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What Causes Chronic Back Pain?

Chronic back pain is back pain that lasts longer than 3 months. It is caused by a wide range of problems. One major cause of back pain is weak muscles. 

What Kind of Exercises Should I Do for Chronic Pain?

By strengthening the muscles in your back, you can improve your posture and increase mobility. Stronger muscles can reduce pain. You can work with a physical therapist to come up with an exercise plan that is right for you.  You can also do the exercises here to help with your pain.

How Long Will It Take to See Results?

Exercises do not work right away. Your routine needs to be repeated several times a week to see results. Be sure to pace your activities. This method will not work if you cycle through overactive and underactive phases. You might be sore when you begin, but you should not experience lasting or abnormal pain during these exercises. Contact your doctor if your pain worsens.

Some back pain may require immediate medical attention. Call your doctor immediately if you experience any of the following:

• back pain with fever;

• numbness in the groin;

• loss of bladder or bowel control;

• leg weakness;

Visit these websites for more information on exercising:

• The National Institute of Aging’s Get Fit for Life guide

• Low Back Pain Fact Sheet from The National Institute of Health

View this PDF to see some exercises from UChicago Physical Therapist Alyssa George:

• Low Back Pain Exercises

• Core Exercises

 

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What is Guided Imagery?

Guided Imagery uses thoughts to ease pain in the body and promote relaxation. This method uses mental images to create feelings of well-being. You can also use other senses to help enrich the mental image.

One common guided imagery scene is seeing yourself on a beach where you can feel sand, hear waves, smell sunscreen, and taste a cool drink.

Here are the 5 steps to your first guided imagery session:

Step 1: Find your “Why” and set the scene. Remember that your goal is to ease your pain. To set the scene, think about your “happy place” – real or imagined. You will use this happy place later.

Step 2: Find a relaxing pose. A popular pose is lying on the back with hands. If you find this pose painful, you may try other poses. You can also try lying how you like to fall asleep. You can even use a pillow or warm blanket! The key is to be comfortable.

Step 3: Controlled breathing pattern. Once you are in a comfortable position, the focus turns to breathing. Deep breathing alone has been shown to have a lot of mental and physical health benefits. Breathing through the nose and out the mouth is recommended. Count up to 3 seconds while inhaling and 5 seconds while exhaling. Use an easy tempo and keep a focus on the breathing throughout the session.

Step 4: Create an image of the environment. Think of the happy place you decided on in Step 1. Try to use all of your senses – what sounds and smells surround you? What would you feel on your skin?

Step 5: Remember your “Why”. Imagine yourself pain-free and relaxed. Imagine what you would do in that scene if you had no pain. Guided imagery sessions can last as long as you want them to. Do not rush the experience so you can feel the full effects.

There are also many phone apps, recordings, and online videos to help you learn and practice guided imagery.

Here are website links to try guided imagery at home:

• Podcast

• Books

  • Guided Imagery for Self Healing

  • 7 Guided Meditation Scripts for Healing Anxiety, Back Pain, Arthritis, Headaches, Bone Injuries, Infection, and Addiction

  • 30 Scripts for Relaxation, Imagery, & Inner Healing

• Apps

  • Headspace

    • Available on Apple iOS and Android Devices

  • Aura

    • Available on Apple iOS and Android Devices

• Online Course

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What is Heat Therapy?

Heat therapy is best for targeting tight joints and muscles.

It works by increasing circulation in the sore area, so this method is great for places that need extra blood to heal and be soothed.

There are two types of heat therapy: dry and moist. Dry heat therapy uses heating pads, and dry heating packs (such as Hot Hands). Moist heat therapy uses steamed towels, moist heating packs (such as beaded heating pads), and hot baths.

When using heat therapy, REMEMBER:

• Apply compress for 15-20 minutes at a time;

• Allow at least one hour between treatments;

• Treatments that are too hot can cause other injuries;

• Falling asleep during heat therapy can also result in injury.

• Do not use heat therapy to treat a bruise or swelling, or on any open wounds.

