Гипертиреоз – Hypertheriosis

Exercises for the back are chiefly intended to strengthen the muscles. The vertebral joints do not need to be exercised, because the spine is never at rest, even when you are in bed. Stiffness in these joints can be helped by exercise only if it is due to weakness in the muscles and ligaments. This can be helped by gently working the muscles. But when there is pain as a result of a disc prolapse, misaligned facet joints or stress from curvature, exercises can do harm rather than good. An important rule is: if an exercise hurts, stop doing it.

Exercises that do not help a bad back

There are some kinds of exercises which should be positively avoided when you are recovering from back pain, and used with caution at all times:

• Bending forwards from the sitting position is supposed to strengthen the abdominal muscles, but is not advisable where the pressure can push a disc protrusion into the spinal canal;

• Techniques (‘hanging’ in the inverted position) to stretch the spine are given by some instructors to reduce disc protrusion and strengthen back muscles, but uncontrolled traction can increase fibrosis and scarring with further loss of elasticity and increased susceptability to pain in the long term;

• Bending sideways can be beneficial in moderation, but always involves some rotation of each vertebra, so that the exercise needs to be done slowly, carefully and over a short range;

• Rotation has been thought to mobilise stiff joints, but excessive rotation is harmful: since the immobile joints cannot be moved, the capsules and ligaments around the joints will be overstrained;

• Toe touching used to be one of the classic exercises for fitness, but to touch your toes while standing (or while sitting) with legs straight and feet apart is likely to do more harm than good, particularly if you use the opposite hand, so adding a twisting motion;

• Double leg raising, often recommended as an abdominal strengthening exercise, can be positively harmful because it puts considerable strain on the lower back. During this exercise the hip muscles have to do most work and as they are attached to the lower lumbar vertebrae and the pelvis, the abdominal muscles are called upon to stabilise the pelvis while the legs are lifted. The weight of the straight legs makes it too difficult for the abdominal muscles to continue to hold the pelvis, which tilts forward. This causes the lumbar spine to hollow as the spinal joints are pulled forward, putting considerable strain on them;

• Lifting both legs up straight, or sitting up from lying with a straight back are two exercises which should not be carried out, except by someone exceptionally fit and well muscled.

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When certain changes have occurred in the structure of the spine, especially if these are the outcome of a degenerative process, there is no way of restoring all the painfree functions of a normal spine.

Sometimes people have to be told that there is nothing more that can be done in the way of medical treatment for their back trouble, and find that treatment by physiotherapists or other therapists does not ease their suffering. They must then learn to live with their faulty spine, since they cannot be given a new one.

Such advice is bound to be depressing, even when accompanied by the assurance that there is no serious organic disease.

Moreover, chronic pain can itself be depressing. Some people in this situation let the rest of their life be dominated by their back; others are more able to meet the challenge and learn to cope by modifying life style, while maximising the painfree range of movement.

Trying anything-Although a patient may have been told that all the normal measures have been tried, there is always a possibility that the verdict may become outdated by new knowledge, improved diagnostic techniques and methods of treatment not previously available.

Some sufferers, therefore, feel that there is always a chance that another surgeon, another doctor, another therapist, may have a way of doing something for them. There are a number of doctors and other therapists in private practice who offer specialist treatment of back pain. They are often exponents of a particular line of therapy.

Other long-term sufferers pin their faith on a succession of non-orthodox treatments which may be providing no more than brief temporary relief. There is probably no harm in this as long as they are seeing a professionally qualified person, even though it is unlikely that one of these treatments will provide a cure, or restore to their spine all its former mobility.

The constant trying out of this treatment or that remedy is likely to set up an endless cycle of hope and disappointment. Miracle cures are mainly anecdotal. There is, moreover, some risk that, for instance, regular manipulation may accelerate osteoarthritis of facet joints, or repetitively overstretch fibrous tissues formed in a previous healing process.

