Eagle Family Back School

Introduction
Welcome to Back School! You are most likely here because your neck or back hurts and you've decided to take "time out to find out" what you can do for yourself about lessening your pain and returning to a more normal lifestyle. Or you are here to prevent back injury from happening to you.

Neck and back pain effects most of us at some point in our lives resulting in altered lifestyle creating "negative stress." We understand your frustrations, especially if your problems has become chronic in natujre. We therefore congratulate you in taking the initiative by studying this information that will identify the many reasons a return to mor enjoyable activities and normal lifestyle have been difficult.

DID YOU KNOW ....
An estimate 8 out of 10 peolpe wil experience neck or back pain at some point in their lives. Only the "common cold" accounts for more work loss days: After injuring your neck or back, you are five times more likely to have a recurring episode.

Neck and back pain are epidemic whereby many causes originate form your personal lifestyle relating to activiteis of daily libing performed both at home and at work.

First we must help you 1)prevent and minimize neck and back pain; and 2) to provide awareness, confidence and knowledge for ongoing SELF-CARE!

Our philosophy is based upon the recognition that preventive measures and personal responsibility are two of the most important aspects of SELF-CARE!

Since each individual's lifestyle is unique, guidelines will be suggested during to allow you an opportunity to apply them to your specufic needs.

ONLY YOU CAN TAKE CARE OF YOUR BACK
Predisposing risk factors to musculoskeletal back injury and/or pain include:
Sedentary lifestyle.
Loss of flexibility and strength.
Poor physical condition and lack of regular exercise.
Overweight.
Poor posture and body mechanics.
Stress and tension.
No warm up prior to undertaking task.

PREVENTIVE MEASURES INCLUDE:
** Decrease sedentary postures and activities.
** Increase and maintain muscle felxibility, strength and tone.
** Warm up prior to working.
** Keep body weight down and improve nutritional habits.
*** Monthly or Quarterly Chiropractic check ups.
** Avoid prolonged postures and awkward position (especially flexion postures).
** Learn about proper body alignments, body mechanics and practice them. >br>** THINK before you lift.
** Listen to your body and respect pain.
** Learn relaxation and other techniques to decrease anxiety and stress.

JOINT PROTECTION:
**Avoid stress, strain, or overuse of joint and supportive structure.
** Maintain full flexibility and range of motion.
** Maintain muscle tone.
** Keep Weight down.

STRETCHING:
** Practice slow and controlled stretching on a regular daily basis. Hold your stretch for a minimum of 20 seconds.
** Be careful not to overstretch.
** Get a stretching guide form your Chiropractor.

RELAXATION:
Learn various relaxation techniques and use those that work best for you.
Perform easy, deep breathing.

FITNESS
** Consider a balace of regular aerobic conditioning; maintain optimal flexibility, strength and muscle tone; focus on a soutce of stress reduction and relaxation; and pracitce good nutritional habits.

"Treat your body and mind with respect; if you do not, nobody elso will."

CLASS I

WHAT IS SO IMPORTANT ABOUT UNDERSTANDING THE ANATOMY AND PHYSIOLOGY OF BACK PAIN?

We will spend a brief period during this first session discussing spinal anatomy and how these structures function. This will allow you to have a clear understanding how lifestyle chn affect pain levels,,, limit movement and lessen your ability to perform various desired activities of daily living.

Although a specitfic accident can cause injury to the neck or back, in most cases symptoms have a tendency to ;SNEAK-UP" on us. By that we mean many injuries are cumulative in nature or a ressult of repetitive movements improperly performed.
prolonged or awkward postures may also contribute causing persistent neck or back pain. Another common cause for injury is when one performs an "unguarded movement" -- like lifting a 50 lb. box that you thought was empty. OUCH!

In most cases, the activity thought to cause injury was simply "the straw that broke the camels back."

Familiarizing yourself with spinal anatomy will help you to: (1) understand the importnace of maintaining normal spinal curves illustrated on the following page; (2) learn better ways to protece your spine; and (3) appreciate the improtance of spinal exercises.

