BACK PAIN

Facts about back pain

• 60% of adults suffer back pain annually
• 30% of adults become chronic sufferers
• only 1% of back pain investigation results in surgery
• in the last certified year there were over 93 million certified days of sickness due to back pain
• back pain sickness benefits have increased by over 200% in the last 25 years
• the number of back injuries continues to rise, although overall accident totals are falling
• the cost to industry in lost production is over 5 billion pounds

Back pain does not kill, it tortures

Look after your back, with the help of the NBPA. The NBPA's ongoing research programme addresses the back problems of everyone - whether in or out of work, young or old, male or female.

How the back works

It is important for every back pain sufferer to learn how the back works. By doing so, you can help to prevent back damage, and gain an overview of what you can do if you suffer from problems.

Your back is one of the most important parts of your body. It contains the spine, which supports the whole body and is in use 24 hours a day - even when you are asleep.

The spine is made up of a number of small bones, called vertebrae, which are stacked on top of one another. The vertebrae are divided into five groups. At the top of the spine are seven cervical (neck) vertebrae, followed by twelve thoracic (chest) and five lumbar (lower back). Beneath these are another five vertebrae, fused together to form the sacrum, and the spine finishes with the coccyx (tail bone).

You may have heard your doctor talking about vertebrae in a form of numbered code (L4, C6 etc.). This is simply a way of pinpointing a particular area. Every vertebra and disc has its own number.

In between each of the vertebrae are "shock absorbers" called inter-vertebral discs. These help the spine to bend in different directions. They are roughly circular in shape and fairly flat, and are made up of an inner, jelly-like substance (the nucleus) contained within a web of tough, elastic fibres called the annulus. If the annulus is torn, the nucleus can protrude or even leak out. The damage is often incorrectly described as a "slipped disc", and should correctly be termed a "prolapsed inter-vertebral disc".

The lower region of the back (the lumbar region) is the most vulnerable area, and back pain often occurs here. This is because the lower region bears the entire weight of the trunk, plus the weight of any load being carried. It also has to twist and bend more than the upper part of the back. So, inevitably, the lower part of the spine suffers more wear and tear, and experiences more problems.

Preventing back problems
Posture

Bad posture looks unsightly, is bad for your general health and can aggravate back problems. Try to maintain good posture at all times, and avoid rounding your back and slumping. Imagine that you are being lifted up by the top of your head - this applies to sitting, standing and walking.

Try to avoid hunching your shoulders and tensing your neck when angry or stressed. If you find you do this often, listening to a relaxation tape once a day may help.

Excess weight only adds to the stresses on the spine, so avoid being overweight.

Exercise

Back pain experts now agree that safe exercise may help back pain sufferers. There are specific exercises for spine strengthening and others to help you relax. It certainly will help to keep your back supple, and keep your whole body fit at the same time. Walking and swimming are excellent for the back, and back pain sufferers often benefit from hydrotherapy sessions.

The NBPA's leaflet "Safe Exercise For Bad Backs" is available in return for an SAE. There are also detailed books on the subject.

Seating

Most people spend long hours sitting, so make sure your chair correctly supports your body. It is all too easy to slouch on the sofa all evening, but for the sake of your back, you should avoid extremely soft or bucket-shaped chairs and opt for those which support the small of the back.

Very low chairs can be uncomfortable and difficult to get in and out of, as can chairs without arms. The best way to sit down is to stand in front of the chair with one foot slightly behind the other, almost under the chair. Bend your knees, and at the same time place your hands behind you to rest on the arms of the chair (or the seat, if the chair has no arms). Then lower yourself gently into the chair.

Placing a small, firm cushion (or rolled-up towel) at the small of the back gives vital support to the lower back area and encourages correct seating posture.

Beds

As most beds and mattresses last a number of years, a good, supportive mattress is essential if you are to sleep well and avoid long-term back discomfort. Note that a supportive mattress need not necessarily mean a hard one - it should allow some absorption of the hip and shoulder. When buying a new bed or mattress, it is vital to take your time and test them out. Lie down in the position in which you normally sleep, and check also how easy it is to get in and out of the bed. The word "orthopaedic" when used to describe a bed does not necessarily mean that it is the best type for a bad back.

