1. Keep feet and knees together and let legs drop down from side to side. Progress to doing

the same movement with the feet off the floor.

This mobilises the spine and strengthens the abdominal muscles.

2. Bend one knee on to chest and hold it with both hands; push the straight leg as flat as

possible on to the floor. Repeat with the other leg.

This mobilises hips and stretches the psoas muscles.

3. From the same position, lift buttocks as high as possible and then lower them. Repeat while

raising both arms above head at the same time; next lower yourself on to one hip only, then

raise yourself and rotate down on to the other hip.

4.Straighten one leg; make the straight leg longer and shorter by tilting the pelvis sideways

away from your waist and towards it. Keep the knee straight. Repeat with other leg.

Remember being comfortable during your floor exercises is important. If any of these exercises produce pain discuss alternative exercises with your therapist.

The next two exercises start while you are standing and involve a chair.

5 Stand with your toes about 30 to 45 centimetres in front of a firm chair. Put one foot up on

to the chair and lean forwards. You will feel the stretch in the front of the straight leg. Repeat

with the other leg. This stretches the psoas muscles.

6. This time, put your heel on to the chair and, keeping the knee straight, lean forwards,

letting the standing leg bend. Repeat with the other leg.

This stetches the hamstring.

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It would seem, therefore, that back pain sufferers of the future are more likely to be offered short shrift by doctors and employers alike. Harsh though this may seem, it has some backing from some advanced medical opinion.

Attitudes to pain-At the root of this search for medical help is said to be the psychological problem of the fear of pain. Attitudes to pain are highly subjective, and conditioned by each person’s individual psychology, which is the product of many different factors. Thus tolerance of pain varies enormously, and the identical kind of pain provokes widely different reactions.

A vigorous approach to back pain is seen in a new exercise method being developed in Denmark. It is designed to strengthen the back and shoulder muscles, which are said to grow weak because modern living causes them to be underused. Contrary to accepted notions, patients are advised to start the exercises while still suffering an acute attack of pain; but the exercises are claimed to be equally beneficial in cases of chronic pain. They are also said to have preventive value.

This new method received a lot of publicity a couple of years ago, and there was controversy over how safe it was as it had not undergone controlled trials. In general, if you are suffering from back pain you should not attempt vigorous exercise unless you have been carefully reassessed and investigated by your medical specialist and seen by a physiotherapist or other health professional, who can advise you as to the suitability for you of particular exercises, and can monitor their effect.

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Assisted or resisted exercises-Joints can become stiff if the muscles which move them are weak; by strengthening these, mobility can be increased. Since each joint movement involves the tensing of a set of muscles and the relaxation of the opposing set, assisted and resisted movement strengthens the muscle by working it in both directions of movement. Assisted movement is when you work your muscles but the therapist helps with the range and direction; resisted movement is when the therapist pushes against you doing the movement.

Proprioceptive neuromuscular facilitation (PNF)-PNF is a system of exercise which aims to obtain maximum muscle activity by using sensory and auditory stimuli to increase the response of the neuromuscular system. Resistance and stretch are also applied to groups of muscles. All muscles function most efficiently in groups – both ‘working together’ and ‘working against’ groups. In essence, the patient performs or tries to perform movements against the manual resistance offered by the therapist in certain spiral and diagonal patterns of movement. The movements contain elements of flexion (or extension) together with a rotatory component, and are closely related to normal functional movement. Maximum contraction of strong muscles is used to reinforce the effort of weaker muscles in the pattern. The specific placing of hands to apply pressure, the use of the voice to stimulate ‘push’ or ‘pull’, the stretching of muscles to initiate movement, are stimuli used to encourage movement. PNF procedures are normally done with the patient lying supine. It is hard work for therapist and patient.

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If you lie mostly on your back, you may find it most comfortable to support your legs, from the knees down, on a pile of cushions; or on a chair or a stool or footstool if you are sleeping on the floor. In this position, the back is kept from arching by being pressed firmly against the mattress (or floor).