JOINTS: When two bones (vertebra) join together, a vertebral joint is formed. This is where motion occurs. The joints of the spine that are commonly injured include: 1. the facet(s) 2. the disk. 3. the sacroiliac joint.

LIGAMENTS
These soft tissue structures "wrap around" the joints offering stability while permitting flexibility and motion. Remember that ligaments have little blood supply and therefore require movement to maintain its healthy status. Proper posture and back dynamics, combined with daily exercise helps keep ligaments strong and healthy.
When ligaments are injured, they weaken and shorten. Gentle exercise properly performed reduces healing time and permits effective repair of injured tissues.

MUSCLES
Muscles and tendons attach to bones. When they contract (shorten), this results in joint movement. These tissues offer spinal stability as well. Many neck and back injuries involving muscles and tendons result from improper back dynamics and posture.
Regular exercise helps to maintain excellent stability and flexibility of muscles. During the second Back School class, we will perform spinal exercises and demonstrate proper stretching techniques.
Why is it important to stretch injures muscles and tendons?

THE SPINAL CURVES
Familiarize yourself with the terminology used when referring to different regions of the spine. Note the normal spinal curvatures when standing. All structures of the spine are under the least amount of stress when normal curves are maintained. Observe how the cervical and lumbar curves bow forward: and how the thoracic and sacrum/coccyx curves bow backwards.

REMEMBER TO MAINTAIN THE NORMAL CURVES! WHY?
What effect does reaching have on the lumbar curve? bending? crouching? lifting?

REMEMBER:
All structures of the spine are under the least amount of stress when normal curves are maintained.

THE VERTEBRAL JOINT
Notice the vertebral joints previously mentioned: (1) the disk located between two vertebral bodies; and (2) the facet joints formed when one vertebra "sits" above the other.
Can you select the facet that shows the capsular ligament wrapping around the joint? Notice how the nerve exits closely to both the disk and facet. What could happen if the capsular ligament became swollen? Many are unaware that the facet joints are similar to the joints of your hands and feet. When the facet joint or ligaments around the facets are injured, this can be quite painful. Remember the last time you sprained your thumb or ankle? The same pain can be experienced when injuring spinal joints.

THE DISK
This ligament is one of the strongest in the body. Oh... and by the way, "it doesn't slip!" Disks are like pads between the vertebrae helping to absorb shock. Notice how it is similar to a "jelly donut." When the tough fibrous layers crack (middle illustration) one can often experience back pain. When the outer layers tear and the "jelly" leaks out, the nerve can be compressed (bottom illustration). What symptoms might you experience?

The disk "breaks down" and becomes painful often times from the effects of cumulative trauma, as was discussed earlier. Improper body mechanics and posture performed over extended periods cause damage to the disk. What about repetitive movements? prolonged posture? improper lifting? How does bending affect the disk?
What effect does maintaining the normal lumbar curve have on the disk?
80 KP equilibrium
25 KP back laying, 75 KP side laying, 100 KP standing, 150 KP stand & bending 140 KP sitting, 185 KP sitting & bending

THE SACROILIAC JOINT
This joint is very strong. Notice all the ligaments surrounding the sacroiliac joints.
When this joint is injured, many of the sacroiliac ligaments can be involved causing low back pain and buttock pain; or even referred pain down the leg. Often times, injury to this joint goes undetected or is misdiagnosed.
Common injuries to this area typically involve a "slip and fall" or twist.

UNDERSTANDING BODY MECHANICS/BACK DYNAMICS AND POSTURE
Body mechanics, sometimes called back dynamics focuses strongly on proper body movements (reaching, bending, lifting, etc.) and how one "holds and positions themselves" (posture). Proper back dynamics and posture can reduce excessive stress to all spinal structures and the negative effect of cumulative trauma.
The "big idea" is to maximize spinal stability and flexibility, and to minimize stress and strain.
This is where maintaining normal (neutral) curves are most important. If you need help visualizing the normal spinal curves, flip back to page #4 before moving on.
Can you see how bending eliminates the normal curve in the low back? This must be avoided whenever possible by performing a straight-back bend.

