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14 Repetitive Strain Injury (RSI) Prevention Tips

Last modified on 2008-11-19 20:49:45 GMT. 2 comments. Top.

Most people do nearly all their work on a computer these days, but life with a keyboard can be dangerous to your health. According to Microsoft, RSI costs UK businesses around £300 million a year in lost productivity, and the European Trade Union Federation estimates that the condition affects nearly a third of workers in the EU, a figure that to me seems a little high. Published peer-reviewed studies put the overall incidence in the population at between five and ten percent, but for certain professions this can rise as high as 40 percent.

It is true that the condition has been met with controversy in the past, presumably because what we call RSI is actually an umbrella for a range of more specific occupation-induced injuries that can affect the hands, wrists, elbows, arms, shoulders and neck, and may affect tendons, synovial spaces in joints, or nerves.

Here are 14 simple steps to help prevent RSI

1. Have a break every so often when using your computer. Every half hour or so, get up and walk around, get a drink of water, stretch whatever muscles are tight, and look out the window at a far off object (to rest your eyes). Only use the computer as much as you have to. Don’t email people when you could walk down the hall or pick up the phone and talk to them.
2. Think about what you are going to write before you type to avoid unnecessary editting. Look something up in a book instead of searching the Web.
3. Optimize workstation to reduce strain on your body. Make sure your monitor is directly in front of you, with the top of the screen at eye level. Make sure your keyboard and mouse are low enough to allow you to relax your shoulders.
4. Sit up straight. Make sure your chair supports your spine in an erect position. Use good posture. If you can’t hold good posture, it probably means it’s time for you to take a break from typing. If you are perpetually struggling to maintain good posture, you probably need to adjust your workstation or chair, or develop some of the support muscles necessary for good posture. A towel roll at the base or your spine can provide significant support.
5. Make sure you use proper technique, let your hands float above the keyboard when you type, and move your entire arm when moving your mouse or typing hard-to-reach keys, keeping the wrist joint straight at all times. This lets the big muscles in your arm, shoulder, and back do most of the work, instead of the smaller, weaker, and more vulnerable muscles in your hand and wrist.
6. Pace yourself. Take a 5-to-10 minute break every 20 minutes and limit your overall time at the computer.
7. Do appropriate upper-body strengthening and stretching exercises. Exercise regularly. Include strengthening, stretching, and aerobic exercises. Yoga and Pilates are especially effective.
8. Stretch frequently while at the computer. You can refer to our At Work videos and follow some of the stretches that can be done at your desk.
9. Do not continue working at the computer, or other hand-intensive activities if you are experiencing fatigue, or pain.
10. Avoid using the mouse and trackball whenever possible. If at all possible use the keyboard instead.
11. Don’t stretch for the hard-to-reach keys, e.g. BACKSPACE, ENTER, SHIFT, CONTROL… basically everything but the letters. Instead, move your entire hand so that you may press the desired key with ease.
12. Use two hands to type combination key strokes, such as those involving the SHIFT and CONTROL keys.
13. When writing, avoid gripping the pen, or pencil too tightly. If your pen or pencil requires you to press too hard, go and buy a new one.
14. It is a good idea to rest your elbows and wrists when you are not typing.

Back Care At Work

Last modified on 2008-10-23 15:48:13 GMT. 0 comments. Top.

The most common form of spinal injury and back pain can be attributed to sedentary lifestyles. Hunched, with shoulders leaning forward, in a car, over a desk, at your computer, or in front of the TV, all of these postures increase the risk of injury and back pain over time.

Cumulative trauma of poor posture, with shoulders stooped forward, results in a stiff thoracic spine – which contributed to a frequent dull ache in the back. Occasionally, muscles surrounding this area of the spine will go into spasms, which is the body’s way of trying to protect the spine and as a result causes chronic pain. It’s like getting cramp in your back, where the muscles grip the joints together, and is excruciatingly painful.

This problem is very common – it is not caused by an old sporting injury or by lifting something in an awkward position which is what most people think when back pain occurs. During the years you spend stooped at your desk, doing the best for your career, you are actually doing the worst for your spine. Locking each joint into the one below with the facets (the two pegs on each vertebrae). These facets normally provide a range of movement to the back, so if they become locked together, the discs do not receive a blood supply or nutrition and arthritic change or premature ageing is likely to develop.

