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Exercises to help prevent back pain

Weak muscles are often at the root of back pain, especially lower back pain. The muscles of the back, the abdomen, and the buttocks all support the spine - these muscles are called the core muscles. Muscles are the spine's main defence against gravity. Strengthening the muscles that support the spine with exercises, can prevent, reduce and even eliminate back pain. Strong abdominal muscles (especially the deep abs) are as crucial as strong back muscles for supporting the lower back and preventing lower back pain. Strong

quadriceps (front of thigh muscles) is important to prevent back injuries when lifting. Proper lifting techniques involve using your legs and if your legs are weak, you may end up using your back. Shortened muscles can throw the spine out of alignment and cause back pain. Stretching exercises lengthen shortened muscles and relieve back pain. Tight back muscles, tight buttocks muscles, and even tight hamstrings (back of thigh muscles) or quadriceps (front of thigh muscles), can affect the alignment of the spine. Stretching the back with stretching exercises also increases mobility of the joints of the spine. Strong and flexible muscles help maintain Proper Posture and prevent Back Strain. Stretching exercises may be done daily. Strengthening exercises should be done three or four times per week - the days off give your body a chance to recover. It may take 6 week to 8 weeks to notice results. To prevent back pain, keep your back fit by doing the following exercises. (Start with five repetitions of each exercise. If you can handle five repetitions without post exercise pain, then slowly add a couple of repetitions each week until you reach 15 repetitions). If you are experiencing back pain or suffer from a back condition, ask your osteopath which exercises are appropriate for you to do.

Back Stretching Exercises Warm-up Exercise before Stretching Exercises Always warm up before stretching exercises. Five minutes of walking, or exercise bike, elliptical trainer, or even marching on the spot is enough. Not warming up before stretching leaves your back susceptible to injuries causing back pain. Warm muscles are more flexible than cold muscles and are less likely to tear. Check with your osteopath before doing exercises that involve twisting or arching the back if you have a back condition. Pelvic Tilt: lower back stretching exercise (also strengthens abs) Lie on back, knees bent, feet flat on floor. Tighten buttocks and abdomen,

flattening small of back against the floor. Hold for a count of five. Slowly relax. Repeat five - fifteen times. Knee to Chest: Gluteal stretching exercise Lie on back, knees bent, feet flat on floor. Grasp left leg behind the knee/back of thigh and pull knee towards left shoulder. Hold for a count of five. Switch sides. Repeat 5 times. Piriformis Stretch: (Stretches Muscles that lie beneath gluteal muscles) Sit on chair Place your left ankle over your right leg, just above the knee and lean forward. Hold for 30 seconds. Repeat on other side. Basic Twist: lower back stretching exercise. Lie on back, arms stretched out to the sides. Bend knees and bring knees up close to your chest Take a deep breath Exhale as you slowly lower knees (keep knees together) to floor to the right or as close to the floor as is comfortable. Pause. Inhale as you slowly return your knees to chest. Exhale as you slowly lower knees to left side Inhale as you return your knees to chest. Repeat about 5 times. The Cat: back stretching exercise Begin on all fours, hands directly under your shoulders and knees directly under your hips. Inhale as you drop tummy towards the floor and look up over your head. Exhale as you bring your tummy back up, rounding your back as you tuck your chin in and tuck your tailbone in. Move slowly back and forth between these two positions pausing on each pose.

Repeat about 5 times. The Cobra: back and chest stretching exercise Lay flat on stomach, forehead to ground, with arms bent and palms down on the ground under the shoulders. Push downward with arms as you raise your upper torso and arch your back. Hold for 3 full breaths before slowly bringing the upper torso back down to the ground. Shoulder, Back, Arms Stretch: Stand with knees slightly bent. Interlace fingers, extend arms forward at shoulder level. Turn palms out and reach your arms further until you feel a stretch. Hold 10 20 seconds. Repeat. Chest Stretch: Stand with knees slightly bent. Hands behind the back, fingers interlaced. Turn palms up extend arms backward. Do not arch the back. Hold 10 - 20 seconds. Sides, Waist Stretch: Stand with knees slightly flexed. (Can also be done sitting down) Place your right hand behind your head. Grab your right elbow with your left hand and pull gently. Bend slowly to the left until you feel a gentle stretch. Hold 10 - 20 seconds. Switch sides. Repeat. Shortened hamstrings can contribute to sway back. Hamstring (back of thigh) Stretch: Sitting on floor, extend right leg, place left foot against right knee. Lean forward (keeping back straight), reaching for foot until you feel a slight pull on you hamstring. Hold for 10 - 20 seconds. Switch sides. Repeat Hamstring (back of thigh) Stretch: Lying flat on back. Raise left leg up. Grab leg and pull up further until you feel a gentle pull in the hamstring Hold for 10 - 20 seconds. Switch sides. Repeat.