You can also seek heat therapy from an expert. Physical therapists can offer heat treatments via ultrasound heat therapy. This option can help when the home treatments do not work for you.

People with certain conditions should not use heat therapy due to a heightened risk of burns or complications. These conditions include but are not limited to:

• Diabetes

• Dermatitis

• Deep Vein Thrombosis

• Multiple Sclerosis (MS)

What Is Cold Therapy?

Cold Therapy does the reverse of heat therapy; It works by restricting blood vessels and reducing inflammation in the sore area. This means that cold therapy is great following injury (bumps, sprains, & strains). It is also good for headaches and migraines when you apply it to the neck.

How to Use Cold Therapy

• Cold therapy can be applied with an ice pack, a frozen sponge inside a freezer storage bag, a grocery item from your freezer (corn, peas).

• Use a barrier (towel) between the frozen object and your skin to avoid skin irritation or injury.

• Apply for 15-20 minutes at a time.

• Ice baths and cold showers are also an option. You should do it for 5 minutes or less at a time – There is no need to overdo it.

• Do not use cold therapy to treat tight muscles and joints.

People with certain conditions should not use cold therapy due to a heightened risk of skin damage or complications.

These conditions include but are not limited to:

• Diabetes

• Multiple Sclerosis

• Poor Circulation

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What Are Meditation and Mindfulness?

Meditation is the practice of focusing your attention, on purpose, to what is present, and trying not to judge your thoughts, feelings, or experience

Mindfulness is the practice of being aware of the present. It is accepted by modern science as an effective technique for addressing different physical and psychological disorders. The terms mindfulness and meditation are often used interchangeably or in combination.

How Do Mindfulness and Meditation Help Relieve Pain?

Pain is an attention-grabbing signal. It is both a physical and emotional experience (I am worried, sad, angry about this pain). It also takes place in a social context (Others don’t understand my pain, they are not helping me enough or they are doing too much for me). We know that our brains respond to what we pay attention to and that the negative emotions connected to pain may make it worse.  Meditation and Mindfulness are tools that help us redirect our attention, notice our habits of thinking, feeling, and acting in response to pain, and lessen the judgment and negative emotions that we may be adding to the situation.  Many people with pain say that meditation and mindfulness helps them feel more calm, and less tension and pain.

Individual Mindfulness Meditation. To practice this type of meditation, sit alone in a quiet comfortable space. Your eyes may be closed or relaxed. The goal is for you to slow down, quiet down, connect with yourself, and pay attention to this moment. Many people focus on their breath during meditation. Mindfulness of breathing is one of the most common meditations. In fact, in most meditations, people use their breath as a sort of “anchor”.  When they notice they are distracted and thinking about something (like the wind and rain dragging your boat around), they gently take another breath and re-focus on the quality of that breath, really paying attention to the way the air feels as it travels up their nose and into their body, noticing how their shoulders or chest or abdomen may rise and fall with each breath, and noticing the air as it leaves their mouth or nose.  Noticing the emotions, thoughts, sensations, urges, whatever, that may be present, but just noting them, as if nodding at a person you know across the street, and gently turning their attention back to their breath, or whatever you choose to focus on for your meditation.

Some people focus just on a meditation of sights or sounds around them, taking time to really focus and observe and describe what is present.  Often, people are able to notice things that usually go unnoticed or that are quickly passed over (e.g., the texture of an object, the way the light reflects on it, the variations in color, the way it changes if you are still and observing it, etc.). This allows them a deeper sense of what is really present in the moment.

A mindfulness technique that many people with pain find helpful is the body scan. When doing the Body scan, you focus on one body part at a time (e.g., hands, arms, shoulders, neck, head, chest, abdomen, back, pelvis, buttocks, thighs, legs, feet, the whole body),  People normally use their breath as an anchor and spend at least a few breaths on each part. Again, they are trying to adopt a nonjudgmental stance and observe and describe what is present.  It is normal to have many distracting thoughts, especially when you encounter painful areas, it may be even more difficult to stay present, because you may notice more thoughts, emotions, and urges to shift your focus. But try to stick with it, return to your breath, and focus on the next part.

