This Old Back; Marketing Master

She's the best. She's the best. She's the best. She's the best. She's the best. She's the best.

This program is made possible by annual financial support from viewers like you. For out of five of us are going to have a back problem if we haven't had it already. It is a major public health problem in this country. Other than a common cold, it's the most frequent reason people go to positions or misswork.

In this country alone, it's estimated that anywhere between 50 and 80 billion, not million, billion dollars a year is spent on back pain. Most of this could be prevented. What you must remember is when it occurs, there are certain ABCs. A, stop what you're doing. Don't continue to play the rest of the 18 holes. Stop what you're doing. Stop what you're lifting. This looks easy, but I can tell you it's not. You've got to maintain your neutral balance and it takes quite a bit of strength. When you're able to do this for 10 repetitions or so, you've gotten yourself in pretty good shape. Help yourself beat the odds of back pain. Stay tuned for this old back with Dr. Stephen Huxula. You'll learn what causes lower back pain. Correct lifting and bending techniques that can protect your back from injury. And for a strong and healthy back, simple exercises you can do at home.

Hello, I'm Dr. Stephen Huxula. I'm chairman of the Texas Back Institute. I'm a spine surgeon and I have a bad back. As many of you probably know, eight out of ten Americans, sometime in their life, will get an occurrence of back pain. That's 80% of the population. We never know when this is going to strike. It can be very sudden. It can strike fear into you. And it's not a pleasant experience. I myself had such an occurrence. It was a horrible feeling. It was as if somebody stuck me with a knife. I didn't know what was going on. And I experienced a fear, concern, agony, pain, muscle spasm. Just didn't know what was happening. In my experience as a spine surgeon and taking care of patients, the single most important thing I've experienced,

because I truly relate to my patients. I truly understood what they felt, what they feared, what they were experiencing, how they suffered, what they were doing, and what they could do for themselves. And most of my patients are thrilled that I have a back problem and I get the problem on and off, because they realize I can understand what's going on with them and basically can empathize. What to do today is to cover with you the statistics of back pain, the anatomy of the back to give you some understanding of what's going on. The causes of back pain, the treatment for it, and prevention. Before we get started, I'd suggest we all sit up straight. The purpose of sitting up straight and proper posture is to take some of the load off the spine and off the discs and distribute it more equally to your muscles. And this makes a big difference on the wear and tear of your back. If we're lying down in bed, there's a certain pressure on the discs of your spine.

If indeed instead of lying down, you're standing. When you're standing, there's probably two to three times the pressure on the spine. When you're sitting, the pressure goes up to four times. And if indeed you lift and you lift properly, it goes up to five times. If you lift improperly, it will go up to ten times. What I'd like to do is start out with the anatomy of the spine, which is the fundamental building structure of what we're going to talk about later. The spine is a great piece of engineering. The base is the bony vertebra, 24 separate bones about an inch in height. The vertebra will line up or a stacked one upon the other. We divide the spine into three separate sections. The top seven vertebra in your neck make up an area called the cervical spine. Below the cervical vertebra is the thoracic spine or the upper back. This area includes 12 vertebra.

Below the chest area are the five vertebra that make up the lumbar spine or the low back. And this is the area that takes most of the weight of your body. And consequently, most frequently we suffer from problems in the low back or the lumbar region. The vertebra themselves are bones that come around the back. And in the center, there's a hole called the spinal canal. And in this canal travels the spinal cord as represented by this yellow structure, which comes right on down the canal, ends about this level. And then you have multiple strands that we call the cauda and quina, which are nerve roots that start coming out. We also see nerve roots here. In a moment, I'll show you the interrelationship of the bones in the ligaments and the discs and the nerve roots. Basically, the bones themselves give you the structure to your spine. However, between the bones, you have the discs. The discs act as shock absorbers. The discs themselves have two components.

There's an inner jelly-like component that we call the nucleus pulposis. And then there's an outer fibrous ring that we call the annulus fibrosis. You might think of it conceptually as a jelly donut. You have the harder outer surface and you have the inner jelly-like surface. Discs generally, when they are affected, can bulge just like a tire could bulge. They can rupture like a blow out of a tire, but they do not slip. So when people talk about slip discs, there's no such thing. The reason for that is the following. The disc itself is attached to the lower part of the upper vertebra and the upper part of the lower vertebra. Attached very strongly, glued in place, and it can't slip. But it can bulge and it can rupture. Another important factor is the disc itself gets blood supply up until we're about age 20. And thereafter the blood supply goes away.

Yet you must get nutrition to the disc. How do we get nutrition to the disc? Well, it's with exercise and motion. Disc can be injured without us knowing it, making damaged discs among the primary causes of back pain. As the soft spongy portion is squeezed, it can push against and break through more and more of the outer disc rings. If the disc bulge is significant, it can cause pressure on nerve roots in the lumbar spine, resulting in irritation of those structures, and that can hurt. If pressure is placed on an already weakened disc by lifting heavy objects without strong back muscles to share the load, the situation can get even worse. The disc can rupture or herniate. When a disc urniates, the jelly-like center, which was causing the disc to bulge before, actually protrudes out beyond the disc wall, resulting in pressure on nerves. The pain can be severe, and unfortunately, once a disc is torn, it cannot be restored to its pre-angury state. However, the torn tissues can heal.

