Low Back Pain During and After Pregnancy Facts

Introduction
Low back pain (LBP) is a common problem during pregnancy and even more so afterwards. The pain can vary from a mild discomfort to severe and disabling. Serious causes of back pain are rare and easy for your doctor or chiropractor to diagnose. Most back pain is mechanical in nature and greatly subsides in just a few weeks.

When should I see a doctor?
LBP often gets better on there own as nature takes its course. Many women do just fine by staying active, coping the best they can, and modifying daily activities as to not re-agitate the tender tissues.

You should see a doctor when the pain is too much for you to cope with or there are specific activities important to you that you are having difficult undertaking. Back pain can occasionally be associated with pain extending down into the leg. This condition sometimes known as “sciatica” and you should see a doctor to diagnose it.

Health care providers are useful for making sure you don’t have serious disease and offering reassurance. Also they can help suggest possible ways to control your pain and advise you of ways to deal with the pain and get on with your life. It is normal to worry about the cause of your low back pain and the impact it may have on your life or the pregnancy. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the pain and that there are ways to relieve the symptoms and get you back to your normal activities. Often the rehabilitation specialist will work hand in hand with your physician when appropriate.

Make sure you work with your healthcare provider to find ways to better manage and control the low back pain.

What can I do for myself?

There are several preventive measures one can take to help reduce the likelihood of developing low back pain or as self-care for back pain.

• Staying active: By staying active often times you can reduce minor episodes of low back pain from becoming more serious. The old notion of staying in bed until the pain is gone is no longer the best advice. The sooner you get moving again, the quicker you’ll progress through the pain episode and move on with your life.

• Lifting: If you have to pick up something try to bend at the knees, keeping your low back curved forward, not slumped. This is called the “hip hinge” and forces you to use your buttock and thigh muscles to take pressure off your back.

Incorrect lifting position with slouch Correct lifting position with hip hinge



• Sleeping: Try supporting under your knees with a pillow when sleeping on your back or between the knees when lying on your side.

• Specific stabilizing exercises: Often a rehabilitation specialist can prescribe specific exercises for back pain to help strengthen and stabilize muscles. As no two patients are alike, your rehabilitation specialist can help find what exercises are appropriate for you.



Ways to increase your activity.
Sometimes it may seem quite daunting to deal with activities which increase your LBP. Often times its frustrating because the activities you were first able to perform without pain are now giving you discomfort. Find out how long you can perform a specific activity without “flaring-up” your condition or making you worse off than when you started. Reduce the amount or time of activity by 20% so you’re able to perform the activity, but it does not take you to the “flare up” point.

Having a little discomfort is normal, though the duration of the activity should not make you worse off than before. Gradually increase the activity little by little, as not to reach the “flare-up” state. Slowly you will notice you’re able to do the activity longer without “flaring-up” the condition. Don’t be too upset if you have a “flare-up,” just reassess your activity level and continue on. Monitor the sciatic leg pain and tell your health care provider if it is either not improving or getting worse. It’s normal to have good days and bad days. Don’t be afraid to ask others for assistance. Your body has changed and it’s natural for symptoms to occur, but they should pass with time.


Here are some other examples of ways to modify your activity:

Staying active and doing your normal activities is one of the most important things you can do for yourself. You may have to modify the way you perform certain activities to keep from aggravating your back. Examples may be how you bend over to pick something up, getting off a chair or toilet, putting on your shoes or pants, sitting too long at work. Your rehabilitation specialist can help you with modifying activities which are giving you difficulty. Massage, manipulation and other modalities may help relieve the pain, but they are best used to getting you re-activated and moving on with your life. Sometimes ice or heat packs may give some relief. Some women find relief with braces or belts that support the increasing abdominal weight. Medication (even over-the-counter) is to be used only with approval by your physician. Ask your rehabilitation specialist about specific problems you may be experiencing.


Rehabilitation
When self-care and activity modification does not give you sufficient relief, see a rehabilitation specialist for help. These doctors and therapists are specially trained to bridge the gap between what you are capable of doing and what you want to do. This may consist of specific exercises prescription that helps improve areas where you are having some difficulty. Make sure and voice your thoughts, fears and concerns to your healthcare provider. Often specific procedures following the pregnancy such as “Caesarian births” or the use of an epidural may dictate a specific kind of exercise or therapy. Pain and “flare-ups” may happen from time to time. This is normal and you will learn “first-aid” approaches for this. However, the more important goal is to re-condition your abdominal and back muscles so you are more stable during your chosen activities.

By staying active, modifying activities, and getting information from your healthcare provider, one can greatly reduce the occurrence or duration of LBP episodes.

