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                             BASIC BACK EXERCISES 
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       Everything have read in previous chapters of this tutorial has 
       led up to this chapter which might more aptly be titled 
       
                        DOING SOMETHING ABOUT BACKACHES 
       
       Before describing the basic exercise regimen, several paragraphs 
       to set a precautionary tone. 
       
       Always seek the advice of your physician before attempting ANY 
       exercise program aimed at relieving backaches. Why? 
       
       There are many reasons. People who have osteoporosis are 
       strongly advised by most physicians to AVOID back flexion 
       exercise movements. Likewise you may have a disc rupture, 
       damaged spinal cord or undiagnosed case of spina bifida. Simply 
       lying on an exercise mat or the living room carpet to "try a few 
       exercises" to see if the pain is reduced is unwise! From another 
       perspective, you may have a serious condition that warrants 
       professional medical attention and the following exercises may 
       provide temporary relief from pain which masks or hides a deeper 
       organic condition. 
       
       I do not mean to frighten you - the majority of back pain 
       sufferers, perhaps 85% or higher, need only exercise and 
       stretching movements. Statistics are on your side that exercise 
       will produce a personal "cure" for your backache. However, play 
       it safe and check with a doctor for clearance on the following 
       exercises which are commonly suggested by many orthopedic 
       surgeons and family physicians. 
       
       Having said that, we should talk about the "when and how" of 
       back exercises. 
       
       For most folks exercise in any form begins with the best of 
       intentions and then fades in both intensity and motivation as 
       the demands of a job, family and other interests begin to pile 
       up. Back pain exercises are different - once you start you MUST 
       stay at it or the pain will return. Back pain exercises are like 
       brushing your teeth: a lifelong commitment. 
       
       Remember that the spinal column is by design unstable and 
       largely held together by muscular effort especially in the lower 
       lumbar region. The muscles which stabilize the spine and back 
       quickly degenerate from lack of use. "Use it or lose it" is an 
       apt warning when it comes to back exercises. 

       These exercises should be done slowly and thoroughly without 
       rushing and for many people the best time to do them is early in 
       the morning just after rising and perhaps after a warm shower to 
       further relax and prepare back and abdominal muscles for a mild 
       workout. Upon arising in the morning, your body will feel rested 
       and your spine will be flexible and at its greatest length due 
       to 8 hours of rest in a prone position in the absence of gravity 
       compression effects. This is an optimum time for a spinal 
       exercise session. 
       
       Most of the exercises are done on the floor. A carpet or towel 
       is all you need. You need to relax and do each exercise 
       deliberately and slowly WITHOUT bouncing! Do NOT hold your 
       breath during any exercise! Light breathing or panting will keep 
       you from straining muscles as a workout proceeds. 
       
       If you have the time in the evening a light "mini-session" of 
       the same exercises prior to retiring adds a bit of extra spinal 
       flexibility, muscle tone and is an aid to restful sleep. 

       The printed back pain guide which accompanies this tutorial 
       illustrates in photographs and drawings many of these exercises 
       and is suggested if you are serious about relieving your back 
       pain. Registered users of this software receive this printed 
       guide which also includes other rsearch and comments. 

       Many back pain patients report surprising relief from pain 
       within the first week during which they have begun the 
       exercises. However it normally requires several weeks to fully 
       restore muscle tone to abdominal, and buttock and back muscles 
       which are weak. Evaluate results at the end of the third week 
       and draw your own conclusions. After a day or so of exercise 
       sessions, you may notice pain relief lasting for about 30 
       minutes to an hour. As time goes on and the workouts continue, 
       pain will usually diminish further. Of course, you must augment 
       these exercises with posture adjustments and other lifestyle 
       changes mentioned in earlier tutorials for the whole "system" to 
       have full effect. Go back and review the posture chapter of this 
       tutorial for tips to protect your back as the exercise routine 
       unfolds. 

       Let's begin... 

       Exercise one: Pelvic tilt. 

       The is the most basic and ESSENTIAL exercise to learn. Lie on 
       your back. Bend your knees and keep your feet flat on the floor. 
       Your knees should be about six to eight inches above the carpet 
       and in this position most back pain sufferers are quite 
       comfortable. Keep your knees bent. Tighten your stomach muscles 
       and squeeze your buttocks tightly together. You should notice 
       your lower back flatten against the carpet. More importantly you 
       should consciously notice that your lower pelvis tilts up. Take 
       small short breaths if necessary but DO NOT try to hold your 
       breath. Try to hold the pelvic tilt position. 
       
       Another way to describe this maneuver is to attempt to flatten 
       your back while you "thrust" your LOWER pelvis upward. The two 
       muscle groups to involve are buttocks and stomach. Relax and 
       repeat three to five times. Hold for the count of 5 to 15 
       seconds if possible on each "thrust". The "hold" is absolutely 
       essential to the process of strengthening the necessary muscle 
       groups. As you gain proficiency in this maneuver see if you can 
       repeat the same exercise standing (bend your knees slightly). 
       
