ALL ABOUT MY BACK by Bruce M. Bowman All About My Back (C) Copyright Bruce M. Bowman 1988, 1989 ALL RIGHTS RESERVED TABLE OF CONTENTS Section 1. INTRODUCTION - - - - - - - - - - - - 2. MUSCLES, BONES, DISCS, ETC. -- MY BACK !! - - - - - 3. GENERAL INFORMATION - - - - - - - - - - 4. HOW TO AVOID BACK PROBLEMS - - - - - - - - 5. WHAT TO DO WHEN YOUR BACK HAS "GONE OUT" - - - - - 6. EXERCISES - - - - - - - - - - - - - 7. DISCLAIMER - - - - - - - - - - - - 1. INTRODUCTION "All About My Back" -- an unusual title for a "treatise" on back health, you might be thinking. Why not "All About Your Back"? Well, that title has probably been taken -- a hundred times or more. But the real reason is that this article is not about "your" back. It is in fact about mine. Rather presumptuous, you say, that I should think you would be interested in MY back. Well, maybe. But if you have back problems, my guess is that you've listened with some interest to what Uncle Fred, and Aunt Gladys, and the neighbor across the street have had to say about their back problems. Just think of me as Uncle Bruce. DON'T think of me as Doctor Bruce. I am not a physician, and I am not suggesting here any treatment or care for YOUR back. Please assume that nothing I have to say pertains to YOUR back. In this article I am relating to you only what I think I have learned about my own back over the past twenty years. If at times you think that some point I am making is a suggestion to you for treatment of your own back, PLEASE put it out of your head. Nor should you consider statements of "general fact" to be necessarily correct. SEE YOUR OWN DOCTOR regarding your back care. If the foregoing, sounds like a disclaimer to you, you're right -- it is. Following my own advice, I get along with my troublesome back much better than in the past. (Twenty years of experience should be worth something!) But for you? -- I reiterate, SEE YOUR OWN DOCTOR. If you wish, ask your doctor questions about any of the statements in the following pages. There may be points of interest to you here that he or she has not thought to say anything about. One more thing. If you have back pains, keep in mind that it is possible that your back is fine and that the pains are caused by some other physical problem. It is very important to consult your doctor to make certain that your problem is not one which must receive some other kind of treatment. And now -- let's get on with it. (By the way, in addition to an unusual title, this treatise has an unusual format. I've written much of it in outline form -- sort of. So you don't want to call it a treatise? How can I argue.) 2. MUSCLES, BONES, DISCS, ETC. -- MY BACK !! The back. It's so troublesome because it is mechanically complex. Persons who have not had back problems, and even persons who HAVE had back problems, generally do not think of the back in terms of its elements. But it's not just an amorphous part of the human body, without structure. Indeed, it has a definite -- if not well understood -- structure, with many elements, all of which have to work together in a proper manner in a healthy back. The primary elements of the back are the vertebral column, ligaments, and muscles. THE VERTEBRAL COLUMN The vertebral column might properly be considered the major element of the back. Variously called also the "spine," the "spinal column," and even the "backbone," the vertebral column is the part of the skeletal structure that holds up all of the body above the waist. The figures below illustrate the shape of the vertebral column in two views, from the front and the side. C C C C C cervical C C vertebrae C C C C C C _____________ C T T T T T T T T T T T thoracic T front --> T vertebrae T T T T T T T T ______________ T L L L lumbar L L vertebrae L L L L ______________ L S sacrum S c and coccyx c View from View from front side FRONT AND SIDE VIEWS OF THE HUMAN VERTEBRAL COLUMN The vertebral column is composed of 24 mobile vertebrae. Seven are cervical vertebrae (the neck), twelve are thoracic (torso), and five are lumbar (the five just above the top of the pelvis). There is also a sacrum and a coccyx, which are comprised of fused vertebrae. The vertebrae are separated from each other by intervertebral discs, which make up about one-fourth of the total length of the column. Viewed from the side, the normal vertebral column exhibits several curvatures. These are illustrated approximately to scale in the above figure. Viewed from the front (or rear) the normal vertebral column forms a straight line. The portion of the vertebral column associated with the "back" is, of course, that portion below the seven neck vertebrae (C's in the above figures). VERTEBRAE, DISCS, AND LIGAMENTS A typical vertebra consists of a bony "body," a "canal" through which the spinal cord passes, and bony "spinous processes" to which ligaments and muscles attach. The bodies of the vertebrae are bound together by the intervertebral discs, which are fastened securely to the vertebrae with ligamentous material. The vertebral column is given its flexibility through the discs, which are stiff but nonrigid, shock-absorbing cushions. The vertebra are interconnected in various ways by ligaments, which help to give the vertebral column strength and stability. MUSCLES The musculature of the back is complex. There are at least six major muscle groups in the back. The muscles are assigned to specific groups because they tend to work together in groups. Both large and small muscles make up these groups, and they are all important. The major back muscles, in conjunction with superficial back musculature and the abdominal musculature, enable the spine to achieve a variety of motions. 