STANDING POSTURE
Proper back dynamics and posture begins with standing. Standing firmly erect eliminated "sagging" of the low back and "slouching" of the mid back and neck reducing stress to all spinal structures. Stand with one knee slightly bent, too.
Notice on the left how "sagging and slouching" increase the spinal curves. Notice on the right proper alignment of the head, back and lower limbs?
To improve standing posture perform the exercise demonstrated during class by clasping your outstretched arms above your head. Feel the tractioning effect and maintain that posture when your arms are relaxed at your side...and feel the difference when walking, too. Stand in front of a mirror, Check your family
Regarding shoes, avoid high heels because this causes increased curves with added spinal stress.

STANDING FOR EXTENDED PERIODS OF TIME!

When working and standing in one position, the lower back tends to "sag" or "bow" increasing the lumbar curve. This becomes quite uncomfortable. To remedy this, change positions frequently and use a foot stool (passive pelvic tilt). This reduces sagging and feels good, too! Wear comfortable shoes and place a cushioned floor mat at your work station, if possible. When washing dishes, open the cabinet and use the lowest shelf for a footrest. Any other unique circumstances requiring prolonged standing? Can you think of other remedies?
Remember...perform a passive pelvic tilt, whenever possible.

THE ACTIVE PELVIC TILT
Tilting the pelvis backwards will reduce a "sagging" lumbar curve. What is the difference between active and passive pelvic tilting? Practice active pelvic tilting as demonstrated during class; and remember to bend the knees and firm up the abdominal muscles and buttocks. Active pelvic tilting will reduce back pain when one stands for prolonged periods...so consider this when appropriate.
Remember...when standing and working to use a proper tabletop height to avoid prolonged or repeated bending. As a general rule, proper table height approaches "elbow level."

REACHING
What effect does reaching have on the lumbar curve? How would you reduce the curve? REMEMBER:
* Use a stool or ladder so the item can be positioned at or below shoulder level, if possible.
* Face the load to be transferred and don't twist.
* When reaching with one hand, brace yourself with the other hand and secure your position.
* Pelvic tilt and keep the abdomen firm.
* If you are performing a two-handed reach, plan the activity from start to finish.

SITTING
When sitting you may think your spine is at rest...but it is not! Remember that there is increased stress on the spine and disc when comparing sitting to standing or lying. When you sit without supporting your low back, the lumbar curve flattens, and your upper back and neck slouches placing excessive stress on your entire spine. Try different items available during class to assist in supporting your lumbar spine which helps maintain the normal curve.
When should you consider the "sitting wedge?"

REMEMBER:
* Check to see if your chair is adjusted properly.
* Sit with your low back supported and feet flat on the floor.
* Use an armrest whenever possible to reduce stress to the upper back and neck.
* Remove your wallet or other bulky materials from your back pockets.
* Organize your work station to avoid repetitive bending, twisting or reaching while seated.
* When sitting and bending to pick something up from the floor, kee
p the back straight. * Remember proper posture when talking on the telephone.
* Avoid sitting on the floor.

On occasion, you may prefer a footrest placed under one or both feet to remove constant pressure from the back of your thigh(s). It is essential that you not remain seated for prolonged periods. Take frequent breaks, stand up and move about. Regular stretching while seated and when standing will be helpful.

REMEMBER when arising from the chair or sitting down:
* Keep the back straight.
* Use the armrests or your thighs for stability.
* Use your leg muscles.
What is the best way to properly adjust your car seat?

IF YOU HAVE QUESTIONS REGARDING PROPER ARRANGEMENTS OF YOUR WORK STATION, JUST ASK!

REMEMBER when COMPUTING to:
* Properly adjust your seat and support your low back.
* Use a footrest on occasion when necessary.
* Take frequent breaks and perform neck and back exercises.
* Practice good "eye-care" by:
1. eliminating any "glare" on the screen
2. perform eye exercises
3. "change your focus" as discussed during class * Properly position the keyboard and visual display terminal; make available a place to rest your arms.