The common age of patients undergoing a herniated disc operation is 40 and signs of disc deterioration are appearing as early as the age of 20. The incidence of back problems among children is also on the increase.

Common back problems associated with office based jobs

The most common form of spinal injury and back pain can be attributed to sedentary lifestyles. Hunched, with shoulders leaning forward, in a car, over a desk, at your computer, or in front of the TV – all of these postures increase the risk of injury and back pain over time.

The wrong type of seating can also cause back pain. For example, a flat seat or one with a negative incline (the seat of the chair leaning backwards) tilts the pelvis backwards and flattens the inward curve of the lumbar spine – the base of the spine. To achieve the correct sitting posture, office workers need a chair which allows the seat to be tilted forward by 5-15 degrees. This position ensures that the curve in the lumbar spine is maintained while you are seated, because the pelvis is rotated forwards.

Other postures can be a pain in the neck for office workers, when people are continuously looking down at work on their desk or reading on a flat surface. The head weighs approximately one stone or 14 pounds and places considerable pressure on the neck and back muscles when hung forward for long periods of time. The optimum angle for working surfaces for reading or writing is 25°. When working at a computer, the optimum height for the monitor is with the top of the monitor at eye level.

For computer users, however, the most common complaint is sore wrists or Repetitive Strain Injury. Contrary to the name of the condition, damage to the wrists is not caused by repetitive motions but by the lack of movement when the wrists are held in a static position. When typing on a keyboard or using a mouse it is recommended that users take a five second pause every five minutes and a rest break once every hour. A rest break is a break away from the desk, to get up and walk around and stretch any static muscles. A new software product, Workpace, which allows computer users to schedule regular breaks, is attracting widespread interest from employers.

About half of the people seen in an industrial situation were suffering from backaches and pains. They were often given weeks off work and if the problem wasn’t serious, they received no specific treatment. That’s no good for the company.

Teaching the workforce how to reach, lift, apply force, bend and avoid stretching, plus self-help and remedial exercises on-site, can reap huge rewards. It alleviates many problems and keeps employees on the job, happy, well motivated and free from pain. Back pain is both unnecessary and expensive while prevention is considerably more cost effective than cure.

Industry and commerce are quickly reaching the same conclusions as sportsmen and women. A growing number of companies are providing posture supporting products and back care programmes for their employees. The measurable results are higher productivity, improved morale and reduced absenteeism. They feel that their money is being well spent and it’s not hard to see why.

Common back problems associated with manual handling jobs

There are certain manual handling jobs which are more likely to put you in an unnatural posture and increase the risk of injury. For instance, laying ground pipe work, painting ceilings or bending over a car bonnet to check an engine.

By carrying out a risk assessment, it is possible to identify which jobs repeatedly take you into a position where, for instance, you are bending forward. This position is known as sustained forward flexion. If you add weight or loading to that bended position the risks of back injury are increased. It is important to avoid putting weight in hands while in the forward flexion position and any equipment or tools used in this position should be as light as possible.

Methods of reducing the risk of injury when you have a job with sustained forward flexion include job rotation. This means that individuals will only be doing jobs which require them to lean forward for short periods, rather than all day. Rest Pause Gymnastics is also encouraged, which requires stretching the back into the opposite position from that which you have been bending.

Alternatively, there are ergonomically designed belts, which you can wear to support the muscles around the spine. The elasticated straps mimic human musculature and help to develop core strength. A properly fitted back support can lift weight from the spine by up to 25%. The Work S’port is unique in being anchored firmly and comfortably into position with a strap that threads easily through the belt loops to keep the support from riding up.

Jobs that require the head to be tilted backwards increase the risk of neck injury. This position is known as full extension. For example, painters and decorators who work on a ceiling or site workers, with the added weight of the safety helmet, who are required to look upwards for their jobs put their neck under strain. Job rotation is a solution to this problem, or if this cannot be done, regular breaks are recommended with head rotations to provide a full stretch to neck muscles.