During meditation, it is okay to have many thoughts. Your mind does not have to be completely quiet for a successful meditation, it would be unusual if it was. Rather, it is about letting thoughts and emotions flow, observing them, and gently, lovingly returning attention to the present and the object of your meditation.

 

Guide to Relaxed Breathing for Meditation

One simple way to help the body relax is to slow down and breathe from the belly. You can do this by using the diaphragm muscles (under the rib cage).

1.  Sit or lie in a comfortable position. Uncross your legs and arms. Try and find a quiet spot free of noise. Close your eyes or look at spot a few inches in front of you. Take a couple of long, slow, deep breaths.

2.  Place one hand on your belly and one hand on your chest. Take a normal breath to see which hand moves the most. Now try to take a breath from your belly. Imagine you are trying to fill a balloon in your stomach with your breath and deflating the balloon as you exhale.

3.  Take a slow, steady breath in through the nose, and then slowly and smoothly exhale. Some people breathe out with pursed lips (as if through a straw); others breathe out through their nose. Some hold their in-breath for a moment and elongate their exhale. Others change the count of the breath to something that feels more comfortable for them. If you begin to feel dizzy, try breathing less deeply and at a more normal rate.

4.  People get better at relaxed breathing with practice. Don’t worry too much about doing it right. It should feel good and be comfortable. Work on making your breaths more slowly and calmly.

5.  You can use the power of your mind to boost the effect of the breathing by imaging yourself becoming more relaxed, looser, calmer, healthier. You can repeat a statement to help you relax (e.g., “With each breath, I feel my body becoming more relaxed and calmer.” “Breathing in relaxation/health and breathing out tension”).

 

Guide to Mindfulness

1. Observe

1.  Find a comfortable position and take a few breaths. Start by observing (an object, your breath, the room around you, etc.). Notice what is present in the moment. Try not to get caught in the experience or trying to control what you see or feel.

2.  Become a curious scientist or a child who is seeing things for the first time. Look closely and notice the details of what you are looking at. What is its size, color, texture? Observe what comes in through your senses: What do you see, hear, smell, feel, taste?

3.  Notice what is going on inside you as you observe. Watch your thoughts coming and going, like clouds in the sky. Also notice each feeling rising and falling, like waves in the ocean. Notice them and be kind to them.

 

2. Describe

1.  Use words to describe your feelings and thoughts. When a feeling or thought comes up, label it. Call a thought “just a thought”, a feeling “just a feeling.” Try not to get stuck by what your thoughts and feelings are saying—keep observing them.

2.  For example, say in your mind, “A feeling of sadness just came over me.” “My chest muscles are tight.” “A thought that I can’t do this came into my mind.”

3.  Allow yourself to notice and describe these feelings to yourself, without trying to change them or struggle with the thoughts.

 

3.  Mindfulness of Breathing

1.  You can practice mindfulness and breathing at the same time by focusing on your breath. Feel the sensations of your breath as it moves back and forth in your body.

2.  What does the breath feel like in your nose, throat, and belly? How does it change from moment to moment? Notice the thoughts, feelings, and urges that arise to distract you from this observation. Can you notice these and let them go, like people passing by you on the street? Say hello to them and let them go, as you turn your attention back to your breath.

4.  Body Scan

1.  Look past your breath toward every part of your body, one by one (e.g., fingers, hands, wrists, arms, elbows, shoulders, neck, head, chest, back, stomach, hips, buttocks, thighs, knees, legs, ankles, feet, toes, and the whole body at once).

2.  If you notice strong feelings or sensations, just acknowledge it, breathe into it, let it go, and move your attention to the next part of your body.

 

Other Mindfulness Practices

You can practice mindfulness of many things: eating, daily activities (e.g., folding clothes, washing dishes, brushing teeth, showering), movement (walking, yoga), nature, sounds, time, pictures.

