and down. (Hold onto the back of a chair for balance if necessary.) Finally, do a set of "wall squats" -- stand with your back leaning against a wall and move your feet outward until they're 12 includes in front of your body. Keeping your abs tight, slowly bend back knees 45 degrees, hold 5 seconds, and slowly return to an upright position.

As your back gets stronger, you'll be ready for more advanced exercises. Your doctor may suggest a knee to chest stretch: Lie on your back with both knees bent. Grab one leg just above the knee and bring the knee to your chest. Hold for 20 seconds, and repeat five times on each side.

You may also want to do straight leg raises: lying on your back with one leg bent and the other straight, tighten your abs and slowly lift one of your legs straight up about 6 to 12 inches and hold it there for 5 seconds. Lower is slowly.Eventually, you can move on to more advanced moves such as push-ups with an exercise ball under your knees.

As with any exercise program, it's always best to start slowly and work up gradually. Be sure to listen to your body: If your back starts complaining, stop! Exercise should feel make your back feel better, not worse.

Back to top

That the human body is meant to move rather than remain static is now generally accepted among manufacturers of workplace chairs. But there is much less of a consensus as to how that principle should be incorporated into chair design.
Some manufacturers stress so-called "correct sitting posture". Others focus only upon upper body movement, with the legs assumed to remain stationary. Both represent static approaches to chair design.

Virtually all body movement begins with the legs. The most obvious example, of course, is walking. Learning to walk can be a difficult process for a child, but once learned, walking is natural, easy and automatic. Most healthy individuals can walk comfortably for long periods of time.

The Scooter Paradox

Consider, on the other hand, an activity many of us enjoyed as children: riding a scooter. When we rode our scooters, one leg and foot remained stationary on the runner, while the other leg and food pushed the toy forward. But soon fatigue would set in and it became necessary to switch legs. Why? Because the stationary leg --not the pushing one --had grown tired.

Remaining motionless is something the human body does not endure well. Soldiers standing at attention during ceremonies must make frequent (albeit furtive) movements of their legs and torsos to avoid acute discomfort.

Most of us have at one time or another observed the attention-getting ploy of a real person posing as a "mannequin" in a department store window. It is fascinating to watch precisely because a completely motionless human body is so unnatural.

Movement Awake and Asleep

Body movement is important even while we sleep. We may be largely unaware of it, but the average person moves and changes position about forty times in a typical night. If for some reason we are unable to move, sleep becomes difficult if not impossible.
The key to body movement, whether while standing, sitting, or lying down, are our legs and feet. They project us forward when we walk or run, but they serve an additional and equally important, if less obvious role, which highlights the physiological necessity of movement.

An Auxiliary Heart

Heart Energy, which comes from the food we consume, along with the continuous supply of oxygen that every cell in our body requires, are provided by the blood flow. After passing through the lungs, oxygenated blood is pumped by the heart throughout the body via the arterial system. Deoxygenated blood then returns to the heart through our veins to renew the cycle.

But since most of the body's mass is below the heart, gravity works against the return process. Fortunately, our leg muscles are large and powerful and they surround the major veins. Movement and contraction of the foot and leg muscles act on these veins to facilitate the circulation of the blood back to the heart. The legs function, in effect, as an "auxiliary heart."

The discomfort that may be experienced when we remain motionless for an extended period is the result of poor circulation and insufficient nourishment (i.e., arterial blood) to our muscle cells.

Our feet and legs serve their circulation-enhancing role even when we are seated. Movement that begins with the feet puts pressure on the veins within the legs, and that, in turn, stimulates blood circulation.

It's obvious, then, that a workplace chair designed around the premise that the seated person's legs should remain static with his or her feet fixed and motionless on the floor is, at best, highly problematical. The end result will likely be fatigue, discomfort, and swelling of the legs.

Steering With the Feet

Happily, better designs are available. Well-designed workplace chairs encourage movement of the seated body that is natural and effortless. That movement begins with and is controlled by the feet. They "steer" the body's movement and the chair responds instantaneously and appropriately. Blood circulation is enhanced through this foot-controlled movement, and the user is able to work comfortably and efficiently throughout the day.

