Some 60-80 per cent of people in the Western World are affected by back ache and if you are aged between 30 and 50, you are most at risk. Why?
If we consider that those of us living in the “developed” world have far more back pain than those in traditional communities around the world, this gives us a clue. The back is an intricate, complex system that does an amazing job.
It acts as our central stabiliser, supporting the head, arms and torso, while keeping us upright. At its core is the spine, which houses the nervous system that runs to the rest of the body, and the mechanics of the spine allow us to twist, turn, bend and manoeuvre in numerous ways. (Post continues after video.)
When functioning correctly it does an amazing job. But the system breaks down when it is asked to function in a way in which it was not designed – and the spine was not designed to spend hours every day sitting.
In short the human body, including the back, was build to be active. We are meant to move. When we don’t move enough, things go wrong.
Unfortunately for so many of us, our work, family and other commitments require us to spend an enormous amount of time sitting. If you have a desk job count up the number of hours per week you spend at your desk. How much time do you spend driving? Watching television? Sitting on trains, buses or planes? Sitting at the theatre or the movies? Dining in restaurants?
When you think about many of our work and leisure activities, they involve sitting down. This puts enormous pressure on the lower back, increases leg weakness (meaning you don’t have the strength to complete daily movements without stressing your back), produces muscle imbalances and reduces mobility of joints, particularly the hips. (Post continues after gallery.)
If you think of the position of your body over a keyboard – the muscles at the front of the hips are shortened, while those over the butt are relaxed; we tend to slouch forward so that the muscles across the front of the shoulders and chest are shortened, while those in the back are relaxed; the knees are bent so that the hamstrings in the back of the thighs are shortened.
Over time this leads to imbalances of muscle pairs – for example the chest is tight while the back is not strong enough, leading to poor upper back posture and pain; the backs of the legs and front of the hips are tight, pulling the pelvis out of position, leading to lower back pain.
Adding to the problem is the way we sit – crossed legs, slouching, stooping – it is little wonder that by the time you are in your fourth decade of life the back starts to object.
Of course there are many reasons why things go wrong – arthritis, spondylitis, disk degeneration, osteoporosis, sciatica and nerve root impingement are just some of the common back problems we face – but at the core of the vast majority of our back problems is our lack of movement, poor posture and too much time sitting.
How can exercise help?
Regular exercise (done in the right way) strengthens the muscles that support the back, increases mobility, improves posture, strengthens bones including those of the spine, and combined with specific stretches releases tight joints, muscles and ligaments.
Along with a healthy diet, exercise will also help you to control your weight and there is no doubt that being overweight, particularly around the middle, is a sure fire way to back pain (ask any heavily pregnant lady). Strange as this may sound, strong abdominals are central to achieving and maintaining a healthy back.
But not the “six-pack” you can see on some very lean men, but a muscle called the transverse abdominus. This is the quiet achiever behind the scenes. It lies below the “six-pack” and runs across the body, rather than vertically, and this is why it is so important. While the six-pack muscles contract to bend forward, or to sit up in bed, the transverse abdominus acts like a corset, supporting the lower back. (Post continues after gallery.)
When you relax this muscle (as most of us do most of the time) your belly pops out, you tend to slouch, the pelvis tips and you end up with an excessive curvature of the lower back -the site of much back pain. By learning to keep the transverse abdominus switched on, and keep it on while you are standing, walking, sitting, and moving in any way, you not only protect your lower back but you get the added benefit of looking taller and leaner too.
To see this for yourself, stand side-on to a full-length mirror in your underwear – allow your mid-section to relax and you’ll find you have a pot-belly, even if you are slim. Now try drawing your navel in towards your spine. Try to do this without breathing in and holding your breath! At the same time imagine you are lifting through the crown of your head. You will see that you automatically stand taller, lift your ribcage up and forwards, your chin drops, your shoulders relax back and down and your pelvis tucks under slightly, taking pressure away from the lower back.
This is good posture and in fact the most recent research shows that by standing and sitting with good posture, we naturally engage our core and don’t need to think consciously about doing so. My Today Show colleague Anna-Louise Bouvier is a Sydney-based physiotherapist, back care expert and author of Fix Your Back (ABC Books).
She says knowing if you are a “floppy” or a “stiffy” is key to developing the exercise program you need for a strong back. ‘Floppies’ are inherently mobile through the joints and can therefore slouch in any position. Just because you can doesn’t mean it is good for you! If you are a ‘floppy’ you need strength in the muscles supporting the spine in order to be able to hold yourself in good postural alignment.
‘Stiffies’ are the opposite – they lack mobility through the joints and the tightness of specific muscles pulls the skeleton out of alignment, resulting in back (and other) pain.
