Care for your back

Back pain is very common and most of us will get it at some time. How you use your back, both at work and home, can determine whether you will have to learn to live with back pain. With the right approach basic back pain could be avoided.

Experts now recognise that the increasingly sedentary lives that we lead contribute greatly to the back pain epidemic that is now being experienced in the western world.

An office worker can spend anything from 25 to 40 hours a week in a static position working at a computer. Travelling to and from work may involve long journeys either sitting (or more likely standing) on a train or bus with no room for movement.

When we get home, it is far easier to sit and eat dinner in front of the TV, spending the rest of the evening sprawled on the sofa, than it is to go out and get some exercise.

If you want to keep your back healthy, it is important to keep it moving and to support it properly when you are not.

A bit about your back

The spine is made up of 33 small bones called vertebrae with discs that act as shock absorbers in between. These bones are given a code to show where they are in the spine. Beneath the lumbar spine there are another 5 vertebrae fused together, forming the sacrum with the coccyx (or tail bone) underneath.

The discs are made up of a soft jelly like substance (the nucleus) which is held inside a tough, elastic and fibrous outer casing (the annulus). If the outer casing of these discs is damaged in any way and causes the nucleus to protrude, or even leak out, it causes what is commonly known as a slipped disc, but correctly known as a prolapsed disc.

The muscles of the back support this structure and when these muscles go into spasms the most common form of back pain occurs. This often happens when you have been doing something strenuous or that involves a lot of bending like gardening, or when you have been in an awkward position for a long time and go to move.

There are other more serious causes of back pain such as disc prolapse and diseases of the spine, but if your pain has subsided and there are no unusual symptoms such as numbness, pins and needles or pain down the leg, muscle spasm would usually be the culprit (if your pain lasts longer than 48 hours and is getting worse, or if any of the signs previously mentioned appear, you should consult your doctor immediately).

The lowest region of the back the lumbar region - is the most vulnerable area, and back pain often occurs here. This is because the lower part of the spine bears the entire weight of the upper body, and is flexed, twisted and bent more than any other part of the spine. It therefore, inevitably, suffers more wear and tear.

You will notice that your spine is not straight, but is actually a's' shape. Not all backs are the same's' shape but they are usually curved with a hollow in the base of your neck and another in the small of your back. This shape should be kept in mind as it is important to keep the natural curves in your spine whatever you are doing.

Healthy sitting posture

Sitting causes the pelvis to twist backwards, flattening the lumbar spine. This causes the muscles to work harder, and places increased stresses on the discs.

How you sit is affected by the backrest angle, the seat base and the support of the base.

Sit with your lower back supported against the back rest at the base of the chair. Tilt your chair seat forwards approximately 15 degrees which induces a natural curve in your spine and if necessary sit on a wedge shaped cushion.

Adjust the seat height and angle so that your hip joints are 10cm higher than the knee joints.

Adjust your work surface so that you keep your elbows at your side. Forearms are parallel to the floor and supported by the desk. Relax your shoulders and keep your wrist in a neutral position.

Relax your shoulders and keep your wrists in a neutral position. If necessary use wrist supports for your keyboard/mouse mat.

Place your keyboard flat on your desk surface and use a vertical stand, attached to the screen, for copying typing.

Hold your head squarely over your shoulders.

The top of the screen should be at eye level and facing you to avoid rotation.

The correct posture when writing is very similar to using a PC, except the use of a writing slope ensures the chin is not tilted too far forwards.Take frequent 1 minute breaks (every 30 minutes)

Perform regular exercises to stretch the neck and shoulders. (perform exercises advised to you by your therapist).

Healthy driving posture

Sitting with the correct posture reduces the strain on the spine and the joints and prevents muscle fatigue. The optimum position when driving is to have the seat back reclined at 15 degrees and the chair seat tipped forward to bring the knees below the hips - this can be achieved by sitting on a wedge cushion.

Try to relax the shoulders keeping a bend in the elbow and a light grip on the steering wheel. Adjust the headrest so that the middle of the headrest is level with the top of the ear. A bad driving position is hunched over the wheel.

Healthy lifting position

To reduce stress on the low back, the following points should be followed:

Always lift objects within your limitations.

Ask for assistance if the object to be lifted is awkward or heavy.

Adopt a firm, wide stance

Bend your knees keeping your back straight when you lift.

Keep the lifted object close to your chest not at arms reach.

Never lift objects above head height, use a stepladder if necessary.

Do not twist when holding a heavy object, especially if the spine is bent .

Avoid jerk lifting.

Avoid lifting after prolonged sitting or early in the morning.

Use the pelvic neutral and co-contraction technique as advised by your therapist to support the spine while lifting.

When shopping:

Try to use a shallow rather than a deep shopping trolley so that you are not bending over to lift out heavy shopping bags.

Push rather than swing shopping trolleys around a corner.

Carry equal amounts of shopping in each hand.

What is physiotherapy?

"Physiotherapy is a healthcare profession concerned with human function and movement and maximising potential:

* it uses physical approaches to promote, maintain and restore physical, psychological and social well-being, taking account of variations in health status

* it is science-based, committed to extending, applying, evaluating and reviewing the evidence that underpins and informs its practice and delivery

* the exercise of clinical judgement and informed interpretation is at its core."

Physiotherapy uses a variety of techniques to help your muscles and joints work to their full potential. It can help repair damage by speeding up the healing process and reducing pain and stiffness. Physiotherapists also have an important role in rehabilitation, for example, helping people who have had strokes to relearn basic movements.

However, Physiotherapists don't just offer treatment, their advice can help you prevent problems from returning or even from happening in the first place.

What types of problems can physiotherapy help?

Virtually any condition that affects your muscles, joints or nerves. Common problems that can be helped by physiotherapy include:

* Painful conditions such as arthritis

* Back and neck pain, including whiplash

* Problems affecting children including cerebral palsy

* Pregnancy related symptoms such as back pain and stress incontinence

* Upper limb work related problems, also known as repetitive strain injury (RSI)

* Asthma and other breathing difficulties

* Sports injuries

* Strokes and other neurological problems

* Symptoms of stress and anxiety.

What does the treatment involve?

Before any action is taken the physiotherapist will assess your condition, diagnose the problem and help you understand what's wrong.

They will work with you to develop an effective treatment plan that takes into account your lifestyle, leisure activities and general health. This will include advice on how you can help yourself, for example, you may be shown exercises that you can do between treatment sessions. Where appropriate, physiotherapists also advise carers how they can help.

Physiotherapists use a variety of treatments. For example:

* Exercise programmes - designed to improve mobility and strengthen muscles

* Manipulation and mobilisation - to reduce pain and stiffness

* Electrotherapy - for example, ultrasound to speed up the healing process

* Acupuncture - used by some physiotherapists qualified to practise this technique

* Hydrotherapy - exercise in water

"Physiotherapists prevent, diagnose and treat neuromusculoskeletal and respiratory impairments and disability. Physiotherapy intervention is physical (including exercise, manual therapy and electrical modalities) and educational.

The goal of these interventions is to reduce pain and optimize the patient's independence and function by improving their ability to move and breath."

Gopi Kitnasamy, Chartered Physiotherapist