Shortened quadriceps can contribute to sway back. Quadriceps (front of thigh) Stretch: Stand up. Bend your knee behind you, grab your ankle and gently pull your heel toward you buttocks until you feel a gentle pull on the front of your thigh. Hold for 10 - 20 seconds. Switch sides. Repeat. Wall Back Stretch: back / neck stretching exercise Stand up with your back against the wall. Try to press the small of your back and the back of your neck toward the wall. Hold for 10 - 30 seconds. Do not overstretch! Neck Roll: To loosen up the neck, where many people carry their stress: Stand or sit up straight with the bottom of your spine turned under. (Do not arch your back) Let your head fall forward, keeping the neck and shoulders relaxed. Slowly roll your head to one side, then let it drop and roll to the other side. Be careful not to overstretch. Do not roll the neck backwards. Stretching using an Inversion Table Inversion therapy has been around for a couple of thousand years. Your feet are securely supported as your body hangs upside down - and the spine is stretched by the weight of your body. Back Strengthening Exercises Many people tend to overdo it when starting strengthening exercises for the back, resulting in back strain. Back pain caused by doing too much too soon sets one back even farther. But the ultimate goal is to be able to do the back strengthening exercises. Strengthening the back can't be rushed. It takes patience but it well worth the effort. Warm-up Exercise before Back Exercises: Be sure to warm up before doing back exercises with five minutes of walking, or using an exercise bike or elliptical trainer,

or even marching on the spot. Warm-up exercises prepare your back for strength exercises or stretching exercises by increasing circulation to the muscles. Activate the Abs First. To activate your deep abdominal muscles, cough once (or pull in and tense your stomach). Hold this contraction during the following exercises to give the deep abs and other core muscles a simultaneous workout. Do not overdo the abdominal tensing. It should not be difficult. Do not hold your breath. This is what "tighten abs" in the following exercises refers to. The Bridge: Strengthens several core muscle groups - buttocks, abs, back Lie flat on back; bend knees at 90-degree angle, feet flat on floor. Tighten abs. Raise buttocks off floor, keeping abs tight. Shoulder to knees should be in straight line. Hold for a count of five. Slowly lower buttocks to floor. Repeat five times. The Plank: Strengthening exercise for back, abs and neck (also strengthens arms and legs) Lay on stomach, place elbows and forearms on floor. In a push-up position, balance on your toes and elbows. Keep your back straight and legs straight. (Like a plank) Tighten abs. Hold position for 10 seconds. Relax. Repeat five to ten times. If this exercise is too difficult, use balance on your knees instead of your toes. The Side Plank: Strengthens the obliques (side abdominal muscles) Lie on right side. Place right elbow and forearm on floor. Tighten abs. Push up until shoulder is over elbow. Keep your body in a straight line – feet, knees, hips, shoulders, head aligned. Only forearm and side of right foot are on floor (feet are stacked). Hold position for 10 seconds. Relax. Repeat five to ten times. Repeat on left side. If this exercise is too difficult, balance on stacked knees (bend knees and keep feet off floor) instead of feet. The Wall Squat: Strengthening exercise for back, hips and quads. Stand with your back against a wall, heels about 18 inches from the wall, feet