Guided Meditation is when something or someone guides you through the meditation process. It can be a recording or a person. One type of guided meditation is Progressive Muscle Relaxation (PMR). PMR focuses on relaxing each body one at a time. PMR helps you to be more aware of your muscles and how tense they feel. Guided meditations may focus on breathing, learning to focus on your breathing and slow it. Some guided meditations ask you to visualize breathing out negative thoughts and breathing in calm and positive thoughts.

 

Resources for Mindfulness and Meditation

• Apps

  • Headspace

    • Available on Apple iOS and Android Devices

  • Calm

    • Available on Apple iOS and Android Devices

• Book

• YouTube

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What is Music Therapy?

Music therapy is a practice that uses music to achieve patient’s goals. The sessions are guided by certified music therapists. A music therapist prescribes treatments that include creating, singing, moving to, and/or listening to music. You may enroll in a music therapy program, or you can try music therapy from home.

Music offers a calm break from pain and can energize and uplift your mood.

How Does Music Therapy Help Reduce Pain?

• Music causes our bodies to produce more happiness hormones called endorphins

• The fun of music therapy distracts you from the pain

• Music helps boredom, loneliness, and anxiety by promoting relaxation

How can I Use Music at Home?

• Think of the happiest moments in your life and what kinds of music matches them (For example: As a child, Bob liked beaches. Now the sounds of ocean help him relax). Add these happy songs to your playlists.

• Ask your friends and family to create playlists for you. Some research shows that music prepared by others may be have a stronger effect on mood than music you prepare yourself.

• Your playlists may be a combination of instrumental music, guided meditation recordings, and songs.

• Enjoy these playlists during painful medical procedures, when experiencing pain, or whenever you need an extra boost of joy!

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What is Progressive Muscle Relaxation (PMR)?

PMR is a way to reduce tension. It works by helping you to notice when you feel tense so you can relax your muscles. This method helps reduce stress, fatigue, and headaches. It can improve sleep and quality of life.

How to Get Started Doing PMR

Find a place where you will not be bothered and where you can lie down and stretch out. Decide whether you want to start from your feet to your head or the reverse. Set aside at least 15 minutes for each session. Plan to do PMR twice a day, every day for the first few weeks.

 

How to Do PMR

1.  Take a slow, deep breath in and tense the first muscle group. You should tense hard, but not to the point of pain or cramping. Hold the tension for 5 seconds.

2.  After 5 seconds, exhale and quickly relax the tensed muscle. You should feel the muscle become loose.

3.  Stay in this relaxed state for about 15 seconds. Notice the difference between how your muscles feel when tensed and when relaxed.

4.  Repeat steps 1-3 for each muscle group. Move from your feet to head or head to feet.

5.  When you are done, count backwards from 5 to focus back on the present.

 

Make sure not to tense your muscles too much. You should not feel intense or shooting pain.

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What Causes Chronic Knee Pain?

Chronic pain in the knee can be caused by many things including overuse, osteoarthritis, tendonitis, bursitis, meniscus tears, and sprained knee ligaments. Strengthening leg muscles can help with many kinds of knee pain. Stretching tight muscles can also take some pressure off the knee joint.

 

Why Should I Use Exercise to Help with Knee Pain?
Knee pain is often caused by weak muscles surrounding the knee. This puts stress on your knee. By strengthening these muscles with exercise, you can relieve some of the stress and reduce pain.

 

Which muscles should I exercise?

The quadriceps (front of thigh), hamstrings (back of thigh), glutes (backside), and calves work together to support the knee. These muscles all need to be strong in order to do their job properly.

 

Exercise from Home

Aim to do these exercises 4-5 days a week for best results.

Standing calf stretch: Face a wall and place both palms flat on the wall, or hold the back of a chair for balance. Keep a slight bend in your knees. Take a big step backward with one leg. Keep your other leg directly under you. Keep both heels flat and press your hips forward. Hold the stretch for 30 seconds, and then relax for 30 seconds. Switch legs. Repeat 2 or 3 times on each leg.

Standing quadriceps stretch: Stand and place one hand against a wall or hold the back of a chair for balance. With your weight on one leg, bend your other leg and grab your ankle. Bring your heel toward your buttocks. Hold the stretch for 30 to 60 seconds. Switch legs. Repeat 2 or 3 times on each leg. If you have difficulty standing on one leg, you can try lying on your stomach while performing this stretch.