Cumulative trauma disorders -CTDs -are a major cause of health problems for workers, and a source of enormous costs for their employers. CTD refers to syndromes marked by discomfort, persistent pain, impairment or disability in joints, muscles, tendons, and other soft tissues, with or without physical manifestations. As the name suggests, CTDs develop over an extended period of time.

CTDs currently account for some 52% of occupational illnesses and injuries, and CTD complaints among office workers are increasing annually. About 47% of CTD cases involve lost workdays, with an average of 76.1 lost days per year per 100 employees.
Of all occupational injuries, 23.9% involve the back. Approximately 90% of Americans will suffer from a significant episode of back pain during their lifetimes, and 7% of those will become chronic back pain sufferers. The costs involved are enormous.
Direct medical costs associated with low back pain are approximately $20 billion annually, and some estimates of total money lost to back pain - direct and indirect costs, lost work time, effect of diminished productivity - are substantially higher per year. A nonsurgical back injury costs industry about $7,000; a surgical case about $100,000.

We customarily think of an on-the-job back injury as resulting from a worker lifting a heavy object, causing acute injury with immediate and intense pain. But as we've moved from the industrial age into the information age, with more and more employees spending their workdays seated, another culprit has emerged: the chair.

Indeed, improper seating may cause not only back pain, but also neck pain, eye strain, abdominal pain, leg pain, and repetitive motion injuries. And it works insidiously. Months, even years, may pass, with substantial medical expenditures incurred, before sitting posture is identified as the source of the problem.

We have been slow in identifying seating as a potential cause of CTDs, perhaps because sitting is ordinarily thought of as a way to relax. Yet 70% of the American work force now sits on the job. Most of those workers also sit on the way to work, during meals, and in the evening to watch television or read.

The root of the problem lies in a fact that seems counter-intuitive: the human body is not made to sit for extended periods of time. We are designed to be upright, walking, running and on the move. Sitting and static standing are detrimental to health.

How does sitting cause back pain? Its effects are multifaceted. Sitting in a typical slumped posture stretches the ligaments and muscles that extend the back, weakening them over time. The stretched position causes the back extensor muscles to become chronically active. This low-level activity can cause a decrease in circulation to the working muscles, resulting in pain and spasms.

These muscle pains and spasms may be exacerbated by stress. One of the most common responses to stress is muscle tension, especially in areas where the body is weakest. Because of sedentary life-styles, lower back muscles have become one of the weakest areas of the body.

Stress on muscles, tendons and ligaments is only part of the story. Sitting -- even correctly --places pressure on the invertebral discs. Sitting in a slumped position can greatly increase that pressure. Prolonged pressure can cause a bulge or herniation of the disk, with resultant back pain. Moreover, the slumped posture tends to push discs out of their normal alignment, leaving them in a vulnerable position for injury from acts as simple as bending over to pick up a pencil.

Such problems can be compounded by the attempt to make workstations as "efficient" as possible, i.e., designing them so that workers hardly have to move. It's a false notion of efficiency, one that results in workers being deprived of movement that is both natural and necessary for their bodies. And it causes those who get into poor sitting positions to simply stay there throughout the workday.

While poor seating can cause or aggravate CTD's, good seating can go a long way toward preventing them. A properly designed chair allows an employee to sit correctly while working efficiently at his or her workstation. Employees should be able to get close to their work while maintaining proper posture, and be able to alter their sitting positions during the workday. The chair should encourage them to move, not surround them and force them to be stationary.

What are the features to look for in a well-designed, ergonomic chair? There are two main ones. The first is flexibility. The chair should be suitable for many job tasks, and should handle the three main positions people assume while working in the seated position: tilted back, upright, and watch television or read.

The second key feature is adjustability. A well-designed chair should adjust to fit the needs of 95% of the population. To do so, it should have the following adjustments, all of which should be easy to reach and perform while sitting in the chair:

But beyond the nuts-and-bolts of selecting an ergonomically healthy chair, there are more general considerations.