shoulder-width apart. Tighten abs. Slide slowly down the wall into a crouch with knees bent to about 90 degrees. If this is too difficult, bend knees to 45 degrees and gradually build up from there. Count to five and slide back up the wall. Repeat 5 times. Leg and arm raises: Strengthening exercise for back and hip muscles. Lie on stomach, arms reached out past your head with palms and forehead on floor. Tighten abs. Lift one arm (as you raise your head and shoulders) and the opposite leg at the same time, stretching them away from each other. Hold for 10 - 20 seconds. Switch sides. Leg lifts: Quad Strengthening Exercise Lie flat on back. Bend left knee at 90-degree angle, keeping foot flat on floor. Tighten abs. Keeping the right leg straight, slowly lift it to the height of the left knee. Hold for a count of 3. Repeat 10 times. Switch sides. Safety Tip for Leg lifts: lifting both legs at the same time causes excessive stress on your lower back so only lift one leg at a time; the opposite leg should be kept slightly bent with foot on floor. Basic Crunches: upper abdominal exercise Lie on back, knees bent. Do not anchor feet. (Anchoring the feet or keeping the legs straight along the floor can strain the lower back). Arms may be folded over chest or kept at sides or hands can be held beside ears with elbows out. Tighten abs. Keep the lower back flat on the floor and neck straight. Keep chin tucked - looking at ceiling helps prevent tilting head up or down. Exhale when raising your torso off the floor and inhale when lowering. Just raise your head and shoulder off the floor three to six inches is enough. Sitting up all the way is hard on your lower back. Do ten repetitions. Neck muscles may tire out before the abs. You can use your hands to help support your neck - but be very careful not to pull on your neck or you could overstretch a neck muscle. Keep elbows out to the side to help avoid pulling neck forward. Don't start out doing too many crunches - the number of crunches performed should be increased slowly. Move slowly when performing crunches- do

not rely on momentum. Rotational Crunch: obliques exercise (sides of the abdomen) Rotational crunch is a slight variation of the regular crunch. (The variation - the direction you raise your head and shoulders off floor is diagonal). Lie flat on back, knees bent, feet flat on floor. Do not anchor feet. Tighten abs. Keep the lower back flat on the floor and neck straight. Rotate your body so that the weight rests on left shoulder. Then, keeping chin tucked, bring your head and shoulders upward and raise your right shoulder higher than the left. Move slowly. Reverse Crunch: lower abdominal exercise Lie flat on back, feet in the air. Bend knees 90 degrees. Place hands under buttocks for support and make sure your lower back remains flat on the floor. Tightening your lower abdomen, lift your buttocks a few inches off your hands. Hold for a moment and lower back down. Do 5 to 15 repetitions. Leg Lifts: lower abdominal exercise Lie flat on back. Bend left knee at 90-degree angle, keeping foot flat on floor. Tighten abs. Keep right leg straight, and slowly lift to about 45 degrees. Pause. Slowly lower leg to floor. Repeat 10 times. Switch sides. Backward Leg Swing: Gluteal exercise (The muscles of the buttocks help support the spine) Stand, holding onto the back of a chair for support. Tighten abs. Swing leg back at a diagonal until you feel your buttocks tighten. Tense muscles as much as you can and swing leg back a couple more inches. Return leg to floor. Repeat 10 times. Switch sides.

Balancing Exercises Balancing exercises also help to strengthen the core muscles (back. abs, and buttocks), which are used in balancing. Doing a variety of exercises will ensure you

target different muscle groups. Opposite Arm and Leg Extension: balancing / stabilization exercise: Strengthens muscles running down sides of spine, back of shoulders, and buttocks Begin on all fours, hands directly under your shoulders and knees directly under your hips. Keep the back flat. Keep buttocks and abdomen tight. Lift one arm up and forward that it is parallel to your back. Keeping the arm extended, lift the opposite leg in the same manner. Keep your face down, head aligned with spine. Keep arm, spine, and leg aligned as if they are forming a flat tabletop. Balance yourself for a count of ten, relax, switch sides and repeat. Remember to breathe. Do a couple repetitions.