Sitting hamstring stretch: Sit with both legs straight in front of you. Do not point or flex your toes. Place your palms on the floor and slide your hands forward until you feel the stretch. Do not round your back. Hold the stretch for 30 seconds. Repeat 2 or 3 times.

Standing half squats: Stand with your feet shoulder-width apart. Lean your back against a wall or hold the back of a chair for balance, if needed. Slowly sit down about 10 inches, as if you are going to sit in a chair. Your body weight should be mostly over your heels. Hold the squat for 5 seconds, then rise to a standing position. Do 3 sets of 10 squats to strengthen your buttocks and thighs.

Standing hamstring curls: Face a wall and place both palms flat on the wall, or hold the back of a chair for balance. With your weight on one leg, lift your other foot as close to your buttocks as you can. Hold for 5 seconds and then lower your leg. Do 2 sets of 10 curls on each leg. This exercise strengthens the muscles in the back of your thigh.

Standing calf raises: Face a wall and place both palms flat on the wall, or hold the back of a chair for balance. Stand up straight, and do not lean. Place all your weight on one leg by lifting the other foot off the floor. Raise the heel of the foot that is on the floor as high as you can and then lower it. Do 2 sets of 10 calf raises on each leg to strengthen your calf muscles

Straight leg lifts: Lie on your stomach with straight legs. Fold your arms in front of you and rest your head in your arms. Tighten your leg muscles and raise one leg as high as you can. Hold for 5 seconds, then lower your leg. Do 2 sets of 10 lifts on each leg to strengthen your buttocks.

Sitting leg lifts: Sit in a chair. Slowly straighten and raise one leg. Squeeze your thigh muscles and hold for 5 seconds. Relax and return your foot to the floor. Do 2 sets of 10 lifts on each leg. This helps strengthen the muscles in the front of your thigh.

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What is TENS?

TENS stands for Transcutaneous Electrical Nerve Stimulation. Transcutaneous means passing through the skin. A TENS unit is a small device. It has a series of stick-on electrodes. Electrodes carry electricity. You put electrodes on your skin to send a small electrical charge. This charge confuses and reduces pain signals sent to your brain. The charge may also cause your body to release natural hormones to lower your pain levels.

 

How to Use a TENS Unit?

You can get TENS treatments at home at your doctor’s or physical therapist’s office.

If you decide to use a TENS unit at home, REMEMBER:

• You must NOT use it if you have a pacemaker or any other implanted heart device.

• You must NOT use it on any area where you have less feeling or numbness as you can burn yourself.

• Your treatments might feel like a buzz, tingle, or prickle but it should never hurt.

There are basic TENS unit features that allow for personalized treatments:

• Treats more than one pain location

• Built-in modes for different types of pain

• Many power levels for varying levels of pain

• FDA-cleared for safe and effective pain treatment

• Easy-to-use buttons and displays

• Portable

Additional TENS unit features to consider:

• Wearable and wireless with Bluetooth^®

• Syncs to a mobile app.

• Dual channel to treat two locations of pain at once.

• Heat combined with TENS.

TENS units are over the counter. You do not need a prescription to buy one unless you want the cost to be covered by insurance. Check with your personal health insurance plan and talk to your doctor to see if you TENS unit can be covered.

You can purchase a TENS unit and replacement electrode pads from most pharmacies. You can also order them online.

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If it’s been a long time since you exercised, you may want to start out slowly. You can start with just 5 minutes and build up to the recommended 30 minutes a day. Your goal should be to get up to taking 100 steps a minute. Remember, the most important thing is to just get started.

What Can Walking Do for You?

• Strengthen muscles

• Improve balance

• Help prevent weight gain

• Lower the likelihood of falling

• Lower risks of heart disease, stroke, and osteoporosis

Take These Steps to Get Walking:

1.  Join a walking program or walk with a buddy. Chances are you’ll stick with a walking program if you have someone to walk with.

