preventing and managing back pain

Preventing and Managing Back Pain

The Stanford Health Series

presents

PREVENTING

AND MANAGING

BACK PAIN

A guidebook to support the video,Preventing and Managing Back Pain

Study Guide

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CONTENTS

πPREFACE.................................................................................. 4PART 1: BACK ANATOMY LESSON ........................................... 5

Sciatica ..................................................................................... 7Other Back Problems ............................................................... 8

Stress and Back Pain................................................................. 9

PART II: BIOMECHANICS – TECHNIQUES TO AVOID TROUBLE . 10When standing ....................................................................... 11When sitting ........................................................................... 11When at a computer ............................................................... 12When driving.......................................................................... 13When lifting ........................................................................... 14Steps to a safer lift .................................................................. 14When sleeping ........................................................................ 16

PART III: EXERCISES AND STRETCHES ...................................... 17EXERCISES TO RELIEVE BACK PAIN ...................................... 17

Supported low back stretch ................................................. 17Single knee-to-chest raise .................................................... 18Double knee-to-chest raise .................................................. 19Supine pelvic tilt .................................................................. 20Stomach-lying flexion ......................................................... 21Quadruped arch and sway .................................................. 21Prayer stretch ...................................................................... 23Prone on elbows .................................................................. 24

EXERCISES TO MAINTAIN BACK FITNESS ............................. 25Hip flexor stretch ................................................................ 25Supine hamstring stretch ..................................................... 27Mid and low back and hip rotation stretch......................... 28

Quadruped opposite arm and leg extension ........................ 29

Abdominal curls .................................................................. 31Dying bugs .......................................................................... 32

ON-THE-JOB STRETCHES ..................................................... 34Standing shoulder and chest stretch .................................... 34

Standing back extension stretch .......................................... 34

Standing hamstring stretch .................................................. 35Standing hip flexor stretch .................................................. 35Back decompression squat .................................................. 36

Seated lower back stretch .................................................... 36

Seated, laid back and up stretch .......................................... 37CONCLUSION ........................................................................ 38

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PREFACE

Chances are, at least half the people you know suffered fromback pain last year—whether they performed heavy physicallabor at work or spent their days at home. In fact, nearly 80%of us will experience some type of back problem during our lives.

The good news: most back pain can be alleviated—or prevented—with the investment of just a few minutes a day in a stretch-ing and exercise program.

The program that follows is organized into three parts.

Part 1 is a quick lesson in back anatomy that will help youunderstand the causes of back pain.

Part 2 identifies activities that put you at risk, and describesthe best biomechanical techniques for completing them.

Part 3 teaches you exercises designed to prevent and/or reduceback pain.

Remember—most of us can dramatically improve our oddsagainst back pain by spending just a few minutes a day on aback care program.


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PART I:

BACK ANATOMY LESSON

The human spine is one of the most complex and vital parts ofyour body. This unique structure is involved in almost everymovement you make—from picking up a piece of paper, to run-ning as hard as you can.

A fit back is strong and resilient,capable of absorbing hundreds ofshocks every day, and supporting loadsfar greater than your body weight. Yetsometimes, even something as simple asbending over for a pencil can cause ex-cruciating pain. To understand whatcan go wrong, it’s important for you tounderstand how your spine works.

Your spine contains 24 interlockingbones called vertebrae, arranged in 3curves that form a natural S shape, ex-tending from the base of your head toyour pelvis. The vertebrae are con-nected to each other by the facet joints.

The 7 vertebrae of the cervical spinesupport your head and allow you tomove your neck.

The 12 vertebrae of the thoracic spine,together with the ribs, provide the rigidstructure which protects the internalorgans.

The lower 5 vertebrae of the lumbar spine are the workhorseof the spine. They absorb nearly all torso stress when you sit,stand, or move. This area is also the site of most back pain. Forease of identification, the vertebrae are labeled using a sequen-tial lettering and numbering system. For example, L4 and L5would be the 4th and 5th vertebrae of the lumbar section.

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In addition to the bony structures, your spine contains 23fibrous, cushioning discs that prevent the vertebrae from grind-ing against one another and contribute to spinal flexibility. Eachdisc has a gel-like center, called the nucleus, surrounded by alayer of fibrous tissue, called the anulus. The anulus supportsmost of the load as the spine moves, but the nucleus helps dis-tribute the load evenly.