Finally, the third most common manual handling work position which increases the risk of injury, is when you are working with your hands above your shoulders. Reaching up to tall machines or up to high shelves can be problematic. The result is a decrease in blood supply to the upper limb. The tendons in the shoulder are very delicate and persistent static work will put these tendons under strain. Most people also experience discomfort and a dull ache in the upper back muscles as a result of holding their arms up in the air for long periods of time.

Case Study: Graham Thorpe, batsman for the England cricket team

World-class sportsmen and women are regarded as the image of health and fitness. However, athletes also suffer setbacks to their career through injury. A back injury may have prematurely ended Graham Thorpe’s winter tour in the West Indies in 1997-1998, but not before he gamely returned to the crease during the fifth test in Barbados, delighting cricket fans with his sixth century for England. How did he do it?

It takes courage, as well as superb technique to perform world-class cricket whilst suffering from a painful injury. Back injuries are an enduring threat to cricketers, particularly during an arduous test series, which gives the players little time to rest. The bending and twisting needed to perform at the highest level puts a lot of stress and strain on the lower back; 90% of all back injuries occur at the base of the spine.

Thorpe was at the crease for over 5 hours as he notched up a century. He is the first to admit that this feat of endurance was made possible by a back support garment, S’port Max. S’port Max is anchored firmly and comfortably into position with integral underpants, preventing riding up or other movement. It is designed to stabilise the back, supporting the spine, without restricting mobility.

Thorpe explains: “The abandoned first test meant that all the players were submitted to a punishing schedule in order to complete the series. In the fifth test, I was 5 not out before lunch, when the muscles in my lower back went into painful spasm. The pain was so acute that I couldn’t resume after lunch so Jack Russell went in.

“However, after some intensive work by Wayne Morton, our team physiotherapist and with the added support of my S’port Max to stabilise my spine, I was able to come back to the crease at the fall of the next wicket – and build on my partnership with Mark Ramprakash, with us both going on to score centuries.”

Conclusion

Work-related injuries are going to happen whether on the cricket field, in the factory or in the office. Both cricket, manual work and office work put a lot of stress on the back and preventative behaviour is critical in avoiding long-term back problems. Adopting the right posture and knowing how to perform physical tasks like keyboard work, lifting, or moving work pieces, are as important on the shop floor or in the office as they are at the wicket.

The biggest challenge is to convince people who are at most risk of back and neck problems to follow simple guidelines on how to maintain a healthy back. Unfortunately, far too many people will only take preventative measures to look after their backs once a problem occurs. It is the healthy people with no evidence of back problems that are at greatest risk. It’s not a question of if; it’s a question of when.

Look After Your Back - Even When You’re Sleeping

Last modified on 2008-02-13 16:21:05 GMT. 0 comments. Top.

There are approximately three million beds and mattresses sold annually in the UK. 30% of beds and mattresses purchased are for relief from a back problem, and 35% of purchases result in a disappointment for at least one partner or both.

Traditionally, beds have been viewed as furniture, and marketed in an extremely visual way by retailers. Terms such as orthopaedic have been introduced by the bed manufacturers, which, in fact, has very little meaning as to the performance of the mattress incorporated in the bed, other than to suggest some form of medical benefit. To date, there has been little or no medical research on sleep surfaces in the form of randomised controlled clinical trials anywhere in the world.

Mattresses should provide an environment in which the skeletal system is fully supported, whilst maintaining correct postural alignment. Equally, this needs to be achieved with comfort i.e. without exerting undue pressure on the soft surface tissue, bony prominences, or muscles of the sleeper. Shear forces also play a part in causing discomfort, particularly amongst the elderly. This is a stretching of the surface and deep tissue, often the cause of pressure sores in hospitals and nursing homes, one of the few areas that has been widely researched.

Sleep Better 2-Inch Visco Elastic Memory Foam Mattress Topper, Queen

In 1997, MAS (Medical Agency Services) carried out a survey of 2500 physiotherapy patients, that showed that 98% of bed purchases were made without any input from a healthcare professional, although they were seeking relief from a medically related condition. Equally, back specialists are reticent to recommend any mattress, as they themselves find it difficult to purchase the correct mattress!

Interestingly, the survey also showed that lighter weight females sought more back and neck treatment where the partner was on average 50 lbs. heavier, and using a firm mattress that they were particularly happy with. The expression ‘princess and the pea’ is often used by lighter weight females, when questioned about firm mattresses.