If we go around to the back of one spine and you feel in the back of your spine in the midline of your back, you'll feel these bony protuberances. These are called the spinous processes. On either side of the spinous process, you have a joint, one on this side and one on this side, called the facet joints. These facet joints are aligned kind of like this, and they have a capsule around them. The capsule is called a synovial capsule, and inside the capsule, there is a liquid synovial fluid, which acts as oil to lubricate the joint, almost like oil in an engine. Basically, however, as you can just see from the anatomy itself, most weight should be carried by the bigger structures or the vertebra. These little facet joints act more to guide the spine, terms of flexion, terms of extension, lateral side bending, or some rotation, but they're not meant really for weight bearing. Such that if you would lift a heavy box or do something heavy in an extended position, if we would extend here, you put the weight on these joints, and they're more apt to get injured.

In addition to all this, we have the muscles, and this is very important, because in and of itself, though these are important for stabilizing your spinal nerves, what helps the spine? Well, it's the muscles. You have muscles in the front, this is the front of the person. You have muscles in the back, and you have muscles at the side. The muscles in the front, we call the flexor muscles, or the abdominal muscles. The muscles in the back are the extensor muscles, and those connect in short segments, or they can connect in long segments. There must be a balance between the front muscles and the back muscles, so it allows you to bend and extend and bend and extend. In addition to which we have muscles that come around the side, called the oblique muscles, and I use it as an analogy in terms of a barrel and a hoop around the barrel that gives it the strength or hoop strength. The hope here is that your muscles are strong enough that they support the spine, and they act almost like a guywires wood on a flagpole when it's very windy out.

You don't put guywires just on one side, or just on two sides. You usually have them on four sides. Same thing here, and that's important to keep clear. In addition to which, what we should always keep in mind when thinking about our back, our legs. Our legs are very, very important in regards to lifting, in regards to doing things. You have very, very powerful legs, and you need to keep them strong, because they really supply a lot of thrust and a lot of energy and a lot of strength when you lift, such as a weight lift. It lifts with his legs, carries it up, and is able to go from there. And it's very important to keep your legs in shape as well. Having understood the anatomy of the spine, the rest kind of falls in place. When we talk about causes of back pain, the most frequent causes of back pain, our muscle strain, the guywires have been strained. If you strain a muscle, you overuse the muscle, you get a spasm, and a muscle almost like a Charlie horse, like you get in your leg, doesn't feel good, hurts.

You can get a disc injury. The disc itself can bulge or could rupture. The third main reason for back pain are your facet joints, the joints we talked about that guide this spine. If they get irritated, almost like a shoulder joint, you throw a hardball too fast, your shoulder gets irritated. The sonovial lining, or the outer lining of it gets irritated, you get swelling. Even though it's a tiny little joint, it hurts, hurts bad. Most frequently, those are the causes of back pain. There can be other causes. Oftentimes, women are worried about osteoporosis. Osteoporosis is a weakening of the bone. You don't have the same bone mass, it isn't as strong. The bones can start collapsing, and as we get older, the bones do get weaker. And you can get, we call, a compression fracture, where the front of the bone collapses, almost like a marshmallow would collapse. A lot of osteoporosis we know today could be avoided with proper exercise. Another thing we commonly hear about is arthritis, and it's, I want to clarify, it's not rheumatoid arthritis, the deforming arthritis, where your hands get deformed and everything gets deformed.

We're talking about a wear and tear arthritis. Though rheumatoid arthritis can affect the spine, it's not the most common cause. Wear and tear arthritis is much more common. It's almost like opening and closing a door. The hinge of that door with time is going to get worn. Our backs get worn, it's normal phenomena. We turn gray, we lose our hair, we do all sorts of things, and it's normal. So when a doctor says you have arthritis, if you back, get him to clarify it. He says it's degenerative arthritis. It's not a bad term. It sounds bad. It sounds like I'm wearing away. We are, but it's slow. We're all wearing away. What are the things we have to worry about? There are certain precautions or warning signs. One is a foot drop. Basically, when you walk, your muscles allow you to pull your foot up, and when you normally walk, it's heel toe, heel toe, heel toe. However, if indeed you have weakness of your muscle, what can occur is you can't clear your foot and you drag your foot.

When you drag your foot like this, you can't bring it up. It's a sign you better see the doctor then. Don't wait to see him two, three, four days from then. If you can't see him, go to the emergency room. There are other warning signs. If you lose control of your bladder or bowels, you don't want to just wait to see if it gets better on its own. Go see the doctor, because if you don't treat this kind of nerve injury relatively soon, it can lead to a permanent change. There are certain other things we have to be aware of. If a person has a history of blood near urinal stool, weight loss of unknown reason, they could have a tumor and back pain. Consequently, with those indications, you want to go see a physician as well. And the last item that I would mention is infection. If you are running a high fever and have back pain, it could be having an infection of your bone or something going on you back. And then again, you should see a doctor for that reason.

