copyright 2008 Cheryl K. Hosken, BSN, MS Psych.
After amputation, the upper part of the body needs strengthening to help with walking and supporting the body. Below are the exercises for upper body strengthening. The "2x10 repetitions" means twice a day and repeat the exercise 10 times.
SHOULDER FLEXION:
Sit up straight in chair. Straighten both arms and slowly lift in front of body until hands are above head (stop if there is any pain). Slowly lower arms to starting position. 2x10 repetitions.
SHOULDER ABDUCTION::
Arms are straight at side, palms facing toward legs. Lift arms out to the side until hands are overhead. Rotate arms outward as you lift over your head (stop if any pain). Slowly lower arms to start position. 2x10 repetitions.
DIAGONAL SHOULDER PATTERN (for pectoralis/chest area and shoulders):
Place hand in front of hip of opposite leg. Palm facing leg. Slowly lift the hand up and diagonally across the body. Lower the arm slowly back to start position. 2x10 repetitions for each arm.
WALL PUSH-UPS:
Stand or sit (don't forget to put on the wheelchair brakes!). Place self approximately 30 cm (1 ft.) away from wall. Reach both hands out to touch the wall. Palms rest on wall. Bend both elbows until nose comes very close to the wall. Straighten elbows. 2x10 repetitions
BICEPS:
Arms are straight at side, palms facing legs. Bend at the elbow, bring hands toward shoulders, twist hands towards shoulders. Slowly straighten arms to starting position. 2x10 repetitions.
TRICEPS:
Raise arm up to a position where the elbow is by the ear. Keep elbow steady. Straighten and bend elbow. 2x10 repetitions.
FINGER STRENGTHENING (need rubber bands) (Use more rubber bands for more resistance)
Place rubber band around fingers and thumb. Spread fingers and thumb apart and bring together. 2x10 repetitions.
If you have any small ball, squeeze them to strengthen hand muscles. Or you can take a sheet of scrap paper and use one hand to form it into a ball to strengthen your hand muscles. 2x10 repetitions
Another way to strengthen arm muscles is to sit next to a wall, push arm against wall and hold it for approximately 10 sec. 2x10 repetitions.
Meditate Word By Word On These Verses:
Gen. 32:24-32.
The Back - A Flexible Framework
The skeleton or bones of the body give the body support. Just as the framework of a building holds it up, the bones and the muscles hold the body erect. Where the bones meet, there are joints to give the skeleton flexibility and movement. There are two categories of the skeleton: the axial which are the central core of the body - the skull, spinal column, and ribs. The appendicular skeleton refers to the arms and legs, shoulders, and pelvis.
The spine is a series of alternating convex and concave curves that support the body and absorb shock. It consists of 33 bones (vertebrae) that allow for movement. The vertebrae at the top of the skull are smallest and have a wide range of movement. The lower bones of the spine are the largest and bear most of the body's weight.
Each bone of the spine is flat and oval. There are pediciles that sit at the back of this bone and join to form a continuous hole for the spinal cord. There are also three wing-like extensions that anchor the muscles to the bone and give the spine a knobby appearance under the skin of the back.
Between the vertebrae is a special padding of tough material called the disk. The disk absorbs shock and prevents the bones of the spine from rubbing together. The disks allow motion between the vertebrae, giving strength and flexibility to the whole spine. To create the curves that are in the spine, the disks sublty change shape. We know that through adequate rest and exercise, the disks absorb fliud to cushion the vertebrae.
1. Why are disks in the back important?
(Only one of the following answers is correct.)
a) because they are round,
b) they provide padding between the bones,
c) they absorb fluid.
Causes of Back Pain
There are several structures in the back that can cause and/or contribute to low back pain. The intervertebral disc is a remarkably versatile and strong structure. It acts as a shock absorber as we go about our activities, but sometimes the disk breaks or slides when there is a sudden, unexpected force (such as a fall, lifting or other trauma). When the disk does get injured it cannot repair itself very well, which is one of the major reasons recurrent back pain is so common.