CLASS II

NOTE: PLEASE TAKE A MOMENT AND REVIEW MATERIALS PRESENTED DURING CLASS I. ALSO READ AHEAD TO GET SOME IDEA OF WHAT'S TO COME! IF THERE ARE ANY QUESTIONS, ASK THEM BEFORE WE BEGIN CLASS II, AND DISCUSS WITH US THINGS THAT HAVE BEEN HELPFUL, AS WELL AS IDEAS THAT HAVE NOT PROVEN EFFECTIVE.

FIRST AID
Whenever you experience an abrupt onset of back or neck pain, it is common to overreact and panic...BUT RELAX. Let us show you some of the things you can do. Although you may want to see your Chiropractor, there are several immediate tips that you should consider doing:
* Find a comfortable position and rest. You may want to continually change positions if more than one is comfortable.
* Pillows can be very helpful...again try to experiment with various positions.
*Pelvic tilting in either a lying or standing position may be helpful. Using a wall as support and pelvic tilting can reduce discomfort as well.
* Use an ice pack, 20 minutes on 20 minutes off.
** Then make an appointment with your Chiropractor.

LET COMFORT BE YOUR GUIDE REMEMBER WHEN ARISING FROM A LYING POSITION:
1. Move to a side lying position
. 2. Flex the knees and hips.
3. Swing the legs and push up with the arms.
4. Stand up from the bed as you would from a chair, keeping your back straight.
How do you know if your bed is too hard? too soft? What can you do?

ICE OR HEAT ???:
Over the years, there has been much debate regarding when to use ice or heat.
Although specific recommendations will be offered, it is very important that you let comfort be your guide. If you are unclear as to what is best following our discussion, ask questions.
Ice should be used initially, 24-36 hours, following an abrupt onset of pain. Apply ice for a 15-20 minute session every hour. Gentle stretching during icing procedures is recommended and may prove beneficial. Heat will increase inflamation which increases congestion which prolongs repair time and may make the injury worse.
Consider the following procedures when icing the neck or back:
1. Place a wet bath towel in the freezer and put a plastic bag liner underneath the towel so that it doesn't stick to the freezer.
2. Remove it in 10-15 minutes.. 4. Following several minutes and while lying on your back, you may want to try knee to chest or pelvic tilting exercises while icing if the low back is involved. Consider additional exercises thought to be effective if other areas of the spine or limbs are painful.
5. If you are icing the upper back or neck, you may want to start gentle stretching exercises to the neck. Also include neck glides as demonstrated during class. Experiment with other exercises you feel are helpful.
Note: Avoid ice if you have problems with circulation or have other health problems that make you feel unsure whether icing is safe. If there are questions ask your doctor.
You may also want to purchase a reusable ice pack. Put it in the freezer for 1 hour then ice for 15-20 minutes then return it to the freezer for 1 hour. Repeat process.
Moist heat with stretching is recommended several days following onset of pain. This may be helpful also as a "pre-warmup" procedure before starting your regular exercise routine.

CLASS III
If there are any questions regarding Classes I and II, ask them before we begin Class III. Let's discuss what you found to be effective and ineffective.
BENDING AND CROUCHING:
Improper bending or crouching techniques cause many neck and back injuries. Maintaining prolonged bending and crouching, or adding twisting motions will often injure the spine. Note how your lumbar curve flattens when performing bending and crouching improperly.
Therefore, remember to:
* KEEP THE BACK STRAIGHT ("BOW" YOUR BACK).
* MAINTAIN YOUR NORMAL CURVE.
* BEND AT THE HIPS AND KNEES!!! not the lumbar spine, keep it rigid.
When bending and reaching, support your weight with the "free hand" using your thigh, by leaning on the desk, or whatever is available. Keeping your feet apart allows for greater stability and balance. Oftentimes, crouching is preferred to bending. When crouching, try to support your weight by holding your thigh or grabbing something stationary, nearby. What activities performed at work or at home require prolonged bending or crouching? When combining crouching or bending with reaching, stabilize yourself and maintain your lumbar curve ("bow" your back).