None of us know when we're going to get back pain. What I'd like to do is review with you some of the things that predispose you for back pain. There are certain jobs that are more significant in regards to causing back pain. Garbage collectors, nurses, do a lot of lifting, a lot of twisting. You'd think they're set up for a back problem. They are. However, desk workers also are set up for a back problem. They're sitting at desks all day long, all week long. They're typing, sitting in front of the video display unit, and basically not exercising their back muscles. Then what happens is, they remember what they can do when they're 18. They go out and play ball on the weekend. We call them weekend warriors. And they hurt the back. And they might not notice until the day after or two days after. But they hurt the back because they were de-conditioned. They were set up for an injury. And they did a 10 of us are going to get an injury. So you want to try to prevent and put all the odds on your side.

And often asked question is weight and back pain. Can weight cause back pain? Well, there are a lot of arguments on that. My own feeling is the following. If you've hurt your back, you don't want to be carrying a lot of extra weight. It's like if that hinge on the door is hurt, you're not going to put an 80 pound sack of concrete on there. And then see how long it'll open and crawl it close. Common sense tells you it's going to make it worse. On the other hand, usually if you're more than, let's say, 10 or 20 cent overweight, the problem you have is you're also de-conditioned. So is it the weight or is it the de-conditioning? Not sure. It's hard to know. It turns to sports. Hopefully we all indulge in some kind of sport. Well, if you play football, if you play golf, if you play tennis or you ski, all of these things can cause problems. Football players, when they are down on the line, they hit each other. We talk about extinction and the facet joints. They're loading the facet joints. They can get injured.

Skiers, when you're skiing down, you're loading, lung loading, unloading. That can be a problem. Golfers, the golf swing, bending and twisting. About the worst thing you could think of. Doesn't mean don't play the sport. It means be in shape. Know what to do if you have a problem. Get back in shape and get back to the sport. The first time you get that back attack all fear strikes you. Because you really can't believe that what I'm talking about is what you're experiencing. Because nobody could experience pain to the extent you're feeling it. It's really not fun. But basically what you must remember is when it occurs, there are certain ABCs. A, stop what you're doing. Don't continue to play the rest of the 18 holes. Stop what you're doing. Stop what you're lifting. Number two, lay down. And the different positions that feel better. Oftentimes lying in your back with pillows under your legs will help.

Or on your side with pillows between your legs. But not extended bed rest. Number three, ice. You ice it for 48 hours and then you go to heat. When you apply ice, a good trick is to keep a little dixie cup in the freezer. Fill it with water, let it get cold and iced. You tear off the top and have somebody massage you back with the ice in kind of a circular motion where it hurts. It tends to numb the area. It tends to anesthetize it a little bit, takes away some of the pain. And it stops some of the swelling because it stops the blood from rushing in. Don't apply the ice for more than about five minutes. Because if you do, you can get an injury from the ice itself. And so you want to be cautious. But ice the first 48 and then you can go to heat. Number four, take an anti-inflammatory. Over the counter anti-inflammatory drugs, like ibuprofen. That's the drug in products such as Advil, Nuprin and Motrin.

Or aspirin are thought to help reduce inflammation and swelling, which helps ease back pain. And a word about bed rest. Not more than 48, 72 hours. If it takes any longer than that, you want to see a physician. Years ago, people would stay in bed two weeks. You get deconditioned, you get a trophic, the muscles atrophy. It's almost like somebody who goes in a cast. They might be up and around walking. Take off the cast. It looks like they have two totally different looking arms. Because it's just worn down. Exercise, I believe, is the mainstay of proper back health. But the exercise itself should be an active approach. And it's not just back exercises. You can't just exercise you back. Your whole body has to be in shape. And we talk about being in shape. It's muscular strength. It's muscular endurance. It's flexibility. It's aerobic conditioning.

Exercise itself, as we know, or often runners who run talk about a runner's high. What is a runner's high? It's thought to be the body's own secretion of what we call endorphins and in kephlins, which are like morphine. They make you feel great. But your body secretes these things. If you don't exercise, you won't have these things pumping through your system. It's a benefit of the exercise, and it also can take away back pain. What I hope to do in the next segment is go over how we can prevent back pain. And what exercises we should be doing, and how do we do them at home? You don't want to get a back attack. Back pain is no fun. Back pain when you do have it affects your entire life. It affects your job. You can't work when you're really asserting.

It affects your family. It affects your friends. It affects your children. I've seen a lot of marriages that are broken up because one or the other's had back pain, and it just hasn't gone away. And after a while it gets old, you can't play ball with your children. You know, go to work. You start losing your income. It's a very distressful thing. And usually when you develop back pain, it's an accumulation of insults that's led to the problem. Back pain rarely just occurs out of the blue like in a car wreck or something like that. Most often it's minor irritations, accumulation of standing wrong, bending wrong, lifting wrong, doing things wrong, not keeping in shape, and then it gets worse. There are many things you can do to prevent back pain, and we break it down really into basic body mechanics, which consists of proper lifting and proper stance and posture, and then exercise. And those are the two main things.