       A further enhancement in the lying position is to see if you can 
       slightly raise your buttocks off the floor. As you stand and go 
       about your activities during the day, try to consciously tilt 
       your pelvis forward using the buttock and stomach muscles. This 
       is how the lumbar region is SUPPOSED to be supported in the 
       first place! 
       
       Here's another tip: remember in a previous chapter we talked 
       about putting a small stool under one foot if you have to stand 
       for long periods of time? Try this and then study how this 
       maneuver automatically encourages a pelvic tilt. The basic 
       pelvic tilt is the key to controlling lumbar (lower back) pain. 

       Exercise two: Hamstring stretch. 

       Lying on your back assume a pelvic tilt position with both knees 
       bent as in the previous exercise. Next bring ONE knee up and 
       finally straighten that leg towards the ceiling and finally 
       stretch your heel - point your heel - towards the ceiling. If 
       you cannot straighten out or point towards the ceiling - and 
       most folks initially cannot - take your time and try to at least 
       extend in that direction. You will feel a stretching and mild 
       pulling behind your knee as your hamstring wakes up. Hold for 
       the count of five then lower the leg. Switch to the other leg. 
       Repeat 5 to 10 times. 

       Exercise three: Knees to chest. 

       Start in the basic pelvic tilt position. Slowly and evenly pull 
       both bent knees to your chest - or as close to your chest as is 
       comfortable. Hold for the count of five then release and repeat 
       five additional times. Keep breathing slowly and gently - don't 
       strain. This exercise is EXTREMELY important. 

       Exercise four: abdominal crunch/sit-ups. 

       Go back to the pelvic tilt position. Gradually tilt and roll 
       your head and chest up and towards your knees. Try to touch your 
       knees with your hands but do NOT allow your back to become fully 
       erect in a sitting up position. Do not attempt a full sit-up 
       since this usually results in rapid bouncing up and down without 
       much real muscle effort. Concentrate on holding the "crunch" 
       position for a few seconds and then down. Repeat five times. The 
       purpose of this modified sit-up is to work on those abdominal 
       muscles. 

       Exercise five: Leg cross overs and trunk rotation. 

       Back to a pelvic tilt position. Extend your right leg flat on 
       the floor. Keep left leg bent slightly. Now lift your extended 
       right leg up and over the left leg and try to stretch it to the 
       left side as far as you can go but try to KEEP your upper and 
       middle back flat on the floor. As your pelvis lifts gradually 
       you will feel a twisting rotation and STRETCHING in your back. 
       Do not extend your leg too far, you just want a gradual rotation 
       you can hold for four or five seconds. Repeat with the other leg 
       extending in the opposite direction. As you limber up you may be 
       able to touch the extended leg to the floor. 

       Exercise six: Spinal twist. 

       A slightly stronger spinal twist than the last. Lay on back, 
       knees bent. Pelvic tilt position. Hands behind the head. Elbows 
       touching floor. Cross your bent right knee over the left bent 
       knee - pretend you are sitting cross-legged on a chair - and 
       then slowly let both legs drop to the side with a resulting 
       twisting motion to the spine. Try to keep upper back and torso 
       relatively flat on the floor as you twist the lower back. You 
       may not be able to let both knees touch the floor but you will 
       feel a stretching and twisting sensation which you should do 
       slowly. Hold for the count of five and then reverse the legs and 
       twist to the other side. 

       Exercise seven: Back arch. 

       Roll over on your stomach and get into a position as if you were 
       going to give a small child a pretend horseback ride. Your 
       weight rests on your two knees and two hands. Now arch your back 
       up like a cat as far as is comfortable and hold for the count of 
       five. Use stomach and buttock muscles to help. Then relax your 
       back and sag for a second like an old swayback horse. Repeat 
       five or six times. This will increase flexibility and continue 
       back muscle exercises. A very worthwhile exercise. 

       Exercise eight: trunk stretch while seated. 

       A good exercise to try in the morning but VERY good to USE 
       throughout the day during work. Sit near the edge of a chair. 
       Legs spread apart. Cross arms over chest. Make sure chair will 
       not slip or slide backwards and then tuck chin down and curl 
       your trunk downwards as if you are trying to touch your head to 
       the floor. Hold for the count of five and repeat five or six 
       times. Stretches the spinal column and muscles. 

       Exercise nine: rotational sit-up. 

       A tough but profitable exercise. Lying on floor on your back do 
       a pelvic tilt. As you begin a traditional sit-up/abdominal 
       crunch described previously, instead rotate to the right or left 
       side letting your weight rest on right or left shoulder. Raise 
       opposite shoulder off the ground. Curl head forward and hold. 
       This produces a twisting effect on the spine and works on 
       abdominals at the same time. A tough exercise but highly 
       recommended. 
       
       This tutorial is merely a starting point! For further 
       information on back care and back pain, be sure to register this 
       software ($25.00) which brings by prompt postal delivery a 
       printed, illustrated guide to back pain written by a physician 
       plus two software disks. From the main menu select "Print 
       Registration Form." Or from the DOS prompt type the command  
       ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO 
       Box 1506, Mercer Island, WA 98040. If you cannot print the order 
       form, send $25.00 to the above address and a short letter 
       requesting these materials. End of chapter. 
       