LIFTING:
Many injuries occur to the spine because of improper lifting technique. Regarding other issues, we talked in terms of setting forth "guidelines;" When lifting, we will be talking in terms of "rules." You already know how to perform proper bending and crouching technique. They are very important and should be implemented during the initial stages of proper lifting technique. Remember to plan your lift! Where are you going to put the load after the lift is completed? Is the pathway clear? Can you handle it, or do you need help? Is your excuse for not getting help listed?
* I'm in a hurry!
* Nobody was around!
* I didn't want to bother anybody!
* I didn't think of it!
* Any others???
Why is it important to have strong stomach and thigh muscles for lifting? ->Because the abdominal muscles provides internal pressure to protect the discs. The thigh and leg muscles do the lifting.
Consider the following rules:
* Plan your lift.
* Test the load...
Does the box really weigh what you thought?
* Assume proper foot position to keep the load close.
* Perform proper bending/crouching technique and "bow" the back.
* Set the abdomen.
* Take a firm grip.
* Lift with the legs smoothly.

CARRYING: Remember to properly plan before carrying (get help, use a cart, etc.). Avoid excessive forward or backward bending. Secure a firm grip, keep the load close and set the abdomen. Check and clear your path.
SETTING THE LOAD DOWN:
* At floor level - Use proper crouching technique and watch out that you don't pinch your fingers. * At table level - place items securely on the table and push load into proper position. If item is to be placed above shoulder level, use a platform so the object can be positioned at or below shoulder height before positioning.

SIDE LIFTING: What is the proper side lifting technique? What unique lifting, side lifting, or carrying activities do you perform at home or at work. Think and plan! Protect your spine.

OVER AND UNDER!
What is important when stepping over a barrier? Get close, keep balanced and move slowly. When stepping under remember to:
* Bow the back and bend the knees.
* Position yourself as close as possible to the barrier that you are moving under. * Maintain good balance.
What unique activities require you to step over or to move under barriers?

PUSHING AND PULLING:
Why is it better to "push?" When is "pulling" a good idea?
Think of proper ways to push or pull a broom or operate a vacuum.
Remember proper pushing technique:
* When pushing a cart keep knees and elbows flexed to absorb shock and inspect surface you are pushing over for any floor/ground barriers.
* If you are using a cart, dolly, or wheelbarrow, make sure that it is in good operating condition and that it can handle the load.
* When slide-pushing, assume a low leverage position and push with your legs and not just with your upper body.
When pulling:
* Set the abdomen.
* Maintain good leverage and a neutral lumbar curve.
* Use your legs while maintaining good balance.

MAINTAINING NEGATIVE STRESS:
* Learn ways to relax.
* Identify situations in your life that make you feel tense.
* When tense, "listen" to your body for signs such as headaches, muscle tensions, stomach upset or other symptoms that you can identify.

RECOGNIZING THE PROBLEM: Ask yourself...
* Do you overreact to minor hassles?
* Have there been major changes in your life?
* Do you suffer from "stress-overload?"
* Do you feel helpless?
Try relaxing and performing deep breathing techniques. Stretching may also prove helpful. Procedures used in class focus on autogenic training (mind over matter) and progressive muscular relaxation techniques. How did it work for you?
Additional relaxation techniques include visualization and biofeedback. Find what is right for you and GOOD LUCK!!!!
Talk to your supervisor and let them know what the problem(s) is/are.

EAGLE FAMILY CHIROPRACTIC
Dr. DAVID AHREND
304-842-SOFT (7638)/842-6809

EVERYDAY STRETCHES
Use these everyday stretches to help relax and fine tune your muscles. Focus on muscles that are most frequently used during your normal day-to-day activities. Activities performed every day require us to often use our body in strained or awkward ways which may increase stress and tension. Taking time out to stretch can reduce accumulated tension and allow our bodies to move with greater ease and comfort.
It is recommended that you perform selected exercises 4-5 times when experiencing discomfort. Experiment by performing all exercises illustrated to determine which ones work best for you. It is normal to feel mild discomfort at the near end range of your stretch. If discomfort continues after relaxing the muscle being stretched, then you should discontinue the exercise and bring it to the attention of your doctor. Again, a good stretch is one that produces the typical "stretch-discomfort" at end range. REMEMBER, if pain continues when the stretched muscle relaxes, discontinue the exercise being performed. Also, if exercising causes a sharp stabbing pain, or arm or leg pain, immediately stop and consult your doctor.