In terms of posture itself, what you want to think about when you're standing, and I forget myself at times, is to keep you back straight. How you keep you back straight, and the simplest way to think of this is to think you have a sky hook right here in your chest, pulling you up. And if you allow this to pull you up, what you can see is I'm getting my normal lumbar curve. I'm getting my normal cervical curve, I've got to bring my shoulders back a bit, it feels awkward, but that's the proper stance, and you tighten your muscles. That's the proper stance, and it definitely makes a difference. Likewise, when you're sitting, there's a curve to the low part of your back, your low part is curved, that's called a lumbar lordosis. And it is very important to maintain that lordosis to keep good body mechanics when you're standing, but also when you're sitting. When we're sitting, what we want to look for, is a chair that supports the lower back. Of recent ergonomic engineers have designed chairs that work for the back.

The study of ergonomics is basically fitting the chair to the person, rather than fitting the person to the chair. We see some chairs that look pretty good, but they're awful to sit in. ergonomic engineers have designed chairs such as this one, which is really designed to support your back. There's a built-in lumbar support, which supports the low part of your back. Other things you want to look for in a chair, is the height of the back part of the chair. If you're a tall person, you need a longer height, if you're a short person, shorter. You want as much support as you can get. You'd like a chair that tilts about 10 degrees as you sit in it. It gives you a little sway back and forth. You want the seat pan to be such that it's wide enough you can move, but not so wide that you slosh around in it. And you want the arms to be such that you can rest your arms and support your body in such a way that you can take the weight off your back from time to time. An additional thing that you'd like in it, is that the seat length be such that you clear the bend of your knee.

So there's no pressure on the blood vessels or the nerves. The last thing you want to consider is the height of the seat itself. You'd like your knees to be level with your hips, such that your knees are not like this, but like this when you're sitting. So they're level. You might think of putting a pencil on your thigh and make sure it doesn't roll off or backwards. Both will tell you that the level is proper. In addition to which this seat has rollers and those rollers afford you the opportunity to move around. But it would be a good idea to put some plastic onto the seat so it rolls more effectively and it doesn't get hung up. Many of us, however, can't afford a seat like this. And there are alternatives. One is to get an orthopedic insert that you just put in your regular seat. Second is to get a towel, roll it, and place it in the small of your back, likewise giving you support. The other thing you want to be cognizant of is every half hour or at least every hour you get up, walk around your desk, stretch.

When I say stretch, not just stretch forward and one good stretch is bend your knees, while your knees are bent, then bend to touch your toes. Just get the legs moving, get the back moving, and stretch by hyperextension exercise. Also help. Another way to do things in the office is to lean against your desk and basically do a full body push-up. Just gets the circulation going. What we don't want to forget is our neck. Many times we're sitting at the desk looking at our video display terminal the entire day. And that needs to be adjusted to the proper height so you're not looking down, you're not looking up, but you're looking at the terminal. It prevents a lot of neck discomfort. Also, when you exercise your back you want to think of exercising your neck. And the best way to do it is a combination of some active exercises and isometric exercises. So that every hour or at least two or three times a day you do an isometric exercise where you keep your neck stable and you press against your neck, pressure against your neck, side, the other side, front, and back.

And consequently you're getting those muscles to function a little. The other thing you want to think of doing are shoulder shrugs where you're going like this and shoulder rolls forwards and backwards. Another consideration is the height of a bench that you're working at. Many people work standing all day. The height of the bench makes a difference. You don't want it too high, you don't want it too low, you wanted it a height where you're comfortable. Many of us like myself stand around all day. I basically when I see patients are in the operating room, I have to stand. Consequently I wear good shoes that give me support. I like cushions shoes with a good arch. And I want to prevent standing too long in one spot. I move around as you've noticed today. I'm moving all the time. I'm shifting my weight.

I'm flexing and extending my muscles as I talk and as I move around. At times if I do get tired I'll go and I'll prop a foot up. And that becomes important. If you are able to prop your foot up, it makes a tremendous difference. As a matter of fact, if you ever go into a bar, you notice people who are standing at a bar for a long time. If there's a railing on the bar, they first put one foot up and they stand there. And then they switch and they put the other foot up. That allows them to stand at the bar. That railing isn't there for the looks. That railing is to keep you at the bar. If you're working at home and you're working in the kitchen and your back hurts, and you're leaning over the sink, or for men if you're leaning over the bathroom sink and you have to shave, and that's one of the worst things for me when I have back problems. The back is killing you and I wear glasses, leaning over. I can't see well. It's hurts like heck. So what I do is I open the drawer under the sink.

And again, I prop one foot up and then I can bend much more easily. I'm using my legs to support me rather than my back. Same thing in the kitchen. I'm doing dishes. I'll open up the cabinet underneath the sink, put one foot up. If indeed what you're doing is you have to load the dishwasher. You've got to think of these things. It prevents back pain. Instead of just bending and putting the dishes in, which might be the fastest way to do it, put one leg in front of the other, kneel down and push it in. Let your legs do the work. Rather than leaning over. Twisting is another major problem. Sometimes we're in a rush and we just twist. I see many patients saying, you know, I just twisted to pick up a handkerchief on the floor. My back went out. Well, try not to twist and try not to twist suddenly. If you see a handkerchief, move towards the handkerchief and bend properly. Twisting is a problem. You best off turning to what you want to get, facing it, and then lifting. When we try to lift an object, this is another thing that oftentimes causes problems. Before you lift anything, have some idea of how heavy that object is.

