My abdominal muscles tore when I had my last baby. Can they be fixed?

You probably mean that your abdominal muscles separated down the center of your abdomen. The medical term for this is diastasis recti. It often happens in women after they deliver a baby. In diastasis recti, the muscles stretch and pull apart during pregnancy and the efforts of childbirth. This is more likely to happen if the abdominal muscles were already weak.


Diastasis recti feels like a gap down the middle of your abdomen until you tighten the muscles, when it becomes a bulge. Usually this condition doesn’t hurt. However, the damage can cause problems with coughing or urinating. The weak abdominal muscles also put you at a higher risk of back problems. Unfortunately, you can’t fix the separation. But improving your abdominal strength can help the muscles work better and prevent back pain. You might find it helpful to work with a physical or occupational therapist. A therapist can develop an exercise program to get your separated abdominal muscles as strong as possible.


I had low back surgery last week. There were no complications, but now my calf muscle is red and very sore. Is it related to my surgery?

Yes. Call your doctor right away. Your symptoms sound like a blood clot in your calf. This condition is called deep venous thrombosis (DVT). DVT can happen after many kinds of surgery.


In DVT, blood clots form in the veins of the legs. If the clot breaks free, it can get stuck in the little blood vessels in your lungs and cause a pulmonary embolism. A pulmonary embolism happens when the blood supply is cut off and part of the lung collapses. This problem can cause death.

I injured my lower back a few weeks ago. It still hurts, but my doctor wants me to go back to work. Shouldn’t I wait until I don’t have any more pain?

Not necessarily. Doctors have found that people who have back injuries do better when they go back to normal activities as soon as possible. This is true even if the pain has not gone away completely.  


The pain of lower back injuries takes time to go away. You will need to be patient. Continue with your rehabilitation exercises, and try to do your normal activities as much as possible. Follow the guidelines given to you by your doctor and physical therapist. They can help you modify your activities so you don’t re-injure your back. Let them know if a particular task aggravates your condition. They can help you find ways to change your job or change the way you do the task so that you don’t hurt yourself again.


I am an athlete. When can I get back to my sport after low back surgery?

It depends on a couple factors. First, it depends on what type of surgery you had. A micro-discectomy, for example, heals faster and involves less recovery time than a fusion surgery.


Second, it depends on how stressful your sports activities are. No matter what you do, you will need to work up to your activities gradually and gently. You don’t want to re-injure your spine. Follow your rehabilitation plan carefully. Your doctor or therapist has recommended it to give you the best chance of making a full recovery.

I’ve been diagnosed with sacroiliac dysfunction. What is it?

The sacroiliac (SI) joint is where your pelvis (the ilium) meets your tailbone (the sacrum). Inflammation or other problems in the SI joint can cause pain up through your low back. Dysfunction means something isn’t working right. In the case of the SI joint, dysfunction has to do with the alignment and movement of the joint. When alignment has changed, or the joint isn’t moving right, ligaments around the SI may be stretched to the point that you feel pain.

I’ve heard that sit-ups can help prevent low back pain. Should I do military sit-ups or the stomach crunches?

Sit-ups can help keep your trunk strong when done correctly. But they’re probably overrated as a way to avoid low back pain. Sit-ups generally strengthen upper abdominal muscles, but the lower abdominal muscles may also need to be worked to help with back pain. Strong lower abdominal muscles help hold your spine steady while you move. 


Therapists usually start thier patients in easier positions, such as lying on on their stomach or on hands and knees, in a crawling position.  The patient then tightens the lower abdominal area  by drawing it inward.  The exercises gradually get harder by having patients move their arms or legs against gravity, causing the lower abs to work harder. 


Abdominal crunches mostly strengthen the upper abdominals and are generally safe to do. Military sit-ups with locked feet, on the other hand, can actually hurt your lower back. Never put your feet under a bar or have someone hold your feet while you do sit-ups. This tightens up the hip flexor muscles, which can increase the arch of the low back.