WHY STRETCH?
Stretching relaxes your mind and tunes your body. Stretch routines should be a part of your daily activities. You should leave ample time throughout your day, so that you can take time out to stretch. As you perform the exercises illustrated, select those that are beneficial and most easily performed throughout your work day. During early morning and evening hours, you can take additional time to perform other exercises included in this manual.
Regular stretching will do the following things:
* Reduces muscle tension and allows you to feel more relaxed.
* Permits easier movement.
* Increases ranges of motion to all joints.
* Makes strenuous activities easier because it prepares the muscles, joints and ligaments for more demanding activities.
* Develops body awareness and puts you in touch with areas that will benefit from increased flexibility. * Helps reduce stress and its effects.
* It feels good!

WHO SHOULD STRETCH?
Everyone should stretch regardless of their age or flexibility. Whether you sit at a desk throughout your day, do heavy physical labor, perform housework, or drive a truck, you should be performing daily stretch exercises. Stretches should be preformed gently and easily, and within a comfortable range.

WHEN TO STRETCH?
Stretching can be done at any time throughout the day. More time is usually available during the morning and evening hours. Become aware of brief periods throughout the day that would allow time to perform the more appropriate exercises for your specific problems. Consider stretching during these times: * In the morning before the start of the day. (THIS CAN PREVENT INJURIES BY WARMING MUSCLES AND RELAXING LIGAMENTS THUS PREPARING YOU FOR YOUR DUTIES.)
* At work when stress levels are increased.
* After sitting or standing for prolonged periods or after maintaining any awkward or prolonged posture.
(IF THIS IS YOU,USE A TIMER AND SET IT FOR 30 MINUTES, WHEN IT GOES OFF, STRETCH FOR A FEW MINUTES, THEN RESUME YOUR WORK. THIS WILL MAKE YOU MORE PRODUCTIVE INSTEAD OF WASTING TIME.)
* When you feel stiff or are anticipating some discomfort.

HOW TO STRETCH?

There is a correct and incorrect way to stretch. The right way is a relaxed, sustained stretch with your attention focused on the muscle being stretched. It is helpful to warm the muscle's before stretching, ie. warm shower in morning or isometric contractions or light workout then stretch. The ligaments and muscle are more pliable and less likely to sustain injury. The wrong way is to bounce up and down or to stretch to the point of pain. Improper stretching techniques can cause more harm than good. You will notice when stretching correctly and regularly that movements will become easier, and ranges of motion for each joint will increase.
When stretching, hold for approximately five seconds. Do not start out by stretching as far as you can. Start off by not going to full end range and then slowly increase the stretch. This will allow the tight muscles to slowly increase in length. AVOID BOUNCING AND CONCENTRATE ON WHAT YOU ARE DOING! You will feel a lengthening of the muscle as you progress slowly following each repetition. Your breathing should be slow, rhythmical and under control. When you take a muscle to end range you may choose to inhale so that additional stretching of the muscle can be appreciated.
It is possible to stretch too far too quickly, and this will result in increased pain levels that will persist after stopping the stretch routine. This should be avoided. Before stretching, try to recall the guidelines designed to let you know when you are performing an "unsafe" stretch as outlined on the previous page. Again, slow progressive stretching is recommended. Hold the stretch for a minimum of 20 seconds for maximum benefit.
It is our hope that you will take these ideas and apply them in such a way so that exercise becomes both enjoyable and a part of your activities performed each and every day.
If you have any questions regarding your specific needs during Back School Classes, just ask. It is likely that others have similar questions, so all will benefit.
GOD BLESS AND HAPPY STRETCHING!