Can you lift it? You need two people. Because it's a large box. It might not be heavy. It might be light. Because it's small. It might not be light. It might be heavy. It makes a difference. When you're going to lift that box, no matter how much of a rush you're in, think and slow down. And when you go to lift the box, approach the box, come as close as you can to the box. You don't want the box way out of your way. You want to be close to the box. You want your feet spread apart, kind of shoulder width. And when you bend, you want to use primarily your legs. So what I'm doing is I'm bending with my legs. I want the box as close as it could be to me. I bring the box up to about knee height next to me, and then I lift with my legs. When I put the box down, I do the same thing. I bend with my legs. I'm not bending with my back. I'm bending with my legs. And I lower the box gently. Lowering the box. I place it down close to me. An alternative would be kind of a split stance. Again, you want the wide stance, but one foot in front of the other.

That as well protects you back. And then you lift the box. Or what you could do is go down on one knee. And that gives you some support. I bring the box close to you, and then come up. All of these techniques are safe. As compared to just bending over at your waist, such as this, and I won't show you that, that can be a problem. It can be a big problem. What about if you brought groceries home, and they're in your car? And for argument's sake, this is the groceries. What you want to do is first be sure the groceries are close enough to you. You're not reaching across the seat if you have them in the back seat. So what you would do, and this is a little high, but you'd put one knee on the seat. Lean in. Again, you're supporting yourself on your leg. Pull the box close. Then lift. If there's something in the trunk of your car, again, open the trunk. Figure out how you're going to lift it. Put one foot on the bumper of the trunk.

Then we're reaching. Pull it out. First bring it close to you. Many patients I see drive for a living, or are going on a trip. They find the vibration of the car sitting for a long time hurts. Fortunately, the American car industry has discovered that ergonomic seats are important in the car. Seats now go up, down, forward, back. You have a lumbar support. Some you can pressurize more or some less. And I tell my patients when they're going a trip to basically vary the seat. So what they do is they drive for 20 minutes, half an hour. If they have an automatic seat, it's easy. They change how close they are, how far away they are, up, down, tilt, whatever. I also advise them if they're going on a long trip to get out of the car, walk around the car, stretch, exercise. One common error is we drive for 6, 8, 10 hours taking the brakes.

Finally get there, we can't wait to get to bed. We reach into the trunk, we lift wrong. Not a good idea. Really, it's a better idea to check into the hotel, walk around a little, stretch a little, get loose, then go get your luggage. You've calmed down, maybe you've had a drink, maybe you've had something to eat. Your back muscles have been worked a little, and you won't be quite the rush to get the luggage out of the back of the car. Many of us travel on airlines. When I travel, if at all possible, I like to get into business class, I can't always do it. Oftentimes I'm sitting in those terrible seats in coach. They give you really very little support. So as I get on the plane, I ask for two pillows. I use one in the small of my back for that lumbar support. The other I put on my knees, and I put my book on my knees, and I don't have to bend over to read. In addition to which I change the angle of the back of the seat. As soon as the plane takes off, and I'm allowed to get out of the seat, I walk around, I stretch, I do these things.

I prop my feet up on my attache case if I need to, to get my knees level with my hips. If you can afford it, or you have it, get those bags on wheels. Where you're not lifting them, you're just dragging them. And the other good piece of advice is to divide what you're carrying into two bundles instead of one. So instead of carrying one suitcase like this, carry two, and you're even out the weight. If your back hurts at all, check in your luggage. Don't carry it on the board. Or ask the steward a stewardess to help lift it so that you don't have to get it up there. All simple things, it sounds like nothing. But if you don't do it in your back hurts, and you wind up at your destination, and you're an agony and can't move, you've ruined your holiday. So far what we've talked about is posture, what we call proper body mechanics. What I'd like to get into next is exercise. We very much believe in the sports medicine approach to back problems.

Unlike the old days where it was kind of heat, maybe some massage, and that's it. We think there has to be an active rehabilitation of the spine. You actively have to participate, which includes aerobic conditioning, flexibility, and strength. All very important. When you're doing an exercise routine, how you do it is also very important. You don't just get out and exercise. As little time as you have, you still have to stick to the basics. You more than likely should start out when you can, doing a little stretching, gentle stretching. Everybody knows when they were running, stretch your calves, but don't really push them hard. Stretch, you feel a little tension. You do the same on the other side. You stretch, and you feel a little tension. What occurs with that is, you're stretching those fibers gently, but they're not warm enough yet to stretch them all the way. You then do some cardiovascular exercise, whether that's walking quickly, gentle biking, stairmaster, whatever. Until your heart rate's up to about 100, or you have light perspiration, you stop.