To make matters worse, the pain often prevents us from getting enough exercise, which adversely affects disk nutrition. Nutrition for the disk is achieved when physical activities and sleep cause the disk to swell up with water and then squeeze it out - much like a sponge. When pain affects our physical activity, the injured disk is deprived of its nutrition and begins to degenerate. Activity is also needed to maintain the exchange of fluids in spinal structures and reduce swelling that naturally occurs in the tissues surrounding an injured disk. This swelling can further irritate nerves that are already affected by herniated disk material.
The muscles, ligaments and tendons in the back are also very important in maintaining proper spinal balance and strength. With decreased activity, the connective fibers of ligaments and tendons can begin to adhere to each other and lose resilience and may tear when sudden overload occurs. Unlike disks or connective tissue, however, when muscles are injured, they can quickly repair themselves. However, muscles contribute to chronic back pain. When nerves are cut or pinched, the muscles they control cannot work, as sometimes happens when a herniated disk presses on a nerve. Also, since muscles are in constant communication with the central nervous system, anger or anxiety can tense the muscles and cause muscle spasms. Ongoing tension inhibits normal muscle function and leads to muscle wasting and further stability problems, which in turn can lead to chronic lower back pain.
Acute Lower Back Pain Caused by Muscle Strain
The majority of episodes of acute lower back pain are caused by muscular strain - from lifting a heavy object or having a sudden movement or fall. Even though this may not seem like a serious injury, the pain can be very severe and last for several hours, several days, or a few weeks.
When the muscles in the back are strained or torn, the area around the muscles becomes inflamed. Because of the inflammation, the muscles in the back can spasm causing pain and difficulty moving. Muscle strains usually heal with time (in two weeks) because muscles have a good blood supply that brings the necessary nutrients to the muscles for healing. However, an episode of low back pain that lasts for more than two weeks can lead to muscle weakness (since using the muscles hurts, the tendency is to avoid using them). This process leads to disuse atrophy (muscle wasting), and subsequent weakening, which in turn causes more pain because the muscles are less able to help hold up the spine.
2. Why do back muscles usually heal quickly?
(Only one of the following answers is correct.)
a) They have a good blood supply that brings nutrients to the damaged tissue,
b) They are close to the nerves that stimulate them,
c) They are large and can heal quickly.
There are three types of muscles that support the spine: Extensors (back and gluteal muscles), Flexors (abdominal and iliopsoas muscles), Obliques or Rotators (side muscles). In general, active and well-conditioned people are much less likely to suffer from back pain due to muscle strain, as regular exercise stretches the muscles so they are less likely to strain, tear or spasm. While some of these muscles are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised. A complete exercise program should consist of a combination of stretching, strengthening, and aerobic conditioning.
Getting an Accurate Back Pain Diagnosis
Because the causes of back pain can be very complex, it is more difficult to get an accurate diagnosis for back pain or neck pain than for other medical conditions. While some spinal diagnoses are relatively straightforward (such as tumors, infections, or fractures), for many conditions there is little agreement among spine specialists about a diagnosis. However, getting an accurate diagnosis is critical, because different diagnoses will require very different treatment approaches. And the sooner an accurate diagnosis is made, the sooner the patient can find an appropriate treatment to for pain relief and rehabilitation.
Diagnostic tests are used to confirm an anatomical lesion as a cause of back or neck pain. They are particularly useful to pinpoint the source and extent of the lesion, which in turn assists in the diagnosis and development of an appropriate treatment plan. The most common diagnostic tests include: X-rays provide detail of the bone structures in the spine, and are used to check for instability, tumors, and fractures. CT scans, which are essentially images like a very detailed x-ray, take cross section images of the body. They provide excellent bony detail and are also capable of imaging for specific conditions, such as a herniated disk or spinal stenosis. MRI scans are particularly useful to assess certain conditions by providing detail of the disk and nerve roots. MRI scans are also useful to rule out tumors or spinal infections. There are a number of other imaging and electrical studies that may also be used, and some injections are used for diagnostic purposes as well as for pain relief.