Approximately, 28% of all patient visits to GPs involve some form of back or neck related pain; therefore, it is somewhat concerning when many GPs continue to recommend a hard mattress for back pain sufferers, although there is no medical evidence available to support this advice.

Hard mattresses are good for you! This phrase has been over-used, and been the cause of much disappointment for consumers. Hard or very firm beds certainly do support the skeletal system, but take little account of pressure affecting conditions, i.e. arthritis, rheumatoid arthritis, insomnia, bursitis, spondilosis, etc. Equally, this type of mattress can often elevate the pelvis, especially females with wider hips, causing lateral distortion of the lumbar spine and shoulder compression. Back sleepers will force the hips forwards into an unnatural position, and flatten the thoracic spine, potentially causing facet joints to lock, and irritation of sensitive joints.

Post-operative patients, particularly replacement hip recipients, having to lie supine for extensive periods to assist tissue healing, often find themselves suffering from different low back symptoms after this experience on a hard or too firm bed.

For side position sleepers, stress can be increased on the elevated hip, where the limb is brought across the pelvis. This stress would be substantially reduced if the hip in contact with the mattress was accommodated correctly, thus reducing the distance between the elevated hip and mattress surface. Many physiotherapists and other back specialists recommend the use of a pillow placed under the elevated limb, or between the knees, in order to open the gait during sleep.

Equally, height, weight, and weight distribution are key factors to take into consideration when attempting to provide low pressure, low shear, and skeletal support. Wide shouldered individuals, with smaller hips and limbs will generally experience shoulder compression on a hard mattress, although the low back is supported correctly. Narrow shouldered females particularly, with larger hips will not have sufficient upper body weight to depress the shoulder area of a hard mattress, resulting in lateral stress of the spine in the side sleeping position. These individuals will almost always have low back pain or stiffness on waking at some time, in addition to experiencing difficulties in finding the correct pillow.

Pocket sprung mattresses incorporate more springs into the mattress core in an attempt to cushion and redistribute the weight of the sleeper. The springs are normally covered with a type of fibre in order to further cushion the effect of the springs. This is an elastic surface that basically exerts a counter-pressure equal to the downwards force of the sleeper. In order to achieve a more contoured feel, and redistribute weight, many manufacturers incorporate a substantial number (hundreds) of springs.

Water Beds are excellent at redistributing pressure as the weight applied is floated across the surface, which has the effect of placing more of the mattress in contact with the body. Unfortunately, weight distribution varies enormously, and as the mattress works on displacement to accommodate the sleeper, postural alignment is difficult to achieve when the larger weight (hips) forces the water to the shoulder area resulting in shoulder compression and a curved spine to side sleepers. Some water beds are compartmentalised, but the chances of getting exactly the right balance of water for both sleepers on a double bed is difficult to say the least! This problem can sometimes be resolved by altering the amount of water.

Latex is widely used in mattresses, and provides for an elastic surface that is already a cushioning surface in itself. Latex is marketed as a natural product, although 80% of the world’s latex is now synthetically produced! The latex foam normally contains ventilation holes from the top to bottom surface of the core; this is also used as a way of softening certain areas of the foam core to accommodate shoulders, etc. A mattress ticking is then used to cover the mattress, and further cushioning fibre is often added. The cover is an important component of the mattress, and if it is unable to stretch, then hammocking occurs and pressure is increased on the soft tissue of the sleeper.

Quality mattresses can be very expensive. They may be made with top quality materials but if they do not provide muscular and skeletal support for that individual, then the product is incorrect and unsuitable, irrespective of the cost.

Mechanical pain affects most people at some stage in their lives and postural changes are common. Rotation of the pelvis can cause one leg to appear short, one shoulder to drop, and the head to tilt. Because of the shorter limb, weight is transferred to this leg, often resulting in sciatic pain in one of the limbs. This condition can be extremely debilitating, and a problem for back pain specialists to stabilise if the patient sleeps on an incorrect mattress. 95% of back pain problems are mechanical and can be treated successfully by chiropractors, osteopaths, and physiotherapists.

