FAQ

My doctor has suggested a cortisone injection for my back. I have heard that cortisone is bad for you. What are the risks of having a cortisone injection?

Cortisone is a steroid. Steroids have gotten a bad reputation because of some really bad side effects suffered by people, such as body builders, who take steroid pills for a long period of time. One or two injections of cortisone into a sore joint or aching back do not carry the same risks. However, there are risks associated with cortisone injection. These risks include infection, bleeding, and headache.

Physical and occupational therapists use their knowledge in human movement, ergonomics, injury prevention, and treatment of work-related accidents and injuries to make sure their patients are safe when returning to work. To understand the type and nature of your job, your therapist may ask you several questions. The information you give can help your therapist design exercises that are similar to your tasks to help prepare you for a safe return to your job. Your therapist may want to go to your worksite and watch how your work tasks are done. This will give your therapist information about risks and whether any changes need to be made. Even small changes in the way your workstation is designed or how you do your job can make a big difference in your comfort and safety at work.

You may need to participate in a physical capacity evaluation (PCE) before going back on the job. This type of testing takes up to five hours and is sometimes done over the course of two days. The PCE measures your physical abilities when doing various work tasks. The results of the test can give everyone involved in your recovery a clear picture of your ability to do your job tasks safely. This is a way to protect you from going back to a job that is too challenging or that could lead to re-injury. If so, your therapist can help by making suggestions of ways to change your job or work tasks so you can return to work safely.

Poor sitting posture can cause back pain. Be sure to sit with your spine in good upright alignment. Improve your sitting posture by using a comfortable chair designed to support optimal posture. Avoid slouching by keeping your low back firmly against the back of the chair. Slouching your spine can strain your neck forward, putting extra pressure on the nerves and arteries leading to your arms. Your shoulders should be relaxed, and your elbows, hips, and knees should be bent at right angles (90 degrees). Avoid putting pressure on the back of your knees. Your feet should be kept flat on the floor or supported by a footrest. If your chair does not give you the support you need to keep in good body alignment, you may need a new chair. Otherwise, try placing a rolled towel or pillow against the small of your back, or consider purchasing one of the many commercial lumbar cushions that are available to help improve your sitting posture.

Using healthy posture is like holding a defense shield against aches and pains in your spine. Pain and injury CAN be prevented. When your joints are positioned in their safe - or neutral - postures, your body works like an elegant machine. It works safely and even more productively. When unbalanced postures are used, problems are more likely to happen. Prevention of pain and injury has a lot to do with keeping a balanced position in your spine and extremities.

Not necessarily. Abdominal crunches do help strengthen the upper abdominal muscles. But many people with chronic back pain already have fairly strong upper abdominals. Chronic back pain has been linked to a loss of muscle quality and nerve function in the lower abdominals. These problems in the lower abdominals mean that other muscles, including the upper abdominals, must take over and do more of the lower abdominals' job.

Strengthening the upper abdominals with exercises like abdominal crunches may help low back pain feel a little better. But strengthening the lower abdominals is more important in preventing and treating low back pain. Working the lower abdominals can improve your core strength, holding your spine steady as you lift, push, and pull. Increased core strength can also help ease your pain and get you back to your daily activities.

Some ways of doing a sit up can hurt your low back. The old way of doing sit-ups with your feet locked under a bar or held by a partner can be unsafe because it allows your larger and more powerful hip flexor muscles to take over if you have weak abdominal muscles. If the large hip flexor muscle, which attaches to the front and sides of your lumbar spine, overpowers your abdominal muscles, your low back can hyperextend. Overworking the hip flexors can lead to a muscle imbalance of tight hip flexors, tight back extensors, and weak abdominal muscles. This can lead to a back problem and may make an existing back problem worse. It is recommended that a "crunch" exercise be used instead. To do this, keep your low back in a safe, mid-line position. Do not secure your feet, and only do a "partial" sit-up

Common factors in chronic and recurring back pain include weak abdominal and trunk muscles, unhealthy posture, and overall deconditioning due to lack of exercise. Exercises should be chosen to offset each of the problem areas that contribute to back pain. Lumbar and abdominal stabilization: Studies show that exercise training for the abdominal and low-back muscles can improve back stability, reduce pain, and make it easier to do activities of daily living.

Postural exercises: Putting safe posture in action is important to protect your back from small injuries that add up when the spine is strained in awkward or stationary postures.

Aerobic conditioning: A well-rounded program for maintaining a healthy spine should include some form of aerobic exercises. Examples may include walking, cross-country skiing, or swimming. It is important that you choose an aerobic activity you enjoy, so you'll stick with it. Remember to always check with your doctor or physical therapist before beginning an exercise program.

After spine surgery, it is possible that you may develop back discomfort in the future. To take care of your spine if soreness or other symptoms return, your physical therapist will give you a thorough home program when you complete your therapy treatments. Continuing with your home program is a way to keep your spine healthy over time. He or she may also show you how to control pain or other symptoms if they do not completely go away, or if they return in the future. These may include the use of ice, heat, positioning, or rest.

Unless you have had a significant spine injury, you probably do not need to use a support belt when lifting at work. Support belts have not been shown to effectively reduce back injuries among workers who lift. Actually, workers who use these devices often gain a false sense of security and may hurt themselves by lifting too much. Long-term use of a lumbar support belt has been shown to actually weaken abdominal and back muscles. This is because the brace becomes the source of support instead of your trunk muscles. A brace may be prescribed if you have had a recent or severe spine injury. However, you will likely be instructed to use it on a short-term basis only and to continue with an abdominal strengthening program.