 

2.  Wear the right shoes.

 

3.  Don’t let a cane or walker stop you. It’s OK to use your cane or walker if you already have one. These can improve your balance and help take the load off painful joints.4.  Aim for the right pace. Try to walk as fast as you can, but still be able to chat with a friend while walking. Aim to work as hard as you do when you climb up the stairs.

 

 

Talk to your healthcare provider if you have any problems.

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What is Tai Chi?

Tai chi (pronounced like “tie chee”) is a Chinese martial art. It uses slow, dance-like movements and deep breathing to focus and find balance. This is also a great introduction to exercise to someone who has been inactive for an extended period. There are many books, videos, in-person classes and online resources (how-to’s, YouTube, online classes) you can find to help begin your tai chi journey. There are many styles, so take some time to find the ones that are right for you!

Getting Started with Tai Chi

Tai chi classes are a great way to get started. Many are available through pre-recorded online videos, but you can also find live online classes where you have an instructor in real-time.

Call:

• Tai Chi Tao Center in Oak Park to get more information on online classes at 708-386-0266

• Tai Chi Center of Chicago (Lakeview) at 312-927-5959

Check out these images from Simplified Tai Chi Chuan Guide (PDF) for some introductory poses.

 

 You can also watch online videos for fully guided Tai Chi sessions!

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What is Yoga?

Yoga is a physical, mental, and spiritual practice that began in India. Yoga technique involves holding poses and postures, deep breathing, and meditation to strengthen and relax the body. It is as much of an exercise as it is a state of mind. Yoga is a great choice for beginners because many of the poses can be modified for those who cannot do the standard pose. Just like Tai Chi, there are many resources you can use to find a style that works for you. Some of these resources include books, videos, in-person classes, and online resources (how-to’s, YouTube, online classes) that you can use to become more acquainted with Yoga. Since yoga is such a popular way to exercise these days, there is also a lot of bad yoga advice out there. Make sure your yoga sources come from a certified instructor. Be mindful of this when selecting your routine or instructor to avoid injury. Stay aware of your personal limits as well – Pushing yourself too hard can make your pain worse.

Getting Started with Yoga:

Here are some standard yoga poses that you can do from home. By learning both the poses and their names, you can prepare yourself for learning from other instructional videos, classes, and books with ease. Each move has many modifications, or versions, that you can do depending on skill and strength. You can do these on a yoga mat, but it is not required. You can also substitute poses that use yoga blocks with thick books. Be sure to only use one book at a time because stacking books will create an unstable surface.

 

 

1.  Downward-Facing Dog / Asho Mukha Scansana

• Start on your hands and knees, with your hands stacked under your shoulders and knees under your hips.

• Spread your hands wide and press your index finger and thumb into your mat.

• Lift your tailbone and press your glutes up and back, drawing your hips toward the ceiling. Straighten your legs as best as you can and press your heels gently toward the floor.

• Your head should be between your arms, facing your knees, and your backs should be flat.

• Hold for 5–10 breaths.

Your focus should be on keeping your spine long – if that means you need to bend your knees, that’s fine. To help keep the pressure off your wrists, spread your fingers wide and put more weight into the pad where your first finger and thumb insert into your palm.

2.  Mountain Pose / Tadasana

• Stand with your toes together and heels slightly apart.

• Spread your toes and place your weight evenly through both feet. Engage your core and tuck your hips under a bit so your tailbone is pointing down toward the floor. Relax your shoulders and roll them back and down.

• Inhale and reach your arms overhead, while pressing down into your feet. You may also put your hands in prayer position in front of your chest or rest them by your sides – all are commonly used variations.

• Take long, slow, deep breaths in and out of your nose.

• Hold the pose for 3–5 breaths.

Keep your arms up by your ears and widen your them if you need to.

 

 

 

 

 

3.  Crescent Lunge / High Lunge / Utthita Ashwa Sanchalanasana

• Take a big step forward with your left foot to start in a staggered stance, with your feet spread in a forward lunge position.

