Postural muscles become short when stressed (overused, misused or abused) and require gentle, safe stretching methods as a rule (yoga type) to normalise them plus reeducation as to elimination of causes wherever possible. If strengthening is indicated isometric exercises are best. However when muscles become chronically shortened they will weaken their antagonists (so that tight low back muscles produce weak abdominals for example) and no strengthening of these weak muscles can occur until shortness and tightness has been effectively corrected. Imbalances such as this (hypertonic group inhibiting weak antagonist group) result in mal-coordination and functional problems, often preceding pathology such as disc herniation by many years. Chronically tight postural muscles affect tendinous structures and influence crowding of joint spaces in time.
2. Techniques Which Can Be Used When Pain is Present Include:
Rest, support, hydrotherapy (including ice), massage, exercise, manipulation, pain killing injections or medication, electrotherapy (including TENS), acupuncture, sclerosing injections for hypo-mobile structures, surgery.
All may benefit from re-education employing stretching exercises, relaxation exercises, stress reducing measures etc.
The safest self-help measures include:
- a/ Muscle energy techniques
- b/ Strain/counterstrain techniques
- c/ Acupressure or neuromuscular techniques
These will be all demonstrated and are described in detail in Osteopathic Self Treatment (published by HarperCollins)
3. Good Habits for the Back (Prevention):
- Postural integrity and use of self is main preventive measure. Stand tall as Head/neck relationship is primary (Alexander approach will explain this further)
- Avoid one-legged standing for any length of time.
- Avoid bending from waist, use hips and knees to raise and lower body and weights.
- Try to organise working heights ergonomically (height of tables, desks, working surfaces etc)
Correct height for work surface is judged by standing alongside it wit h arms relaxed. If worktop height is correct it will match level of wrist. Better high than low.
- Sit well back into chair, with adequate support. Ensure that when seated for any length of time knees are at least on same level as hips. If not use small support for feet.
Swedish designed ‘Balans’ chairs in which individual kneels are best, but expensive.
- WHEN LIFTING HAVE WEIGHT CLOSE TO TRUNK, ARMS CLOSE TO SIDES, AND BACK AS STRAIGHT AS POSSIBLE.
- Avoid lifting and twisting at same time especially when back is bent.
- Arch back when sneezing and coughing.
- Try to balance carrying such as shopping bags or suitcases to avoid one sided stress.
- When lifting avoid heavy objects, rather try to lift more frequently with lesser loads each time.
- When placing items into boot of car use knees and hips, and/or spread legs to lower yourself to correct height, all the while keeping back straight. Same for bed making. Better to kneel for this than bend.
- When gardening ensure long-handled tools to avoid stooping action. Use kneeling stool with arms to help getting up and down for lengthy jobs such as weeding.
- Reduce stress levels so that what is being done with muscular action does not involve excessive effort. In other words avoid overuse.
- Sleep on firm surface, sidelying best (face down is harmful to neck and back) using one medium cushion to support space between neck and shoulders.
4. What to Do in Sudden Attack of Backache.
Use ice pack (frozen peas!), bed-rest, possible first aid support using strapping or corset type support.
Avoid anything which hurts the area. Stay still. Get advice.
5. When to Call In or Visit an Osteopath or Chiropractor
All chronic back conditions can be helped to some extent, once serious pathology has been ruled out.
Acute back pain where no organic disease is present usually benefits.
Recent studies show chiropractic/osteopathic methods speed up recovery compared with rest of other methods, such as those used in physiotherapy.
6a. Where to Find an Osteopath/Chiropractor
Obtain names of local MROs or MBCAs from registering authority. General Council and Register of Osteopaths, 56 London Street, Reading, Berks. (0734-576585)
Ensure osteopath is member of Register as this guarantees 4 year full-time training or MD training plus osteopathy. Look in Yellow pages for box of MROs or members of British Chiropractic Association. MCOs are members of college of Osteopaths and will have had a six year part time training which is also very sound.
6b. When Should MD be Called First?
If in any doubt as to nature of problem see a doctor or consult a registered osteopath. If the problem is not the result of active degenerative disease (arthritis, osteoporosis etc) an osteopathic practitioner will help to some extent, and will be trained to know what not to treat and when to refer to MD specialist.
6c. What Conditions Should be Suspected in Back Pain Which is Not Clearly of Mechanical Origin?