As we grow older, muscles, ligaments, and tendons shorten, generally resulting in a stiffening of the spine and associated joints. This often leads to postural changes and mechanical pain, as the skeletal system is faced with an imbalance, causing muscles to be used out of equilibrium. One hip can be loaded when walking, causing inflammation of the joint as the hip is constantly used in the wrong alignment. Facet joints of the spine can lock causing a further stiffening of the spine, resulting in back or neck pain.

Mattresses can either assist treatment of mechanical pain, or seriously hinder recovery. If the specialist is able to mobilise the affected joints, there is no point in placing stress on the affected area for eight hours during sleep, as the brain will simply trigger a guarding action, by activating muscles and ligaments to compensate for the lack of support. With deep sleepers who lie in one position for long periods, this can have the effect of allowing the muscles to get into painful spasm. Light sleepers may toss and turn all night to overcome the problem of spasm, but of course they are not getting quality sleep.

Quality sleep is an elusive commodity for millions. The complex process of attaining a quality sleep pattern can be compromised by the wrong mattress. Of course, there are many factors that can affect sleep, not least the taking of alcohol at night to aid the sleep process. Unfortunately, this is only a short term solution, as alcohol affects the natural melatonin produced, which is the hormone governing the sleep pattern. The sleeper will often wake after a few hours, and be unable to get back to sleep. Stress is an important factor when trying to physically get to sleep in the first place. Muscles will be tense, blood flow decreased, the brain will be overactive. Therefore, a comfortable, cosy, yet supportive environment, with low pressure and low shear is required in order to: allow for muscular recovery, remove pressure from bony prominences (shoulders, hips, knees, and ankles) and enable the musculo-skeletal system to relax.

The reduction of pressure will normally enable those with difficulty in staying asleep, to sleep for longer periods.

Profound sleep can have side effects if the individual has postural problems. Lying in the same position for long periods, where some form of pelvic dysfunction is identified, will certainly result in substantial muscle spasm in the lumbar area on waking.

Restlessness during sleep can be extremely frustrating for many individuals, as there is often an uncontrollable urge to continually reposition themselves before, and during sleep. Restless legs is a relatively common condition, normally exacerbated by pressure to the hips when sleeping in the side position. It is much misunderstood, but increasingly suggested by specialists that excessive pressure to the soft tissue and muscle surrounding the hips causes these muscles to become traumatised with reduced circulation, resulting in stimulation of the limbs.

Sleep should be a fully remedial and refreshing experience. The average number of movements in sleep is approximately 50-80, although this can be reduced to 18-20 on the correct sleep surface. The human body has approximately 700 muscles, most of which need to relax during sleep! Certain muscles, such as calf muscles act as blood pumps and assist circulation during sleep, but most muscles associated with the spine should relax when sleeping.

Insomnia, a total lack of sleep, can be attributed in many cases to a poor or unsuitable mattress, or even something as simple as an incorrect pillow. Many insomniacs are simply over-sensitive to poor skeletal support, shoulder compression, or dysfunction of the cervical spine (neck). Stress related insomnia can be relieved when the muscular system is afforded the chance to recover during sleep, which will normally give longer periods of sleep to these sufferers.

Visco-elastic mattresses comprised of heat and weight sensitive polymers, have been shown to be of great help in reducing pressure whilst maintaining skeletal support. Used widely in hospitals and nursing homes, these mattresses conform exactly to each individual’s shape, and weight distribution, and immediately reform to the new shape when turning in bed. Generally, this type of mattress is only available through a specialist source and is not normally found in retail stores. One advantage of this type of material is that two sleepers of vastly different weights can be correctly accommodated on the same mattress, avoiding the need to resort to twin beds after years of companionship during sleep.

Pillows made from visco-elastic material support the skull and neck without applying undue pressure, as they conform to the exact shape of the sleeper, thus spreading the weight evenly and uniformly along the vertebrae.

Pillows are a constant cause of frustration for many. It has been shown that probably 80% of pillow problems are not related to pillows at all. The problem is normally mattress related, where the sleeper is unable to get the shoulder into the correct position, and feels the need to elevate the skull. In addition, on the wrong mattress, the skull is at a different height when sleeping on the back or side. This can have the result of forcing the head forward when turning involuntarily onto the back, resulting in neck pain, and stiffness between the shoulder blades on waking.