If you really cannot replace an old or sagging mattress, put a board under it as a temporary measure. Alternatively, if the bed itself is causing problems, put the mattress on the floor.

There is no ideal posture for sleeping, it depends on which position is most comfortable for you. Too many pillows, however, will provoke any neck pain, as can lying on your stomach.

Around the house

As we use our backs every minute of the day (and night) it is not surprising that there are innumerable ways of damaging the back around the house. Common sense and forward planning is the answer.

Housework can put a great strain on backs. Learn to take frequent breaks between chores - never struggle on until the pain forces you to stop. When vacuuming, work in short stretches, keeping the vacuum cleaner close to your body and using short sweeps. Try alternating the arm you use, and make full use of the cleaner's accessories. Store the vacuum cleaner where it is easily reached.

Take some time to rearrange your kitchen into a back-friendly area. Organise your cupboards so that everyday items are easy to reach. If you have to get something down from a high cupboard, use safe steps - do not overstretch.

Rather than stooping over the kitchen sink, raise the height of the basin inside it by placing it on another, upturned basin. You can also try placing one foot on a low stool or block, to reduce any strain, or open the cupboard under the sink to allow more room for your knees.

If your working surfaces are too high, sit on a stool of the correct height, keeping your back straight. Long-handled brushes are well worth the investment. Remember to bend from the knees when lifting heavy items in and out of the oven (especially the Christmas turkey!). If you intend to refit your kitchen, it is worth thinking about a wall-mounted oven.

In the bathroom, kneel down to clean the bath and toilet, and bend your knees when cleaning the basin.

When making beds, always kneel rather than stoop. Resist the temptation to do everything from one side of the bed by stretching over - better to spend a few extra minutes moving round the bed than a few days in it with a bad back!

Wet clothes are heavy, so always carry your laundry basket in front of you, not resting on one hip. Rest the basket on a garden chair when hanging out washing, to save bending down to ground level.

Try ironing sitting down, or resting one foot on a raised block or low stool. Do not stand for too long without changing position.

Fit a basket to the inside of your letter box to catch the mail, and fit a box on the wall outside for milk and parcel deliveries.

Taking care of yourself

Clothes which restrict mobility can cause back pain; tight jeans, in particular, can cause considerable back stress. High heels are likely to cause poor posture at the very least, and should be avoided.

When washing your hair at a basin, bend your knees. Even better, wash your hair in the shower, or by kneeling at the side of the bath and using a hand-held shower adaptor.

Back strains can easily happen when getting in or out of the bath, so consider buying a non-slip mat or grip rail to put inside it. Do not stretch to reach the bath towel, have it within easy reach. When drying your feet, avoid bending over by sitting down and raising your foot towards you. And remember that a hair drier is useful for drying parts of the body that are difficult to reach, but never use it in the bathroom.

Try to avoid constipation if at all possible. The lower back muscles are easily strained when extra effort is required.

In the workplace

More and more office workers are suffering from back, neck and wrist problems, simply from sitting at an office desk all day. There are several reasons: badly designed office furniture; sitting in awkward positions; and not changing position often enough, for example.

The NBPA has produced a helpful leaflet "Better Backs For Office Workers", available for an SAE. For immediate help, make sure your chair is at the correct height in relation to your desk. Try putting a small cushion at the small of your back. Take frequent short breaks to move around and stretch your muscles. Check that you are not needlessly stretching when you could move frequently used items on your desk nearer to you. For example, if you are right handed, your telephone should be on your right hand side. A sloping board is an excellent and inexpensive investment if you have a lot of paperwork.

If you have to stand for long periods at work, have a low stool available so that occasionally you can rest one foot on it and thus vary your weight allocation. If your job involves repetitive actions (e.g. driving or working at a conveyor belt) you should always take regular, short breaks in which to move around.