• Bend your front knee and keep your back leg straight and heel lifted off the floor. Try to bend your front leg so that your thigh is parallel to the floor. Square your hips toward the front.

• Extend your arms toward the ceiling on either side of your head and stretch up as you also press into the mat and feel the stretch in your hips.

• Hold for 5 breaths and repeat on the other side.

• To move into Low Lunge / Anjaneyasana, simply drop your back knee to the floor, keeping the leg extended long and the shin flat on the mat.

It’s more important to keep your spine long than it is to straighten your back leg. Feel free to bend your back leg if it will help you lift your torso and lengthen your back.

 

 

 

 

 

4.  Warrior II / Virabhadrasana II

 

• Take a big step forward with your left foot to start in a staggered stance, with your feet spread in a forward lunge position.

• Extend your arms so that they are parallel to the floor.

• Bend your left knee so that it’s at or near a 90-degree angle, your thigh parallel to the floor, while keeping the right leg straight.

• Point your left toes forward and turn your right foot out to the right so that it’s at a 90-degree angle with your left foot. Your left heel should be in line with the arch of your right foot.

• At the same time, twist your torso to the right so that your left hip is facing forward, and your right hip is facing toward the back. Your left arm and your head should both be pointing forward and your right arm should be pointing back.

• Hold for 1–5 breaths.

Make sure your left knee doesn’t move past your ankle. If it does, reduce the depth of your lunge a bit.

 

 

 

 

 

5.  Triangle / Trikonasana

 

• Start in Warrior II.

• Straighten your front leg. Then, reach forward with your left hand toward the ground. Tilt your torso forward and rotate it open to the right side.

• Rotate your arms to 6 and 12 o’clock. Rest your left hand on your shin, or the floor if you can, and extend your top arm fingers toward the ceiling.

• Hold for 5–10 breaths, then switch sides.

It’s more important to keep your spine long than it is to reach low to your leg or floor. If this position is too hard, you can use a block under your bottom hand to add more stability to this pose.

 

 

 

 

 

6.  Tree / Vrsasana

• Start in mountain pose with your toes together and heels slightly apart.

• Bring your right foot to the inside of your left shin. Squeeze your foot and shin together. The knee of your right leg should be turned out and your right thigh facing down toward the ground at a 45-degree angle.

• Once you’ve found your balance, lift your hands to prayer position in front of your chest (as shown), or up overhead if that feels better for you.

• Keep your gaze focused on a fixed point in front of you to help stay balanced.

• Hold for 5–10 breaths, then switch sides.

If this pose is easy for you, feel free to try lifting your foot higher on your opposite leg, closer to your inner thigh.

 

 

 

 

 

7.Seated Forward Fold/Paschimottanasana

• Sit on the floor with your legs extended in front of you. Flex your feet. Sit up tall with a straight back.

• Bending from your hips and keeping your flat back, fold your upper body over your lower body.

• If you are able to, grab onto the outside of each foot, or your ankles or shins. Release your neck and let your head hang heavy.

• Hold for 5–10 breaths.

Feel free to bend your knees until your back lengthens and you can tip your hips forward. Again, keeping your spine long and flat is more important than keeping your knees perfectly straight.

If you feel tension in your low back, bend your knees. For a deeper release of tension in the back and hamstrings, place a block underneath your hands and press into it.

 

 

 

 

 

8.  Child’s Pose / Balasana

 

• Come to your hands and knees on the mat.

• Spread your knees as wide as your mat, keeping the tops of your feet on the floor with the big toes touching.

• Bring your belly to rest between your thighs and root your forehead to the floor. Relax the shoulders, jaw, and eyes. If it is not comfortable to place the forehead on the floor, rest it on a block or two stacked fists. Finding a comfortable place for the forehead is key to gaining this soothing benefit.

There are several possible variations for your arms. You can stretch them in front of you with your palms toward the floor or bring your arms back near your thighs with the palms facing up. These are the most common variations. You can also stretch the arms forward with palms facing up, or try bending the elbows so that the palms touch and rest the thumbs at the back of the neck. In this position inch the elbows forward.