By our early 20s, the cushioning discs that separate the verte-brae begin to lose their elasticity and moisture. They shrink. It’snot some mysterious process. It happens to everyone, similarto your hair turning gray or weakening eyesight.

In addition, normal wear and tear produces tiny fissures or tearson the discs’ surfaces. This is what we call degenerating discs.Disc tears can be painful; the development of these tears in thedisc is one of the most common causes of back pain, referredto as discogenic pain.

Discs are a potent source of chemical inflammation, and smallinjuries can be very painful, due to the marked inflammatoryresponse that is associated with the injury. Disc degeneration,which may allow the facet joints to rub against one another, maylead to painful problems such as osteoarthritis. A worn facetjoint can also rub directly against nerves, and cause pain.

Besides supporting the back, the vertebrae are critical in pro-tecting the spinal cord. Nerves branch from the spinal cord,

vertebra

discfacet joint


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between the vertebrae, to extend to other parts of the body.When you realize that nerves pass through the vertebrae, itbecomes easier to understand how bulging disc material, or ashift in the vertebrae, can cause pain both in the back and otherparts of the body.

Sciatica

Many people have experienced excruciating,burning, or shooting pain down the leg into thefoot. Or a dull deep pain in the buttock. Painmay even seem to jump from point to point.The lay term that refers to radiating leg pain issciatica, because the prominent nerve cords run-ning down the leg are called the sciatic nerve.Sciatica, however, is not caused by pressure onthe sciatic nerve but by pressure or irritation ofthe spinal nerve roots.

In addition to vertebrae and discs, your spine also includesseveral fused vertebrae located in your coccyx, or tailbone, andthe sacrum—a triangular bone that forms the rear wall of thepelvis. Between the sacrum and the hip bone, or ilium, is thesacroiliac joint, which transfers the body weight to the leg.

Ligaments—the tissues that connect bones to bones—bind thevertebrae together and to the pelvic ring to keep them in place.

And finally, hundreds of muscles support the spine, and enableyou to move, lift, or turn. The movement to be performeddictates which muscle groups will be used.

Most back pain is related to disc problems. They’re part of thedegenerative process. But disc problems aren’t always symptom-atic. Studies show that one-third of people over 50 have bulg-ing or ruptured discs, and for much of the time, this causes themno pain whatsoever.

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Other Back Problems

• Osteoarthritis: a chronic inflammation of thesoft tissues in the joints.

• Spinal stenosis: a narrowing of the spinalcanal, which is often associated with arthritis.

• Spondylolisthesis: a slippage forward of onevertebra over another.

• Osteoporosis: stress fractures of the vertebraecaused by loss of bone density.

Often back pain, even when it’s severe, is caused by simplemuscle and ligament strains.

When your muscles are weak, tense, overworked, or subjectto sudden forces or heavy loads they react to guard you fromfurther damage with a powerful, sustained, involuntary contrac-tion. This is called a spasm.

Physicians now believe that the best medications for back paincaused by back spasms are common analgesics, such as aspirin,acetaminophen, and ibuprofen.

Research also shows that recovery is enhanced by stayingactive. Prolonged bed rest actually seems to delay the healingprocess. Back specialists recommend that patients walk, under-take gentle exercise, and continue in normal activities, ingeneral staying as active as pain will allow. Most back pain,regardless of origin, shows improvement within a few days, andmost people experience recovery in four to six weeks.


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Stress and Back Pain

Stress also contributes to the risk of back pain.When you’re under stress, one of the primaryphysical reactions is the contraction of themuscles of the entire body including the musclesof the back.

Learning to manage your time better and learn-ing how to deal with difficult people are twotools that can help reduce your stress load.

Not smoking can also help. Research shows thatsmokers tend to have higher stress levels andconsistently higher rates of back problems thannon-smokers.

You can also reduce stress through regularexercise, and relaxation activities.

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PART II:

BIOMECHANICS—TECHNIQUES

TO AVOID TROUBLE

Scientists have studied the human body to understand betterhow we can avoid the pain and problems that come with cer-tain activities. Two principles have proven to be important nomatter what the activity is.

1. A neutral body position means that your ears, shoulders,and hips line up. When standing in a neutral body posi-tion, the outer part of the knee and the outer edge of thefoot line up with the ear, shoulder and hip. This providesa stable base, and puts the least stress on your muscles,tendons, and joints.

