TAKING CARE OF YOUR BACK: AIR TRAVEL-CARRYING LUGGAGE
Airline seats vary in comfort according to the price. Economy-class seats are designed to be particularly mean with elbow and leg room, but on long journeys, even the more expensive seats can leave you feeling stiff. Get up and walk about at least every hour if you possibly can.
Sleeping in your seat has to be done in one position – leaning back – and that is usually a sure way to a stiff neck. The inadequate little cushions handed out by the airlines on
long-distance flights are not much help: placed behind the neck, they are unyielding and slide out. Most airport shops and luggage shops sell U-shaped inflatable cushions which support the neck quite efficiently, and the airline’s cushion can go in the small of your back or be used as and additional arm support.
A shoulder bag, such as an airline carry-on bag, is better than a hand-held bag, provided this does not lead to uneven posture on one side – try putting the strap diagonally across the body rather than over one shoulder. Or carry two evenly loaded bags, one in each hand.
Suitcases and holdalls can be troublesome to someone liable to back pain. The logical solution to carrying luggage is to divide the load into three: in a rucksack over your shoulders, and one small case in each hand. The rucksack certainly distributes the weight more evenly and allows the back muscles to contract more evenly on both sides.
A suitcase with its own wheels can take much of the lifting out of moving luggage. Make sure that the handle is at a comfortable height, that the suitcase comes with a strap to pull it along, otherwise trying to wheel a small suitcase with castors underneath would mean walking with an awkwardly twisted spine.
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UNDERSTANDING BACK TROUBLE: PREVENTING A RECURRENCE-BACK SCHOOLS AND ADVICE ON POSTURE
For people who have already experienced one episode of back trouble, the probability of being struck by an acute attack of back pain is higher than for people who have never yet been troubled. This is because an attack, regardless of what caused it, tends to leave the victim with a degree of damage to the tissues, or with less elastic back and abdominal muscles than before.
Back schools-There are a growing number of back schools, usually attached to physiotherapy departments in hospitals. Instructionshould consist of advice on how to use the body, actively and posturally. Anatomy of the spine and descriptions of the causes of back pain are included. Advice on the layout, planning and design of work – ergonomics – is also given. The lesson is simple: the better you understand your back, the more readily you can cope when it is painful.
Advice on posture-Many of us acquire minor postural deformities which lead to avoidable backache and which can be treated: for example, the tendency to a rounded back, head poked forward and shoulders tensed up. If this is due to muscular imbalance and stiffness, exercises should help. But often it is just a matter of habit. Old habits should therefore be shed and new ones learned, and postural advice on a new way of using your body can help.
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CONSERVATIVE TREATMENT: INJECTION THERAPY
Injection therapy-In some cases, pain can be relieved by injecting pain-relieving drugs directly into the area of the spine where the pain appears to be localised. It can be effective for treating ‘trigger points’ (fibrositis), small, very painful nodules of muscle and/or fibrous tissue often in the buttocks, neck and shoulders, tension or pressure on which often spreads the pain over a wider area.
A corticosteroid drug may be injected, together with a local anaesthetic to limit the inflammatory process. The relief may not be immediate, or long-lasting, and a number of injections may be required for the treatment to be effective.
Epidural injections have been are used for pain which has not yielded to any other methods. These injections are given into the epidural space between the dural tube and the spinal canal, at the lower end of the sacrum. They consist of a corticosteroid drug mixed with a local anaesthetic. This numbs the tube, and reduces inflammation, such as that set up by a prolapsed disc. The injection cannot put right the prolapse itself, but in most cases time is the best healer for this, and epidural injections, like other pain-relieving measures, make the period of waiting seem less interminable.
Much backache arises from the facet joints. Pain originating in facet joints can radiate down the leg and mimic sciatica. In some cases, injecting steroids and a local anaesthetic into the joint can modify the pain. If relief is only temporary, the nerve to the facet can be destroyed, producing permanent relief. The technique is one which is reserved for experts.
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UNDERSTANDING BACK TROUBLE OTHER BACK PROBLEMS-OSTEOPOROSIS
This is a bone condition associated with growing old, and may affect any bone, not just those of the back. It takes the form of loss of bone material (calcium and minerals), making the bones fracture more easily. The spine tends to shrink in overall length, so that the person becomes shorter. In advanced cases, the affected vertebrae may collapse in a series of crush fractures, so that the sufferer develops a curvature of the spine, becoming round-shouldered. The ‘dowager’s hump’ seen in elderly women may be caused in this way.
There is some association with the sex hormones, because osteoporosis is common in
post-menopausal women and women whose ovaries have been removed. In them, it responds dramatically to treatment with oestrogen-hormone replacement therapy.
Physically active people are less likely to develop osteoporosis. Exercise is thought to have some protective function. Bone loss can be the result of prolonged immobility, and is one reason why doctors discourage patients from staying in bed longer than absolutely necessary. Astronauts spending weeks and months in space beyond the reach of earth’s gravitational pull also suffer bone loss – but this is not yet a common hazard!
The loss of bone is not in itself painful, but there may be pain anywhere in the spine and in the joints between the spine and the ribs, as the spine adapts to its new conformation. Loss of spinal bone leading to crush fractures may lead to trapping of pain-sensitive structures, such as nerve roots.
A related but much less common complaint is osteomalacia, a softening of the bones caused by vitamin D deficiency in adults (in children the result is rickets). It is thought that osteoporosis and osteomalacia may respond to increased calcium and vitamin D in the diet. But this is in no way proven, and people should certainly not dose themselves with calcium supplements – these may even make you ill.
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THE ABDOMINAL MUSCLES
These share the task of keeping the spine upright by exerting a pull down the front of the trunk that counterbalances that exerted by the back muscles. They also help the spine to bend, by pulling the front of the rib cage closer to the pelvis.
Abdominal muscles also control twisting actions between the shoulders and the pelvis – no golfer could do without them – and they are used when pushing, and for holding the posture when leaning backwards. When the body is bent sideways, they share the work with the back muscles on that side.
A muscle called psoas (from the Greek for loin) passes from the lumbar vertebral bodies, round the pelvis, and over each hip joint to the upper end of each thigh-bone. It contracts when you sit up from lying down. When it is active, it pulls on the lumbar vertebrae, compressing the discs.
There is also an indirect mechanism by which the abdominal muscles support the spine. When a weight is being lifted, these muscles, in conjunction with the back muscles and the other muscles forming the abdominal cavity, tighten automatically. This increases the pressure inside the cavity, making it load bearing (in the same way that inflating a balloon makes it able to support a weight), and as the compressed abdomen presses against the spine, it absorbs some of the load on the spine, and helps the back to straighten up.
Weight-lifters deliberately increase their intra-abdominal pressure by wearing a special belt. For ordinary people, it is enough to keep the abdominal muscles in good condition: this is very important for preventing backache.
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