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Back pain

ARTHRITIS FOUNDATION OF VICTORIA
www.arthritisvic.org.au  ... (Copy reviewed 2005)

BACK PAIN ..

Back Pain: A very common condition

The spine is the central support system of the body. We only realise how much work our backs do when something goes wrong. A sedentary lifestyle, poor posture, being overweight, bad working practises and a high level of stress all contribute to back problems.

Some facts

• 60% : 80% of people in the Western world are affected by back ache.
• The incidence of back problems is highest between the ages of 30 : 50 years.
• Back pain is the third most common cause of loss of work days (after headache and the common cold).

Some Basic Anatomy

Parts of the Spine

Vertebrae : 24 bones are stacked One On top of the other to form the spinal column.

Intervertebral discs : cushions of cartilage separating the vertebrae. They act as shock absorbers and enable the spine to move in many directions. Each disc has a soft jelly-like inner core surrounded by rings of tough fibres.

Facet joints : small joints which maintain spinal stability.

Spinal cord : a cable of nerves running from the brain through a canal in the centre of the spinal column. Nerves to the arms and legs pass through openings between the vertebrae.

Ligaments : strong fibres provide support to the joints of the spine.

Muscles : large and small muscles produce movement and give the back dynamic support. Other muscle groups from the shoulder girdle, chest, pelvis, hips and abdomen rely on their attachment to the spine so they can move other parts of the body.

Prevention and controlling back problems

• Always be aware of how you are using your back.
• Improve your posture and the way you move when you sit, stand, work and play.
• Include regular exercise as part of your normal lifestyle.
• Reduce the amount of stress in your life.
• Persistent, complex or severe back pain may be best helped with treatment by a suitably qualified doctor or physiotherapist.

What causes back pain?

It is pain which makes us realise that our back is not functioning properly. Often pain develops gradually of intermittently and the cause is not obvious. The back is a complicated structure and pain can occur anywhere along its length. Most commonly it occurs in the neck and the lower back. People are often concerned that back pain indicates other serious disorders.

Back Strains

Abnormal stress, either sudden or over time, can injure the muscles, ligaments or joints of the spine. An acute back injury may result from an unexpected jolt or incorrect lift. Alternatively, poor posture and weak muscles can lead to a chronic backache. Muscle and ligament strains are the most common cause of back pain.

Disc degeneration

Degeneration of the outer layers of a disc result in flattening and bulging.

Arthritis

Like other joints of the body, the spinal facet joints can develop arthritis. There may be degeneration and inflammation within the joint and the growth of bony spurs (osteophytes) on the edges of the vertebrae. Commonly arthritis of the facet joints is associated with disc degeneration.

Some forms of inflammatory arthritis such as ankylosing spondylitis directly involve the spine.

Sciatica

The sciatic nerves run from the lower back, across the buttocks and down the backs of the legs. They can be irritated by a bulging disc or inflamed facet joint and pain can occur anywhere along their paths. Referred pain from spinal disease can occur anywhere in any limb.

Osteoporosis

Loss of calcium from the bones of the spine may result in partial collapse of the vertebrae. This is most common in post:menopausal women.

Emotional stress

Increased muscle tension will often stir up an existing back problem. Prolonged muscle tension will result in muscle imbalances and abnormal stress on the spine. Increased backpain may be associated with periods of stress.

There are a number of other significant, though less common, causes of back pain. These need to be investigated if severe pain persists.

Exercise your back

• Improvement in general fitness helps to reduce and prevent back pain.
• Regular back exercises will help to:
  • strengthen muscles supporting the back
  • stretch tight joints, muscles and ligaments
  • increase mobility
  • improve posture
• Start with three to five of each exercise daily and gradually build up to 10.
• Discontinue any exercise that causes pain, severe discomfort, leg numbness or tingling.

Some back exercises

Knee to chest Bend one knee up towards the chest and hold with hands for a count of five. Slowly straighten the other leg along the floor. Hold for five counts. Return to starting position, then repeat on opposite side.
Pelvic tilt Tighten buttocks and stomach muscles so that the lower back flattens and the pelvis tilts upwards. Relax. Tilt pelvis downward by arching the lower back off the floor. Relax.
Knee rolls Roll both knees to one side, then to the other. Keep elbows on the floor.
Semi sit:ups Tuck in chin, slowly lift head and shoulders by stretching both hands between knees. Lower shoulders (keep chin in), stretch both hands to the right and left knees. Lower completely. Relax
Bridging Slowly peel buttocks and back off the floor. Lower slowly, stretching spine along the floor.

Care for your back

Good posture

• maintains the spine in its optimal position,
• puts least strain on intervertebral discs,
• allows spine, head, arms and legs to move more efficiently,
• improves breathing capacity,
• allows internal organs to work more effectively,
• improves circulation,
• looks and feels better.

A vertical line from the ear should cross the tip of the shoulder and the middle of the hip then pass behind the knee cap and just in front of the ankle joint. Poor posture changes the normal curves of the spine and puts abnormal stress on joints, muscles and ligaments.

Good posture is not a rigid position but more an awareness of relaxed balance and lift which can be maintained in all positions, during all activities. It comes by lifting upwards from the crown of the head so that a feeling of elongation passes down the spine. As a result the chin drops, the shoulders rest down and back, the rib cage lifts forwards and up, the stomach flattens, the pelvis tucks under and the knees soften.

Seating

Sitting  puts more strain on the lower back than standing. This is even greater when slumped in a chair. Choose a chair which supports the lower back. Sit right back with feet resting flat on the floor. Use a small cushion or lumbar roll to support the curve of the lower back if necessary. Keep your back straight when working at a desk. This may mean adjusting the height of the desk or using a sloped work surface.

Adjust your car seat so you can sit upright without stretching for the steering wheel or pedals. On a long use a lumbar support and have frequent breaks to stretch and exercise.

Lying

Back ache can often be relieved by lying on the floor with your knees bent. For sleeping, have your mattress on a firm base and use a low pillow. Avoid lying on your stomach as this strains the neck and lower back. The best bed for a bad back is one which you find comfortable and in which you wake up with minimum pain

Lifting

Think before you lift. Know your limitations. Ask for help or use equipment if necessary.

Plan your lift

• check that surroundings are clear,
• stand close to the object,
• keep your back straight and bend at the hip and knees,
• take a firm hold of the object holding it close to your body,
• tuck in your chin, tighten your stomach muscles, keep your back straight and lift by straightening your knees,
• if lifting with another person, work together on the '1,2,3,:lift! " principle.
• push or pull an object rather than lifting it.

Working and Other Daily Activities

• always keep your back straight,
• arrange your work space so that the most frequently used items are within easy reach to avoid a' lot of bending and stretching,
• squat or kneel down to work at a low level,
• carry objects in both arms close to the body; avoid one:sided carrying if possible.
• when sweeping or vacuuming use short strokes, bend your knees and move your feet to avoid over:reaching.
• before you do something, try to find a way that puts less strain on your back. Remember basic standing , sitting and lifting principles. Review daily activities with these thoughts in mind.

see also NEV link:  www.badback.com.au