Exercising Using an Exercise Ball Exercising with or without equipment is effective, but the exercise ball is often used by physical therapists. Also called the Stability Ball because you have to stabilize or balance yourself on the ball. Stability ball exercises are great for strengthening the back and abs as these core muscles are activated by the act of balancing. Pick an exercise ball where your legs are parallel to the floor when sitting on it. Exercise balls are over inflated balls. The softer the exercise ball, the easier it is to balance on it. The further the ball is from your body, the harder the exercise. When doing exercises using an exercise ball, keep the abdomen tight. Doing exercises with an exercise ball activates the muscles than run up and down the spine, and other deep core muscles. Stabilization Exercises Using An Exercise Ball The following stabilization exercises are performed while sitting on the exercise ball: Feet flat on floor with hips and knees bent at a 90-degree angle. Tighten abs. Keep back straight. Raise and lower one heel at a time. Raise and lower one foot at a time a couple of inches off the floor as if marching. Raise and lower arm, alternating sides.

Raise and lower arm while lifting opposite heel off floor. The following stabilisation exercises are performed while lying on the exercise ball: Lie with stomach over ball. Place hands flat on floor. Tighten your abdomen and keep your back straight. Place hands flat on floor. Walk on hands away from ball until ball is under legs. Walk back to starting position. Place hands flat on floor. Walk on hands away from ball until ball is under legs. Slowly raise and lower alternating arms. Place hands flat on floor. Walk on hands away from ball until ball is under legs slowly perform push-ups.

Low Impact Aerobic Exercise Doing low-impact aerobics is a relatively safe way for persons with recurring back pain to begin strengthening their back and abdominal muscles. For those with weak back or abdominal muscles, strength must be built up gradually to avoid re-injury and more back pain. Aerobic exercise also helps keep weight down, which relieves back pain, especially lower back pain. Aerobic activities also help relieve muscle tension and back pain by relieving stress. Low-impact aerobics tone the muscles that support the back without causing undue strain on the back. Besides strengthening muscles, low impact aerobics increase circulation, which aids in healing and improves the health of the intervertebral discs. Low impact aerobics include: swimming, walking, using a stationary exercise bike or an elliptical trainer. High-impact aerobics (where both feet leave the ground at the same time) such as jumping rope or running puts undue stress on your back. When your feet hit the ground extra stress is placed on the intervertebral discs and joints of the spine. If you suffer from lower back pain, or want to prevent back pain, stick to low-impact activities. Water exercise is especially beneficial for those with back pain caused by osteoarthritis of the spine or disc problems. The buoyancy of the water supports

the majority of the body weight, taking pressure off the joints and intervertebral discs. The resistant properties of water make the muscles work harder to perform movements such as walking, marching, or other water exercises. You can strengthen the muscles that support the back without stressing the joints and discs. The pressure the water exerts on the body prevents an injured joint from further inflammation and post exercise back pain. Always warm up for at least 5 minutes with of walking or performing the same activity as you are about to do but at a slower pace. This slowly increases your heart rate, breath rate and body temperature to allow your body to adjust to the higher demands of aerobic exercise. Cooling off in the same way for another 5 minutes allows your body to adjust to its resting state and prevents blood from pooling in your extremities. 5 minutes of walking can help flush waste products from the muscles and prevent post exercise soreness. Tip: Wear proper footwear. Wearing footwear with adequate cushioning and support help absorb shock and decrease the risk of back pain. Tip: Stay Hydrated. Drink plenty of water before, during and after aerobic activity to replace water lost by perspiration. Dehydration can cause muscle aches - plenty of water is needed to help the body flush out the acidic waste products that can build up in the muscles during exercise. Keeping fit with an exercise plan that includes back stretching and strengthening exercises is very effective for the prevention of recurring back pain. Exercises for all the muscles that support the back, especially the abs, are also important. Increase the duration of back exercises gradually to avoid overuse injuries. It may take a couple of months, but if you stick with it, you will see results. Check with your osteopath before doing back exercises if you have a back condition or other medical condition.