2. Working within reach means you should keep your workwithin 14 to 18 inches of your body, and at about waistlevel. Reaching too far forward, too high, or too lowstresses your back muscles.

At work or play, two categories of factors significantly increaserisk.

1. Biomechanical factors – the types of physical activitiesyou engage in, and the techniques you use when perform-ing them.

2. Conditioning factors – your muscle tone, strength, andflexibility.

In the course of your day, the activities that can increase yourrisk of back problems include

• frequent, or heavy lifting;

• twisting;

• bending;

• pushing, or pulling;

• sitting or standing in static positions;

• overreaching;

• poor sleeping positions.


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THE BASIC ACCOUNTING EQUATION

The good news: scientists have determined the safest way to per-form the many tasks we do every day.

When standing:

• Keep your hips flexedby propping one foot.

• Shift your weight often.

• Don’t lock your knees orstand with your feet tooclose together.

• Wear low-heeled shoes.

• Avoid holding heavy one-sided loads. They forceone shoulder lower thanthe other and twist yourback.

When sitting:• Make sure your chair

provides good lumbarsupport. (You can use asmall pillow or rolled-uptowel for support.)

• Avoid slouching.

• Keep your knees levelwith, or slightly lowerthan, your hips. If pos-sible, keep both feetfirmly on the floor or ona footrest.

• When writing or readinguse a slant board or evena slanted loose-leaf note-book to raise the copycloser to you.

• Keep wallets out of your back pockets. Sitting on a bulkywallet can cause or aggravate back, hip, and leg pain.

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When at a computer:

• Your monitor should be in front of you at eye level.Your keyboard and mouse should be approximatelyat waist height.

• Instead of twisting your torso to reach items, move yourwhole body, keeping your shoulders, hips and feet facingin the same direction.

• Avoid upper back and shoulder strain by keeping yourkeyboard and mouse close.

• If you have the habit of cradling the telephone betweenyour neck and shoulder, get a telephone headset or neckrest—especially if your job requires long stretches of timeon the phone.

• Stand up periodically, and take mini stretch breaks.


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When driving:

• Keep your back against the seat, using a lower-backsupport if needed.

• Keep your body close to the steering wheel. Move the carseat forward, so your arms are relaxed, and your feet areclose enough to reach the pedals without stretching.

• Avoid twisting sharply from the neck or waist. Instead,do full body turns from your hips. To get out of the car,swing both legs around, and use your hands to helpsupport your body weight.

• Stop frequently to get out, move around, and do somestretching. And since vibrations from the car fatigue yourback muscles, try not to jump into strenuous activity rightafter drives of 30 minutes or more.

• When getting into the car, stand with your back to theseat and support yourself with your hands. Sit downgently, then bend your hips and your knees to lift bothfeet into the car. Use your hands to help turn your entirebody forward in the seat.

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When lifting:

Statistics show that the number one back pain trigger is lifting.

Good lifting technique can help prevent pain and injury.

Before you lift anything, look at it and ask yourself:

1. Can I lift this easilyby myself?

2. Can I hold it close to mybody while I’m lifting it?

If the answer is “no” to either

question, consider

• splitting up the load;

• using mechanical aids;

• getting help.

Steps to a safer lift:

1. Tighten your abdominal muscles to brace your back andmaintain the curves of your spine.

2. Lift smoothly and gently without jerking the load, twist-ing or rotating.

3. Keep your feet, hips and shoulders facing in the samedirection.


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Awkward Position—When lifting somethingthat’s inside a recessed area like a box or trunk,brace one knee on the outside surface, or extendone leg backward. Hold on to the side of thebox or car with one hand, as you pull the ob-ject closer with the other. Get the object as closeto your body as you can before lifting.

Above You—When removing an item from ashelf, stand on a stool or ladder. Slightly bendyour knees, don’t reach way above your head,and don’t stand on tiptoes. Slide the objectdown your body.

Ground Level—When lifting an object from thefloor, bend your knees and keep your head up.Bent knees take pressure off your back by let-ting strong leg muscles do the work. Never bendforward from the waist, or drop your headlower than your shoulders. Straddle the objectif possible. Tighten your abdominal muscles tobrace your back. Hug the object close to yourtorso, near your navel, and gradually straightenyour legs to a standing position.

