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that provides cushioning. If a disk begins to degenerate and becomes less supple (usually because of overuse or pressure), the disk may move from its normal position (prolapse). This action squeezes some of the jellylike substance out through a weak point in the harder outer layer, resulting in loss of the cushioning and causing painful pressure on a nerve. This condition is called a prolapsed disk (sometimes referred to as a herniated, ruptured, or slipped disk). The disks in the lower back are especially susceptible to prolapse. A prolapsed disk between the vertebrae of the neck can put pressure on a nerve root and cause pain and tingling down the arm. Episodes of pain from a prolapsed disk may recur, sometimes resulting in chronic back or neck pain. The most serious complication is damage to the nerve roots of the spinal cord.

Protecting Your Back

It is impossible to protect yourself completely from back problems, but you can reduce the strain on your back by following these tips:

• Maintain correct posture. Don’t slouch when standing or sitting. Keep your head up, your shoulders straight, and your chest forward. When you stand, try to balance your weight evenly on your feet.

• Avoid awkward movements such as bending over and twisting at the same time.

• Learn the techniques that can help you avoid injuring your back when lifting heavy objects. Keep your back straight, bend your knees, and grasp the object firmly (make sure it is close to you). Because your legs are stronger than your back, let your legs do the work, and straighten them to lift the object.

• Avoid wearing high heels; the higher they are, the more they force your posture into an unnatural position that strains your back. Wear low-heeled, comfortable shoes.

• Sit properly. Don’t slump, and don’t cross your legs. Select a firm, high-backed chair that supports your lower back, or use a cushion to support the small of your back. Adjust your workstation if necessary. Your feet should be flat on the floor or on a footrest, with your knees bent comfortably at right angles. In your car, your knees should be higher than your hips, and you should be able to reach the pedals without stretching.

• Sleep on a firm (but not hard) mattress, or put a stiff board under your mattress (between the mattress and box spring).

• If you are overweight, try to lose weight (see page 53); excess weight puts strain on your back.

• Relax. Tension leads to bad posture and causes muscle fatigue.

Symptoms

The symptoms of a prolapsed disk may develop suddenly or gradually. If you have a prolapsed disk in your neck, you may wake up with a sore neck or gradually become aware of numbness, tingling, or weakness in your arm. You may suddenly feel intense pain in your back, often along with burning pain down one or both legs, when you bend over or lift something. You may have back and leg pain that comes and goes and worsens over several weeks. If the prolapsed disk is in the lower part of your back, you may develop symptoms of sciatica (see page 1006).

Back-Strengthening Exercises

Exercises that strengthen your abdominal muscles can help keep your back muscles flexible and prevent back injury. Try to do these exercises at least three times a week. If the exercises cause any pain while you are doing them, or if you have pain or feel stiff the next day, talk to your doctor—you could be overdoing it or not doing the exercises properly.

Pelvic tilt

Lie on your back with your knees bent, feet flat on the floor, and your arms at your sides. Tighten your abdominal muscles as you press your lower back into the floor. Hold for 5 seconds. Release. Do one to three sets of 10.

Bridging

Lie on your back with your knees bent, feet flat on the floor, and your arms at your sides. Tighten your abdominal and buttock muscles as you lift your buttocks off the floor. Hold for 5 seconds and slowly return to the starting position. Do three sets of 10.

Extension

Stand with your feet comfortably apart, knees straight, and hands against the