Sources from "clinicalrehabspecialists.com"

Low back pain

Low Back Pain Facts

Low back pain is a common ailment which most people (80-85%) suffer with it at some time in their lives. The causes of low back pain are poorly understood and can range from trauma, poor lifting and overuse/underuse of the muscles. 85% of the time the pain is mechanical coming from either the muscles, joints or ligaments. Fortunately, it is rare for the pain to be caused by a serious medical problem and such causes can be ruled out by a thorough history and examination from your healthcare provider.





When should I see a doctor?

Often low back pain episodes will get better on there own as nature takes its course. It’s important to stay as active as possible as the old adage of bed rest and trying to completely avoid pain is not the best advice. Most people do just fine by staying active, coping the best they can, and modifying daily activities as to not re-agitate the tender tissues.

You should see a doctor when the pain is too much for you to cope with or there are specific activities important to you that you are having difficult undertaking. Understand that low back pain is a very common problem and the chances that it is caused by serious disease are very rare. Health practitioners can help suggest possible ways to control your pain and advise you of ways to deal with the pain and get on with your life. It is normal to worry about the cause of your low back pain and the impact it may have on your life. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the pain and that there are ways to relieve the symptoms and get you back to your normal activities.

Make sure you work with your healthcare provider to find ways to better manage and control the low back pain.

What can I do for myself?

Keep in mind that staying active with your normal activities is the best thing you can do to limit the effects of low back pain on your life. You may have to modify the way you perform certain activities to keep from aggravating the tender tissues. Examples may be how you bend over to pick something up, getting off a chair or toilet, putting on your shoes or pants, sitting too long at work. Pain medication, hot/cold packs, massage, manipulation and other modalities may offer pain relief, but they are best used to getting you re-activated and moving on with your life. Keep in mind that the pain is your own and the manner in how you deal with it and return to normal activities is the greatest thing you can do for yourself. Try to stay working as only in cases of particularly severe pain do you need to be off work. You may need to find restricted duties or reduced hours, but staying active is important. Staying active helps prevent long-term problems. If it has been several weeks since you have been back to work, you really should be planning with your doctor or therapist and employer how and when you can return. Here are some ideas to keep your low back pain from becoming a more long-term problem:

•Keep moving.

•Do not stay in a position for too long.


•Move before you stiffen up.


•Move a little more each day.

•Don’t stop doing things-just change the way you go about doing them.


Ways to increase your activity.


First ask what is it that I want to do? Is it walking further, going up stairs, shopping, etc.? Find out how long you can perform this activity without “flaring-up” your condition or making you worse off than when you started. This is individual to you. Reduce the amount or time of activity by 20% so you’re able to perform the activity, but it does not take you to the “flare up” point. Having a little discomfort is alright, though the duration of the activity should not make you worse off than before. Gradually increase the activity little by little, as not to reach the “flare-up” state. Slowly you will notice you’re able to do the activity longer without “flaring-up” the condition. Don’t be too upset if you have a “flare-up,” just reassess your activity level and continue on. It’s normal to have good days and bad days. It takes some patience, but it works.


Ways to Modify Your Activities

Sitting

Find a chair that is comfortable to you and supports the small of your back, you may have to experiment with several. Get up and stretch often.


Rising from a chair
Avoid slumping as in the left hand picture. Instead stick your chest out as in the right hand picture to protect your back. Getting up and down like this utilizes what is called “the hip hinge” to spare your spine. This can be incorporated in other lifting and bending activities as well.



Desk work
Make sure the height of the chair fits the desk. Arrange the keyboard monitor and phone so you do not feel strained. Get up and stretch often.

Driving
Adjust your seat from time to time. Try some support in the small of the back. Take regular stops and get out of the car for a quick break. Walk around and stretch.

Lifting
Think before you lift on the best way to move the load. Don’t lift more than you need to. Keep the load close to your body. Lightly tighten your stomach muscles to brace your back. Turn with your feet when carrying the load, don’t twist the back. Finally, be sure to “hip hinge” to maintain an upright spine as the picture above shows.

Carrying and shopping
Ask yourself if you need to carry at all. Keep the load close to your body. Split the weight of the load between two hands. Push carts with both hands.

Daily activities/hobbies
Don’t do any one thing for too long. Keep changing activities.

Sports
Continuing to play your normal sports is fine, but you may need to modify your game or decrease your intensity.

Sleeping
Some people find relief sleeping of a firmer mattress; possibly try a sheet of chipboard under the mattress. Painkillers an hour before you go to bed may help.

Sex
Sex is fine, but you may need to try different positions.