That takes about five minutes, perhaps. You stop, and then you stretch further. Once you stretch further, then you go through your full cardiovascular workout, which basically usually takes about 25 to 30 minutes, getting into your target heart rate, which varies depending on how old each person is, and your physician can help you determine that. When you're finished exercising, guess what? You're going to stretch again. You need to stretch again. Most of us get lazy when we finish and we just stop. Very important to stretch and cool down. Additionally, it's very important to be consistent. Once you start an exercise program, stick with it. Exercise one day a week, it's not going to do anything for you. You have to exercise at least three days a week. I see patients who like to exercise doing every possible exercise you can think of. Most commonly, I see runners. What I advise them, they can get back to running if they have a back problem. But they first have to do exercises, strengthen their back. I then caution them in the proper running shoes.

I caution them the surface they're running on. I relate to them. It's important not to increase distance and speed at the same time. And if you feel any back pain, stop. And also, first, warm up. Walk before you run. Don't remember what you did when you were 18. When you were gung a den, and now you're 35, and you think you could do it because you could do it when you're 18. Maybe you'll get there, but you've got to build up to it. Bicycling. We see many bicyclists. It depends what kind of bicycling you have as to whether it harms you back or aggravates the back situation or whatever. You see these touring bikes and racing bikes where you hung over the front wheel. Not too comfortable. It gets kind of bad and very thin tires. I advise my patients with back pain to get a mountain bike. The mountain bikes have the thicker tires. It gives you a little more shock absorption quality. You're sitting upright rather than slouched over. It's just an easier way to do things, and you're still getting aerobic conditioning and building up your leg muscles, which are very important. Traditionally, we've always heard, and everybody here, I'm sure, has heard, swimming is great for your back.

Again, that's not necessarily true. Swimming is good because it unloads you back. You can do water aerobics, which is good, but certain swimming strokes are bad. If you do a butterfly where your arms are coming out over your head, hyper extending your neck, hyper extending your back, not very good for your back. Your Australian crawl, the same thing, you're turning your neck constantly. Some people change it by going both ways, but it's not very good for your neck. And it doesn't always feel good for your back. Those are my patients who want to exercise in the water. What I tell them to do, if they have any neck problems or any back problems, get a snorkel, get a mask, and then they can swim. Because they're not bringing their head out of the water and causing all this hyper extension. And they are having the benefit of unwading. The other frequently seen patient is the patient who plays golf. There's nothing good about golf for your back. Nothing. But when you're once a golfer, always a golfer. And nobody wants to give it up.

Doc, if you may have this operation, can I go back to playing golf? Doc, if I get better, can I go back to playing golf? Hear this 100 times a day. Hi, treat patients by telling them they're their own master. They've got to make their own decisions. I'm there to help them and to inform them. And what they have to do is modify their golf swing if they want to go back. They must warm up. Most golfers don't warm up. You go out to the driving range or you go out to the golf course. The guy gets out there, tries to blast that ball, but hasn't warmed up. Hasn't stretched. You need to have a specific stretching program before you go out and play golf. If you have a back problem, you have to modify your swing. Don't hit it as hard. When you're bending to pick up a golf ball, use kind of a golf player's bend that is bring one foot back, the other foot forward, bend like this. Don't bend it, you waste. Little tricks like that make a difference. The other thing you want to do is always cool down. No matter what sport you do, cool back, cool down. The back has to get time to readjust. When we come back, what I'd like to do is get into specific back exercises

to both relieve back pain and prevent re-angery. How do you treat back pain? What exercises should you be doing? Earlier, we spoke about the abdominal muscles and the paravertibral muscles, the flexor muscles and the extensor muscles. It's very important that these muscles are in balance, and that we keep them both strong. Problem one has, however, is not all back problems are the same, and some exercises feel good for some people and some for others. Extinction exercises where you're arching your back often feel better for people who have disc problems or have muscle problems. Flexion exercises where you're bending forward often helps if you have problems with those small joints in your back. What's very important to know is if any exercise hurts, stop doing it. In general, in treating back patients,

the theme of no pain, no gain, doesn't work. If you're starting to get pain, you stop. The trick is to go up to that point and then stop, but not go past it, because you might very well make it worse. In order to help us demonstrate some of the exercises we should be able to do at home, I've asked Paula Gilbert Watson, who's one of the therapists with us at the Texas Back Institute, to come and help demonstrate. Instead of doing them on the floor so that you can see things better, Paula's going to do it up here on the counter. What we're going to start out with are really flexibility exercises. Paula's going to lie down, turn over onto her abdomen. She's going to get herself comfortable, and then she's going to start doing what we call extinction exercises. She's basically going to just get into position where she's lying like this, stay in that position for about three to five minutes,

just to get the normal arch back to the back. Once she's been able to attain that, she's going to start using her arms. She's going to lean on her elbows, and not necessarily the same day, it might be day one you can't do this, day two maybe you can. She's getting more of an arch to her back by doing this. And with time, hopefully, she's going to be able to push up to the full extent of her arms length, causing more of a curve to the back, increasing the flexibility to back, and doing perhaps five to ten repetitions of this. This really tends to loosen up one's back, but if you have pain when doing this, don't do it unless you've gotten the advice of a professional. Next, what we're going to hope to show you are some flexion exercises. Paula's going to turn on to her back, and she's going to do what we call a pelvic tilt. She bends her knees, she gets her feet flat on the floor,

and basically now what she's going to try to do is move her pelvis in such a way that she lowers the flat of her back right onto the table. She's going to do this to try to hold that position, once again, to try to flex the spine a bit. This at first might feel uncomfortable, once again, if it's too uncomfortable, stop and don't do it. The next exercise she's going to show is the knee lift. What Paula's going to do is put down both legs, and then she's going to start bringing up one leg. She's going to pull that leg up into her chest. By doing this, she's exercising the hip muscles, as well as her back muscles. With time, she's going to alternate, and go to the other leg. Then, eventually, what she's going to do is bring up both legs together, bringing them up to her chest, and now she's also working on her abdominal muscles.