An accurate clinical diagnosis is based on correlating the findings of the diagnostic tests (such as an MRI), with the patient's specific symptoms and the physician's findings from a complete physical exam. While it is difficult to believe, despite a battery of diagnostic tests many times there is no anatomical reason that can be found that can account for a patient's pain. However, if there is no anatomical reason for the patient's pain, the pain is still real and needs to be managed.
3. Back pain is best diagnosed by:
(Only one of the following answers is correct.)
a) a series of x-rays and scans,
b) a series of x-rays and physical examination done by the doctor,
c) the correlation of the physical examination by the doctor and the x-rays and scans.
Rehabilitation for a Healthy Back
People who suffer from lower back pain are often encouraged to participate in their own recovery, but they are seldom given the knowledge and tools needed to accomplish this. Feeling less pain is only the beginning of rehabilitation since further episodes of back pain may be common as time passes. Fortunately, a person can avoid recurrences by rehabilitating his back, whether it is the first experience with low back pain or whether he has had extensive treatment or even surgery.
Acute and Chronic Back Pain
There is a difference between acute pain and chronic pain. We have all experienced acute pain from a sudden soft tissue injury, such as a sprained ankle, or even just a simple paper cut. The pain is immediate, but gradually resolves as the injured part heals. Unlike acute pain, chronic pain comprises a constant low level of stimulation to the nervous system that eventually becomes a pattern. It may even persist as a "neural memory" after the initial source of irritation has resolved. The adaptation of our nervous system to this chronic stimulation creates an environment in which events that previously caused no pain become a source of pain. Pain may even progress to uninjured areas. Emotional distress and certain medications can increase pain. An effective solution is to distract the nervous system by means of active exercise in a controlled, non-destructive manner. This also helps to create the physiological conditions that allow the injured structures to heal.
Match these words with the following definitions:
A.Neural memory, B. acute pain, C. chronic pain, D. CT scan.
4. a constant low level of stimulation to the nervous system that is interpreted as pain
A,
B,
C,
D.
5. a detailed image that shows a cross-section of the spine
A,
B,
C,
D.
6. a remembrance of pain that is not present because the source of the pain has been stopped
A,
B,
C,
D.
7. a sudden injury to soft tissue or muscle
A,
B,
C,
D.
In addition to stretching, strengthening and aerobic exercises, there are several basic guidelines that can help you in your healing and rehabilitation process. These guidelines include:
Manage anxiety
Controlling anxiety and fear of re-injury is very important to regain normal muscle function. The basis for these psychological reactions to low back pain lies in the central nervous system, which responds to pain by instructing the muscles near the affected part to protect against further injury. Only appropriate physical training that specifically tells the muscles to improve their function can overcome this neurological barrier to normal muscle function.
Eat properly
The healing process can be aided with appropriate nutrition, which includes adequate calorie intake in a balanced manner. If all calories consumed are in the form of sugars (such as breads, pasta, and sweets), any calories not immediately needed for energy are converted into fat. Extra weight is NOT needed while a person is in the healing process. The diet should include adequate protein as a source of the building blocks of soft tissue healing. Additionally, fresh fruit and vegetables supply the vitamins and trace elements necessary for effective healing. A vitamin supplement may also be helpful.
Control medication use
While medications are often important for pain relief, one should also be careful about the use of medications. For example, use of narcotic medications and muscle relaxants over time may cause depression and should be used as little as possible. Also, while anti-inflammatory medications may provide pain relief, there is no evidence that they do anything to speed the process of healing. The use of heat or cold, or liniment or massage, as a mechanism for pain control is a very safe and positive alternative for pain management.
Get adequate sleep
One of the best ways to encourage sleep is to induce physical weariness through active exercise. Chronic inactivity does not create a need for the deep sleep that is so helpful for physical and emotional healing. Clearly, stimulants such as caffeine or nicotine should be avoided at bedtime. Smoking should be avoided because it also diminishes the available blood supply and makes the nervous system more sensitive.
