Over 20 years of working with a lot of therapists and physical trainers has reinforced my belief even more that the popular convictions about back pain relief have no scientific basis. Which is why recurrence in back-related ailments is very high. Physiotherapists typically advise you to build up “strength” in the muscles of the torso, i.e., the abdomen and the spinal erectors.

Building muscle strength is only part of the story. The more critical and yet the more neglected aspect of back pain management is to build up “endurance” in the back’s core stability muscles. As a physiologist understands it, muscular endurance and muscular strength are completely different concepts.

The preferred mode of approach with patients of back ailments is to concentrate on the “stability” of the core muscles. My experience with a large number of clients has made me conclude that instability and inflexibility of the spinal muscles seems to be the biggest “problem” that leads to a whole range of back ailments. The situation becomes worse with lack of flexibility in the muscles distant from the spine. I am not talking about the muscles of the back alone here. Lack of flexibility in joints away from the pain site, for instance around the ankles, can lead to poor posture, which may cause strain to the musculoskeletal structure of the spine.

A proper back-health maintenance as well as rehabilitation programme should aim at working on improving the stability and flexibility of all joints of the body and eliminating symptoms of chronic shortening in the muscles.

WHAT IS BACK STABILITY?

Unless the tissues surrounding it support the spine, it tends to “wobble” in ways that impinge on nerves and this leads to deterioration of the entire spinal structure. The correct approach should be to introduce the patient to specific exercises (to be illustrated in this column next week) in order to build strength, endurance, flexibility and stability. This will help to develop a more comprehensive back maintenance programme.

COMMON CAUSES OF BACK PAIN

SLIPPED DISCS

What is it?

Discs don’t actually “slip”, but that is the more commonly described condition for a herniated or prolapsed disc. Spinal discs are mostly made up of fluid. With age, the discs lose water and the outer fibres become stiff and flaccid, a bit like a dried-up raisin. A healthy disc helps to maintain the space between the vertebrae but a shrunk disc is unable to perform the function and likely to “slip”.

What you can do:

Unfortunately not much till it occurs! There are seldom if any warning signals from your spine that a disc is about to herniate. But regular exercises keep the disc well oxygenated and healthy and reduces the risk of herniation.

What a surgeon can do:

Perform a surgical procedure called laminectomy, which relieves the pressure on affected nerve tissues.

SCIATICA

What is it?

A shooting pain running down from the lower back and buttocks to the legs, sometimes as low as the ankles or toes.

What you can do:

Knock down some anti-inflammatory over-the-counter medicines and take it easy for a few days. Bed rest beyond the first couple of days may seldom be necessary. Get back to a rehab programme as soon as possible.

What a doctor can do:

A specialist will decide whether any neuropathy is involved and take a call on surgical intervention (not common in most cases). In most cases, the patient is ready to resume normal operations in a few days.

SPONDYLITIS

What is it?

The spine is made up of 33 vertebrae with discs in between that act as shock absorbers. With age, the inside nucleus of the discs shrink and become tough, causing the bones around them to spread. These extra bony growths called osteophytes press on the nerve roots and can really make you go “ouch”!

What you can do:

Ice packs, non-steroidal anti-inflammatory drugs, gentle exercise and palpation can reduce the pain. Maintain good posture when working, driving and sleeping. If symptoms persist, see your G.P.

What a professional can do:

Recommend strengthening and stretching exercises and therapy under a physiotherapist. Acupuncture and injections are other options. Surgery is a last resort.

LUMBAGO

What is it?

Pain in the lower back that is mechanical in nature and often occurs in people involved in hard physical labour.

What you can do:

Rest and conservative treatment through the acute stage. A regular and scientific rehab programme is beneficial: a weak back and core muscles will increase the risk of backache.

Avoid bending for long hours, sitting on the floor or driving for long hours.

What a professional can do: Your doctor will probably refer you to a physiotherapist for a back maintenance programme.

ARE YOU SITTING COMFORTABLY?

Elbow: Sit at your desk so that your upper arm is parallel with your spine. Rest your hands on the keyboard. Move your chair up or down until your elbows are at a 90° angle.

Thighs: Your knees and your hipbone should ideally be at the same height from the floor. If your knees are lower, then put a step or platform under your foot.

Calves: You should be able to put a clenched fist between the back of your calf and the front of your chair. If you can’t do that easily, the chair is too deep. Either insert a lumbar support or get a new chair.

Lower-back support: Your backside should be against the back of a chair. Use a cushion or back support that causes your lower back to arch slightly so that you don’t slump forward as you tire.

Eye level: Close your eyes while sitting comfortably in your chair with your head facing forwards. When you open your eyes, you should be looking directly at the centre of your screen. If not, adjust the level of the screen till it’s right.

Go, take a walk: Prolonged static posture is not good for your back. Stand, stretch and walk for at least a minute for every half-an-hour of sitting. It’s also a good excuse to get some fresh air.