Post-Injury Exercise

When back pain is caused by an injury, maintaining day-to-day activities is usually recommended. BED REST FOR A COUPLE OF DAYS ONLY: Muscles go into spasms at the site of an acute injury (triggered by inflammation). Muscle spasms restrict movement to protect the body from further injury. Muscle spasms may cause intense pain. For the first couple of days after an acute back injury, lying on a firm surface may be helpful in relieving muscle spasms and pain. After a couple of days, bed rest is counterproductive. Prolonged bed rest weakens the back and delays healing. For the majority of people experiencing back pain from an injury, maintaining normal activity speeds up recovery. Maintaining normal activity is better than either bed rest or getting into an exercise program too quickly. In the case of an acute back injury, back exercises (except for gentle stretching exercises) are best started after the majority of back pain has resolved. It is important to maintain day-to-day activities, as bed rest will not speed up recovery and prolonged bed rest causes wasting of the muscles. Weakened muscles make recovery more difficult. If you are suffering from severe back pain caused by an acute injury, a couple days of bed rest may be necessary until inflammation and muscle spasms have subsided, but get up and get moving as soon as possible. Increase activity slowly. Try to get up and walk around the house a little. Do a little more every day. The muscles that support the back are activated during almost any activity - even while simply sitting or standing the core muscles support the weight of the body - so maintaining daily activities will maintain the muscles that support the back. Walking and swimming are low impact activities that can be started before the back pain has totally resolved, as recommended by your physician. Stay away from high impact activities until you have completely recovered from a back injury.

Start with gentle stretching exercises only. Stretching exercises for the back increase circulation to the muscles to speed healing, relieve tight muscles and back pain, and help increase mobility. A warm shower or bath before exercising will loosen up tight muscles and ease pain, making the exercises easier to do. Save the strengthening exercises until your back pain has gone or as recommended by your osteopath. Until back pain is gone (usually two weeks to two months for back muscle strain), avoid exercises that put pressure on the lower back, such as leg lifts done in a face down position. You don't want to restrain injured muscles and cause a flare up of back pain. If you are unsure as to what exercises are safe, a physical trainer can create a personalised exercise program for you to follow. Aqua-aerobics are particularly beneficial. Warm water increases circulation, speeds healing, relaxes tense muscles, and eases pain, which makes the exercises easier to perform. Many public pools offer Aqua-aerobics classes. When you have recovered from your back injury, begin strengthening exercises that target your core muscles. Strong back, abdominal, and buttocks muscles support the spine, take stress off the joints of the spine, are vital to good posture, and will reduce the chance of recurring back pain. Do strengthening exercises regularly to maintain strong muscles.

Posture Good Posture Habits Proper Posture Prevents Back Pain. Poor posture (sitting, standing, or lying down) makes the back more vulnerable to injuries and back pain; weak or shortened muscles contribute to poor posture. Fatigue also contributes to poor posture and back pain. Poor Posture and Back Pain When the spine is not in proper alignment the muscles, ligaments and spinal joints all are under extra stress. Muscle strain is the most common cause of back pain

due to poor posture. Discs can also suffer from poor posture. When the spine is in proper alignment, the cushioning, shock absorbing discs that are in between the vertebrae are not overly stressed and not as subject to injury. Lower back pain is the most common back pain caused by poor posture, as the lower back supports most of the weight of the body. However, poor posture can also cause upper back pain, especially in those who slouch. Neck pain is also common. Strong Muscles for Proper Posture Muscles support the spine. A weakness in any of the muscles that support the spine makes it difficult to maintain proper posture. Poor posture is a common cause of back pain due to muscle strain, especially lower back pain. Exercises that strengthen and stretch the muscles that support the spine help maintain proper posture. The back muscles, ligaments & discs are under extra stress when the spine is not in proper alignment. Strong muscles help keep the spine in proper alignment and prevent back pain. Strong muscles also prevent the spine from extending beyond its normal range of motion, which is essential to protecting the ligaments and disks from injury. Flexible Muscles for Proper Posture Tight, shortened muscles in the back or buttocks can throw the spine out of alignment and cause back pain. Stretching the back muscles is important for good posture, but other muscles, such as shortened hamstrings (muscles in back of thigh), can also affect spinal alignment. What is Good Posture? Many people remember being told 'Stand up straight' or 'Don't slouch' when they were children. Like 'eat your vegetables', this is still good advice. The spine, however, is not actually straight. The healthy spine curves inward at the neck, outward at the chest, and inward at the lower back. These two curves balance each other to ensure that the pull of gravity is evenly distributed. If the curves of the spine are increased or decreased the muscles, ligament and joints have to work harder to support the weight of the head and body. This leads to fatigue, strain and back pain.