The shoulder should not be placed at 90 degrees to the mattress as this may trigger spasm in the trapezius muscle. The trapezius muscles perform a variety of actions, including acting as a platform for elevating the skull and need to recover during sleep. If the shoulder is placed slightly forward on the mattress, in front of the sleeper, assuming the mattress can accommodate this position, the risk of forcing the scapula towards the spine is reduced. When positioned in the 90 degree position sleepers may wake with upper arm pain and sensation to the little and ring fingers.

If a pillow applies excessive pressure to the neck in the back sleeping position, particularly the C2, C3, vertebrae, then treatment that has been provided will almost always be compromised. Pressure can irritate the nerve sheaths, sensitive muscles, and facet joints in the neck. Equally, if the joints are not resting easy, the inflammatory process may be sustained and any recovery will be much more difficult.

Shoulder compression on a firm surface will often force the scapula (shoulder blade) towards the junction of the upper spine and neck, and affect the C6/C7 vertebrae. The nerve pathway at this site travels down the arm, and causes either upper arm pain or pins and needles in the little and ring fingers or both, especially if there is already a problem in this area.

Many shoulder problems are caused by referred pain from the neck, therefore, stabilising the neck during sleep is of paramount importance. The skull is, in the main, held up by the shoulder muscles, therefore any compromising of these muscles during sleep will generally not be solved by a pillow, if the shoulders are being compressed for long periods.

How do you buy a bed? A question asked by so many. Surely, if the muscles and ligaments take on average, 5-7 nights to adjust to a new mattress, how can lying in a bedding showroom for ten minutes or so, be the safe route to a successful purchase?

You cannot test a bed when you are awake! Even our night attire will have an effect on the comfort level of a mattress. Tight, daytime clothing can often give a false perception of a bed, as the fabrics do not give on the mattress. Loose clothing should be the order of the day when trying a mattress in a showroom.

Involuntary movements made during sleep, are not normally tested when we are awake in a retail store. Most purchasers in showrooms test their prospective purchase lying on their back, although they sleep on their side for the most part.

Many European retailers allow purchasers to try a bed or mattress for at least a week. Therefore, in order to rest easier, you may have to insist that the retailer allow you to trial the bed or mattress at home!

Advice from Wendy Emberson MCSP SRP, Chartered Physiotherapist:

1 If you sleep well on your current mattress and get up feeling lithe and ready for the day – do nothing.

2 If your mattress is too firm, i.e. your shoulders and hips don’t sink into the bed, and you feel as though you’re balanced on top of the bed rather than supported by it – then
consider the possibility of buying an overlay of the new visco-elastic polymer material.

3 If your mattress sags in the middle – then consider buying a new supportive mattress that allows for your shape and weight. You may prefer a conventionally sprung mattress – not too firm and probably with standard posture springing. You may like to try the visco-elastic material as a full thickness mattress.

4 Pain in the neck and shoulders? Sleep with one pillow. Again there are now pillows in this same material. But also look carefully at your mattress – if your shoulders don’t sink into the bed then you may be pushing your shoulders into your neck and causing the pain.

5 Don’t forget to check your children’s beds as well. They can suffer disturbed nights just like adults. [With the increase in back pain in children, their beds are equally important.]

6 If you are not sure whether your mattress is a problem, then ask someone who has the required knowledge – not just an opinion!

7 Ask the supplier if you can return the mattress within a specified time, if it does not improve your night’s sleep. You cannot tell by lying on a showroom bed for a few
minutes. After all, if you are allowed to test drive a car, then why not a bed?

Buying a new bed can be an expensive mistake. It is not just the cost of the bed, but the loss of work, the loss of income to both employer and employee, and the enormous personal cost in terms of pain and possible disability that can be reduced and maybe even avoided. Most people will keep a bed for about 10 years. Make sure you don’t buy 10 years of
avoidable pain!

10 Stretches to Relieve Back Pain

Last modified on 2008-10-19 20:45:02 GMT. 4 comments. Top.