Companies must learn to include workplace ergonomics as part of their long-term planning. Today's furniture purchase may have a profound effect on a company's work force health and productivity for years to come. If, in a few years, the company finds itself facing workers' compensation claims or diminished employee productivity measured in hundreds of thousands of dollars, today's savings of $50 to $100 per chair is of little value.

Equally important, ergonomics should be made an integral part of employee education and training. Employees must be taught to sit correctly and alter their postures frequently.

The process of selecting a chair for a workplace should not be, as it too often is, a decision to be made in a matter of minutes. A different perspective is needed. It may take as much as two weeks for the body to get used to a new way of sitting. Sitting posture is a habit, and habits are not easily changed. Employees should be allowed time to adjust.

Ergonomics is a bottom-line issue for any business. Good seating means a healthier and more productive work force. It's that simple.

Movement for the seated worker may seem like an oxymoron, which Webster defines as a combination of contradictory words such as jumbo shrimp, thunderous silence, or sweet sorrow. Is it odd to think of a worker who sits most of the day in the context of movement? Not if you consider the potential gains from movement, or physical activity. How, and why should office workers and others who sit for a living be active?

There are many good reasons to be physically active. The 1996 US Surgeon General Report documents very real benefits of a physically active lifestyle. These include increased longevity, reduced risks of cardiovascular disease and lower rates of several types of cancer. But are these benefits available to seated workers? The answer is yes! In fact a workplace can actually encourage physical activity. And certainly physical activity during leisure time is beneficial as well. But aside from the importance of an active lifestyle, there are special problems for people who sit much of the day at work. Therefore specific movements or activities need to be targeted to keep these problems from becoming significant
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Special concerns for the seated worker. There are three areas of concern associated with prolonged sitting, generally considered to be more than four hours per day. These areas are the spine, the circulation, and the muscle and joints.

The spine. Two problems of the spine are associated with prolonged sitting. First, sitting places a high load on the intervertebral disc, the moveable structure in between each of the bony vertebrae. It may seem curious that sitting creates a high load on the spine, since sitting is often viewed as a position of rest. But the pressure on the disc is actually highest in sitting, lower in standing, and lower still lying down. Staying seated for long periods keeps the disc in a 'high pressure' situation and over time sets the stage for degenerative, or 'wear and tear' changes. The second problem is that with the disc in a highly loaded state the flow of nutrients is inhibited. Most of the tissues in the body such as muscles and the brain have blood flowing to and from them to provide nutrients, and to remove the byproducts of their work. The disc, however, does not have blood flowing to and from it, so it must get its nourishment from the process of loading and unloading. This cycle is similar to the way a dirty sponge might get rinsed out, by repeatedly placing it in clear water, and then squeezing it out. Staying for long periods of time in a highly loaded posture (like sitting) is not good for the disc, but neither is staying in an unloaded posture (like lying down). The real health of the spine occurs with moderate repetition of the cycle of loading and unloading, provided that the loading is within reasonable limits.

Circulation. Prolonged sitting reduces the circulation of blood in the legs and feet. This reduction is the result of the combined effects of gravity, furniture, and a muscle pump that is usually turned off in sitting. These cumulative effects can cause pooling of the blood and a 4-5% increase in the volume of the legs and feet during a typical workday. This swelling of the legs and feet can be uncomfortable, and reduced blood flow can affect tissue health. It's hard to do anything about gravity, but there are other solutions!

Muscles and joints. With sitting, several parts of the body may become tight, either through muscle shortening (a loss of muscle strength) or joining tightness and contracture. Common areas of tightness for those who sit include the front of the hip, the front of the chest, and the back of the neck. The low back often loses its natural curve (or lordosis) when sitting, and as a consequence the back can become tight in a flattened-back posture. Wherever tightness occurs, it can limit movements needed for tasks and activities both in and outside of the workplace.

Targeted solutions. Movement is one of the answers for these problems! A key component to a successful ergonomic program is movement. For the spine, sitting during the workday already provides the loading part of a health cycle, so interventions for seated workers emphasize unloading. The unloading movement can be simple...regularly getting up out of the chair and standing or walking. Unloading the spine can also occur with leaning back into a well placed backrest, or by resting the arms on the chair armrest during down (non-work) periods.