Exercise properly
Exercise in a controlled, gradual, and progressive manner is the only way we can tell our body to heal. Injections and medications can provide pain relief but cannot stimulate the healing process. If a pain problem has persisted for many weeks, the body is demonstrating that there are barriers to the healing process that need to be eliminated. The natural stimulus for the healing process is active exercise. Active exercise means we use our nervous system to tell the muscles what to do, and includes dedication to an appropriate, comprehensive exercise and rehabilitation program.
Finally, an important guideline is to seek the assistance of an appropriately trained and licensed health professional for your rehabilitation. And it's always important to see a physician if your lower back pain lasts for more than a few weeks or a month, or if you have any symptoms that cause you concern, as the continued pain and/or symptoms may signify a serious medical condition. Ultimately, participating in developing and maintaining an active rehabilitation program for back pain should help you heal faster and have fewer recurrences of pain.
8. What is a good alternative for pain management?
(Only one of the following answers is correct.)
a) eating ice cream to distract your mind from pain,
b) use of warm or cold on the back,
c) sleep.
Exercises
Active therapies (exercises) are typically necessary to rehabilitate the spine and help alleviate pain. Importantly, a regular exercise routine provides patients with the means to help avoid recurrences of low back pain, and helps reduce severity and duration of potential future episodes of low back pain. Generally, a patient's exercise program for low back pain should include:
- stretching (such as hamstring stretching),
- strengthening (such as dynamic lumbar stabilization exercises),
- and low impact aerobic exercising (such as walking, bicycling or swimming).
Stretching
Any form of inactivity, especially where an injured back is involved, is usually associated with some progressive stiffness. Therefore, it is necessary to push the range of motion as far as can be tolerated (in a controlled manner). Patients with chronic pain may find it takes weeks or months of stretching to mobilize the spine and soft tissues, but will find that the increase in motion provides meaningful and sustained relief of their back pain. Stretching exercises should focus on achieving flexibility and elasticity in the disc, muscles, ligaments, and tendons. Additionally, it is important to activate and strengthen muscles not directly involved with the injured area, such as the arms and legs. For example, the hamstring muscles play a role in lower back pain, as it is clear that hamstring tightness limits motion in the pelvis and can place it in a position that increases stress across the low back.
Almost everyone can benefit from stretching the soft tissues-the muscles, ligaments and tendons-around the spine. The spinal column and its contiguous muscles, ligaments and tendons are all designed to move, and limitations in this motion can accentuate pain. Patients with chronic pain may find it takes weeks or months of stretching to mobilize the spine and soft tissues, but will find that meaningful and sustained relief of low back pain follows the increase in motion. The hamstring muscles seem to play a key role in low back pain, as patients who have low back pain tend to have tight hamstrings, and patients with tight hamstrings tend to have low back pain. It is not known which comes first, but it is clear that hamstring tightness limits motion in the pelvis and can place it in a position that increases stress across the low back. Therefore, it follows that stretching the hamstring muscles typically helps decrease the intensity of a patient's back pain and the frequency of recurrences.
A hamstring stretching routine should include applying pressure to lengthen the hamstring muscle for 30-45 seconds at a time, one to two times each day. The pressure on the muscle should be applied evenly and bouncing should be avoided, since a bouncing motion will trigger a spasm response in the muscle being stretched. The hamstring muscle may be stretched in a number of different ways.
9. What is range of motion of muscles and joints?
(Only one of the following answers is correct.)
a) the number of degrees that a joint and its muscles can move in one direction or another,
b) the number of ways that a joint and its muscles can move,
c) movement back and forth in a joint and its muscles.
Hamstrings
-Sit on a chair and place the legs straight out in front on another chair, then reaching forward to try to touch the toes. One leg at a time may be stretched.
-One of the least stressful techniques is to lie on the floor and bring the leg up straight. One leg at a time may be stretched.
With time the hamstring muscle will gradually lengthen, reducing stress to the low back. Stretching should not be linked to other exercises, since those exercises may not be done on a daily basis. In order to make stretching a part of one's daily regimen, it is best to stretch every morning when getting up and before going to bed. These exercises will help strengthen your muscles, making everyday activities easier, and helping to prevent back and neck injuries. You should perform the strengthening exercises 3-4 days a week. Perform the exercises slowly, avoiding sudden jerking movements. DISCONTINUE AN EXERCISE IF IT IS PAINFUL; especially if you are unable to do a beginning level strengthening exercise. Also, DO NOT HOLD YOUR BREATH WHILE DOING THESE EXERCISES.