If you have managed to find a comfortable position, the tendency is to stay put, but you should try to vary it from time to time, for the good of your circulation. Also, if you remain immobile because of back pain you may find yourself feeling stiff all over after a time. Changing position may call for some courage: do it slowly and gradually. Changing from a horizontal to a vertical position is what hurts most, so do not try to sit up. As for turning over in bed, you may find this easier to do if you bend your knees, bringing your heels up towards your buttocks, and, keeping your shoulder in line with your hips, let the knees fall to one side and use the weight of your legs to roll you over.

For getting out of bed, try this method: turn on your side, then edge over to the side of the bed, keeping your knees bent; then let your legs slide over the edge, acting as a counterweight as you push yourself upright with your arms. Have a chair at hand to lean on as you get to your feet.

In the end, you will probably work out for yourself, by painful trial and error, the method of getting out of bed that causes the least discomfort. Even so, try to limit the number of occasions of doing it, especially during the first day or so. Moderation in eating and drinking will limit the number of times you have to go to the toilet; and you may not have much appetite in any case. Avoid alcohol, which may interact with the pain-killing drugs you are taking; some people find that it makes the pain worse.

You may find yourself temporarily constipated, which may be the effect of taking some types of pain-killer, or of immobility, or fear of the pain that getting out of bed causes. This is a temporary problem, and there is no need to worry or do anything about it.

Keeping moving-At this stage you cannot do much in the way of exercise, but try to move your legs at regular intervals. The longer you remain immobile, the longer it will take you to recover your strength and mobility.

Even when you are suffering severe pain, and are frightened to move, there are bound to be some movements you can make without pain.

Start with these. Try wriggling your toes, bending and circling your ankles, working the feet up and down, bending and extending the knees. Do this for a few minutes, every hour or so. If any movement causes you pain, avoid it, and try to find another that does not. In between spells of leg movements, do some slow deep breathing.

A weight off your mind-It may not be easy for you to induce your tensed muscles to relax if at the same time you are brooding about the work and other obligations for which you are now temporarily disabled. A serene frame of mind may seem rather too much to expect from someone who is being racked by acute back pain, but relaxation involves both body and mind, so if you can find a way of relaxing your mental tension, the pain may affect you less.

The best thing to do is to accept the situation, and abandon, as much as possible, feelings of guilt about neglected work, missed appointments and so on. You are a victim of force majeure: the matter is out of your hands for the time being. You will have to ask someone to do some telephoning for you, cancelling engagements, and arranging for other people to stand in for you, at home and at work. Accept the need to rest and look after yourself for a few days. Do not be tempted to get up too soon. The more you can allow yourself to be philosophical about the situation, the more rapid is recovery likely to be. For a while the world will have to roll on its course without you. This advice is more easily given than followed.

But don’t become an invalid-Other people can affect your back pain. Some families enjoy making a fuss of an invalid and that may actually inhibit the natural desire to resume normal life. One danger with giving in to back pain for too long is the stiffness and weakness which ensue.

Supporters of the ‘pain confrontation’ school of thought argue that there is no evidence that activity is harmful and that, contrary to common belief, it does not necessarily even aggravate the pain as long as specific activities which increase the load on the spine are avoided. Increased activity may promote bone and muscle strength and may increase endorphin (a pain-reducing hormone) levels and reduce sensitivity to pain. They also claim that there is no evidence that early return to work increases the likelihood of future recurrences. These views are not universally accepted. Remember, seek professional advice. Know what is the cause of your backpain.

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Compression forces which are too powerful for the discs to absorb – for instance, the violent jolt of a leap from a height, as in a poor parachute landing – may cause a crush fracture of a vertebra: shattering the vertebral body or forcing it out of shape, or breaking off the transverse processes.

Spinal fractures are often, but not invariably, painful; they usually mend with rest. A crush fracture may displace part of a vertebra so as to produce a slight hump that can be seen and felt. Sometimes an X-ray discloses bone damage of which the owner of the spine was unaware, and which gave no trouble. However, the most serious fractures, those that damage the spinal cord, can cause paralysis below the site of the injury.

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