3. GENERAL INFORMATION a. Eighty per cent or more of cases of lower back pain are due to muscle spasms. A spasm is a tightening of the muscles which cannot be voluntarily controlled. It may come on very suddenly or build over a period of days with gradually increasing stiffness in the muscles. b. Backs rarely "go out" in the sense that a vertebra or disk becomes displaced. It is true, however, that a muscle spasm can significantly alter the normal contour of your spinal column. c. Keeping your muscles loose and relaxed is a primary element of good back health. d. Recurring back problems may, but do not necessarily, have as a primary or secondary cause a new or old injury to a muscle or ligament. Usually the underlying cause is wear of the intervertebral discs. They can also dry out to an extent, with age, and as a result lose some of their shock absorbing ability. e. In more cases than most persons would believe, emotional stress is a trigger for back problems. It can cause the muscles to become and remain tense, and eventually an incapacitating "twinge" (spasm) will occur. f. Strengthening your stomach muscles could be a key to reducing the amount of difficulty you will have with your back. There must be good balance between the strength of the back and stomach muscles, and most persons have stomach muscles which are weaker than they should be. g. Many back problems begin with a change to a more sedentary life style. If you are spending more time sitting -- at a desk or watching TV -- than you used to, don't be surprised if your back begins to give you some trouble. h. No two backs are exactly the same and no two back problems are exactly the same. Back care methods that work for you may not work for someone else, and vice versa. Even for a given individual, a particular exercise or back care regimen will not always serve equally well because there are many changing factors -- such as age, overall health, emotional tension, injuries, activities in work and leisure--which influence the state of your back. i. How often do you see someone under 25 or 30 years of age who has a back problem? Seldom. There are several reasons for this. First, they are likely to be more active and in better overall condition than older persons. Second, they may have fewer stresses in their lives. Third, being younger, they may not yet have suffered some seemingly minor back injury which could lead to recurring problems. Fourth, they have not yet begun the inevitable decline with age from their physical peak; their bodies are able to overcome structural flaws and physical weaknesses that will begin to be evidenced in older bodies. j. Whether you have had problems with your back or not, you should try to develop good back care habits. Don't take your back for granted. Treat it well. If you haven't had back problems, you don't know what you're missing -- and you don't want to find out. 4. HOW TO AVOID BACK PROBLEMS Not every point listed here is pertinent to everyone. Persons with a chronically troublesome back may find benefit in all points. Others, persons who have never had back problems, may have only casual interest in this list of do's and don'ts. But persons that do not have back problems should keep in mind that while the reason may be that they have "good genes" or that they are treating their back well, it could also be that bad habits just haven't caught up with them yet. a. Make a modest set of back and stomach exercises a part of your daily routine. The most important exercise is the pelvic tilt, which is described in Section 6. 1. Exercise twice daily (but not too ambitious a program or you'll find it too much trouble or too boring and soon quit -- better to faithfully exercise in a modest program). 2. Do not exercise so much that your back always hurts. Exercise in moderation. 3. Exercise when feeling tight (even if it hurts). Exercises will help keep your muscles loose. Also, you will probably find that pain is often diminished after just six to ten repetitions of the most basic pelvic tilt exercise. b. Sit-ups are good, but always do the bent knee type of sit-up. Do NOT do that exercise with your legs straight. That will strain but not strengthen your back. Instead, bend your knees and keep your feet flat on the floor. Also, NEVER do any type of leg lift exercises; they are good for your abdominal muscles but very bad for your lower back. c. Do not do ANY exercise which overstrains or arches the lower back. Exercises to avoid include backward and forward bends and touching your toes with the knees straight. d. Do some pelvic tilt exercises if you're on your feet for a long period -- for example, standing in line at the grocery store. You can do them while standing, and your exercises will not be noticeable by anyone around you. (See Section 6 for a description of The Standing Pelvic Tilt.) e. When