Around and about

Early spring and autumn always bring a good crop of patients to doctors' surgeries complaining of "gardening backache". Avoid being one of them by following the gardening guidelines. The NBPA produce both a video and a leaflet on this subject - contact us for details.

If you have a problem back, let someone else do the lifting and carrying for you whenever possible. If you must lift, learn the "lifting code" (see below). When loading items into a car boot, always load the heaviest items nearest the door, to minimise stretching and lifting when unloading. The NBPA's leaflet "Better Backs For Drivers" gives helpful information on driver's backache (send an SAE).

Carry heavy goods in two bags, splitting the weight between each arm. If even this is uncomfortable for you, consider having your groceries delivered, or take someone with you when you go shopping!

The ideal way to carry luggage is in a well-loaded rucksack or in two cases, as above. Wherever possible, make use of airport trolleys.

Lifting babies and children

Pregnancy and child care often bring on long-term backache. The rules are the same as for lifting any item - bend from the knees, not the back, and hold the child closely in front of you. Try to avoid carrying the child on one hip.

With toddlers and young children, try standing in front of them, holding out your hands and asking them to "walk" up your legs. Children love this game, and it saves unnecessary bending.

For detailed information about this area, send an SAE to the NBPA for our leaflet on "Back Care in Pregnancy and After".

Lifting regulations

Remember, as a result of the recent directives from the Health & Safety Executive, employers are now required by law to avoid hazardous manual handling operations as much as possible. If your job involves a lot of heavy lifting and carrying, check that you are not being asked to do anything that is now illegal.

The NBPA publishes several books on lifting and handling in the workplace, including "The Guide To The Handling Of Patients" and "Manual Handling - An Ergonomic Approach".

The lifting code

1. Prepare for the lift. Check the load's weight and if you think it is too heavy, get help. Check your route is clear of obstruction.
2. Stand close to the load, feet either side of it. Keep your back straight throughout. Get down to the level of the load by bending your hips and knees.
3. With elbows close to the body, grip the load securely. Use the whole hand, not just the fingers.
4. Lean forward a little, keeping your back straight, and with one smooth movement, straighten your hips and knees and lift the object close to your body. Try to avoid using the back at all.
5. To lower the load, reverse the action. Bend your hips and knees with a straight back and put the load down.

Do's and don'ts

A sudden, acute attack of back pain can strike at any time, but it does help to be prepared. Remember, this advice is for short-term, acute back pain only, not necessarily for long-term, chronic pain.

First and foremost, do not ignore the pain. It is there for a reason; it is the body's way of telling you something is wrong. It may sound obvious, but the first step is to stop doing whatever started the pain attack in the first place. For example, if you are gardening and feel a sudden sharp twinge, do not be tempted to carry on for a few more minutes before it gets dark, or before the rain comes on. Stop what you are doing and ease yourself gently into a more comfortable position.

Do

• Try lying face down on the floor, hands by your sides, immediately the pain starts; this takes the pressure off the back
• Go to bed for one or two days and have a complete rest
• Apply an ice pack (or a bag of frozen vegetables from the freezer in an emergency!) if you find it brings relief (do not apply ice directly to your skin as it may cause a cold burn
• Try applying gentle warmth, via a warm hot water bottle, if the pain is not helped by an ice pack
• See your doctor after one or two days if the pain is still bad; before you see him/her, do make a few notes on how the pain started, how bad it is, what makes it feel worse/better, etc.
• Take painkillers at regular intervals (but no more than the recommended dose, and always read the instructions)
• Use a relaxation tape if you have one, to help calm the mind and ease body tension
• Use this rest period to look at your lifestyle and try to work out ways of avoiding the problem in future; resolve to improve your posture and, if necessary, to buy a lumbar roll to help you sit properly

Don't

• Be a hero; if it is more comfortable to crawl around on all fours to get to the bathroom than to stand upright, then do so.
• Do any bending, twisting or lifting until the pain has been gone for a few days
• Say no if a partner or friend offers to massage your back; just ensure they treat you gently and stop them if anything they are doing causes pain
• Rush back to the activity which caused the pain, even when you feel much better