STATIC FLOOR • 5 minutes Purpose Relaxes the hips and back, making the body receptive to the exercises to follow. (Note: This position can also ease sudden pain.) What to Do Lie on your back with both feet and calves resting on the seat of a chair, knees bent 90 degrees, and arms out to your side, palms up. Relax your back into the floor and breathe through your diaphragm.
PIRIFORMIS STRETCH • 1 minute per side Purpose Back pain is often caused by one leg riding higher than the other. This stretch loosens the hips to balance the spine. What to Do On your back with knees bent, feet hip-width, arms wide, bring your right ankle to your left knee, then pivot to the floor on your left. Press your right knee slightly away, stretching the outside of the right hip.
INVERTED WALL • 2 minutes Purpose Stretches your suck and tuck-shortened hamstrings, preparing you to walk and run in balance. What to Do Lie on your back with your legs straight up against a wall, spread hip-width apart. If necessary, scoot away from the wall slightly so that your tailbone and entire back are on the floor. Keep your feet flat, as if you were trying to balance a tray on your soles.
OVERHEAD EXTENSION • 1 minute Purpose Lengthens and decompresses your spine, making you stand taller and relieving painful pressure on squeezed discs. What to Do Sit in a chair with your knees bent at 90 degrees. Roll your hips forward. Interlace your fingers with palms up and extend your arms straight up until your elbows lock. Pull your shoulder blades together. Don't lean back, and don't let your arms bend. Allow your abs to relax, creating an arch in your lower back.
WALL SIT • 1-2 minutes Purpose This lower-body strengthener is the glue holding all the previous exercises together. It takes pressure off the back (where it has settled after years of bad posture) and puts it on the legs and hips, where it belongs. What to Do With your lower back against a wall, slowly walk your feet forward. Keeping feet hip-width apart and straight ahead, slide down the wall until your knees are at a 90-degree angle. Press your lower back into the wall by shifting your weight to your heels and off your toes. Relax your abs and shoulders as your thighs burn.

--Roy M. Wallack

PART TWO
First Aid for a Bad Back
Even elite athletes can throw out their backs. Here's how to be ready.

On the second day of the 2005 Presidents Cup, Tiger Woods's back went into spasm after a rough swing on the sixth hole. Dr. Thomas M. LaFountain, director of chiropractic services for the PGA tour, came to his rescue, applying ice, deeply massaging his middle back, and, during a rain delay, realigning him, which put Tiger on course to land his first four-ball Presidents Cup victory. Here's LaFountain's method.

PHASE I: Recovery
1. Apply ice to the painful area.

2. Use nonsteroidal anti-inflammatory painkillers (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve).

3. Do low-grade stretching. Lie on your back, pull one knee to your chest, then to the opposite shoulder, and do pelvis tilts (press your lower back into the floor, hold 10 seconds).

4. Don't confine yourself to bed. While it's okay to take it easy for a little while (try lying on your side with a pillow between your knees), immobility can allow the muscle contraction to worsen.

5. Stretch and get moving. Stretch for a few minutes in the morning and for 20 to 30 minutes at night. Take short (3-to-5-minute) walks throughout the day. 6. Engage your abs. The connections between the abs and the lower back support your frame. If you consciously activate the abdominal muscles as you move, they ease your back's workload.

PHASE II: Rehabilitation
1. Flexibility. Concentrate on stretching the muscles in your mid- and lower back, hips, and hamstrings (see previous page). Consider Pilates or yoga, which can strengthen underused muscles that support your posture and your back.

2. Spinal mobility. Once your muscles are loosened a bit, seeing a chiropractor can improve spinal mobility. This will help keep tight muscles from remaining contracted.

3. Core strength and stability. Each day do gentle crunches and "Supermans": Lie on your stomach and lift your right arm and left leg, then repeat with the opposite limbs.

4. Nutrition. Stay well hydrated, and maintain a proper daily balance of carbs, protein, and fats (ideally, 40/30/30) to keep your frame strong.
-- Benjamin Ryan

PART THREE
Persistent Back Pain
As you deepen your back's debt to poor posture, that stiffness after a long day can galvanize into lifelong trouble. Managing back pain is an essential part of being active, and as you grow older it's important to know your treatment options.

If you have... MILD PAIN
If you've given up on jogging, you're the first to bow out of any heavy lifting, and time at your desk job has you fighting stiffness after a few hours, consider the following first:

Chiropractic
Many swear by spinal manipulation, and it's often covered by insurance. But research shows that, in general, chiropractic treatment provides only modest, short-term benefits: mostly pain relief, not actual improvement in back function. To find a local chiro, go to the American Chiropractic Association's website (amerchiro.org).

Acupuncture
The jury is out on whether this ancient form of Chinese medicine helps back pain. Much of the research on its efficacy has been either lousy or inconclusive (or both). But it may be worth a shot. Many insurance plans have discounts for alternative therapies like acupuncture.

Yoga
Findings from the Group Health Cooperative in Seattle show that yoga can help treat back pain. Researcher Karen Sherman recommends gentle forms; avoid vigorous Bikram or power yoga and opt for something such as viniyoga or restorative yoga. Ask the instructor if he or she can tailor the poses to your needs.

Massage Therapy
Group Health research also found that massage both alleviates pain and improves your back's everyday function. And it's usually not blissful or meditative; it can be rather painful. But stick with it: An average of eight such treatments over a 10-week period provided relief for a year or more.

If you have... MODERATE PAIN
When physical manipulation hasn't helped, you can't play sports, and lying prone is the great joy of your day, there are more invasive options.

Trigger point injections
Sometimes there are specific knots in the muscles that can cause what's known as "referred pain" elsewhere in the body. The doctor will inject the trigger point with an anaesthetic to relax the knot and a corticosteroid to break apart the fibers and prompt them to repair themselves. Pain specialists often provide this treatment, and for good reason: It can be torturous.

Cortisone injections
Doctors use an X-ray camera to guide them as they inject cortisone deep into the spine to reduce inflammation in the discs or joints. This generally eases pain temporarily, though some people find extended relief from the injections. The idea is to try to change the local chemical environment that has been making your nerves overly sensitive.

Transcutaneous Electrical Nerve Stimulation
Commonly known as TENS, this technique utilizes a portable device that blocks pain signals by providing electrical stimulation as you go about your day. Again, however, the efficacy of TENS is highly variable.

Ultrasound
Ultrasound waves send heat into the body and penetrate much deeper than the warmth from a hot pack. While this treatment is certainly not a panacea, the practice does improve circulation and blood supply and relaxes nerves.

If you have... INTENSE PAIN
If you've exhausted your options, and signs point to a spinal abnormality, some doctors may suggest surgery. It's risky, radical, and hotly debated.

There is vast, contentious disagreement in the medical community about using MRIs to diagnose back pain, and about the efficacy of back surgery, which involves cutting uncomfortably close to the spinal cord. "It's still a matter of debate whether having back surgery is any better than not having back surgery," says Dr. James Dillard, author of The Chronic Pain Solution. About the only thing doctors do agree on is that back surgery should be reserved for only the most select minority of patients who haven't responded to less invasive treatment. There are four basic categories.

Discectomy
Here, doctors remove herniated discs to relieve nerve pressure.

Laminectomy
The back of the vertebra, called the lamina, is removed to alleviate pressure on the spinal cord.

Spinal fusion
The adjacent vertebrae are fused with hardware or a bone graft.

Artificial Disc Replacement
The name says it all: An entire disc is removed and replaced with a prosthesis.
-- Benjamin Ryan

Photographs by: Monte Isom
(September 2006)