It is therefore extremely important, if you have a back problem, or have had one in the past, to ensure that your spine is as mobile as possible and supported by strong and responsive muscles.

The following exercises, if performed regularly, will help to improve spinal mobility and strengthen the muscles which control the movements and postures of the spine.

Start gently with the easier exercises at the beginning of each section. When you can easily do 12 or 15 repetitions of that exercise, add the next one.

You should not carry out any exercise in a way that causes pain which continues after the exercise is finished. However, if your spine is very stiff, you may feel some discomfort while stretching. As long as this discomfort goes when you stop the exercise, it is likely to be helping to restore your range of movement and will become easier on subsequent occasions. If the discomfort persists, omit that exercise.

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There are a number of aids to back comfort, some designed for the disabled, which can be used to make life more independent.

Pain clinics-If you have chronic back pain which you are finding hard to cope with, your GP may refer you to a pain clinic run through a local hospital or physiotherapist. A number of services are offered at such a clinic, although the particular range varies from health authority to health authority. Advice on pain-killing drugs will be given, suitable physiotherapy techniques, occupational therapy, and counselling may also be available. Some clinics employ acupuncturists who specialise in pain relief, and TENS machines may be used.

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Soft tissue techniques-The most familiar soft tissue technique is massage whereby muscles, tendons and ligaments are mobilised by the therapist’s hands and fingers in order to induce relaxation, increase local circulation and relieve pain and allow movement. Massage is usually used in conjunction with other procedures, for example ‘deep’ heat.

Regional mobilisation-For people with spinal problems, this is used to treat areas of stiffness and altered movement accompanied by pain. The techniques which are used often have an effect on groups of joints and their surrounding tissues. Regional mobilisation involves gentle and repeated passive movement of the affected area to relieve pain and increase the range of movement.

Localised mobilisation-When pain arises from a spinal disorder, the physiotherapist locates the level of the spine producing the symptoms, and may then use localised mobilisation techniques to relieve the pain and restore the normal range of movement. Localised mobilisations consist of passive, small-range, repetitive movements, usually in the painfree range.

The most vigorous of the manipulative procedures is the application of a deliberate thrust to increase joint mobility, taking the movement a little farther than it goes in ordinary active movements, but within the normal passive range. The manoeuvre should only be used by a therapist with special knowledge and skills.

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Pain in the back-Any of the tissues of the spine can be a source of pain except for the discs and the cartilage of the facet joints which have no nerve supply. If the pain arises in the more superficial muscles, it can be identified as coming from a particular spot. Pain from around the facet joints and ligaments is less easy to pinpoint; and if it arises as the effect of a ruptured disc, it is felt too diffusely to locate precisely. When it is the nerve root that is irritated, pain can be felt anywhere in the region which that nerve supplies. Thus, pain from injury to the sacral or lumbar nerve roots may be felt in the lower back or to one side, or, very often, down one leg on the same side as the nerve. Disturbance to cervical or upper thoracic nerve roots may produce similar symptoms in an arm. Pain from the waist region is often felt in a buttock or groin. Similarly, pain originating in the ligaments and joints of the lumbar spine may be felt across the back of the hips, round the groin, across the buttocks, along the thigh to the knees or even further down the leg.

A sufferer’s doctor or physiotherapist should be helped to identify the level in the spine of the source of pain by an exact description of where the pain is felt and its nature.

Root involvement; nerve root lesion-These are medical terms for the condition in which a nerve root is being irritated by being compressed or angulated, so that its blood supply is restricted. As well as pain, there may be other symptoms; if the nerve is of the motor type, whose function is to stimulate muscles into activity, the affected muscle may become weak, and have a reduced reflex response. It is seldom that all the nerves of a nerve root are damaged: as a rule, only a small proportion of them is affected.

Constant irritation of the nerve root in its dural sleeve may set up inflammation throughout the surrounding tissues, and this can cause adhesions to form between the walls of the spinal canal and the dural tube which sheathes the spinal cord, and also in the intervertebral foramina, the facet joints of the vertebrae, and the surrounding ligaments. These adhesions prevent the nerve root from moving easily in and out through its foramen with the normal movements of the spine and limbs, and this may cause pain. If a disc prolapses backwards, the prolapse can, depending on the size of the spinal canal, involve the cauda equina itself. This is rare, but if it happens, the resulting back and leg pain, with numbness, weakness and disturbance of bowel and bladder function, creates a surgical emergency.

Other symptoms-Pain may be accompanied by other symptoms, such as a feeling of dullness or heaviness, or perhaps coldness or a tingling sensation. When a lumbar nerve root is irritated or compressed, there may be weakened muscles as well as pain; a loss of sensitivity in the skin of the leg and the foot; pins and needles; tingling, heaviness, constriction or cramp.

When the spinal canal in the lumbar spine is constricted (spinal canal stenosis) so that there is pressure on the spinal cord, or when the bundle of nerve roots in the Cauda equina or blood vessels are compressed, the symptoms, in addition to pain, may include weakness in the legs, so that walking becomes difficult, and weakness of the bladder and bowels, even incontinence, may result. Medical help should be sought without any delay.

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When the tear is very severe, the pulpy nucleus of the disc is forced out by the pressure of the vertebrae above the tear (like toothpaste squeezed out of a tube), and protrudes out of the tear. Such an injury is rare. If the outer casing does not tear, the nucleus will remain contained within the casing, but its pressure may cause the disc to bulge outwards.

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