standing in one place for a long time it is good to stand with one foot elevated if possible -- for example, on a box or low foot stool. f. Don't kneel on two knees. One is better. Kneeling accentuates the curvature of your lower back. g. Regular exercise of a general nature -- whatever you enjoy -- is important. It keeps your muscles in good tone and keeps them loose. Swimming is normally considered a good exercise for persons with troublesome backs. h. If you have a history of severe difficulties with your back, it might be necessary to avoid sports that put extra stresses on your spinal column. Examples of such sports are: jogging, which repeatedly jars the spine; golf, which twists the spine; and tennis, which requires sudden stops and starts. i. Lifting: 1. Use your legs to pick things up -- bend from the knees, not from the waist. 2. When lifting anything heavy, do a standing pelvic tilt and maintain it while lifting. 3. Turn to face any heavy object that you must lift. 4. Never lift a heavy object higher than your waist. 5. Hold heavy objects close to your body. 6. Avoid carrying unbalanced loads. 7. Avoid leaning over (or reaching out) to pick things up. If it is necessary, then be certain to first do a standing pelvic tilt and hold it while you are leaning over and lifting. j. Sit, if possible, rather than stand to do any task that requires bending over even slightly for more than ten seconds or so. k. When driving, stop frequently (every two hours) for rest stops -- just to walk around and "get the kinks out." l. Use a lower back support for long distance driving, particularly if you have a history of back trouble. Car seat back supports are commercially available, but you can also use a small pillow or a bath towel that has been folded several times. The idea is to prevent your back from settling into slumped curvature. Just put the pillow on the seat cushion and against the back of the seat before you sit back against it. This should be done in airplanes also; two of the pillows provided by the flight crew are perfect for this purpose. m. When you get into a car, don't put one leg in, sit down, and then pull the other leg in. Instead, you should sit down on the seat sideways and then swing your legs in. n. Don't sit at a desk too long without getting up -- you need a good mix of sitting, standing, and walking. o. During prolonged sitting, cross your legs to rest your back. p. Good posture is important, particularly when sitting at a desk. Don't slump! Try to be continuously aware of the way you are sitting. Most persons slump much more than they think they do when sitting. It's surprisingly easy to break this bad habit. If you must slump, do it by leaning back slightly against your chair in order to lessen the pull of gravity. q. Avoid soft sofas altogether, if possible. But if you sit on one, sit back and relax. Lean against the back of the sofa. And you can prop your feet up on something, too, if you want. But don't settle in for too long a time without getting up and moving around -- say, every hour at least. r. When sitting, always have your knees higher than your hips in order to lessen the curvature of the lower back. A footrest can be used. s. Consider getting a recliner chair (e.g., La-Z-Boy, Barcalounger, and others) to use instead of your sofa or easy chair. A recliner can make a big difference to your back for several reasons. First, if used in a reclined position it will reduce the pull of gravity on your muscles. Second, it will provide good head and neck support. Third, the built-in lower leg and foot rest will help prevent too much curvature in your lower back. Fourth, it is almost impossible to slump in a recliner chair. t. Consider getting a rocking chair. Rocking is restful for the back because it changes the muscle groups used. u. When driving, don't sit too far from the pedals. This emphasizes the curve in the lower back. v. How to sleep: Your bed and your sleeping position should be such as to prevent unnatural curvature, with resulting strain, of your spinal column. (See the figures in Section 2 which illustrate natural curvatures.) For example, when you are sleeping on your side, your spine -- from the top of the neck to the bottom of the lumbar area -- should be in a straight line, i.e., in a plane parallel to the floor. 1. if sleeping on your back (best), place pillows under your knees 2. if on your side (also good), draw your knees up slightly 3. do not sleep on your stomach 4. use a thin pillow -- too much pillow or none at all is bad for your back because both situations cause your spine to bend improperly 5. use a mattress of medium firmness -- one too hard can be as bad for your back as one too soft w. Don't let your head and neck fall forward while you are reading or driving. This can strain your neck, lead to tightness of the shoulder muscles, and in turn cause tightness in the muscles of the upper and lower back. Try to keep your entire spine erect whether sitting or standing. x. Take aspirin when your back is hurting; in addition to making you more comfortable, the relief from pain will allow your muscles to loosen up to some degree and will reduce nerve irritation, which would cause your muscles to tighten even more. It's a vicious circle. y. Take