Prevention of

Back Pain

Throughout this book I have contended that most back pain is preventable, and that the back pain you may be experiencing now can be treated without surgery or elaborate and expensive treatment plans. I've already said, more than once, that the main reason people have back problems is aging of the spine. Another reason is we just don't take very good care of our backs.

The key to avoiding most back pain is to minimize the stress on your back. This does not mean"do nothing." With a little knowledge and a proper implementation of that knowledge, you can take control of your back. In the next two chapters I will discuss specifically the steps you can take to getting and maintaining a better back. This chapter will deal with your everyday behavioryour body mechanics. In the next few pages we will look at some of the do's and don't's of body mechanics: How to stand. How to sit. And how to perform certain tasks.

In the next chapter I will give you nine exercises to help strengthen the muscles your back depends on for support.

Four Weeks to a Better Back

While reading this information, it is important to remember that you are the most important person in determining the health of your back.

Good Body Mechanics

I know. I can hear you thinking, Dr. Chiu, what do you mean by body mechanics? Do you think I'm some kind of machine that you tune with wrenches and screwdrivers?

In a way, yes. That's exactly what I mean. Except that the tools are they way you use and position your body what we call posture. Posture is important in all activities, even the way you stand, sit, and lie down, or sleep.

Remember when you were growing up how everybodyespecially your parents, relatives, teachersinsisted that you stand up straight? Even some of your school books touted the virtues of good posture. Remember this line, "Stand up straightslouching like that looks terrible."?

When I was growing up I really thought that the only reason so much emphasis was put on good posture was that bad posture is unsightly. Today, of course, I know that appearance is only part of the reason good posture is so important. A lifetime of standing, sitting, lying down and walking incorrectly can cause serious back problems.

The first step to preventing back pain is maintaining good posture. Your back's health depends largely on the curvature or your spine. It's a matter of physics. When force is applied to a curved structure, the greatest point of stress is applied on the inner side of the curve. This is why so many of us have trouble with our lower backs, or lumbar region, where the greatest curve is. The greater the curve of your spine, the greater the

Prevention of Back Pain

pressure to the lower back. Excessive pressure causes excessive wear. As we have already seen, wear and tear causes degenerative problems.

Standing

While standing, the least amount of stress is applied to your cervical if you hold your head high and tuck in your chin. This position actually straightens out the cervical spine. It is also important that you hold your stomach in and roll your hips to the back a little, moving your pelvis slightly forward. Tighten your buttock musclessqueeze them together somewhat. Standing like this will help reduce the pressure on your lumbar spine.

The idea is to stand as erect as possible, so that your body forms a straight line. A good rule of thumb is to try to line up your ears, shoulders, knees

Four Weeks to a Better Back

and ankles. Line up your head and your pelvis, and the rest of the body should follow.

Standing for long periods can also put a lot of stress on your back. If you cannot avoid standing for long intervals, try not to stand in the same position too long. Shift your weight now and then. Another good way to relieve pressure is to stand with one foot resting higher than the other, on a rail or some other low object. Change legs now and then.

If you work in a profession that requires you to stand for long periods, you should, if possible, avoid wearing high heels. This type of shoe causes you to stand unnaturally, increasing the curve in your back.

A while back I had a TWA flight attendant come into my office complaining of severe back pain. A very attractive young woman, her pain was so severe that she was convinced that she needed surgery, and that her career with TWA was over. After examining her, I determined that a big part of her problem was her shoeshigh heels.

At that time most airlines required their flight attendants to wear pumps. I could hardly believe it. When I first told my patient's supervisor that I could not release her employee to return to work until she was allowed to wear better shoes, I was told that company policy required female flight attendants to wear high heels. It was a long struggle, but my patient was finally allowed to return to work. And nownot that I had anything to do with itI notice that none of the airlines are

Prevention of Back Pain

requiring their employees to stand all day in those dastardly shoes.

Sitting

We live in a society where more and more people are making their livings sitting for long periods. Sitting improperly can cause undue curving of the spine. There are many sitting positions, such as slumping or leaning forward in your chair, that can actually apply more pressure to the spine than when you're standing.

