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 Pains & Aches

October 2009
Minding Back Pain
Dr Yash Gulati
 
With advanced technology and improvements in working methods, we really should expect fewer physical complaints, but this is not so. The human body was built for movement, for activity with speed and precision. However, over the last few centuries, 'civilisation' has made our requirements to move much less necessary than it was during our ancestors' time - for example, we don't have to run around and hunt for food today.

We use vehicles, work stations and equipments which the earlier generations never even dreamt of. These newer modifications in our lifestyle with less emphasis on mobility have taken their toll, because our body is the same, as it was millions of years ago. And this, is leading to an increased incidence of back pain because of abnormal stress on our spine.

It is a fact that even today, primitive races like the aborigines in Australia suffer very little from back pain and their back is less marked than say, in the 'civilised' races. African tribes also reveal a very low incidence of slipped disc and even they have much greater range of movements in their spine and other joints. This leads us to conclude that greater mobility and physical fitness is a hallmark in preventing back problems and the lack of these surely leads to higher incidence of back pain.

There are over 100 accepted causes of lower back pain; incidences where the cause of back pain cannot be found out are more. The most common cause of back pain remains wear and tear of the structures constituting the spine due to abnormal use of the back and poor posture.

Good posture can be defined as any position, which allows good use of the body for a specific task and is comfortable for as long as the posture is held. Even though a particular posture may not cause immediate discomfort, continued poor posture will in the long term cause back pain. The curve of the lower back just above the pelvis is called lordosis. When standing, this curve is naturally present and varies from person to person. The curve can be altered by changing the tilt of the pelvis. An increase or decrease of the curve for a prolonged time, or frequently for a shorter time, causes pain. Good posture is the most important way of preventing back pain.

Posture while standing
In the upright posture, the spine has a stabilising function. The body weight is transmitted from the shoulder girdles to the pelvis by hydraulic system of the thorax and the abdominal cavities. Back posture, particularly hyperlordosis (increase in the curve of the lower back) associated with lax abdominal musculature impairs the function of this hydraulic system, thus leading to overloading of several spinal segments in the lower back. All the upright positions, other than that of the physiological vertical axis, increase the strain on structures such as discs and ligaments. Further, more stabilisation by the muscles is less good during movements, especially if performed abruptly or associated with lifting a weight.

Being overweight, with protruding belly in particular, changes the curvature of the back and the line of the centre of gravity, which was passing from the shoulders to the centre of the pelvic girdle, now actually passes from in front of the pelvic girdle. This strains the muscles and the ligaments all the time. It is therefore, extremely important for a person to stay slim and trim so that abnormal forces are not put on the structures constituting the spine. If you stand or walk a lot, low heeled shoes are necessary to maintain the proper curve at the small of your back.

To relieve strain on the back:
  • No matter what you are doing, get one foot supported higher than the other, for example, when waiting for a bus, put one foot up on something and change from one foot to the other occasionally.
  • In the workplace, put one foot on a ledge or stool underneath your work surface to relieve the pressure on your back, while standing. This is true for all people whose work posture comprises of standing – like shopkeepers, sales men, surgeons etc.
  • Another way to prevent back strain while standing is to have the working surface at the right level - half way between the wrist and waist when standing with your hands by your side. The surface on which the housewife puts the stove in the kitchen should conform to this height.
Sitting
  1. Choose the correct chair for your height:
    • Your feet should be supported on the floor comfortabley.
    • Your feet should not be dangling.
  2. Sit in a chair with proper support for the lower back. A good chair should support the normal curves of your back.
  3. Choose a chair with armrests. The armrests should not be too high or low.
  4. Posture and sitting position are very important when working at a desk or table. Always ensure that
    • You have a chair of correct height which supports your lower back.
    • Reading stands, computer monitor, work station etc should be at such a height that you do not have to bend front or sideways to do your work.

Driving
The driving seat should support properly. If there is a gap in between your back and the seat it should be filled with a small cushion or one can use a backrest. Seated properly, your knees should be higher than your hips. This can be ensured by moving the seat backward or forward a bit – this will relax the back while driving. If necessary, a small cushion could be placed under the thigh.

