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Hello Zurich magazine - October Issue 2004

Is your posture giving you back pain?

We live in a society of modern medicine and everyday comforts so why is back pain one of the most common complaints in the Western world?

In most cases, chronic back pain (as opposed to acute, but we will come to that later) is caused by bad posture. The developed world may seem to have made our every day lives easier but it has also made us lazier. Physicians working in missionary hospitals in the Third World comment that they very rarely come across chronic back problems. These poorer nations are forced to be more physically active as they have no modern gadgets to help them with everyday tasks, have to depend on walking everywhere and they certainly do not sit on comfortable chairs and sofas! In fact it has been proven that a lifestyle of sitting on the ground has given them a 30% greater surface area of the pelvic and a great angle of movement in the hip joints making the pressure on the lower spine considerably less.

Anyway, back to our modern society where good posture is increasingly harder to maintain and where back pain is something that nearly every person will experience at some point in their adult life. If you have been unfortunate enough to suffer from not only lower back pain but also neck pain or pain in the arms or wrists from repetitive movements, this article is relevant to you.

I speak of back pain from experience. Although as a health practitioner I should know better, I have suffered a lumbar disc prolapse and still live with the symptoms from it. Why did it happen? Of course it does not set me in good stead to be 6 foot tall, just having longer levers puts extra pressure on weight bearing joints, but to add to that I was (up until 2 years ago), a competing athlete and a mobile massage therapist. Carrying a 20kg massage table around London and up and down English four storey homes, as I found out, was not conducive to a healthy back!

So let me briefly explain how your posture can lead to you experiencing back pain and better still, how to avoid it.

Acute pain

Acute pain (sudden onset of sharp pain) occurs when you place a sudden heavy force on your body at a bad angle, e.g. when you can lift something heavy with bad posture, perform and over ambitious golf swing or tennis serve. Bending forwards without bending the knees and in addition, twisting your torso and trying to lift a heavy load is about the worst thing you can do and will invariably cause injury to the muscles and ligaments of the lower back and at worse, rupture a lumbar disc. Over exertion is especially a bad idea if you are past your twenties. Please don't do it! First make sure you keep your back straight, bend the knees and lift in a forward position only.

Acute pain can also occur if you are taking part in a physical activity or sport and go beyond your body's natural range of motion, such as an over ambitious golf swing or tennis serve.

Even if you are bent forward and you suddenly cough or sneeze it can lead to sudden pain as a lumbar disc comes under strain.

All these acute attacks are usually easy to recover from, with the right treatment from a trained therapist (physiotherapist or sports injury specialist) and although incredibly painful at the time, should ease off pretty quickly.

Chronic pain

Chronic pain (constant ongoing pain or stiffness) takes longer to develop as it arises from a lengthy period of bad posture. We are all guilty or it, as sitting or standing for prolonged periods cause the supporting muscles to tire and leaves us slowly moving into a slouched position. The obvious situation is sitting at a desk and computer for many hours. If you work in an office it is important that you have a good chair with lumbar support and that you sitting well. This means with your feet flat on the ground, a 90 degree angle at the knees so that your thighs are horizontal and not pushing down too heavily on the seat and that your elbows are comfortable on the desk allowing your shoulders to be relaxed, not too raised or too low. If possible your stomach should be resting gently against the edge of the desk so that you are not slouching forward to reach the keyboard, mouse etc. You should be trying to sit constantly in a good upright position whilst keeping the lumbar curve (lordosis) in place.

Another bad habit to avoid is slouching on the sofa or in a poorly supporting armchair at the end of a busy day. This is a time when keeping the curve in the lumbar spine is more important than ever as a full day of sitting badly or driving will have overstretched the muscles and ligaments. It is better to seat watching TV in a well-supported chair or lying on the floor, on your back with a support under your knees. This is very important if your back is feeling sore from the day's activities. These statistics below give a clear picture of the differing pressure on the spine:

Postural position Load on the lower spine (with gravity)
Sitting slouched in a desk or armchair approx. 165kg
Sitting correctly with a tall back approx. 150kg
Standing tall and correctly approx. 65kg
Lying with the legs up at 90 degrees approx. 12kg

After sport, this is equally true, as exerting the body and then lying in a bad position will only worsen the strain on the back. If the sport you do often leaves you with niggling discomfort afterwards, make sure to look after yourself post sport or it could only be a matter of time before you injure yourself more severely.

How else can you help yourself?

There are several exercises that you can do by yourself to relieve mild or an acute attack of back pain in order to restore the natural lumbar curve.

  1. Gentle back extension -lying face down on the floor with your hands next to your shoulders in the press-up position. Straightening your elbows and push the top half of your body up as far as the pain permits and hold for several seconds. Do this several times in the day. (Pic 1/2)
  2. The cat curl -whilst kneeling on your hands and knees, slowly curve your back by pulling in your stomach and turning your chin under. Hold for a few seconds then unfold your body and once back to a neutral position (flat back) arch your back and your neck slowly by tilting your pelvis to the floor and look upward. Repeat these two movements several times in one session. (Pic 3/4)

Of course equally important is to build up strong core muscles (i.e. the deep abdominal muscles and pelvic floor muscles- yes men have those too!). Activities that you can do on a regular basis to help strengthen your posture are:

The Alexander Technique
Feldenkrais Technique
Yoga (not recommended for people with serious back or neck problems)

I would also recommend purchasing a copy of 'Treat Your Own Back' by Robin McKenzie (ISBN: 0-9598049-2-7). This is a very useful easy-to-read guide as to how to take care of your back and includes Self Help exercises.

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