The Health Blog

When sitting at leisure, the important thing is to get the buttocks well back into the chair because sitting slouched in a chair may flex the lumbar region more than any other movement or posture. Some back sufferers are more comfortable if they avoid crossing their knees and sit with their feet and knees well apart.

If the chair is soft and does not give enough support, put a cushion at the small of the back. Some people with back trouble prefer high-backed chairs. Support is also important at shoulder level since several back muscles run from the base of the neck to the lower spine and pelvis. The facility to tilt the back of the chair temporarily also helps to redistribute weight and muscle tension.

Choose a chair that is the right height for you: your feet should be planted on the floor, not dangling in space. Avoid a very low chair as this can put undue strain on your back when you get up out of the chair.

Arms on the chair assist in reposition the trunk, and assists in rising to the standing position without rotation.

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Back pain frequently responds well to physiotherapy, the treatment by physical methods, as an alternative or adjunct to drugs or surgery. The methods include several different therapies, manipulative procedures, therapeutic movement or exercises, treatment with heat, cold and with electrical equipment. The aim is to help restore the function of the body and rehabilitate the patient: it also includes advice and instruction on posture and daily activities.

Interferential therapy-This is another method of using electric current, via electrodes, attached to the skin around the painful area, to relieve pain by blocking the pain reception network, and to reduce inflammation by promoting better circulation. It may also be used to stimulate muscle contractions by applying a different frequency. The patient feels a tingling sensation, as in TENS.

Which kind of physiotherapy? There are different types of treatments for different conditions, different stages of the same conditions and for different patients. The physiotherapist will design a program specifically tailored to your individual back problem, and this program will take into account the condition, its stage and the patient.

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If your back trouble is not improving, or, having got better, keeps recurring, or your GP thinks there could be some uncommon reason for your trouble, your GP may suggest that you should be seen by a specialist. This will mean going to the specialist’s rooms or going to a hospital as an out-patient (or being admitted as an in-patient for a day, for investigation) to attend a consultant’s clinic in the orthopaedic or rheumatology or neurology or rehabilitation department. The appointment may be for a date weeks or even months ahead, though if your case is considered urgent on medical grounds, you may be seen more quickly.

In the letter of referral, your GP will give the specialist a history of your trouble, their own conclusions from the examination(s) you were given and any tests that have been carried out, such as X-rays.

The specialist’s aim will be twofold:

1. to find out the originand cause of the pain.

2. to suggest other forms of treatment, possibly sugery.

The questions you are asked, the examination and any further investigations that are ordered by the specialist will all be directed to this purpose, their scope depending on whether this is your first spell of back trouble, or a recurrent problem which has not yielded to treatment.

The specialist will want to know about your previous medical history, operations, severe injuries or prolonged illnesses, and whether you are currently having treatment for any other condition.

When the tests and investigations have been completed, the specialist may be in a position to tell you whether there is any serious disease. If the specialist does not reassure you on this point, do not hesitate to ask.

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The ligaments in an adult have very little elasticity. They can be strained, that is, overstretched by violent action, usually at their points of attachment to the bone. They can also tear, usually in the direction in which their fibres are weakest. Torn ligaments heal rather slowly (more slowly than bone).

Ligaments do not have blood vessels within; any bleeding which occurs when a ligament is torn comes from the surrounding tissues. This results in the formation of fibrin, protein fibres which form new tissue to mend the damage. Often this causes scar tissue to form along the line of the mend (rather like excess glue along the cracks in repaired china), and this may adhere to the surrounding tissues, hampering the movement of the ligament. Further strain may wrench and tear these adhesions, causing more inflammation, and pain. These healed ligaments are even less elastic than before the injury.

Joints at risk-The little facet joints at the side of the spine take more mechanical strain from unequal stresses on the spine than the main intervertebral joint itself. The subsequent inflammation is a common cause of lower back pain, particularly the type that gets worse with exercise or as the day goes on.

The facet joints in the lower lumbar spine have the function of preventing the vertebrae from rotating, and so are especially vulnerable to damage from twisting movements, but joint injuries may occur anywhere along the spine.

At the upper end, strain on the cervical vertebrae can send the neck muscles into spasm, producing a ’stiff neck’ (called torticollis, or wry-neck). This usually gets better in a short time when the spasm relaxes.

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Sufferers may have the additional problem of convincing others that they are really suffering. The cause of their complaint is not obvious, there is no visible abnormality and there is no objective way of verifying it. When a bone is broken and the limb is put in plaster, everyone knows why you are housebound for a while. With bronchitis and a course of antibiotics, people will accept that you are really ill. But if you have back or neck pain, while everyone will agree that you may need a few days to rest, that may be all. Employers are sometimes intolerant of lost work time (three out of every four people will experience back pain at least once in their life) because they believe back pain is a good excuse for a ’sickie’ or for the avoidance of certain tasks. On the other hand, some people with a highly developed sense of responsibility to work may be reluctant to take adequate time off. Many doctors would consider this attitude foolhardy. Some, however, would recommend a speedy return to work as part of the philosophy of confronting pain rather than giving in to it.

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