Preventing Back Pain |
Introduction
The human spine is a complex piece of engineering that performs a range of functions as well as coping with a variety of physical stresses and strains.
The spine consists of 34 irregular shaped bones called vertebrae. These are stacked on top of each other and separated by tough fibrous pads called intervertebral discs. The discs act like shock absorbers.
The spinal column is held together by strong ligaments, and the vertebrae are connected together by the facet joints. The facet joints are small fluid filled joints where movement takes place. The muscle layers surrounding the spine provide support and contract to produce movement. Despite the spine being a strong flexible structure it is vulnerable to injury.
Our bodies are designed to be active and our increasing sedentary modern lifestyles appear to be a major cause of back pain. It is estimated that 80% of people will experience back pain that lasts more than a day during their lifetime. Nearly 5 million working days were lost through bad backs in 2003/4 in the UK. The estimated cost to employers was between £590 million and £624 million per annum.
This is information page is a guide to helping you reduce the chances of developing a bad back by taking care of it on a daily basis.
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Getting out of bed
- On waking before getting up, do 2 simple exercises to get your back moving. Pull each knee and then both knees to your chest (10 times). Keep your knees and ankles together and gently roll from side to side (10 times)
- Never sit up straight in bed. Move carefully onto your side and then lever yourself up into a standing position
- If you dry your hair with a towel, do not throw your head back from side to side. Keep your chin towards your chest
- When getting dressed put socks and clothes on in a sitting position or lean against a wall. Do not try and stand on one leg to dress
- Put shoes on in a sitting position or put your feet up on a chair
- Making the bed - Bend your knees if you reach for the blankets across the bed. Try to make the bed in a kneeling position. Keep the bed freestanding away from walls for easier access
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Journey
- If you are able - walk or cycle to work
- If you drive to work, do the following to improve your posture: sit with your back firmly against the seat. If there is no lumbar support then use a small cushion or lumbar roll. The seat should be adjusted so that your arms are roughly at 90° and you are not reaching for the steering wheel. The height of the seat should allow your knees to be slightly higher than your hips. Adjust the central mirror in an upright posture, this will also help you become aware of any slumping. Adjust the headrest so that there is no more than 3 - 4 inches gap between head and the headrest. On a long journey (more than 1 hour) stop and walk around for 5 minutes.
- If you travel by train - sit with your back against the upright of the chair and avoid slumping. If you are forced to stand, stand with the weight mostly on the back of your feet, knees slightly bent and shoulder width apart, shift weight from one foot to the other.
- Flying - when sitting use a lumbar roll or small cushion in the low back. Try and get up and walk every 30-45 minutes, this will also help stimulate blood circulation. Ask for an aisle or bulkhead seat if you suffer back pain.
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The Work Place
- Use an ergonomically designed office chair that has a stable base (5 legs in a star shape) is adjustable in height and that the seat back is adjustable in both height and tilt.
- Arrange your workstation so that the computer monitor is at horizontal eye level. Use a footrest if your feet are dangling. Adjust the chair height so the shoulders and elbows are completely relaxed. Keep the computer screen and keyboard in front of you, do not twist and place the screen at arms length. Do not cross your legs. Change position every 20-30 minutes.
- Try and walk in the lunch hour or if time permits and it is available visit the gym or swimming pool.
- Try and use the stairs at work instead of using the lift
- Do not cradle the phone between your ear and shoulder, this puts a lot of strain on the neck.
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At Home
- When cleaning the bath or toilet, make sure you kneel and avoid stretching
- If you are vacuuming an upright vacuum cleaner is better than one that you drag along. When using the vacuum cleaner a broom or a mop keep your back upright and try to rock from one foot to the next. Avoid stretching and use short sweeping movements.
- When loading or unloading a dishwasher, tumble dryer or washing machine, never twist and bend at the same time. Squat or kneel.
- When ironing adjust the board so it is at waist height. Stand upright with feet apart and knees slightly bent
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Shopping
- Do not shop until you feel fatigued, make several shorter trips if necessary.
- When using a shopping trolley bend your knees when reaching into it. If you use a basket do not overload it, use two and distribute the weight. When carrying carrier bags, keep the weight as balanced as possible and do not carry for long periods of time. Try using a backpack for heavier items.