If your job demands long hours of driving on a regular basis, then it would be a good idea to break the journeys after driving for a half hour or an hour, stretch a bit to relieve the stress and then restart driving only after that. When getting out of the car, swivel your whole body towards the door rather than suddenly jerking it out. Slide your feet onto the ground and then get out.

Lying
Your bed should be firm with a good mattress. It is not necessary to lie on the floor or on an absolutely hard surface. The only thing one has to ensure is that the bed should not be swinging or slouching in nature because such a bed will spoil the normal curve of your back. Use a single good pillow. It does not matter whether you lie on your back or your side while sleeping - that depends on your habit. Sometimes it is comfortable for the back to put a pillow under the knees while lying down.

Carrying
Use the same principles for carrying objects as you would for lifting, but also remember that if you have a load to carry, balance your body by: 1. Carrying two small loads rather than one large one: always carry two small shopping bags rather than one large heavy bag so that you can divide the weight into two, and thus get your body balanced. 2. If the load cannot be divided, hold it close to the body, with a firm grip in both hands.

Lifting
Bending forward to lift things off the floor is a bad idea. It does not matter whether the object is heavy or light, your back would be happy if you follow these principles of lifting:
  1. As you approach, relax your knees. Lowering movements should start at the knees and not at the head.
  2. After bending your knee, get close to the object to be lifted, almost sitting down on the floor.
  3. Get a good balance by keeping your feet apart. One foot should be a little ahead of the other foot.
  4. Now lift the object gradually, smoothly without jerking.
  5. Keep the object close to the body.
  6. The back should be straight though not necessarily vertical.
  7. Gradually get up without twisting the back.
  8. If the load is too heavy, do not lift. And get help.
Exercises
These exercises help prevent pain. You must be pain-free before starting them. If you have back pain, or if when you start these exercises some pain is provoked, you must consult your doctor or physiotherapist before continuing them. The exercises must be carried out in a slow, controlled fashion, starting with just a few repetitions of each exercise. You can gradually increase the number of repetitions over some days.

Flexion in lying
  1. Starting position: lie on your back with your knees bent up and feet flat on the floor.
  2. Bring both knees up towards your chest.
  3. Place both hands around your knees and gently but firmly pull the knees as close to your chest as you can. Hold this position for a count of five and then return to the starting position.
  4. Relax, repeat this stretch five times.
Your bed should be firm with a good mattress. It is not necessary to lie on the floor or on an absolutely hard surface 

Abdominal strengthening exercise
  1. Starting position: lie on your back with your knees bent up and feet flat on the floor.
  2. Place your hands behind your head to lightly support it, keeping arms parallel to the ceiling.
  3. Lift your head and shoulders upward towards the ceiling.
  4. Hold for a count of five and return to starting position.
  5. Relax. Repeat 10 times.
  6. Gradually, increase the number of repetitions of this exercise to three sets of 10.
Back strengthening exercise
  1. Starting position: lie face down with a pillow under your abdomen; fold your hands and place them under your forehead.
  2. Lift your head, shoulders and arms six inches from the floor, hold for a count of five and return to the starting position.
  3. Relax. Repeat 10 times.
  4. Keeping your knee straight, lift one leg six inches from the floor. Hold for a count of five and return to the starting position. Relax.
  5. Lift the other leg in the same way, holding for a count of five.
  6. Repeat 10 times with each leg. Remember to keep your hips on the floor when lifting your leg. Gradually, increase the number of repetitions of these exercises to three sets of 10.
Extension in lying
  1. Starting position: Lying face down, place hands under the shoulders in a press up position.
  2. Strengthening your arms, gently lift your head and shoulders up as far as you can, to increase the hollow in the lower back. It is important not to lift your hips from the floor when doing this stretch.
  3. Hold this position for a count of five and return slowly to the starting position.
  4. Relax. Repeat this exercise five times.
Padma Shri Dr. Yash Gulati is Senior consultant, Department of Spine surgery atApollo Indraprastha, New Delhi

    
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