When standing, the centre of the head, the shoulders, centre of the body, knees and feet should line up vertically.

Lower Back Posture Errors The positioning of the pelvis controls the curve of the lower back. The pelvis should be in a neutral position. If the pelvis tilts forward, sway back results (the natural inward curve of the lower back is increased). If the pelvis tilts backward, flattened back results (a decrease in the natural inward curve of the lower back). Control of the pelvis is key in keeping the lower spine in proper alignment and preventing lower back pain. Like the spine, the pelvis is supported by muscles of the back, and abdomen and buttocks and strengthening these muscles helps maintain good posture and prevent back pain. Sway Back When the pelvis tilts forward the lower back arches excessively - sway back. Sway back places extra stress on the ligaments of the spine and leads to back pain. Sway back is more common in a standing position than in a sitting position. Wearing high heels also causes the pelvis to tilt forward and contributes to sway back. Shortened muscles can also cause swayback. Stretching these muscles and maintaining the pelvis and spine in a neutral position can restore good posture and relieve back pain. Not only can shortened back muscles cause sway back and back pain, but shortened hamstrings (muscles at back of thighs) can contribute to sway back and back pain. There should be a slight inward curve to the lower back. To see if your back curves excessively (sway back), stand with your back against a wall, place your feet about 6 inches from the wall. Make sure you head and buttocks are against the wall. If your posture in correct, you will have no more than two inches between the small of your back and the wall. If it is over than this, you have sway back. If you have more than 2 inches between the wall and your neck, the muscles in the back of the neck and back need stretching. Don't be impatient. Lengthening the muscles through stretching exercises must be done gradually to avoid overstretching injuries. Overstretching muscles in the neck and back can result in intense neck and back pain and stiffness. Sleeping on your stomach shortens the

muscles in your back and encourages sway back. Sleeping on your side with the knees bent helps counteract a sway back and can relieve back pain. The pelvic tilt exercise is especially good for a sway back and can relieve lower back pain. The 'cat' is also beneficial, see above. Flattened Back There should be a slight forward curve to the lower back. Flat back is more likely to be a problem when sitting than when standing. If the pelvis is tilted too far backward, the lower back loses its natural curve, muscles and ligaments are stretched, causing lower back pain.

Upper Back Posture Error Rouded Shoulders If your shoulders are rounded you need to stretch the chest muscles and strengthen your upper back muscles. Rounded shoulders are usually the result of slouching. Prolonged slouching can strain the muscles between the shoulder blades, causing upper back pain. When slouching, the natural forward curve of the neck is also exaggerated, which can also result in neck pain. It is more common to slouch when sitting. Slouching is often caused by fatigue, especially when sitting in front of a computer. Slouching also compresses your diaphragm, when leads to shallow breathing. Proper posture allows proper breathing and sufficient oxygen intake. Getting enough oxygen helps to relax muscles and prevents stress from building up in the muscles, especially the muscles of the neck and back. Tense muscles are a common cause of back pain and neck pain.

Neck Posture Error Head Forward The back of ears should be in line with shoulders, chin parallel to floor. Being in a bent over position or slouching causes the head to be too far forward. When standing or sitting in an upright position the weight of your head (about 15 pounds) is