Robaxin, a muscle relaxant, when your back is particularly tight. It's important to ward off the spasm since it can take days to get it to loosen up and since the spasm itself can cause tissue damage to the muscle, which will require time to heal. (Generic replacements for Robaxin are robomol and methocarbamol. Their cost is about half of Robaxin's, but they're just as good -- they contain exactly the same drug. Robaxin and generic replacements are available only by prescription.) z. Use a full-length hanging exercise to keep muscles loose. (See Section 6.) aa. Do pelvic tilts during the day from time to time when standing. bb. Women: Don't wear high heels. They cause overstrain of your back by increasing the natural curvature of the lower spine. cc. If your back is not feeling well, try lying on your stomach on a chaise lounge for ten minutes or longer. The kind with the plastic straps and without a metal support bar in the middle is best. Normally lying on your stomach is not considered good treatment for your back, but sometimes this will help to "get the kinks out." If you can get some sun (i.e., warmth) on your back at the same time, so much the better. dd. Don't lift too much or exert yourself for too long without rest if you have a history of back problems. If you're feeling well, it's only too easy to forget about those problems you've had. DON'T forget. And DON'T overdo -- it may be too late by the time you realize you have. Got a big job to do that could be hard on your back? Don't do it all at one time. Do half in the morning and half in the afternoon. ee. If your back ever hurts a little (or a lot) after you've been sitting on the floor or the ground, don't do it. ff. Be aware of the state of your back. 1. Is it tight? A problem might start with tight muscles in either the upper or lower back. 2. Have you felt a twinge? 3. Does it hurt? 4. Does it feel tired? gg. If your back is feeling tight, tired, or sore, lie down for ten minutes. You should lie with your back on the bed or the floor with your legs drawn up so that your knees are bent and elevated. hh. If your muscles feel stiff when you get out of bed in the morning, a five or ten minute hot shower (or bath) will help considerably in "getting the kinks out." If you normally take a shower at night, switching to the morning might be worthwhile. ii. It is not uncommon for back problems to show up when warm summer weather is on the way out. You may need to be particularly attentive to the state of your back in October and November. 5. WHAT TO DO WHEN YOUR BACK HAS "GONE OUT" (usually muscle spasm) a. Lie down on the floor or carpet on your back with feet on the floor and knees drawn up. Lie next to a table or chair, which will assist you in getting up. Rest for ten to twenty minutes. Get up by turning (rolling) to one side (left) and pushing off floor with your hand (right) until your upper body is upright. Use a chair or table to help you stand if necessary. Take three aspirin with a glass of water. Take a muscle relaxant pill if you have a prescription. Either take a shower or hot bath and go to bed, or go straight to bed. Use a heating pad on your back while in bed (medium temperature). Before getting into bed, try the hanging exercise if possible. And while lying on the floor, do the pelvic tilt exercise a few times. It will hurt, but do it anyway. b. Lie on your back or side in bed. 1. On back: Draw up your knees. Also, place a small "throw" pillow or cushion under the lower half of you hips/buttocks so as to cause something of an involuntary pelvic tilt. Use a heating pad. 2. On side: Draw up your knees. Keep your knees separated by a doubly folded pillow or two small "throw" pillows. (The effect of this is not noticed immediately, but on a time scale of hours it definitely helps.) c. It is sometimes helpful to soak in a medium hot bath for 20 or 30 minutes. Lie flat on your back, knees bent. Try to avoid having your head bent too far forward by the back of the tub. d. Sometimes when your back "goes out," you will need to rest diligently to recover. Other times you will need a period of rest followed by a period of mixed rest and being up and about. Be careful not to stay in bed longer than seems necessary. That can sometimes do more harm than good. e. Try to avoid constipation. It's common with back spasms and it will prolong your recovery period somewhat, as well as making you feel even more miserable. f. Do pelvic tilt exercises even though they will probably hurt at first. g. Do the hanging exercise. Just stretch if you can't hang. Raise your arms over your head (together or one at a time) and strain to reach as high as possible. h. If you are crooked (tilted) to one side, it is because your spasmed back muscles are drawn up unevenly on one side in comparison to the other side. This causes many other muscles to have to work in an out-of-balance manner, so you may hurt all over, particularly if you force yourself not to rest. Don't make these traumatized muscles have to fight gravity. Get to bed! (If you are tilted to the left, the muscles in the right side of your back are spasmed. You may not be able to tell that it is the muscles on the right from the way it feels, or by looking in the mirror or feeling with your hand. This is