Once again, you want to do about five to ten repetitions of this. The next exercise she's going to show is a hamstring exercise. As we know, the hamstrings, the muscles in your legs, very important because your legs support your back. It's very important to keep these legs and these hamstrings flexible. What Paula's going to do is raise one leg up to the ceiling. She brings it up bent. She puts her hands behind her thigh, and then she stretches her leg out until her foot is parallel to the ground. This is not easy to do from scratch. It's something you build up too slowly. She does this alternatively from one leg to the other leg. Again, you want to do about five to ten repetitions. In general, that's what you want to do. Five to ten repetitions of these stretching exercises. Another important exercise that Paula's going to show is this morning are the hip flexor exercises.

What you're going to notice is, Paula is going to go down on one knee, and you can put a towel under that knee, if you like, or if you have a carpet, that's fine. She's going to balance herself on her other thigh, and then she's going to slowly rock her pelvis forward and her body forward stretching the hip flexors. Again, you'll feel a little bit of a pull. Notice, Paula's keeping her back straight as she does this, and she's breathing slowly. Very important to breathe in and out, exhale and inhale, and be conscious of your breathing. First, what we'd like to show you are abdominal strengthening exercises. The first thing you're going to see Paula do is try to find what she calls her neutral position. Now, what we call neutral position, we all have a different position in terms of where we're comfortable. The question is, are we comfortable in more extinction or more flexion? And simply by Paula varying her pelvis,

she's getting a little more extinction in her low back, or a little more flexion in her low back. Once she's reached her neutral position, she's going to try to maintain that position as she exercises. And what she's going to first do is exercise with her arms. She starts out bringing one arm over her head, and then alternates arms. And as she's doing this exercise, and she does this for several repetitions, she then starts to bring in her legs, and does one leg, and then the other leg. And then if you get really good, what you're going to do is now do your arms and legs together, alternating. Right arm, left leg, left arm, right leg. This looks easy, but I can tell you it's not. You've got to maintain your neutral balance, you've got to maintain your position, and it takes quite a bit of strength. When you're able to do this for 10 repetitions or so,

you've gotten yourself in pretty good shape. Next, what we're going to do is basically have Paula switch over and lie on her stomach. Once again, she's going to attain the neutral position. And as I said, for some of us, we want more lordosis, we have more of an arch to the back, and some of us going to be more comfortable with less arch to the back. And she first attains that position that she's comfortable in. Thereafter, what she's going to do is, alternately, work her arms. First one arm, and then the other arm. And in like fashion to when she was on her back, she's then going to start thinking about working with her lower extremities. First one leg, and then the other leg. And notice, she keeps her back in that same position that she struck at first. Finally, and once again, it's more difficult than it looks. She's going to alternate left arm, right leg, right arm, left leg.

And she'll do this once again for about five or ten repetitions. Another back strengthening exercise that you'll find is an extension exercise, and some people might want to put a pillow under their belly first to get in more comfortable position. Keep your chin tucked a little bit, and then what Paul is going to do is come up and extend. And gradually hold that and then come back down again. Once again, she's going to try to do about five or ten repetitions to this. This tends to strengthen those back muscles. Next, what we're going to show you is what we call the squat. Paul basically takes a stance where her feet are spread apart about shoulder width, toes are pointing outwards slightly. Her back is straight, neutral position, hands on the hips,

and then she's going to go into the squat. Again, this looks easier than you think. She's going to hold for five or ten seconds and then come up. Many of you who are skiers know how important it is to do that exercise to get your legs in shape prior to skiing. And this keeps you back in shape as well. Thank you, Paula. I have another couple of exercises and concepts that I'd like to discuss with you. The first is that of relaxation. It's very important to be able to take a little time out of your day as busy and stressful as it is and relax. And what I suggest to my patients are to find a comfortable place where they can preferably lie down, close their eyes, try to get their mind off everything and just concentrate on breathing. Just kind of breathing in and breathing out and relaxing getting away from it all. There's no doubt stress plays a big role in all of our lives and it's very much associated with back pain.

If we can just learn to take some time away from the stressful day and relax, it tends to pump in the endorphins and in kephlands, makes us feel better, gives us a little break from what we're doing. The last suggestion I have in terms of an exercise is have some fun. Do something you like to do. Take up a sport, get into an activity, something in terms of your leisure time that you look forward to doing and that you can do for the rest of your life. We've covered an awful lot in the last hour. At this point what I'd like to do is give you the opportunity of asking any questions you might have. Are there any questions in the audience? Yes. I see a lot of people wearing back braces. Are they good for you? There's a great debate about that and I agree with you. I see a lot of people wearing them also. I personally feel they play a role, but not in and of themselves. If you're wearing a back support to avoid exercising, to avoid lifting properly, no.