When you move or carry objects, keep objects as close to thecenter of your torso as possible, to avoid back and shoulderstress. For example, carry boxes or grocery bags with both arms.Shift lopsided loads from one side to the other for short peri-ods. And keep the loads as light as possible.

Hand trucks, carts and wagons are valuable tools to help pro-tect your back. But be sure to use them properly. To move theload, push, don’t pull, keeping your elbows close to your bodyand your head up. (Pushing provides twice as much power, andputs less strain on your back.)

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When sleeping:

Even sleeping can stress muscles and ligaments. Here are guide-lines for a good night’s rest.

• Use a firm, but not a rigid mattress. A little softness isrequired to give maximum support, while some firmnessencourages you to change positions occasionally, and reststress points.

• If possible, sleep on your back, your head level with yourshoulders.

• Elevating your torso can also reduce strain on the lumbarcurve, and ease pain. Unfortunately, this posture cancause unnatural twisting, especially when sleeping onyour side or stomach. If you do elevate your torso, besure to keep your neck nearly level with your shouldersto avoid neck strain. A better way of reducing stress onthe lumbar curve is to place a small pillow or towel underyour knees, flexing your hip joints.

• If you’re a stomach sleeper, place a small pillow underyour hips or stomach, to keep your lower back fromsagging out of neutral position.

• And consider using a body pillow, to give all-nightsupport no matter how you sleep.

Every daily activity you perform with good body mechanicsmeans one less movement that puts you at risk for muscle orjoint overload or stress. Paying attention to your body mechan-ics takes only a few seconds, but it can help you avoid days ofpain.


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PART III:

EXERCISES AND STRETCHES

A regular program of physical conditioning is one of the bestways to help your back. Stronger muscles help support yourspine, increased flexibility helps with everyday movements, andimproved circulation assures healthier tissues.

As with any exercise program, start gently, allowing yourmuscles to stretch and your respiration rate to build. Begin withpain relief exercises to ease any discomfort you might be feeling.Move on to the exercises that maintain back fitness. Usestretches throughout the day to keep your back loose andflexible. At all times, pay attention to how you are feeling anddiscontinue any exercise that causes discomfort. And if you havepreexisting conditions, check with your doctor before you start.

EXERCISES TO RELIEVE BACK PAIN

Some exercises and stretches can actually alleviate existingback pain.

Supported low back stretch

(This exercise helps relieve discomfort and relax the back.)

Lie on your back on a firm surface. Place a pillow under yourknees to relieve pressure on your lower back. You may also wishto place a small pillow or towel under your head or neck.Relax, and focus on deep breathing. Hold the position for atleast 10 minutes.

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Single knee-to-chest raise

(This exercise helps relieve tightness in the buttock and backmuscles.)

1. Lie on your back with both knees bent at about 90degrees, feet flat on the floor, and arms at your sides.

2. Grasp one thigh behind your knee, and pull it towardyour chest, gently rounding and stretching your lowerback. Hold 20-30 seconds.

3. Then return your leg gently to the floor, and repeatwith the other leg. Switch back and forth from oneleg to the other.


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Double knee-to-chest raise

(The knee-to-chest raise gently rounds and stretches your lowerback.)

1. Lying on your back, lift one knee, then the other, towardsyour chest.

2. Grasp both thighs behind your knees. Keep your head in aneutral position by not arching your neck, and be carefulnot to lift your rear too high. Your lower back shouldremain pressed into the floor.

3. Hold 20-30 seconds.

4. Return your legs gently to the floor, and repeat.

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Supine pelvic tilt

(Doing the pelvic tilt while resting on your back gently stretchesthe lower back and strengthens abdominals.)

1. Place both feet on the floor with your knees bent andarms at your sides.

2. Exhale, and tip your pelvis so that your lower backcomes into contact with the floor.

3. Tighten your lower abdominal muscles, and hold for 20to 30 seconds, while continuing to breathe naturally.


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Stomach-lying flexion

(This simple position is helpful when you want to get directpressure off your back.)

1. Lie face down and place a pillow under your stomach toflatten your lower back.

2. Hold the position for at least 10 minutes, focusing ondeep, regular breathing.

Quadruped arch and sway

(This exercise helps stretch and relax the back muscles througha functional range of motion.)

1. Start in the all-fours quadruped position.

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2. Carefully round your back by pulling in abdominalmuscles and dropping your head slightly forward,keeping your hands and knees still. Hold for 20 to30 seconds.