If your pain is not settling down or getting worse, you may need further assessment from your health care provider. Make sure you ask questions or voice your concerns about your pain to your healthcare provider.


Rehabilitation

If there are specific activities which you are having difficulty with, a rehabilitation specialist can help. Once serious causes are ruled out and the pain is under control, the rehab specialist examines where the dysfunction lies. First identify specific goals or limitations you wish to overcome that are agreed upon by both the practitioner and you. The rehab specialist will perform a functional evaluation to determine what you are able to do and what areas may be causing some trouble. Bridging the gap between what you are able to do and what you want to do is the essence of rehabilitation. This may consist of specific exercises prescription that helps improve areas where you are having some difficulty. Make sure and voice your thoughts and concerns with your healthcare provider. Pain and “flare-ups” may happen from time to time. This is normal and should not be the focus in care. Rather, try to focus on the exercises that are bridging the gap to your goals and what activities you want to do.

It is important that you maintain contact with your healthcare provider. If the pain is not settling down or is getting worse, you may need further assessment. Follow up visits provide you the opportunity to obtain more information and address any fears or concerns you may have with your low back pain.

www.clinicalrehabspecialists.com

Headache

Headache Facts

Introduction

Headache pain is a common problem which many individuals seek relief through health care assistance. While the pain is common, headache treatment and management can be an ongoing source of frustration for many individuals. There are many types of headaches with differing causes, presentations, durations and intensities. These may range from the common migraine, classic migraine, tension, cluster, temporal aritis, and sinus headache. While a headache’s presentation and symptoms may be similar or different from one patient to another, effective treatment strategies usually take an individualized approach to identify the cause for appropriate management.

The most common forms of headaches are tension and migraine headaches. Tension headaches are a non-specific headache which usually stem from overactive muscle tension in the head, shoulder and facial areas. Dull, achy, non-pulsating pain is often felt in the temples, TMJ, forehead and base of the skull. There is usually a correlation to daily stress and these headaches do not commonly associate with bouts of nausea, eye pain, facial numbness.

More than 28 million Americans suffer from migraine headaches which are generally more severe than tension headaches. Women are three times more likely to suffer migraine headaches than men. These headaches may be influenced by external factors such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near-daily use of medications designed for relieving headache attacks; bright lights, sunlight, and fluorescent lights; TV and movie viewing; certain foods; and excessive noise. Migraines often occur with nausea, visual pain or disturbances, facial and hand numbness, and sensitivity to light and sound. Migraine headaches usually last in bouts, lasting from a few hours to several days. Classic migraines differ from common migraines due to the aura (flashing lights, blind spots, or jagged lines in vision, smelling strange odors and difficulty speaking) that will precede the manifestation of the migraine by 10 to 30 minutes.

When should I see a doctor?

Understand that while headaches are quite common, they can greatly impact the quality of your life and limit your daily activities. Seek care from your healthcare provider when you are unable to manage or cope with your headache. Your healthcare provider will take a history to try and identify the cause of your headache and rule out sinister causes. Once “red flags” have been eliminated, treatment solutions are offered to control the pain and reduce future reoccurrence so you can get back to your daily activities. While serious pathology is a rare cause for most headaches, it is normal to worry about the cause of your headache pain. Often fears of more serious disease may be of worry to you. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the headache pain and that there are ways to relieve the symptoms and get you back to your normal activities.

What can I do for myself?

Since headache occurrence can be frequent, often there are ways to cope with an episode and limit its effects. Some individuals keep a headache diary to track headache triggers such as specific types of food or stressful situations that can be avoided in the future. In the event of a headache, avoiding certain types of light, finding a quite place to rest, reducing light exposure with sunglasses or sitting in a dark room may help ease the pain. Some people find sipping strong coffee helps with the headache pain. Others find alternating a hot compress for several minutes on the forehead followed by a cold compress helps reduce the pain and repeating this cycle several times. Try different coping strategies and see what works best for you. Some over-the-counter medications may help you control the pain. Prescription medications may also benefit some individuals. Speak with your healthcare provider about such remedies to determine if they are appropriate for you.

Rehabilitation

If your healthcare provider determines that your headache is from a musculoskeletal origin a rehabilitation program may be ordered. This may consist of short term trial of spinal mobilization/manipulation, soft-tissue treatment, neck stability exercise training and/or sensory motor training all used to reduce headache intensity and prevent reoccurrence. Workplace and lifestyle advice is often incorporated to improve management skills. The Brugger relief position is excellent stress “micro-break” which relaxes over-tense muscles.

Neck retraction is another exercise that helps to increase neck stability and stretch overactive muscles at the base of the skull.