If you wear a back support and you recognize what it's doing is reminding you to lift properly, reminding you to be careful, keeping your back warm, perhaps giving you some support, but not at the expense of not doing your strength and exercises than I think it's fine. Another question? Yes, sir. Doctor, it seems the older I get, the more and more doctors I get to know and love. I have run into some advice now and then for us. That relates specifically to a senior, senior citizens. I'm talking about those of us in our 70s and above. The advice is stop running around, take a pain pill and get on with your life. What do you think of advice like that, sir? Well, I don't quite believe in that. I myself in my 50s and I feel like I'm 30 and I think a lot of it has to do how you think and how you feel, but I think a key part of it is exercise.

I think in order to stay long, young, you have to keep going. I think you need to have the cardiovascular system going, you have to keep your back in shape, you have to think positively. I think you need medication on occasion, but I would rather look at it holistically. Is there another question? I'm really scared of surgery. How do I know what's best for me? I'm also scared of surgery. I think the definition of major surgery is anything done to yourself. Consequently, if one can avoid surgery and do the things they want to do in life, they should. But I think it's very important that we're all assessed of the risks and rewards involved with a surgical procedure if it's the last resort to getting ourselves better. And you also have to know what are the chances of getting better with surgery. A second opinion never hurts. So that if indeed simple techniques aren't working, I advise my patients to seek a second opinion besides myself that they understand I am not foolproof.

I have good results, but I don't have perfect results. And anybody who tells you they have perfect results, you better run out the door. Any other questions? It's back pain or reditary. It seems like my brothers have bad backs. Well, as I mentioned earlier in the show, 80% of us, one time or another, have a bad back problem. That's 4 out of 5 of us or 8 out of 10 of us. Naturally, people wonder if their uncle or father or brothers had back problems and they get one if it was hereditary. It can be, but it's usually just associated with your lifestyle. Another question? Doctor, are there any specific tests that can tell me what's wrong with my back? Yes, there are, but in general, most diagnoses are made from the history the patient gives and the physical exam. When there is an indication for another test, such as an MRI scan or a CT scan or a myelogram, then he needs to order that.

However, there have been studies done if you take 100 people off the street who have no back pain and do an MRI scan on them. 30 of those 100 might well have abnormalities. And the abnormality might look like a bulging or ruptured disk, but you don't operate on those 30. They don't even have a problem. So it's very important to associate the problem with the findings on the test and you don't operate on an X-ray, you operate on a patient. Next. Is home massage good for an injured back? Pretty much whatever feels good when you have a back problem. I think massage does help. It tends to bring new circulation into the area and most of my patients feel very comfortable with a massage. Once again, however, you don't want it just to be massage. Massage is a passive thing. I want you to get active, do your exercises, your proper body positioning in terms of lifting and standing and squatting, et cetera. But in conjunction with that, I think massage is great.

Are there any other questions? My husband and I fight over what kind of bed is best, firm, extra firm, or soft. Could you tell me which one would be best? Traditionally, I tell my patients that a firm mattress is best. In the past, people refer to the C-leaf posture pedic. Nowadays, they're all sorts of orthopedically designed firm mattresses. However, not every mattress fits every person. Consequently, I tell my patients to go try the mattress for a day or two. Find out what motel or hotel might have that mattress and see if, indeed, they can't sleep in it before they buy it. Another thing patients often ask me is water beds. The old water beds where they didn't have a lot of ribbing didn't give much support. Nowadays, you can get water beds that have a lot of support in it and that you can heat or cool. So once again, how firm the mattress, what exactly you prefer, really depends on what makes you feel the best

and gives you the best night sleep with the least pain. Is there any other question? Yes, sir. I still don't understand. My back feels fine. I feel great. And then I've been down to pick up a small plant. And I'm in total agony. What happened? I often ask myself that same question. I think that unfortunately, once one's had a back problem, the chance of recurrence is four times as great as if you hadn't had a back problem. And we never know when we're going to get a recurrence. But the key is the keeping shape such that when you do get a recurrence, you get over it more quickly and have recurrences less frequently. Are there any other questions? I think it's important that you remember that the back is a magnificent structure. It allows us to reach down to the ground, to reach up to the sky. It allows us to continue our daily living. Spinal reach search, which is going on continuously, is helping answer a lot of questions about the spine

and how do we get ourselves better faster and prevent the injury in the first place. What we do know is that there is a very delicate relationship between the bones, the discs, the nerves, the muscles. And then when you injure one piece, they're all attached and it causes pain. The problem we get into is when we move in unsupported motion, when we bend wrong, twist wrong, lift wrong, don't do the things in the proper way, we set ourselves up for back injury. If you can change the way you do things, adhere to proper body mechanics, exercise to the extent that we've taught you here today, I think it's going to make a big difference for you and the quality of your life. It's important to keep a strong and healthy and flexible back for doing all the things you want to do and to beat the odds in terms of getting back pain. I've enjoyed being with you. Thank you. May your old back be strong and healthy. It's the only one you have, so take care of it. Thanks.

Thank you. This is PBS. you