3. Now allow your stomach to relax. Let your back swayslightly by extending your hips backwards. Keep yourweight evenly distributed and your hands and knees still.Maintain a neutral neck position by keeping your eyes onthe floor in front of you.

4. Repeat this exercise several times.


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Prayer stretch

(This stretch is useful for relaxing buttock and back muscles.)

1. Start in the all-fours quadruped position.

2. Then gently lower your rear backwards until you aresitting on your heels with your arms extended forwardand your back gently rounded—focusing all the time ondeep, regular breathing.


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Prone on elbows

(This exercise helps stretch the muscles in the front of the bodythat provide good postural support for the spine.)

1. Begin in a stomach-lying position. You may want to use apillow or towel under your abdomen for comfort.

2. Place your hands 6 to 12 inches in front of your shoul-ders, and slowly bring your elbows in, so that your upperbody forms a gentle backwards “C.” Use your shouldersand arms, not your back muscles, to lift yourself. Keepyour lower back relaxed and your head in a neutralposition—not arched backwards. Push only as far asis comfortable for you.



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EXERCISES TO MAINTAIN BACK FITNESS

The following are important preventive exercises that youshould do on a regular basis to keep your back fit.

Hip flexor stretch

(This exercise helps stretch the muscles of the hip and upperthigh.)

1. Kneel on the floor on your left knee. With your upperbody straight, extend your left leg backward.

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2. Then, push your hips forward, keeping your hips squareand your upper body perpendicular to the ground.

3. As you move forward, you should feel the stretch in yourhip and upper thigh. Be sure your knee doesn’t go pastyour toes. Hold the stretch.

4. Repeat with your other leg.


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Supine hamstring stretch

(This exercise helps stretch the back of your upper thighs.)

1. Lie on your back in a neutral position, with your kneesbent and your feet flat on the floor.

2. Clasp your hands behind your right knee. Gentlypull your leg towards your chest. Then push your footforward towards the ceiling until you feel a stretch inthe back of your right upper thigh.

3. If you can, slowly extend your bottom leg until it is asstraight as possible.

4. Repeat with your left leg.

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Mid and low back and hip rotation stretch

(This multi-step exercise helps stretch your chest, shoulder, midand lower back, hip, and outer leg.)

1. Lie on your back with your arms out to your sides atabout shoulder level. Bend your knees and place your feetflat on the floor.

2. Slowly rotate both legs to the right, keeping your upperbody square to the ceiling, and both shoulders on thefloor.


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3. Now, slowly slide your left knee towards your rightshoulder, and press your opposite hand—the right hand—outside the knee to apply gentle pressure. You should feela stretch on your lower back, hip, and outer leg.

4. After holding for 20 to 30 seconds as usual, slowly returnto a centered, neutral position, and repeat to the left. Ifit’s more comfortable for you, you can do this stretchwith your bottom leg straight.

Quadruped opposite arm and leg extension

(This exercise helps strengthen shoulder, back and buttockmuscles.)

1. Start in the all-fours quadruped position, with your handsunder your shoulders, and knees under hips. Keep yourhead neutral with eyes on the floor.

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2. Now tighten your abdominals and extend your left leg,sliding it back and lifting until the leg is parallel with thefloor. Your foot should be relaxed, not pointed or rigid.

3. Lift your opposite arm until your hand is parallel withthe floor. Be careful not to let your lower back sway oryour head arch.

4. Repeat with the opposite leg and arm.


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Abdominal curls

(Abdominal curls strengthen the abdominal muscles, whichsupport the back.)

1. Lying on your back with your knees bent and feet flaton the floor, support your head with your hands, withelbows out to the sides. (If this position is not comfort-able for you, try placing your hands on your chest or onyour thighs.)

2. Press your lower back to the floor, then slowly lift yourupper body by pushing your chest forward towards yourpelvis until your shoulder blades clear the floor, makingsure to exhale as you curl up, and inhale as you release.

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Don’t strain your neck. If you feel discomfort in yourneck, you may be pulling with your shoulders and neckmuscles. Try to keep your chin tucked in and neutral, andfocus on pushing with your chest.