An X-ray showed a vertebra in my low back that is slipping forward. Will it keep slipping? Could it slip completely off the rest of my spine?

Your doctor probably saw a condition called spondylolisthesis, where one vertebra shifts foward. It usually occurs in the lower back. It can happen because of an injury or a problem in the joint between the vertebrae. It can also be the result of spondylolysis, which is a stress fracture in the bony ring that forms the spinal canal.


When spondylolisthesis happens in teenagers, the upper vertebra will sometimes slip completely off the lower vertebra. If you are an adult, chances are slim that the vertebra will slip completely off the one below. Your condition might not get any worse, but you are more likely to develop chronic back pain. It is important that you take preventive measures, including exercise and improved posture, to avoid problems. If your condition does worsen, surgery is an option. But you would be better off if you could avoid surgery.

I started walking for exercise to help my long-term back problem. Lately I’ve started getting a burning pain in my legs after a few minutes of walking. It goes away if I rest. What is happening?

There are a couple possibilities. In either case, you should see your doctor.


If your pain goes away gradually when you sit, you may have spinal stenosis. Spinal stenosis is a condition in which the spinal canal or openings around the spinal nerves narrows. The sitting position opens the space around the nerves, relieving pressure. Spinal stenosis can be caused by disc problems, bone spurs, infection, or tumors. It is more common in people over 60, but some people are born with narrower spinal canals and may develop the problem younger.


If the pain goes away without sitting down, the problem may be a lack of blood supply to your working muscles. This condition is called intermittent claudication. The aching, cramping or tiredness caused by walking go away in less than five minutes of rest. The lack of blood supply is usually caused by hardening in the blood vessels of the legs, which is called arteriosclerosis.

I know it’s important to bend my knees when I lift heavy things. But I’ve had surgery on both of my knees, and they really hurt when they bend too far. How can I protect my knees and my back when I lift?

That can be difficult. It would be best to lift heavy items from waist level so you don’t have to bend your knees. If you have to lift heavy items from the ground, try to bend your knees only as far as they can go without hurting. Then lower your body by bending at the hips and keeping your hips back. Your low back should be arched in slightly. Grab the item without rounding your back. Without holding your breath, tense your abdominal muscles and lift. Straighten up from your hips. The idea is that your hip muscles will take most of the load, rather than your knees or low back. 

My lower back hurts. Should I go to work?

If you can manage your pain, and if you can do your job without causing more pain, it’s probably OK to work. If your pain is severe, and if your job makes it worse, then you may need to a short time off. 


When your lower back pain interferes with your job, you need to see a doctor. Your doctor will be able to help you manage your pain. Your doctor can also give you guidelines on how to do your job so that you don’t further injure your back. Your doctor may also put limits on the amount of time you should spend sitting, standing, or walking, and may restrict you from tasks such as lifting or carrying heavy items. You may also need to work with a physical therapist to help you control your pain and strengthen your back. The key is to get you back to your normal activities as early as possible, including work.


 


I have low back pain. If I just use a brace, will it go away?

A brace all by itself will not heal your back. Supportive braces can help, especially if you have severe pain. However, long-term use of a brace can lead to a weakening of muscles around the spine. This can make your problem worse.


You may need the support of a brace, but don’t wear it for long periods of time. Take it off to do gentle stretches and exercises prescribed to you by a doctor or therapist. They can also suggest ways to control your pain, including cold and heat treatments and medications. All these therapies together can help heal your back. Don’t depend on just one method of treatment.

I’m using a back support belt for my intense low back pain. It helps so much. Why can’t I wear it all the time?

That’s not a good idea. A support belt can improve your posture and limit your movements, which can help calm pain. It can create abdominal pressure, easing the pressure around painful discs in the lower back. But if your wear the brace all the time, the muscles of your abdomen and lower back start to rely on it. Eventually they atrophy–they get weaker and smaller. This will just make your problem worse.


