Back or neck pain can make you miserable. For example, a child caregiver who bends over to pick up a child, or who carries a child on her hip during the day may later have hip and back pain. Then there is the couch potato who rolls over to get the TV remote off the floor, and "blows a disk." You may know someone who currently has or has had back pain. If you have not experienced back or neck pain in your life, you are in the great minority.

When back pain strikes, people may seek physician care, use medication, get massages, apply heat or ice, or even have surgery. Each of the above may be helpful and necessary. However, the secret to back care is prevention. There are two components to preventing back pain: education and exercise.

Education

Learning about the skeletal system can help you understand why back injury occurs. The skull has seven neck bones attached called the cervical vertebra. The next 12 bones, the thoracic vertebra, attach to the rib cage bones. The lower five back bones, called the lumbar vertebra, connect to the sacrum, which is the end of the spinal column. From there, the hips tie into the thigh bones, and finally end up at the feet.

Most back-related pain is either in the low back or in the neck. The middle bones attach to the ribs, which provide greater stability, although not as much mobility. However, the low back and neck do not have this type of connection, and, therefore, provide greater mobility but sacrifice stability. So when you have an injury, it typically is because the chain has broken at the weakest link.

In the low back, you have large muscles that take over the job of the rib cage and provide stability. If these muscles are weak, you increase your risk of injury. If you strengthen the muscles of your low back and abdomen, you will have a much greater ability to enjoy life with a reduced risk of injury. The single most important stabilizer muscle in the lower body is the Transverse Abdominis muscle (TVA). It is the muscle that bridges the gap between the ribs and hips and is the muscle closest to your intestinal region. It wraps all the way around your body from your navel to your spine and its primary function is to stabilize your body and pull your belly in, like when you are trying to put on a tight pair of pants. When was the last time you tried to squeeze into a tight pair of pants? Remember how you sucked your belly inward in an effort to zip up the pants? That is the TVA muscle at work. If you cannot effectively draw your belly in, you have less than optimal voluntary control.

Your best bet at preventing low back pain or injury is to establish voluntary control of and strengthen your transverse abdominis muscle (TVA). Coupled with proper lifting techniques and breathing, you should have a safety net to prevent injury. Not to mention that your tummy will be firmer, flatter, and strongeran added benefit!

Exercises

Work on each of the following exercises in order. Once you master the first one, begin working on the second, then the third, and so on.

• Transverse Abdominis Trainer (TVAT). Get down on your hands and knees with your wrists under your shoulders, and your knees under your hips, as if you were going to crawl. To make sure you are in the correct position, ask someone to put a broom stick on your back so that there are three contact points-your head, your middle spine, and your sacrum. There should be gaps between you and the broom at your neck and at your lower back. In other words, if you were to stand up against a wall and make sure your head was back on the wall, you would have the same three contact points. This is called the "neutral position." Take a deep breath, making sure your tummy protrudes and gets larger as you breathe in air. Next, blow out all the air and pull your tummy in, making your waist as small as you can. Do not allow your spine angle to change from the broom stick. Hold your tummy in for 10 seconds. Repeat the process 10 times.
• After you master this exercise on all fours, advance to your feet. Stand on your feet and place your hands on your knees; in this position you will look like the "short stop" in a baseball game. Again, have a friend place the broomstick on your back so you will align your spine in the neutral position as described in the first exercise. Then breathe in and out as described above.
• After you master the second position, stand up fully against the wall with your head touching the wall and repeat the process. Once you can do at least 10 repetitions of all three positions, you are ready for the next exercise. Stand in front of a chair, take a deep breath and hold the breath. Pull your tummy in and make yourself as skinny as possible while holding your breath. At this point, lower yourself down slowly into the chair until you feel your bottom touch the chair, but do not sit down. Instead, begin to stand back up and slowly blow your air out. Make sure you do not allow your tummy muscles to relax at any point during this exercise!

Proper Lifting

Childcare providers constantly are lifting things from the floor, especially children. To prevent injury, practice proper lifting. Before lifting an item such as a bag of groceries, take a deep breath and hold it. Pull your tummy in and make yourself as skinny as possible while you lower yourself from the hips. Think about the broom stick on your back to ensure that you have a neutral spine while lifting. Bend at the knees and hips, not the back, and with your breath held and your belly pulled in, grab the object as closely to your feet as possible. As you began to lift the object, slowly blow out the air until you have completed the lift. Keep that TVA tight and lift with the legs and not the back.

RESOURCES

American Academy of Orthopaedic Surgeons, 6300 North River Rd., Rosemont, IL 60018-4262; 800-824-BONES (2663), www.orthoinfo.aaos.org

American Physical Therapy Association,1111 North Fairfax Street, Alexandria, VA 22314-1488; 800-999-2782; www.apta.org

INTERNET RESOURCES

Mayo Clinic, www.mayoclinic.com/invoke.cfm?id=DS00171

Spinal Health, www.spine-health.com

Fitness Together, www.fitnesstogether.com