 

 

 

 You can also follow along with online videos!

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What is Pilates?

Pilates is a low-impact exercise method that focuses on strengthening your core and increasing flexibility and balance. While Pilates classes can involve special equipment, like a machine called a Reformer (the one that looks like a bedframe that slides up and down), it is not required. That means you can do a Pilates routine from home. Like yoga, there is a huge trend to do Pilates, so be sure that you are choosing classes and materials from certified instructors. You can try books, videos, in-person classes, and online resources (how-to’s, YouTube, online classes). Do not let the culture or the prices intimidate you – It can be fun way for beginners to start getting active! If you are nervous about starting, or if you are on a budget, there are many free videos online that can show you how to get started.

Getting Started with Pilates:

If you own a yoga mat, you can use it for Pilates but it is not required. These exercises focus on making your core stronger, but will help build other muscles as well. Some of these moves will have you kneel on the ground. If that is too uncomfortable, and if you have the room, you can try those poses in bed. You can also wea soft knee pads. Make sure the knee pads are not too slippery, or use them on a carpeted surface if you do not have a yoga mat.

Kneeling Rear Leg Raise

• Position your body on all fours with your weight evenly distributed between elbows and knees. Gently engage your core and extend your right leg back with toes pointed and hovering slightly above the ground. While keeping the leg straight, lift your leg as high as you can without causing discomfort or arching your back. Lower the leg slowly back down to starting position, and switch legs. You can bend the raised knee if that is more comfortable.

 

Single Straight Leg Stretch

• For those who have limited mobility, chair Pilates is a good way to tone and strengthen your legs, butt and abs.

• Sit in a chair with good posture. Extend both legs straight out at a little more than a 90-degree angle, with toes pointed and on the ground. Lift the right leg up very slowly. Without lifting the body at all, raise the right leg as high as you can, until it is about parallel with the ground. Breathe in while lifting the leg.

• Lower the leg, again very slowly. Breathe out as the leg is lowered. Repeat this step with the right leg 10 times. Then repeat these steps with the left leg.

 

 

Swimming

• Lie on your stomach on the floor with your legs extended behind you, knees hip-width apart. Stretch your arms forward so they’re shoulder-width apart.

• Pull your belly button up and in toward your spine as you lift your right arm and left leg off the floor. Your head and chest, if possible, should also lift off the floor, but only lift as far as you comfortably can. Keep your neck neutral, and gaze down on the floor, if that helps. Lower back down and repeat on the opposite side with left arm and right leg extended.

 

 

Bird Dog

• Start on all fours with your hands below your shoulders and knees below your hips. Engage your core, keep your spine neutral, and gaze down or slightly forward.

• Lift your left arm and extend your right leg until they’re in line with the rest of your body. Pause, then lower back down, and repeat on the opposite side with right arm and left leg extended.

To make it easier, keep your hands on the floor, and only extend your leg.

 

 You can also follow along with online videos!

 

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What are topical medicines?

• Topical medicines are put on skin to relieve pain.

• They can be creams, gels, ointments, sprays, and patches.

• People respond differently to them.

• If one doesn’t work, you can try another one that has a different active ingredient.

• Use on skin that is clean, dry, and not open or cracked.

• Use only one at a time on the same skin area.

• Stop using it if you get a rash.

• The topical medicines listed below are over-the-counter, which means you can buy them at your local pharmacy.

• Generic store brand options are effective.

What kinds of topical medicines are there?

 

Lidocaine numbs pain temporarily.

Active ingredient: lidocaine

Some brands are: Salonpas or Aspercreme Lidocaine

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) decrease inflammation.

Topical NSAIDs are safer than NSAID pills, like ibuprofen (Advil) or naproxen (Aleve). They can decrease pain more than Hot and Cold medicines.

Active ingredient: diclofenac

Some brands are: Voltaren, Aspercreme Arthritis Gel

 

Hot and Cold medicines distract your nerves temporarily.

Active ingredient: capsaicin or menthol

Some brands are: Tiger Balm, Ben-Gay, Biofreeze, Salonpas, IcyHot