3. Then slowly lower to the starting position.

As you do this exercise, be sure not to pull with your elbows,or lead with your chin. And don’t go too fast. Research showsthat abdominal strength is best built with slow and controlledmovements. Repeat until you are fatigued, with the goalof gradually building up to several minutes of abdominalstrengthening 3 to 5 days every week, doing the exercisesin sets of 12 to 16.

Dying bugs

(This exercise is excellent for abdominal strengthening and backstabilization.)

1. Start in the neutral, bent-knee position, with your handson your hips to make sure you don’t move your pelvis.

2. Pull in your abdominal muscles until your lower back ispressed into the floor. Take a few breaths as you hold thecontraction.


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3. Now, still holding this position and keeping your backpressed to the floor, slowly pull your left knee to yourchest, then return your foot to the floor, and pull yourright knee to your chest. Exhale as you bring your leg up,and inhale as you lower your leg. Repeat 20 times witheach leg.

4. As you get stronger, add your arms, lifting the oppositearm overhead to touch the floor behind you as you bringeach knee up.

When you’ve finished your exercise set, allow a period of gentlewarm-down exercises to avoid stiffness. The back is a very com-plex apparatus, with each person’s back different, so you mayneed to experiment to find which exercises build strength with-out causing pain.

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ON-THE-JOB STRETCHES

In addition to setting aside a special time for exercising, you alsoshould do regular on-the-job stretches, to compensate for stay-ing in one position for extended periods of time, or goingthrough the same movements repeatedly.

Here are some easy stretches that will help you keep your backloose and flexible.

Standing shoulder and

chest stretch

(This stretch is especially good for peoplewho work at computers or desks.)

1. Clasp your hands behind your backand roll your shoulders backwards.

2. Push your hands down towardyour heels.

3. Now, contract your shoulderblades together, and hold atleast 10 seconds.

4. You should feel a great stretchacross your chest and the frontof your shoulders.

Standing back extension stretch

(This is a good stretch to reverse slump-ing.)

1. Stand with your legs apart and placeyour hands on your lower back.

2. Pull your abdomen in. Tuckyour chin.

3. Then gently arch backwards untilyou feel a gentle stretch in yourlower back, without archingyour head backwards.

4. Hold at least 10 seconds.


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Standing hamstring

stretch

(This is a good stretch for theback of the upper thigh.)

1. Extend one foot forwardand pull your toes up.

2. Bend your back knee.

3. Pull your hips back andlean slightly forward untilyou feel a gentle stretch inthe back of your upperthigh. Be sure to keep yourchin in.

4. Hold for 10 seconds.

5. Repeat with your other leg.

Standing hip flexor stretch

(This is a good stretch if you sit for longperiods.)

1. Extend one leg back, slowly, so thatyour feet are apart.

2. Gently bend your knees

3. Press your hip forward. Youshould feel a stretch down yourhip and upper thigh.

4. Hold 10 seconds, then repeatwith your other leg. If you haveknee discomfort, you may wantto do an alternative stretch.

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Back decompression squat

(This exercise helps relievestress and tightness in theback.)

1. Bend your knees,and lean forwardto place both handson your knees.

2. At the same time,press your buttocksbackward and moveyour head forward tocreate the feeling of alengthened spine.

3. Hold for 10 seconds,and then carefully return to a standing position.

Seated lower back stretch

(This stretch helps releasestress and tightness in theback and buttocks.)

1. While sitting down,lean forward, usingyour hands to helpguide your chest toyour thighs. Avoid rais-ing your tailbone fromthe chair.

2. Relax, and hold forat least 10 seconds, be-fore returning toan upright position.


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Seated, laid back and up stretch

(This stretch reverses slumping.)

1. Move forward in yourchair, then gently raiseboth arms backward andoverhead, gently archingyour back.

2. Hold 10 seconds, andthen return to thestarting position.

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CONCLUSION

Exercises and stretching work! Most back pain can be allevi-ated—or prevented—by spending just a few minutes a dayfollowing a stretching and exercising program.

Start today. Select a few of the easier exercises, and practicethem. At work, take a moment or two to stretch. Then gradu-ally expand your program, so that you’re regularly doing all thestretches and exercises that are comfortable for you. You shouldbegin to notice a reduction in the intensity and frequency of yourback pain.

But once you begin to feel better, don’t quit your program.Exercises can help relieve back pain, but they’re also for backpain prevention. Make your stretching and exercise program aregular part of your daily routine.


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Notes

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Notes

preventing and managing back pain

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