Pain of mechanical origin will usually cause pain related to movement (not normally painful at rest).
If mechanical pain is severe it may continue at rest but adoption of new position will usually ease it. If pain is persistent at rest suspect deeper pathology or structural damage. Mechanical pain is usually intermittent.
If pain is noted when a joint is actively moved in one direction and passively moved in another then soft tissue involvement is probable.
If joint pain is noted on active and passive motion in same direction then internal joint dysfunction is likely.
7. What Osteopaths Do, What Chiropractors Do.
Methods of joint mobilisation and structural reintegration will be discussed and demonstrated. Basically osteopaths mobilise restrictions with due attention to soft tissues and to total mechanism. Chiropractors tend to deal more with local problem and to use very specific high velocity low amplitude adjustment techniques, usually based on interpretation of x-rays of the area.
In general osteopaths use less invasive (gentler) approaches.
8. Exercises to Help Back Problems.
- Lying on back, light ‘flattening’ of back to bed/floor while alternately, and slowly, stretching heel away from body. Repeat five times each side.
- Lying on back always have knees slightly flexed over cushion/ bolster. Exercise to ease low back tension/disc conditions involves bringing one knee up towards chest, held at knee by same side hand, and then bringing other leg up similarly. Lie holding knees in this curled position (usually painless, stop and abandon if painful). As exhalation occurs ease knees towards shoulders, hold for a second or two and slowly return to starting position on inhalation. Repeat for several minutes (20 cycles or so) Do this every hour or two when in pain.
- Apply ice pack when inflamed for up to 15 minutes at a time. If heat (hot towels are best) ever used always finish with short cold application (half a minute).
Ideal to use warmth before exercise and ice after.
- If not completely bedridden SLOWLY perform gentle flexion, extension, rotation and side bending in seated position. Note which movements do not hurt and which do. Perform the painless exercises every two hours for a series of repetitions taking up to five minutes overall and cease any movement which causes more than mild discomfort.
Recheck after a few days and reevaluate painful and painless movements and only do painless movements.
- Sit on dining room type seat and ease forwards so that one hand grasps front leg of chair on same side, and to slowly flex forwards running hand down chair leg. Do same other side, then down back one leg of chair and then other. Abandon any movement which is painful. Seated hanging forward breathe deeply and relax for a minute or so before stretching further forward (painlessly).
Repeat several times during day.
9. Other Problems:
Osteoporosis, post-natal conditions,
Osteoporosis often involves ‘splinting’, especially in spinal regions. Do nothing physical, apart from ice massage!
Post-natal conditions require evaluation as to type of dysfunction. The sooner an osteopath/chiropractor can be consulted the better.
Trigger point pain. Many back and head/neck pains relate to trigger point (myofascial triggers) activity, which can be safely treated using methods of soft tissue manipulation.
Self stretching and self-massage (tennis ball massage!) can be effective and safe. All self-help measures carry two warnings:
- If it doesn’t rapidly resolve the condition get professional advice and
- If it hurts more than a little stop doing it.
All chronic pain conditions require attention to your belief system, with modification if necessary of the attitude to the pain and your understanding of the pain process.
Introduction of element of ‘control’, as well as using safe self-help measures (hydrotherapy, ice massage, self-massage, TENS etc) as well as general dietary guidance and awareness of nature and causes of pain allows for better coping skills to be gained.
10. Pain Reduction via Diet.
Inflammatory processes depend upon presence of substances called leukotrienes.
The main metabolic source of these in the body is from animal fat derived arachdonic acid.
Reduction of meat and dairy fats reduces levels of arachdonic acid and therefore of leukotrienes, thus reducing intensity of inflammation.
This is further helped by addition of fish derived oils (eicosapentenoic acid or EPA) which is found mainly in cold water fish such as herring, sardines and salmon. EPA capsules are available at health stores and pharmacies (and on prescription if your doctor is amenable).
Inflammatory pain processes can be further helped by taking enzyme rich substances such as pineapple bromelaine (Larkhall Laboratories. These proteolytic enzymes should be taken between meals in doses of 500 to 1000mgs daily while inflammation is present.
Further Reading:
Osteopathic Self-Treatment: Leon Chaitow (HarperCollins-Thorsons)
The Back: Relief from Pain Dr.Alan Stoddard (Martin Dunitz)