Here are ten simple stretches that you can do to help relieve back pain. Everyone can benefit from stretching the soft tissues - the muscles, ligaments and tendons - in the back, legs, buttock, and around the spine. The spinal column and its contiguous muscles, ligaments and tendons are all designed to move, and limitations in this motion can make back pain worse.

People with ongoing back pain may find it takes many weeks, or months of stretching to mobilize the spine and soft tissues, but will find that sustained relief of back pain will usually follow the increase in motion.

Keep the following in mind when starting a stretching routine:

• Wear comfortable clothes
• Stretching should be pain free; do not force the body into difficult positions
• Move into the stretch slowly and avoid bouncing, which may actually tear muscles
• Stretch on a clean, flat surface that is large enough to move freely
• Hold stretches long enough (20-30 seconds) to allow muscles or joints to become loose
• Repeat the stretch, generally 5 – 10 times

If you already have low back pain, or neck pain, it is best to check with a physician or physical therapist to discuss whether the following exercises should be done.

Neck and shoulder stretches

A stiff back is sometimes accompanied by a stiff neck. The following exercises can be done to stretch the neck and shoulder area.

1. Flexion Stretch—Chin to Chest
While standing or sitting, gently bend the head forward while bringing the chin toward the chest until a stretch is felt in the back of neck.

2. Lateral Flexion—Ear to Shoulder
This exercise stretches the neck area below the ears as well as the top of the shoulder. To begin, gently bend the neck to one side as if to touch the ear to the shoulder until a stretch is felt in the side of the neck. Switch to stretch the other side.

Back stretches

Many back pain patients know the feeling of tension in the back, especially first thing in the morning. These stretching exercises can help bring back some suppleness and increase mobility, decreasing back pain and discomfort.

3. Back flexion exercise
While lying on one’s back, pull both knees to the chest while simultaneously flexing the head forward until a comfortable stretch is felt in a balled-up position.

4. Knee to Chest Stretch
While lying on the back with the knees bent and both heels on the floor, place both hands behind one knee and bring it to the chest.

Hips and gluteus stretches

The hips and buttocks (where the gluteus muscles are) support the lower back and stretching these muscle groups plays a pivotal role in maintaining spine flexibility.

5. Hip stretch
While standing with feet should-width apart, take a half-step back with the right foot, bend the left knee and shift weight back to the right hip. While keeping the right leg straight, bend forward more and reach down the right leg until a stretch in the outer hip is felt.

6. Piriformis muscle stretch
The piriformis muscle runs through the buttock and can contribute to back pain or leg pain. To stretch the this muscle, lie on the back and cross one leg over the other and gently pull the other knee toward the chest until a stretch is felt in the buttock area.

Hamstring stretches

The hamstrings run through the back of each thigh. Tightness in this muscle limits motion in the pelvis which can increase stress across the low back and corrupt correct posture. Stretching the hamstrings with these exercises can gradually lengthen them and reduce the stress felt in the lower back. Options for hamstring stretching exercises, listed from most difficult to least difficult, include:

7. Standing hamstring stretch
This is the most common technique. While standing, simply bend forward at the waist with arms hanging down and with legs relatively straight. Try to touch the toes but do not strain to do so. Stop when a stretch is felt in the hamstring.

8. Chair hamstring stretch
Less strain is applied to the back by sitting on a chair and placing the legs straight out in front on another chair. In this position, reach toward the toes. One leg at a time may be stretched.

9. Towel hamstring stretch
One of the least stressful stretching techniques is to lie on the floor and pull the leg up and straighten by holding onto a towel that is wrapped behind the foot. One leg at a time may be stretched.

10. Towel hamstring stretch
Another less stressful option is to lie on the floor, with the buttocks against a wall, and place the foot up against the wall and then try to push the knee straight. One leg at a time may be stretched.

Hamstring stretching should include applying pressure to lengthen the hamstring muscle for 30-45 seconds at a time, one to two times each day. The hamstring muscles will lengthen over time, decreasing stress on the low back. Since other exercises may not be done everyday, stretching should not be just linked to other back pain exercises. In order to make stretching exercise a part of one’s daily routine, it is best to stretch every morning when getting up and before going to bed. Stretching exercises are good back hygiene, just like brushing one’s teeth twice a day is good dental hygiene.