If you’re not sure which one you are Anna-Louise says “whatever you hate is what you need”. In other words if you love stretching (because you are good at it) you are probably a floppy and it’s not in fact what you need; whereas if you hate stretching (because you are not good at it) you are most likely a ‘stiffy’ and this is exactly what you need.
Flexibility for the “stiffies”
Certain styles of group exercise class focus on flexibility and these are fabulous to include in your weekly exercise program – including yoga, Pilates, BodyBalance and stretch classes. Otherwise you can simply include the following key stretches at home. Do them every day, holding each stretch for a minimum of 30 seconds.
Stand with feet hip-width apart and step one foot back into a lunge position with both hands on your front knee. Straighten the back leg and sink through the hips while keeping your torso upright. Repeat on the other leg.
Lie on your back with both feet flat on the floor. Extend one foot towards the ceiling and straighten (but don’t lock) the knee. Take both hands (or a rolled up towel if you can’t reach) behind the thigh and gently pull the leg towards you without bending the knee. Repeat on the other leg.
Chest and shoulders
Stand with feet hip width apart and link your fingers behind your back. Keeping your shoulders down, lift your interlaced hands upwards and outwards to open through the chest and the front of the shoulder.
Strength for the “floppies”
Floppies need to build strength in the muscles around the key joints – hips, knees and shoulders – to hold the joints, and thus the spine, in proper alignment. Squats and lunges can’t be beaten for developing lower body strength, and add a specific back exercise such as a seated row.
Basic tips to care for your spine
- Avoid bending from the waist whenever possible – squat, crouch or kneel down instead
- Ladies - save the high heels for evenings when you know you will spend little time on your feet – dinners or the theatre are fine – the rest of the time go for a flat shoe or a low heel
- Never walk any distance in high heels - put them in your handbag and wear your flatties for the journey, slipping into your killer heels for arrival
- Don’t twist your spine while carrying a load
- Invest in a good quality firm mattress
- Sleep with only one pillow if you sleep on your back, and two if you sleep on your side – the goal is to ensure alignment of the neck and upper back
- If you sleep on your side put a small pillow between your knees
- When walking up stairs plant your whole foot on the step, not just the ball & head up
- Avoid always carrying your toddler on the same hip – alternate and use a sling if carrying for any length of time
- Avoid working for long periods on a laptop – invest in a docking station and monitor
- When sitting - think about your posture, keep your core switched on, place both feet flat on the floor, or position one forward and one back, and get up to stretch every hour or so
- When sitting on standing don’t look for external support from the chair or by leaning on something – use your own internal stabilisers to maintain good posture eg standing evenly on both feet without leaning on a table or wall
- Crouch or squat with the load between your feet
- Hold the load close to your body
- Take a deep breath and brace your core abdominals
- Keeping the load as close as possible, stand up by using your butt and leg muscles
Remember to reverse the process when putting the load down.
Who to see when there are problems
If you are already suffering from pain or discomfort seek professional help before you engage in an exercise program. The cause of the pain must be established so that specific exercises along with other therapy can be advised. So who can help?
Many health professionals, both mainstream and alternative, offer therapy for back pain. Who will be of most help will depend on a number of factors including whether the pain is acute or chronic, your own belief in the therapy, the skill and experience of the practitioner (there are good and bad in each category) and your commitment to putting their advise into practice.
Your GP may be your first port of call and can often diagnose the problem and guide you towards the most appropriate specialist if they can’t help you themselves. Not all GPs are receptive to alternative therapies and so you may have to find your own therapist if you would like to give these a go.
Osteopathy is a system of healing based on manipulation of the bones or other parts of the body. It is now widely accepted as an effective holistic approach to diagnosis and treatment for pain. Back pain is the most problem osteopaths deal with.
Physios have a practical emphasis to relieving your pain and preventing the problem from reoccurring. They will primarily use physical means such as exercises and massage, along with specific treatments such as manual therapy. They are renowned for their expert treatment of sports related injuries, but can provide effective treatment for a range of back ailments.
Chiropractors use a system of manipulating the spine, believing that many problems throughout the body stem from the spine. They will usually take x-rays and these form a major part of their diagnostic technique. Many back sufferers have found relief in the hands of a chiropractor.
These are medical specialists who look after the musculo-skeletal system and you will need a referral from your GP in order to see one. Contrary to popular belief they will rarely recommend surgery and this is usually a last resort. Education, medication and specific exercises are more likely.
While it may not solve the mechanical problem, if chronic pain is an issue, acupuncture may certainly help with management of the pain.
Do you suffer from back ache?
This post originally appeared on Dr. Joanna. You can read the original here.