because the tight muscles are probably "deep" muscles, not just under the skin. But tightening up of muscles along the right side of your back will cause the right side of your pelvis to be pulled up, and therefore you will tilt to the left when standing.) i. If you tilt to one side or the other when your back is giving you problems, you may find that sleeping on one side or the other aggravates your condition. When my back is "out" I tilt to the left, and I find that I do better sleeping on my LEFT side than on my right. The muscle spasm is normally made worse by sleeping on my right side but alleviated by sleeping on my left side. j. While standing, try letting all of your muscles go loose. In particular, let your stomach muscles go slack and let your arms hang limp so that you look as if you have a beer belly and a sway back. Stand like this for ten seconds or so. Sometimes it helps. k. If you have pains shooting down your legs, it is because nerves in your back are traumatized. This may be a more serious back problem than one without leg pains, so it might be particularly important to see a doctor, particularly if it persists for more than a day or two. l. How can I get out of bed when it hurts to raise my body? If you get out of bed on the LEFT side, follow these instructions. If you get out of bed on the right side, replace left for right and right for left throughout. 1. Roll to your left side. 2. Reach over your body with your right hand and arm and push down on the left side of the mattress to partially raise yourself. At the same time swing your legs off the bed. 3. With your left arm push up until you are sitting vertically on the edge of the bed with feet on the floor. 6. EXERCISES The following three points regarding exercising have already been made in Section 4, How to Avoid Back Problems. They are repeated here as a preface to instructions for a set of strengthening and stretch exercises. 1. Exercise twice daily -- probably first thing in the morning and again just before bed. Do NOT be too ambitious about your program, however, or you'll find it too much trouble or too boring and soon quit. It's better to faithfully exercise in a modest program. 2. Do not exercise so much that your back always hurts. Exercise in moderation. 3. Exercise when feeling tight (even if it hurts). Exercises will help keep your muscles loose. Also, you will probably find that pain is often diminished after a minute or two of exercising. I include only exercises a. and b. below in my daily routine. Exercise c. is normally a good one to include, but I omit it because it aggravates my particular back problem. Exercises d. and e. are basically exercises for special situations. They might be done often but they would not normally be included as part of a regular routine. a. The Basic Pelvic Tilt Exercise --- ----- ------ ---- -------- This exercise decreases the arch in the lower back by stretching out tight back muscles and strengthening stomach muscles. It should be done twice daily starting with three repetitions. Increase by one or two repetitions each day until you are doing ten repetitions twice daily. Perform this exercise as a normal part of your daily schedule, but also do pelvic tilt exercises whenever your back is feeling tight to help loosen it up. Instructions: (See the illustration below.) Lie on your back with your knees bent and your feet flat on the floor. Tighten the lower stomach muscles and at the same time pinch the buttocks together. This should tilt the pelvis (hips) thereby pushing the small of the back flat on the floor. Exert pressure as if you are trying to push the small of your back through the floor. Count out loud and hold this position for five seconds. Then relax for three or four seconds and repeat. Notes: 1) Do not push with the feet. 2) Do not lift the buttocks off the floor. 3) Do not hold your breath. 4) The pelvic tilt exercise is best performed on the floor or other firm surface, not on the bed. XXX XXX XX XXXX X XXX X XXX XX X XXXXXXXXXXXX XXX XX XX X XXXXXXXX XXXXXXX XXXXXX XX XX X XX XXXXX | XX XX X X | XXXX XX XX X V XXXXX X XXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXX --------------------------------------------------------------------------- THE BASIC PELVIC TILT EXERCISE (push small of back against floor at arrow) b. The Pelvic Tilt Exercise with Shoulder Lift --- ------ ---- -------- ---- -------- ---- This exercise is not much different from the basic pelvic tilt. It is important to do this exercise as well, however, because it helps more in strengthening the lower stomach muscles. With regard to the number of exercises to do each day, follow the directions given for the Basic Pelvic Tilt Exercise. Instructions: (See illustration below.) Do a basic pelvic tilt. Then tuck in your chin and with your arms folded across your chest, raise your head and shoulders off the floor. Hold for a count of 5, maintaining the pelvic tilt. Lower your head and shoulders to the floor and then relax. Rest for three or four seconds continuing with repetitions. Notes: 1) Do NOT raise your back off the floor, only your head and shoulders. You'll be surprised how much this exercises your stomach muscles. 