EXERCISE
Appropriate exercise helps to maintain back health and general fitness. Through exercise, the strength and flexibility of the back can be maintained or improved. However, if the exercise is performed incorrectly, one might hurt one's spine. The structure of the spine is very complicated and back pain can be difficult to cure. Therefore proper posture is very important in keeping the health of the spine. Physiotherapist can advise for proper treatment and appropriate exercise to relieve the pain. Exercise guideline for lower back is given in the page 12.

BACK PAIN DURING PREGNANCY
In approximately 80% of women who are pregnant, back pain is prevalent. This pain may start during pregnancy, or within three weeks of delivery. Usually during the third trimester, 50% of pregnant patients will experience back pain. The etiology of pain is probably related to a combination of mechanical, metabolic, circulatory, and psychosocial contributing factors. Most probably cause is due to a change in hormonal influence that causes change at the insertion point of ligaments to the bone. There is some evidence to suggest that a different set of receptors is sensitized in the lower spine during pregnancy by hormones. In most cases, pain does improve after the postpartum period. Patients are instructed to avoid excessive weight gain, exercise to strengthen the back muscles, maintain correct posture and to wear sensible shoes (not high heels). Treatment options are available including a pelvic belt, exercise, appropriate rest, medication, massage and standard back exercises. Bed rest and exercise appeared to be the best treatments resulting in the rapid recovery of 65%.

CONCLUSION
Regarding low back pain, change in life style and exercise has got a tremendous role. Yet a person can experience the ailment. Most of the cases can be improved by conservative treatment. When surgery is inevitable, a clear cut preoperative diagnosis, especially with the reports of MRI or CT is essential, otherwise it is very difficult to perform spine surgery depending on assumption. In our country now a days the outcome of surgery is really auspicious.

Reference _____________________________

1 ATUL T. PATEL, M.D. and ABNA A.OGLE, M.D. University of Kansas Medical Center, Kansas City, Kansas
2 Kerry H. Levin, MD, Neurologist, Department of Neurology. The Cleveland Clinic Foundation
3 Dr. Kraus, Neurosurgeon, West Houston Medical Center, Houston.
4 Back pain at work: Strategies to prevent aches, pains and injuries: Mayo Foundation for Medical Education and Research
5 Handout on Health: Back Pain, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
6 Back pain during pregnancy by Harry Lockstadt, M.D. Bluegrass Orthopaedics, Lexington, Kentucky, USA
7 Epidemiology of Back Disorder by Nisha J Manek; A J MacGregor
8 Low Back Pain Exercise Guide: American Academy of Orthopedic Surgeon
9 Does smoking cause low back pain? by Donald J. Frisco, MD
10 Thomas G. Lowe, M.D. Orthopaedic Surgeon, Woodridge Spine Clinic, Wheat Ridge, CO, USA
11 http://familydoctor.org/117.xml
12 http://www.nids.nih.gov/disorders/bac
13 http://www.Backpainforum.com
14 http://www.pain-relief-study.com

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