In the subacute state, the focus is not only on pain relief but also on teaching back-friendly everyday movements and functional training of the stabilizing muscles to build up a trunk muscle corset. Activities of daily life = back-friendly behaviour in everyday life and at work Standing upright: goals: First of all, the patient should develop a body awareness of how the difference between “casual” standing and an active posture feels. In a casual standing position, the patient hangs in the passive supporting apparatus of the spinal column, consisting of the bony components of the spinal column, the capsule and ligamentous apparatus and the intervertebral discs.
In the long run, passive standing leads to overloading of the supporting system, increased hollow back formation and overstretched knee joints. An active posture requires a good active support system (deep and superficial trunk muscles) in order to maintain an upright body position even for several hours a day. Only after a longer period of exercise is an upright posture perceived as a relief, since the trained muscles can be used economically with less tension and strength.
If possible, the long standing should be interrupted by changing from one leg to the other and by relaxation phases while sitting. For training the body feeling, teaching correct posture and economic weight distribution, the help of a therapist and a mirror is useful. Through the mirror, the patient is able to control his posture correction independently at home.
Exercise performance:
- Learning to stand upright
- Economic tension of the postural musculature
- Relief of the passive supporting apparatus
- Starting position: Stand
- Active lifting of the longitudinal arch of the foot
- Slight knee flexion
- Active lifting of the pelvic floor muscles
- Active tensing of the deep abdominal muscles
- Straighten the sternum – show gold medal –
- Long neck stretches
In acute back pain, prolonged sitting can often increase the pain, since the load pressure on the intervertebral discs is higher than when standing or walking. Longer periods of sitting should therefore be avoided in acute conditions. First of all, with the help of the therapist and a mirror – self-control is possible at home – the patient should develop a body awareness of how the difference between “casual” sitting and an active upright sitting posture feels.
When sitting casually, one hangs in the passive supporting apparatus of the spine, which leads to an increased pressure load on the intervertebral discs and the ligaments in the lumbar spine. In addition, neck pain can occur in the “round-backed sitting posture” due to hyperextension of the cervical spine. Starting position: sitting on a stool or chair Targets:
- Learning to sit upright
- Economic tension of the postural musculature
- Pressure relief of the intervertebral discs
Exercise performance: Of course, this active sitting cannot be held for long by an untrained patient.
By repeatedly practising the active sitting posture, the basic tension of the muscles is built up accordingly and can then be activated over a longer period of time with less effort. In any case, the disc-plagued patient should consider the purchase of a seat that relieves the spine at home and at work. Relieving tips:
- The feet stand firmly on the floor, hip and knee angle not less than 90°, the legs are set apart
- Find the middle position between “hollow back” and “round lumbar spine”, sit on the sit bones
- Active lifting of the pelvic floor muscles
- Active tensing of the deep abdominal muscles
- Raise the sternum – Show gold medal –
- Shoulder blades towards trouser pockets
- Long stretches of the neck = suggestion of the double chin
- Frequently change posture, leaning on backrests or table
- Change of position on the chair to the front and back.
Sliding only by the strength of the gluteal muscles (ham sliding)
- Turn the chair frontally to the person sitting next to you
- Use cushions under the buttocks (possibly a slanted wedge cushion) and in the lumbar spine for better back support
- Set up an ergonomic workstation
- Description Seating furniture and ergonomic workstation
When bending down and especially when lifting with a bent and additionally turned back, a massive increase in pressure on the intervertebral discs occurs. Most patients with a lumbar disc herniation have already experienced this painfully. Any incorrect posture when bending and lifting can again cause increased back pain and in the worst case, promote a recurrence of the herniated disc.
Above all, prolonged working from a stooped starting position such as in the household, gardening or in certain professions and the “incorrect lifting and carrying” of heavy objects should be avoided. However, it should not be concluded from this to avoid these activities and only to take it easy, which would ultimately only result in further muscle loss and progressive reduction of physical performance. The activities must only be carried out in a different way.
However, the prerequisites for this are good leg muscles and knee joints that are as healthy as possible. Goals:
- Learning how to bend and lift painlessly without back pain
- Pressure relief of the intervertebral discs during bending and lifting
- Prevention of recurrence (relapse)
Starting position: Step position Execution of the bend: Starting position: Stand with broadly straddled legs, feet pointing outwards Execution of the lift: Cave: asymmetrical, one-sided loading of the spine should be avoided
- Move as close as possible to the object to be lifted and place straight in front of it
- When bending the knees, the buttocks move backwards at the same time
- The upper body is simultaneously stretched out from the hip joints and brought forward while tensing the trunk muscles
- The object is lifted and worn close to the body
- Place the object directly in front of the body again
- The way back is the opposite way
- When carrying the items, distribute them over 2 pockets
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- Go to the kneeling position with support on the thigh
- The upper body is brought forward as straight as possible
- Lighten! Pick up an object or tie the shoes, for example
- Return to the standing position with renewed support on the thigh
- If the strength of the leg muscles is not sufficient you can use a stool to support yourself when walking up and down
- Alternatively, when tying shoes or cutting nails, place one foot on a step or on the edge of the bathtub
- Carry out work on the floor in a four-footed position (knee pads)