supported by your entire spine, which acts as a pillar for your head. Poor posture habits such as leaning forward puts the burden of supporting the head on the muscles in the neck. This causes muscle strain and pain in the neck and can even cause headaches. Once the neck muscles are strained, leaning your head over for even very short periods of times can cause neck pain. Proper posture allows strained neck and back muscles to heal more quickly. The head is heavy and the muscles of the neck take the entire load when your head is forward, creating neck pain. Proper Posture While Sitting Many people spend much of their workday sitting. Proper posture while sitting is vital for preventing back pain. Even when maintaining good posture, sitting for prolonged periods of times can tire the back muscles. Take frequent breaks from sitting; take a short walk every half hour to hour, as the human body was not designed to stay in one position for long periods of time. Also, the discs are under more pressure when sitting than while standing. Having a chair that reclines slightly shifts you weight onto the backrest of the chair; this allows your back muscles to relax, and takes some of the pressure off of the discs. Adjustable Chairs With Good Back Support Prevents Back Pain. The pelvis should be in a neutral position. Certain chairs cause the pelvis to tilt backward, decreasing the curve of the lower back (flattened back), which places extra stress on the lower back and causes back pain. If you don't have access to a chair with a good back support, place a small pillow in the small of the back to correct the curve. Some people try too hard to sit up straight and actually end up tilting their pelvis forward and arching their back. This increase in the curve of the lower back (sway back) also strains the lower back and causes back pain. When sitting in a chair, the feet should be supported. If the seat is too high for the feet to reach the floor, use a platform to rest your feet on. The knees should be level with or slightly higher than the hips. Besides lower back pain, neck pain is common when good posture is not

maintained while sitting. Make sure your computer monitor isn't too high of low. You shouldn't have to tilt your head up or lean forward to see the screen. We often extend our neck to look at a computer screen, sometimes because it is too far away, sometimes out of habit. Looking upward or looking downward or sideways (which is common practice when viewing a document upon a desk) puts excessive strain on the neck and upper back and causes neck and back pain. The arms should hang at your sides. If your computer keyboard is too high or too far away the arms have to be kept raised or extended, resulting in tense shoulder and upper back muscles and back pain. The top of the computer screen should be just below eye level. When reading, place the material on an angle; don't place the reading material flat on a desk or your lap. Leaning your head over for prolonged periods of time is brutal on your neck muscles. Proper Posture While Lying Down Supporting the spine in its natural alignment while sleeping is important to let the back muscles fully relax and to avoid overextending the muscles, ligaments and spinal joints. A supportive and comfortable mattress is important and using a pillow (between the knees for side sleepers, under the knees for back sleepers, or under the hips for stomach sleepers) can also help take stress of the spine. Lying on side with knees bent - pillow between knees for support: Lying on your side with the knees bent helps counteract a sway back and can relieve back pain. Using a pillow between the knees helps prevent twisting of the spine. Lying on back with knees bent - pillow under knees for support: Lying on the back with straight legs can cause low back pain. If you prefer to sleep on your back, bend your knees slightly and place a pillow under them for support. Lying on your stomach - pillow under the hips: Lying on your stomach increases the curve of the lower back, leads to shortening of the muscles in your lower back and encourages sway back. If you absolutely must sleep on your stomach, place a pillow under your hips to help support the lower back. However, sleeping on the stomach also can strain the neck and is generally

not advisable. Neck support: The pillow supports the neck by filling the space between the head and shoulders. The pillow should not force your head upward or allow it to fall downward, but should keep it in a neutral position. The pillow should also feel comfortable. People who sleep on their stomachs only need a very low pillow. The Role of the Mattress A good mattress will conform to the spine's natural curves and keep the spine in proper alignment. When lying on a saggy or too soft mattress, the spine is thrown out of alignment. An overly soft mattress allows the lower back to sink too far into the mattress, which can irritate the spinal joints and result in lower back pain upon awakening. Back muscles also become strained as they attempt to keep the spine in proper alignment. If the mattress is too firm there will be gaps between the inward curves of the body and the mattress that leave parts of the back unsupported. Pressure points will be created on the parts on the body that has contact with the mattress, as there is less area to distribute the weight of the body. The solution is to get a relatively firm mattress with enough cushioning for comfort. (There must be enough cushioning to distribute the weight of the body and eliminate pressure points) If you already own a bed that is overly firm, adding a good quality foam topper may be enough. A mattress wears out gradually - springs and foam gradually lose their ability to recover height - resulting in a gradual loss of support and comfort. Sleeping on a new mattress may improve sleep and reduce back pain and stiffness. Keeping the spine in proper alignment while standing, sitting and lying down can relieve or prevent back pain. Tip: Change Positions Frequently for Back Pain Prevention and Relief. Holding any position for too long can also tire out the back muscles and cause back strain and back pain. Holding a position in which the spine is out of alignment makes the back even more vulnerable to back pain. Changing positions frequently will avoid using

the same muscle group for too long.