Do's and Don'ts

A sudden 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 - 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, don't be tempted to do "just another five 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: Use common sense!!!

DO: Lie down immediately! Try lying on your back, while on the floor. Hands by your sides, knees bent and feet on the floor. This takes the pressure off your back by flattening the low back.

DO: If you see swelling, apply an ice pack (or a bag of frozen vegetables from the freezer in an emergency!) if you find it brings relief. Be careful with ice. When applied directly to your skin as it may cause a cold burn. Remember if you see swelling apply ice, otherwise you can use heat. Use common sense and remember this example: if you struck your thumb with a hammer, the thumb would swell and turn read. You would never apply heat (that would cause more swelling, redness and pain) apply ice.

DO: 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 better/worse etc.

DO: Take painkillers at regular intervals (but no more than the recommended dose, and always read the instructions and especially the contra-indications).

DO: Use a relaxation tape if you have one to help calm the mind and ease body tension. Don't panic. When a low back spasms and you can not walk, this does not mean you are going to be paralyzed.

DO: 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. Frankly, the more it hurts and the longer it hurts, the more you will be motivated to improve proper body mechanics and activities of daily living.

DON'T: Be a hero. If it is more comfortable to crawl around on all fours to get to the bathroom than to stand up, then do so.

DON'T: Do any bending, twisting or lifting. Learn the correct techniques. Do not attempt to exercise or stretch the pain away without consulting your doctor.

DON'T: 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. Use common sense.

DON'T: Rush back to the activity which caused the pain, even when you feel much better.

How the Back Works

We all accept the importance of taking care of our teeth by brushing and flossing. It is equally important for us to look after our spines. 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. Even more important, the spine contains the lower portion of your brain, the spinal cord. Your brain and spinal cord comprise your central nervous system, that controls, coordinates and regulates all activity of your body by receiving and transmitting nerve impulses.
The spine is made up of 33 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 and so on. This is simply a way of pinpointing a particular area. Every vertebrae and disc has its own number.
In between each of the vertebrae are 'shock absorbers' called intervertebral 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 fibers 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 intervertebral 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 more 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 - 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 exercises 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.

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 the back, you should avoid oversoft 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 in 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 - its 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, you can put the mattress on the floor. There is not 'best' 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

Pillows

Your head weighs about 10-13 pounds. The only rest your neck muscles get is when you are lying down! When you sit and stand, your neck muscles are working. The normal neck has a "spring like" curve that is convex towards the front of the neck.
When sleeping, we want to maintain this normal curve. Hence, the pillow that you use should facilitate the maintenance of this curve and prohibit your sleeping in a position that disables this normal curve. However, again common sense prevails. Use whatever pillow allows you to sleep comfortably.

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. Organize 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. Don't 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 encourage bad posture - 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 most of the time.

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 adapter.

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 for 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 hairdryer 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 are some of the main ones.

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; and 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, and so on.

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.

Gardening

Early Spring and autumn always bring a good crop of patients to doctors' surgeries complaining of 'gardening back pain'. Avoid being one of them by following the gardening guidelines.

Safe Lifting and Carrying

If you have a 'problem back', let someone else do the lifting and carrying whenever possible. If you must lift, learn the LIFTING CODE (see below).

Driving

When loading items into a car boot, always load the heaviest items nearest the door, to minimize stretching and lifting when unloading. The NBPA's leaflet 'Better Backs for Drivers' gives helpful information on driver's backache - send us a SAE.

Shopping and Traveling

Carry heavy goods in two bags, spitting 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! Get someone else to push the supermarket trolley.

The ideal way to carry luggage is in a well-loaded rucksack or in two cases. 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 '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 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 as shown. 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.

Biomechanics
Backache Tips
Spinal Health Tips