2) If you have had any problems with your neck, you should avoid neck strain by clasping your hands behind your head instead of folding your arms across your chest. XXX XXX XX XXXXXX rrrr XXXX X XXX XX rr rlll XXX X X X rllr r l XXXX XX X X X lll rr rll XXX XX XX X XXXX XX rr r XX XXX XX XX X X r XXX XX XX X XX | XXXX XX XX XXXX V XXXXX X XXXXXX XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXX ----------------------------------------------------------------------- THE PELVIC TILT WITH SHOULDER LIFT (arms folded across chest or behind head) c. The Lower Back Stretch Exercise --- ----- ---- ------- -------- This is an excellent stretch exercise for the muscles of the lower back. It should probably be included as one of the exercises in your regular routine. With regard to the number of exercises to do each day, follow the directions given for the Basic Pelvic Tilt Exercise. Instructions: (See illustration below.) Lie on your back on a firm surface. Both knees should be bent and both feet should be flat on the floor. Bring one knee up toward your chest and clasp your hands around it, pulling it tightly to your chest. Hold it there for a count of 10. Then lower your leg slowly, putting it back (with bent knee) along side your other leg. Relax, and then repeat with the other leg. Notes: An alternate exercise is to bring both knees up to your chest at the same time. Do a pelvic tilt first. Hold your knees to your chest for 10 to 20 seconds before returning to your original position. Repeat five times. If you wish, you can rock back and forth while holding your knees. xx xxx xxxxx xxxx x ----- xxxx xxxxx XXX [ ]xxxxxx xxx XXX XX xxxxx[ ] xx XXXX X x [ ]xxxxxxx XXX X x [ ]xxxx XXX XX X xx [ ] xxxxxxxx XX XX X XXXXXXXX XXXXXXXX xx[ ] x XX XX X XX XXXXX [ ]xx x XX XX X X ------- ] xxx XXXX XX XX X ] XXXXX X XXXXXX XXXXXXXXXXXXXXXXX-----------XXXXXXXXXX XXXXXXXXXXX --------------------------------------------------------------------------- THE LOWER BACK STRETCH EXERCISE d. The Standing Pelvic Tilt Exercise --- -------- ------ ---- -------- The pelvic tilt exercise can be done at any time to help loosen tight muscles, even when you are on your feet. It should also be done (and held) whenever you are lifting something heavy. Instructions: While standing, tighten your lower stomach muscles and at the same time pinch your buttocks together and while rotating the top of your pelvis backward. This will flatten the small of your back just as in the basic pelvic tilt, which is done while lying on the floor. Hold for a count of 5 before relaxing. Repeat several times. Notes: This exercise is not really any more difficult to do than the basic pelvic tilt, but it may require some practice to learn. Learn how to do the basic pelvic tilt properly before trying the standing pelvic tilt. Also, the standing pelvic tilt may at first be easier to do with your back against a wall, but it will soon become easy to do standing anywhere. e. The Hanging (or Standing) Stretch --- ------- ------------- ------- Lower back pain is often accompanied by tightness of the shoulder and upper back muscles as well as tightness of all of the lower back muscles. Muscle tightness, and pain, can often be considerably reduced by stretching exercises. This one makes use of gravity to stretch, and thereby loosen, your muscles. This "exercise" can sometimes work a quick "miracle" if your back is acting up. But it could also be a good one to make a part of your daily routine since it helps keep your muscles loose. Instructions: Find something that is almost as high as you can reach from which you can hang from your hands -- a beam say. (You might use a beam in your basement or garage, a chinning bar, a tree branch, the back of a step, or the top of a sturdy door.) Reach up with both hands and get a firm grasp. Then bend your knees so that your feet are no longer on the floor and your entire weight is being supported by the beam. Hang from your hands for ten seconds if you can before letting yourself down. Wait for 20 or 30 seconds (walk around a little) and then repeat the exercise. If you cannot find anything from which to hang, try a standing stretch exercise. It will help also, although not as much. With your feet slightly apart reach toward the ceiling with both arms. Keeping both feet firmly on the floor, try as hard as you can to reach as high as you can. Hold for a count of 4, and repeat several times. A variation of this is to keep one arm down at your side while reaching up with the other. Alternate from left to right. Notes: If you cannot hang and hold your entire weight for ten seconds, hang for a shorter length of time or allow your legs to relax only partially so that your feet are still on the floor and your weight is being supported partly by your feet and partly by your arms. 7. DISCLAIMER No statements made in this treatise should be considered to be unquestionable truth, nor should any statement be construed as advice to you for treatment or care of your own back, regardless of my wording. All statements herein reflect my understanding, as a layman, of the human back and relate to care of my own back. Do not care for your own back on the basis of statements made here unless your own doctor is in agreement. Please read Section 1, the Introduction, for further discussion of the intent of this document.