So follow your doctor’s or therapist’s guidelines about when and how much to use your brace. Take it off to do stretches and other exercises. And once your pain starts to go away, you should use your brace less.  



 


Some of my co-workers use back support belts when they lift at work. Should I use one?

Probably not. Back support belts can provide muscle support, but they can also make you more likely to overdo it. Long-term use of back support belts can also cause the muscles of the abdomen and lower back to weaken, making back problems more likely.


Medical research has shown that back support belts can help men when they catch an unexpected load that comes directly from the front. However, the benefit was small, and women did not receive the same benefits from the belt. In the same study, support belts actually hurt people who caught unexpected loads from the side. The belts kept key muscles from responding appropriately.


Back support belts may be appropriate for some people who have had back injuries.  However, a support belt should only be used for short periods.  It should be removed often to do a program of exercise to improve abdominal muscle strength.

I feel like my low back pain is going to last forever. When will it go away?

It’s hard to tell. Sometimes low back pain goes away quickly, and other times it sticks around for months. In people suffering their first bout with low back pain, it often goes away completely within two months, even without treatment. But for some people low back pain becomes a chronic, recurring problem.


There is no way to predict which group you will fall into. The best bet is to get medical attention for your pain. Your doctor can recommend ways to manage your pain, and suggest ways to help you avoid problems in the future. Even if your pain doesn’t go away completely, there are many strategies for controlling it so that it doesn’t control you.


I know it’s supposed to be better to lift with bent legs. But it’s easier and faster to keep my legs straight. Is lifting with straight legs really so bad?

Yes. When your knees are straight, your lower back carries most of the stress. When you bend your knees and lift with your legs, your hip and thigh muscles do most of the work.


You are right that lifting with straight legs is in some ways easier. It doesn’t take as much energy, and your heartbeat doesn’t rise as much. But to help keep your back healthy, you need to lift with your legs. It’s especially important if the load is big, but it’s also important when you’re lifting something small.


Even if you are strong and in great shape, unsafe lifting postures can cause small injuries to the soft tissues of the spine. These “microtraumas” can eventually add up to one big back problem. 


I am almost 70, and I’ve gotten used to the arthritis pain in my right hip. But now I have pain that goes from my low back to my knee along the front of my thigh. What is the causing this pain?

You will need help from your doctor to determine whether the pain comes from your arthritic hip or a new problem in your low back. Your doctor will probably inject a numbing medication such as lidocaine into your hip. If the pain in your thigh goes away, you know the hip is the problem. You will need to look at different treatments for your hip problem.


If the injection doesn’t take the pain away, you will need to do tests to determine what type of problem you have with your back. Your doctor will help you control the pain and get you started on a treatment plan for your low back problem. 

Can what I do at work affect my chances of having low back pain?

Available science isn’t clear about conclusions that job tasks, even heavy types of work, cause pain.  Actually, activities like heavy lifting and prolonged sitting may be connected because back pain may simply be aggravated in people who do these activities. Low back pain may have more of an affect on people who have to do a lot of lifting. This is because they more commonly stay off work or require a longer period before getting back on the job.


Jobs that involve whole-body vibrations (such as heavy equipment operation) seem to pose some added risk for low back pain.


Good physical conditioning, weight management, routine stretching, and using safe body movements can reduce the chances of having back problems, as can avoiding injuries and not smoking. People with one back injury are more likely to have another. And people who smoke run a higher risk of having back problems.

Are men and women equally at risk for developing low back pain?

Generally speaking, yes. Heavy physical work or very sedentary work contributes to low back pain in both sexes. Studies have shown that some risk factors are different for men and women. For men, doing heavy activities outside of work, and a job with poor social relations and lots of overtime are connected with a higher risk for low back pain. For women, smoking and work that involves whole-body vibrations and gives little influence over work conditions create a high risk of low back pain.