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Back pain frequently responds well to physiotherapy, the treatment by physical methods, as an alternative or adjunct to drugs or surgery. The methods include several different therapies, manipulative procedures, therapeutic movement or exercises, treatment with heat, cold and with electrical equipment. The aim is to help restore the function of the body and rehabilitate the patient: it also includes advice and instruction on posture and daily activities.

More than one method of treatment may be tried; each patient’s condition and progress is reassessed regularly, and the treatment altered accordingly. For example, a patient with very acute back pain may initially be given heat treatment and an instant support to wear. This may be followed after a couple of days by traction or gentle mobilisation, and possibly later by controlled manipulation, and the treatment usually includes a regimen of exercises and instruction on how to lift and move safely.

What a patient does when not having treatment plays an important role in recovery; the physiotherapist will, therefore, usually advise what he should do between treatments. Patients who hope and expect that the physiotherapist will work on them to get them better are not pleased to discover that they are, instead, expected to participate actively.

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The body’s central nervous system consists of the brain and the spinal cord, which is the brain’s extension down the spinal canal. The nerve roots which pass in pairs out of the spinal cord at the level of each vertebra, and at the sacrum, proliferate into an abundant network of nerves, some as long as one metre, reaching to distant parts of the body. They carry information about injury along the spinal cord to the brain, which acts as a control centre, where the information is interpreted in the form of a sensation of pain. The sensory nerves which bring it are able to convey information about the type of injury; thus, the pain of a blow is different from that of a pinprick.

Pain is not sensed in the injured tissues themselves: the experience of pain is registered in the brain. For pain to be felt, there must be, or have been, a nerve supply. Some structures of the body have little, or none: for instance, the nucleus of an intervertebral disc. If it is damaged, no pain will be felt unless part of the disc presses on one of the nerve roots, the dural tube or on a ligament. Therefore the absence of pain does not necessarily mean that there has been no injury.

There can be an interval, sometimes days, between injury and sensation of pain. If you are concentrating hard on something else, you can often override the pain message. Sportsmen, in particular, often fail to realise that they have been hurt, until the game they are playing is over. A severe pain can mask a lesser pain, rather like a strong radio signal suppressing a weaker one. Thus it may not be until the more severe pain has responded to treatment that a secondary pain reveals the presence of a lesser injury

Pain is both a mental and a physical event, and the extent to which it is found endurable depends largely on individual temperament. Some people give way rapidly, and take to their bed, while others grimly remain at their posts, regardless of suffering. There is an intelligent compromise between these extremes: an awareness that pain is, in general, a warning of injury or risk of injury through misuse or malfunction, which should not be neglected.

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Any muscular activity and movement causes some increase in spinal stress. If you stand on the bathroom scales and watch the pointer while you raise your arms, you will see it move up. The force needed to lift the arms is passed down your spine to your feet and (via the scales) to the floor. The same is true of every other activity – pushing, pulling, carrying, getting up, sitting down.

Body movements that are caused by outside forces also cause stress on the spine. Most forms of transport, from horses and bicycles to trains and buses, bounce and jolt the human frame; apart from jolts and jars, most people occasionally stumble or fall. The force of all such vibrations is imparted to and resisted by the spine, but in most cases it suffers no serious injury, because of its capacity for absorbing shocks. It converts the energy into movement by going with the impact instead of resisting it and alters the quality of the applied force, so that it is less likely to cause injury.

The function of converting force into movement is a vital one. Unless some of the applied energy can be quickly converted into movement, it will break bones or cause other injury. In young and supple people, much more movement can be produced than in someone old and stiff, and they can therefore take more punishment than the elderly. As well as being more mobile, the structures in a young spine can bend or change shape more readily in response to loads and muscular tension. This is why the young are better than old people at ‘taking’ forces and reducing them.

Spinal functions also include a safety mechanism: namely, protective backache or. pain. Pain is information and mainly of value in giving warning of postural stress. It is not so effective at preventing injury caused when something proves too heavy to lift or will not move because it is, unexpectedly, stuck – then the pain may come too late.

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