For the areas of the body such as the front to the hips, specific movements can work to regain normal motion. Other stretches might work on the low back lordosis. In workers who do not have tightness, these stretches can prevent it from becoming a problem. Details of these and other 'exercises' can be found in a variety of books and videos available in the market today.

Improving circulation of the legs and feet of seated workers and preventing swelling requires active movement of the legs, ankles and feet. The contraction and relaxation of the muscles that occurs with even a simple exercise like foot circles provides a pumping action that assists with the return of blood to the heart. This activation of the muscle pump can occur either from a seated position or with moving in and out of the chair. The movements from a seated position are facilitated with a chair that is unlocked and that is designed to encourage movement.

Summary. Movement in the work place for the seated worker should attempt to minimize the adverse outcomes of sitting. But these movements alone cannot and should not be the single focus of a healthy work experience. Ideally there is a systematic ergonomic approach to the task at hand. This is often accomplished through a cooperative effort of workers, management and experts in industrial health and ergonomics. For a seated worker an ergonomic review might result in using a footrest, task seating (a chair) that is easily adjustable and moveable, appropriate placement of a keyboard, monitor or other tools of the trade, job rotation, a work/rest schedule that pays attention to overuse, and management and peer encouragement of movement including getting workers out of the seated position regularly. A height adjustable work surface can also allow easy movement to standing, creating productive time out of the seated position. In summary, the benefits of movement are enormous in an environment that attends to health, safety and productivity.

Two final thoughts. Even in the ideal work setting, if it exists, the individual worker needs to be responsible for actually performing the movements or stretch breaks. This requires education, motivation and active participation on the part of the seated worker. Secondly, a program of movement or physical activity should be reviewed with an appropriate health care provider before beginning if there is some medical risk.

With fair weather and the long days of summer upon us, more and more of us are taking part in outdoor activities. However, those of us with neck and back pain often fear the consequences of an enjoyable day out of doors. The thought of participating in our favorite activities -- and participating in sports in particular -- can raise anxieties about the pain and suffering that may follow such strenuous outdoor escapades.

Playing sports is one approach that many people choose to get the exercise that they need to keep their bodies strong and healthy. For people with back pain, sports can still be a viable option if they pay attention to their back. The trick lies in knowing how to perform your favorite sports properly and safely. When sports are enjoyed in a safe and comfortable manner, the end result is a satisfying workout session that has done more benefit than damage to your body – and your back!

Below is some information about how some of the summer’s most popular sports can affect your back and neck, as well as some guidelines on how to help avoid later pain while you exercise. By following these guides, you may be able to enjoy your favorite outdoor activities, without any additional stress or pain at the end of the day. Of course, if you have any concerns, be sure to consult your physician before participating in these sports. Also, please remember that there are professionals or instructors in almost every sport who are willing to share their expertise. They can teach you proper form for a new sport or help you keep the proper technique for a sport you already know.

Warmup

For every sport, a thorough warm-up should be completed before starting to play. The warm-up will be specific to the muscles used in that sport, but it should also prepare the back for the stresses to come.

Bicycling

Areas of Interest/Concern

Pain Prevention

Golf
Areas of Interest/Concern

Pain Prevention

Running

Areas of Interest/Concern

Pain Prevention

Swimming
Areas of Interest/Concern

Pain Prevention

Tennis
Areas of Interest/Concern

Pain Prevention

Answers at Healthy Back
Even with these great sports safety tips, you might occasionally experience pain after a jaunt outdoors. But you don’t have to let that pain linger! At Healthy Back, we feature a variety of different items that can help get rid of that activity-induced pain pronto. Visit your nearest Healthy Back store today and let our comfort consultants show you how our inversion tables, massage chairs, recliners and more can help relax that stressed back and have it feeling better in no time! Check out our E-News coupons page to find extra savings for our preferred Internet customers. Stop by Healthy Back today and feel better than ever before!