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Gardening
- Gardening is a form of exercise so spend 10-15 minutes doing simple back mobility exercises to warm up
- Wear clothing that is loose and comfortable and keep your muscles warm
- Do not work in a stooped position. Keep upright and kneel to do tasks such as weeding. Digging should be done with the back upright. Avoid twisting and use feet
- If you use a lawnmower, keep upright and rock from one foot to the next. Avoid too much twisting if you use a flymo - move your legs.
- When pruning and cutting avoid overreaching and use a stepladder. Garden centres also sell specially designed tools for people with back pain.
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DIY
- When painting pay attention to posture and keep your arms relatively close to your body. Using rollers can reduce the amount of time spent with brushes. When painting ceilings either us roller on a stick or a brush for short periods. Don not look up for more than 5 minutes
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Home Furniture
- If your living room chairs are too soft then try using a ½ inch piece of plywood to improve supports. If you cannot avoid slumping on your sofa then try lying on your back or side with cushions supporting your neck. Avoid watching television at an acute angle, try and face the television
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Bedtime
We spend a third of our lives sleeping. At night the spine can completely relax and it is at this time that healing and repair take place.
- Try and sleep on your back with a small pillow underneath your knees. If you sleep on your side, place a pillow between your knees to keep the pelvis in a neutral position. Avoid sleeping on your stomach, if you cannot place a flat pillow underneath the stomach
- In general use a firm mattress to give the spine support and allow for the natural curves of the spine. Sleep is a vital component to maintaining a healthy spine, because our discs absorb water during the night to help provide their shock absorbing quality. The repair process also takes place (see earlier item)
- Try and change your mattress if it is more than 8 years old and sags when you sit on the edge of it. Use a plywood board under the mattress to provide greater support. If you buy a new bed try and test it in the store for at least 10 minutes
- Take a warm bath before bed to aid relaxation. Do not make the bath too hot if you have high blood pressure or are medically unwell. 20-30 minutes is the ideal duration, and use a bath pillow for your neck and a rolled up towel under your low back.
- Try and avoid reading and watching television in bed. If you do read try lying on one side then the other with a pillow between your knees. If you watch television try and place some pillows under your back so you do not slump too much.
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Extra Tips
- General Lifting - Face the object you intend to lift. Bend at the hips & knees and keep the abdominal muscles tight. Keep the spine straight. Do not lift heavy objects on your own.
- Exercise - Gentle exercise can build strong back and abdominal muscles to support the spine. Good quality muscles also absorb the day-to-day stresses and forces reducing injury to the spine. Exercise such as swimming, walking, Pilates, yoga and gym programmes are good examples.
- Smoking - reduces blood flow to vertebrae and increases possibility of injury. Slows down the repair process.
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Children
- Bend knees and hips when lifting children and do not twist
- Adjust cot height to reduce bending. Keep your back straight and bend knees
- Car seats can be very awkward and it is very hard to get into a car with a baby or small child. Make sure you bend your knees and do not reach into the car.
- When playing with children, kneel to adjust to their height
- If you play active sports like football in the garden, do gentle stretches and warm up first.
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Pregnancy
A woman's posture changes during pregnancy, and as the baby grows there is an increase in lordosis of the lumbar spine and kyphosis in the thoracic spine. Impingement of spinal joints in the low back can produce pain. Also hormonal changes (the hormone is called Relaxin) are designed to make pelvic joints and ligaments more elastic and flexible - this increases the possibility of a joint strain. After birth, sudden changes in weight, posture, poor abdominal muscle tone and softened ligaments combine to make the back unstable. Women after pregnancy need to be particularly careful with bending, lifting weights and carrying.
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Posture
Posture is extremely important and affects the mechanics of your back. the ideal posture is one in which load is shared equally across all the spinal joints and discs. The muscles should be well toned but relaxed enough to help maintain a gentle 'S' shaped spine. Correct posture is related to good fitness combined with a relaxed mental and emotional state.
Posture Test
To achieve correct posture:
Stand with your back to a wall and a small hollow in the low back. with the shoulders flat against the wall bend both knees very slightly and push the lower back into the wall using the abdominal muscles. Walk away from the wall and imagine a cord pulling the top of your head and gently lengthen the spine.
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Stress
Stress has a major impact on the health of our spines. Stress increases muscle tension which reduces flexibility and increases joint stiffness leading to pain.
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