bharat low back

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Strengthening Low Back Pain

ExerciseYoga improves

Range of Motion, Mobility, Strength

results in pain reductionAs well as gives

ease to sore stiff muscles



Pathophysiology of back pain

� Pathology, broadly speaking, is the "study of thenature and cause of disease´ or the results of disease in the body.

� Physiology is the study of normal, healthy bodilyfunction (as opposed to anatomy, which is thestudy of normal structure).± When something disrupts normal physiological

processes, it enters the realm of pathophysiology.

� Pathophysiology looks at the detailedmalfunctioning that comes from or - alternately -causes disease.



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 thetwo pelvic bones.



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 ringhas 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 hollowtube that surrounds the spinal cord and nerves.

± The laminae provide a protective roof over these nerve tissues.





Anatomy of Lower back

� The facet joints are located on the back of the spinal column. There are twofacet 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 thespine. Where these knobs meet, they form a joint that connects the twovertebrae. 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, withoutfriction.

� 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.



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



Cause of Back pain

� Ruptur ed DiscA ruptured intervertebral disc, also called a herniateddisc, is another common cause of back pain. How totreat the back pain from a herniated disc depends on the

particular individual and situation.� Discogenic Back Pain

Discogenic back pain is the result of damage to theintervertabral disc, but without disc herniation. Diagnosisof 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



Cause of Back pain

� Lumbar Muscle Strain

Muscle 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



Cause of Back pain

� Spinal StenosisAs we age, the spinal canal can becomeconstricted, due in part to arthritis and other

conditions. If the spinal canal becomes too tight,back pain can be the result.

� Lumbar Spine Ar thr itisArthritis most commonly affects joints such as

the knees and fingers. However, arthritis canaffect any joint in the body, including the smalljoints of the spine. Arthritis of the spine cancause back pain with movement.



Cause of Back pain

� Osteopor osisOsteoporosis can cause a number of orthopedicproblems and generalized discomfort. Back pain fromosteoporosis is most commonly related to compressionfractures of the vertebra. Osteoporosis causes weakbones and can lead to these fractures.

� SpondylolisthesisSpondylolisthesis causes back pain because adjacentvertebra become unstable and begin to "slip." The mostcommon cause of spondylolisthesis is due to

degenerative changes causing loss of the normalstabilizing structures of the spinal column. If the spinebecomes unstable enough, back pain can become aproblem.



Sign & Symptoms

� Have significant back pain lasting mor e than 3 weeks

� Have back pain that becomes wor se when you r est,or wakes you up at night

� Get numbness or weakness in legs while walking

� Low back pain extended down to leg

� Leg pain incr ease if you lift knee to your chest or bend over ± If so, there is a good chance a disc is irritating a nerve.

� Have per sistent bladder or bowel pr oblems



Back Pain Tr eatment

� 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





Safety : Yoga

� Always warm up before Yoga

� Yoga should not cause pain, mild discomfort isacceptable.

� Never bounce or havr jerky motion� Never lock joints arm/leg while doing yoga

� Do not compete

� Happy thought, smiley face, thus relax your bodyand cortex

� Do each stretch 3 to 5 times

� Hold stretch for 5 to 30 seconds



Yoga remedies: Three sessions

� Perform Yoga exercise in sequence :

± Warming up

± Yoga for back pain

± Relaxation

� Do no compromise with Warming up andRelaxation 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



Warming up

� Side Bending

� Backwar d Bending

� For war d Bending� Pector als Str etch

� Tr apezoids str etch

� Neck str etch� Arms and Legs



Warming up

� Leg Exercise

� Hips Exercise

� Lower back Twist� Back twist



Warming up

� Pelvic Tilt± Star ting 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 whilebreathing easily in and out. Hold for five seconds. Do not holdbreath.

� Pelvic Lift± Star ting 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 inthe previous exercise, then slowly lift your buttocks off the floor as far as possible without straining. Maintain this position for 5seconds. Lower your buttocks to the floor Do not hold breath.



Yoga Remedies

� Bellow postur e (Knee to Chest )± Star ting 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 theposition for 30 seconds. Switch legs and repeat.

� Bellow postur e (Knee to Chest ) followed by leg Raised up.± Lie on firm sur face. Knees bent and feet flat on the table. Flatten

your back to the floor by pulling your abdominal muscles up andin.Action:

± Br ing one knee towar d your chest. Hold this position

± Raise your leg keeping your knee str aight. Hold for ____ seconds.Slowly lower the leg to the floor . Repeat on the opposite leg.



Yoga Remedies

� Hip Rolling (8 var iation)

± Star ting 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.



Yoga Remedies

� Boat postur e (3 var iation)± Star ting 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 andslowly reach your elbows to your knees, curling your trunk. Keepneck muscles relaxed and breathe normally Return to thestarting position.

± With your hands behind your head, slowly curl your head to your chest and then your trunk. Relax, breathe and then slowly returnto the starting position.



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



Relaxation

� Bhamri (Buzzing bee) pranayam

� Relaxation



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.



Life style and other tools

� Sun bathe technique

� Message with sesame oil

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bharat low back