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Patient Discussion Handout 3:  Overcoming your back problem 
  By now your health care provider has recommended you begin to get back to your daily activities.  Even if you required surgery, you can now safely begin a specific, gentle exercise program to condition your body and your back muscles.  This program will increase your back's ability to help you do the things you want and need to do. 
  Start with a simple, safe exercise such as walking, stationary bicycling, or swimming to build your general stamina.  If you have been inactive, you may need to begin slowly and gradually increase your activity each day.  Your health care provider will make specific recommendations for safe exercises that do not stress your back any more than sitting on the side of your bed.  Exercise helps because it: 
-   Trains the muscles that protect your back. 
-    Conditions your whole body. 
-    Stimulates the body to make its own powerful pain killers. 
-   Allows you to do more things more comfortably. 
You also will find out what you can do easily and what takes more effort. 
  Reality about back problems.  Although your recovery seems slow, your symptoms will continue to decrease unless you are inactive.  However, your back may never feel as "young" as it once did.  This happens to many of us by age 30, most by age 40, and just about everyone by age 50.  Back problems often are the first sign of aging.  You may have noticed that few professional athletes can continue competing beyond age 40.  While some people may be able to resume strenuous activity after back problems as they get older, it usually needs to be at a slower pace.  Most people need to "shift gears" and make changes in goals and activities as they grow older. Even at a slower pace, exercise will help you to be able to tolerate more of your daily activities. 
  Once you have had an activity-limiting back problem that lasts more than a few weeks, there is a 40 to 60 percent chance of having another back problem within the next few years.  However, symptoms usually are not as severe in future episodes as in the first episode. 
  Success.  As you begin to recover, the goal is to try to prevent back problems from returning or, if they do return, being severe.  Success will depend upon two factors.  The first is the condition of your protective muscles.  The second is the activities you ask your back to tolerate. 
  Ignoring either of these factors usually means more back problems.  For example, a coal miner can expect further problems because mining is so demanding on the back.  By contrast, a member of royalty who never needs to stress his or her back but does no conditioning exercises also can expect regular back problems.  How well YOU do in the future will depend on what kind of condition you are in and what you ask your back to do.  The more quickly you and your protective muscles tire, the greater the chance that your symptoms will return.  Taking action to condition the protective muscles of your back can reduce your future problems. 
  Safe exercises that are good for you and your back.  Although exercises such as walking, stationary bicycling, or swimming are safe, you may feel some discomfort when you first start.  After muscles become better conditioned, the soreness goes away.  For example, during the winter when the weather is bad and many of us might stay indoors and be less active, the muscles of the back can lose their conditioning.  When the first day of spring arrives and many of us go out to garden, the back may begin to ache when the out-of-condition protective muscles easily tire.  Continuing such work daily over a few days or weeks reconditions the protective muscles so that they don't tire quite so easily, and the soreness disappears. 
  Remember that an increase in discomfort in an already painful back is common.  But safe exercises (that involve less stress on the back than sitting on the side of the bed) should not harm your back.  The shorter the time since beginning the conditioning, the greater the chance of increased soreness. 
  Conditioning requires regular activity.  Regular activity is essential to obtain the conditioning effect to protect your back.  Conditioning is achieved by building up to 30 minutes of continuous walking, stationary cycling, or swimming at a targeted heart rate (Table 1) or through jogging for 20 minutes.  Conditioning works best if combined with your normal, daily activities both at home and at work.  Stay as active as possible and exercise every day. 
  Your health care provider may have suggested ways to modify your daily chores to reduce the chance of irritating your back.  Such changes at home or work are usually temporary.  They are intended to give you time to improve the condition of your protective back muscles so that you can resume most normal activities.  Table 2 offers guidelines to your health care provider on work recommendations to allow you reasonable time to recondition your back.  Long-term activity tolerance varies greatly from person to person.  Age and overall health are important factors, too. Regular, mild exercise may be enough for some.  Others may be able to return to vigorous activities at a slower pace. 
Points to remember: 
  • Both your level of physical conditioning and the stresses you put on your back will determine how often you will have problems and how severe they become. 
  • Conditioning usually requires daily work and commitment. 
  • Be sure your activity goal is realistic and you know what it will take to achieve it. Once you are over your back symptoms, or after a month of general conditioning training, your health care provider may suggest that you begin doing back muscle, trunk, or extremity exercises to gain further tolerance for specific tasks. 
    If you have great difficulty resuming your previous daily routine, you may need to consider whether your old routine is realistic for you now. 
    Table 1.  Building exercise tolerance 
    1.  Try to maintain your daily activity as close to your normal level as possible.                                                         
    2.  As soon as possible begin walking, riding a stationary bicycle, or  swimming.  Choose what works for you.                              
    3.  Gradually build up to 30 minutes of activity without stopping.       
    4.  Once you can tolerate 30 minutes of activity, establish a target heart rate that will help you to condition your muscles, heart, and respiratory system.                                              
    5.  Then, your health care provider may also recommend some exercises for your back muscles.                                               
    Table 2.  Guide for negotiating sitting and unassisted lifting limits when patient fears normal activity     
    Remember, that any avoided activity must be replace with safe conditioning to reduce the amount of debilitation. 
                                      Severe       -       Moderate     -             Mild          None    
    Sitting                     |     20 min  -  -   -   -   -   -   -   -   -   -   -     50 min  
    Unassisted lifting    |     20 lb.    -       20 lb.     -     60 lb.  -     80 lb.  
     ( Women > 50 years)  |     20 lb.    -       20 lb.    -      35 lb.   -    40 lb.  
     Without getting up and moving around. 
     Modification of NIOSH Lifting Guidelines, 1981, 1993.  Gradually increase unassisted lifting limits to 60 lb. (35 lb. for women over 50 years) by 3 months even with continued symptoms.  Lift objects close to belly button. Limit twisting, bending, and reaching when practical.   
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