Abdominal Exercises
Lie on your back with your knees bent and feet flat on the floor. Tighten your abdominal muscles and tilt your pelvis backward, pushing your lower back toward the floor. Hold 3-5 seconds, then relax. Do 10-20 repetitions.
Curl-up
Slowly curl your chin toward your chest and continue to roll upward until your shoulder blades have cleared the floor. Hold the position for 3 to 5 counts, then slowly lower. Do 10-20 repetitions.
10. Why is it important to stretch the hamstring muscles?
(Only one of the following answers is correct.)
a) They are large and need it,
b) Because it seems that if they are tight, there is a greater chance for lower back pain,
c) To prevent back pain.
Waist/Obliques
Start with the pelvic tilt position. Keep one elbow on the ground to support your upper back muscles and ensure full range of motion. Leading with the opposite shoulder, slowly curl your body up, rotating your trunk toward the opposite knee. Once your shoulder blade has cleared the floor, hold the position for 3-5 counts, then slowly lower. Do 10-20 repetitions.
Lower Back
Lie flat on your stomach. Raise one arm at a time, then try one leg at a time. Hold each for 3-5 counts, then slowly lower. Do 5-20 repetitions for each arm and/or leg. Progression of this exercise - When raising one arn and/or leg at a time becomes easy, try raising the opposite arm and leg at the same time. This must be pain free!!
Upper Back
Bend your elbows. Slowly press your elbows straight back, squeezing the shoulders together. Hold for 3-5 counts and relax. Do 10-20 repetitions.
Bent-Over Rowing
When you are able to perform (A) without feeling tired. Stand with feet shoulder-width apart and knees bent. Bend over at the waist to about 70 degrees, keeping the normal curves in the back. Holding light weights in your hands, let your arms dangle straight down. Slowly raise elbows up, until they are level with the shoulders and bent at a 90-degree angle.
Shoulder Shrugs
Keeping your head over your shoulders, slowly raise your shoulders up toward your ears. Hold 3-5 counts. Then press the shoulders down as far as possible and hold 3-5 counts. Do 10-20 repetitions. Progression - When you are able to perform these without feeling tired, try to perform with light weights in your hands. IT MUST BE PAIN FREE!
Neck
Tuck in chin. Push head back against your hands or the floor (if lying on your back). Hold 3-5 counts. Do 10-20 repetitions.
Extensions
Place your hand on the side of your head. Tuck your chin in and push your head to the side, against your hand. Do 10-20 repetitions.
Low Impact Aerobic Conditioning
Finally, conditioning through low-impact aerobic exercise is very important for both rehabilitation and maintenance of the lower back. Aerobically fit patients will have fewer episodes of low back pain, and will experience less pain when an episode occurs. Examples of low impact aerobic exercises that many people with back pain can tolerate include:
- Water Therapy (also called pool therapy or hydrotherapy)
This provides buoyancy as well as mild resistance.- Walking
Many people think that walking as part of their daily routine (e.g. at work or while shopping) is enough. However, this stop-and-start type of walking is not adequate for aerobic conditioning. Instead, continuous walking at a sustained pace for a minimum of twenty to thirty minutes is required to provide aerobic conditioning.- Stationary biking
Riding a stationary bicycle provides aerobic conditioning with minimal impact on the spine. This is also a good exercise option for people who are more comfortable positioned leaning forward. Depending on your injury and exercise preferences, you may prefer a different form of exercise. It may be helpful to discuss your options with your physical therapist or physician to identify an appropriate form of aerobic exercise for you and incorporate it into your exercise routine.
11. A healthy back is:
(Only one of the following answers is correct.)
a) a back that does not give you pain,
b) a back that is strong and supple,
c) a back that has muscles regularly strengthened by exercise.
(Most of the information used for this lecture comes from the website www.Spine-Health.com)