Keep in mind that while headaches can be unpleasant and greatly affect the quality of our lives, there are emerging treatment strategies that can empower the patient to effectively control a headache’s intensity and frequency. Speak with your healthcare provider about any fears and concerns regarding your headache pain and discuss a management plan that works for you.

WWW.CLINICALREHABSPECIALISTS.COM

What is ‘whiplash’?


‘Whiplash’ is what happens when someone’s head moves forwards and then backwards quickly. This quick back and forth movement may cause injury to the neck. This whiplash movement often happens in car crashes. People who have been in a crash often complain of neck pain and stiffness afterwards, sometimes even a few days after the accident. For most people the pain is mild, does not interfere with their normal activities and gradually gets better. Research indicates that people who carry on with their normal activities recover faster than people who stay at home and reduce their activities.

Some people have more severe neck pain. They may also experience:
• headaches
• pain in the shoulders and arms
• dizziness or altered sensation
• weakness in the arms.

These people should see a doctor immediately since they may have a Whiplash-Associated Disorder, or WAD as it also known.

What is WAD?

The term WAD stands for Whiplash-Associated Disorders. It covers a range of neck problems resulting from the whiplash motion of the accident. These can range from no discomfort at all to very severe injuries.

To help the doctor work out how serious your injury is and the most appropriate treatment, the neck problems from a whiplash have been grouped into four ‘grades’ of WAD.

Grade 0 no pain or discomfort. No physical signs of injury.

Grade 1 neck pain, stiffness or tenderness. No physical signs of injury.

Grade 2 neck pain, stiffness or tenderness and some physical signs of injury such as point
tenderness or trouble turning the head.
Grade 3 pain, stiffness or tenderness and neurological signs of injury, such as changes to
reflexes or weakness.
Grade 4 pain and fracture or dislocation of the neck.


When should I seek medical advice?

You should seek medical advice after an accident if you have:

• medium to severe pain in your neck
• neck pain plus stiffness (you have problems turning your head)
• arm numbness or weakness
• drowsiness, nausea, vomiting, confusion
• any complaints that are not getting better or are getting worse.

These symptoms may mean you have WAD.
It is important that you see your GP for a medical assessment.
A registered health professional such as your GP, physiotherapist or chiropractor is the best person to advise you about how to manage your whiplash injury.

It is also important that you tell your GP of other professionals who may be treating you.

How long will it take me to get better?

This will depend on the extent of your injury. Every injury is different.
Most people will be able to continue with their normal activities, but it may take weeks, or even months, for the discomfort to go away completely.
If you have had to reduce your normal activities, you should be able to return to them within weeks.
It may seem that it is taking a long time for you to recover. If you are worried about this, or if your pain gets worse, see your doctor immediately.


Treatments that are recommended

Act as usual: you may have pain but maintaining your normal activities is an important factor in getting better.

Exercise: specific exercises to restore muscle control and support your neck should improve postural control and prevent unnecessary postural strain. General exercise and activity are also important.

Pain relieving medication: pain relieving medication such as paracetamol can be prescribed. For more severe cases, anti-inflammatories can be prescribed in the short term to reduce pain and swelling. Use of medication should be limited as it may have side effects.


Treatments that may be used

Advice about posture: advice about how to sit and stand correctly can be helpful in addition to maintaining usual activities and exercising.

Joint Mobilisation: a therapist gently and repetitively moves the joints in the neck region to reduce pain and restore normal movement in the neck. This can be used if it reduces your
symptoms. It is important that your therapist is registered, qualified and trained to do mobilisation.

Spinal Manipulation: a therapist applies a gentle quick single thrust to the joint to the limit of its range of movement. This produces a clicking sound. The manipulation aims to reduce pain
and restore motion. It can be used if it reduces your symptoms. You should check that your health provider (medical practitioner, chiropractor, osteopath or physiotherapist) is registered, qualified and trained to do manipulation. Complications from manipulation are rare but include stroke and death.

Combination of Treatments: a combination of treatments such as exercise and mobilisation can be used. Traction: a machine gently stretches the neck. Traction can be used with other treatments. There is no evidence that traction works for WAD, so it should only be used if it reduces your symptoms.

Acupuncture: fine needles are inserted into specific points on the body. There is no evidence that acupuncture works for WAD; it should only be used if it reduces your symptoms.

Improving your environment: learning about the structure of your neck and how it works can be helpful. Improving your work practices can lessen unnecessary strain and allow you to function well in your normal daily activity. For example, the chair you sit on at work may need adjusting. It may also help to stand up for a break or change position every 20 minutes. If you have learnt relaxation techniques these may be helpful in managing pain associated with WAD.

TENS, heat, ice, massage, ultrasound, laser, short-wave diathermy: TENS (Transcutaneous Electrical Nerve Stimulation) is a low frequency, painless electric current sent through the skin to reduce pain.
This and other passive treatments/electrotherapies, if administered by trained professionals, are additional treatment options during the first three weeks. They are used with manual and physical therapies and exercise to help you return as soon as possible to your usual activity.

Rest: a period of bed rest is not recommended for people with WAD Grade 1. People with WAD Grades 2 and 3 should not have bed rest for more than four days.

Surgical Treatment: in almost all cases of WAD Grades 1 to 3 surgery is not required.

Collars: the use of a collar, sometimes called a neck brace, is not recommended for WAD Grade 1. If prescribed for WAD Grades 2 and 3, a collar should not be used for more than three days as it may slow your recovery.

Exercises that might help The following exercises should help to heal your neck.* Perform all exercises in a slow and controlled manner. The exercises are designed to restore the movement and muscle control around your neck and to reduce unnecessary postural strain and muscle pain.


When you are performing the exercises, stop and contact your doctor or therapist if you notice:

• dizziness, light headedness, blurred vision, fainting or disorientation
• sudden pain shooting down your arm, or numbness or weakness in your arm or hand
• unusually severe neck pain
• exercises consistently producing a headache, which persists.

For each exercise:
• move smoothly and slowly, without sudden jerks. The key is precision and control.
• keep your mouth and jaw relaxed. Keep lips together, teeth slightly apart and let your tongue rest on the roof of your mouth.
• gently hold your shoulders back and down so that they are relaxed while doing all exercises.
• in movement exercises, try to move the same distance to each side. If one side is stiffer, move gently into the stiffness. Move to that direction a little more often.
• expect some discomfort, but remember exercises should not cause severe pain.

Lie down with a soft pillow under your neck, and with your knees bent up.

The chin nod exercise

Gently and slowly nod your head forward as if to say ‘yes’. Feel the
muscles at the front of your neck.
Stop the nodding action just before you feel the front muscles hardening.
Hold the nod position for five seconds and then relax. Gently move your head back to the normal start position. Repeat up to 10 times.

Head rotation

Gently turn your head from one side to the other. Look where you are going. Progressively aim to turn your head far enough so your chin is in line with your shoulder and you can see the wall in line with your shoulder. Repeat 10 times to each side.


Correct postural position

Correct your posture regularly by gently straightening up your lower back and pelvis. Now gently draw your shoulder blades back and down (women towards their bra clip). Hold the position with ease for at least 10 seconds.

This position will prevent and ease muscle pain and tension in your neck and shoulder muscles. Repeat the correction regularly, every half hour during the day. You can do this exercise at work, in the car, train or bus and sitting at home.

Neck isometric (no movement) exercise

Sit in the correct postural position as described above. Make sure your chin is relaxed and slightly down. Place your right hand on your right cheek. Gently try to turn your head into your fingers to look over your right shoulder but allow no movement. Hold the contraction for
five seconds. Use a 10% to 20% effort, no more! Repeat with the left hand on the left cheek. Do five repetitions of the holding exercise to each side.

Sit in the correct postural position. Repeat all exercises below 10 times to each side.

Rotation: gently turn your head from one side to the other. Look where you are going, progressively aim to see the wall in line with your shoulder. This exercise is similar to the one you did lying down. This time you do it sitting.

Side bending: gently tilt your head towards your shoulder and feel the gentle stretch in the muscles on the side of your neck. Perform the movement to both sides.

Bending and extension: gently bend your head towards your chest. Lead the movement with our chin. Moving the chin first, bring your head back to the upright position and gently roll it back to look up towards the ceiling. Leading with your chin, return your head to the to the upright position.

Where else can I get help?

Specialist health professionals
Your GP can refer you to health professionals who are experts in treating WAD. These may include a GP who sees a lot of WAD patients, specialists, physiotherapists and chiropractors.

Pain management clinics
You would normally be sent to a pain management clinic only if your injury and/or pain is severe and long lasting.

Community resources
Evening and community colleges run classes in relaxation and stress management, but see your doctor before starting one of these. For the phone number of your nearest college look under
‘Evening & Community Colleges’ in the White Pages phone book.

Local hospitals may also run relaxation classes.
Web site The MAA web site www.maa.nsw.gov.au has general information on rehabilitation and other publications on Whiplash-Associated Disorders.

Claims Advisory Service
For information or assistance on a CTP claim contact the Motor Accidents Authority Claims Advisory Service on 1300 656 919.

Source from "clinicalrehabspecialists.com"