The best sitting position is one in which your legs are level with your hips, your feet flat on the floor. Your back should be supported firmly by the back of the chair. You can also support your spine a little more securely by leaning your lower back against a pillow, a rolled up towel, or specially made lower-back pillow. Another option is an orthopedically

Four Weeks to a Better Back

When working, you can relieve back stress by using an ergonomic chair with lower back suppor

When relaxing, you can relieve back stress by using an ergonomic chair with lower back support

Ergonomic chairs can relieve stress on your back.

Prevention of Back Pain

support built in. These chairs are sometimes called ergonomic chairs.

Whenever possible, the chair you sit in should have armrests to relieve the pressure your dangling arms apply to the lower spine.

If you are in a job where you are required to sit for long periods, you should get up and walk around for a few minutes every half hour or so.

It has been predicted that in another 20 years, or so, about 80 percent of the work force in this country will be sitting in front of computer terminals. This is not good news for our backs, which reminds me of a patient of mine who worked for the phone companya directory assistance operator.

I hadn't talked to her very long when I realized that her pain was being aggravated by the placement of the computer screen at her station. The monitor sat in front of her, down low on the desk, so that she had to bend her neck downward to look at it. Talking to her further, I realized that she was not the only phone company employee who had back problems. Getting a company like Pacific Bell to change the way they do things is not easy, but once they saw the benefitsespecially in lost time and compensationthey put the monitors up and to the side to save the operators' backs.

I also suggested the monitors be adjustable from left to right, to keep operators from having to hold their heads in the same position for long periods. Or that they design some stations with screens on the left side and others with screens on the right and rotate the employees from day to day. I'm not sure how that suggestion worked out.

If you are sitting for long periods, you should avoid slouching in your chair. This is terrible for your spine. We hear this a lot, especially when we were youngsters and teenagers. Still, many of us develop detrimental sitting habits when we are young, and the bad habits follow us into adulthood. Some of us sit improperly until the time when we begin to develop back problems. The sad part of this is that the back might not have been compromised in the first place, if we had practiced good posture.

Four Weeks to a Better Back

Sleep and lay down with your neck and back straight.

Sleeping

Whenever many of us think of back pain in relationship to sleeping, we automatically think about our mattress and pillows. A lot of time and research have gone into developing "orthopedically designed" sleeping furniture. It's often difficult to determine just what role your bed is playing in aggravating your back pain. I've read some accounts that say what you sleep on doesn't matter at all.

Not too long ago a colleague of minea pediatriciancame to see me complaining of back pain. I had known this man for a long time, and I knew a lot about his lifestyle. He was not overweight, he exercised regularly, had good posture and was overall mindful of his health. He couldn't think of an incident that could have caused and injury. Perplexed, he came to me seeking an answer.

Prevention of Back Pain

When sleeping, keep your neck and torso aligned.

We talked for awhile. I contemplated doing a full examination and x-rays, until he told me about the new pillows his wife had bought him for his birthday. He described them as thick and plush. I asked him to bring them in to my office.

The pillows were indeed plush and thick. His wife had obviously barred no expense when buying them. The problem was that they were too thickthey lifted my friend's head too far off the bed, causing an unnatural curve in his neck. I told him to get rid of the pillows.

Ditto!

Four Weeks to a Better Back

A few minutes after he leftabout the length of time it took him to get homehis wife called. I had also known her for a very long time. She was angry about the pillows.

"Humor me," I said. "Just try it."

Within a couple of days my friend's back pain subsided.

This is not to say that your bedding is always part of the problem. Sometimes it plays no role at all. However, a good rule to remember when purchasing a mattress is that firmer is better. Soft or sagging mattresses do not support the back. While sleeping, your body, including your neck, should be as level as possible. Try to sleep in a position that is comfortable. If you already have back pain, maybe you should try not to sleep on your stomach. This posture tends to exaggerate the curve in your lower back.

Getting into and out of the bed properly can also be important, especially if you are already in pain. You may have to experiment a little, so move gradually and slowly. The pain will let you know if your movements are wrong. Try to follow these rules:

Getting into bed: First sit on the side of the bed with your palms resting on the mattress. Slowly lower your body sideways, at the same time raising your legs. You should end up lying on your side. Use your arms to support your body, rather than your spine.

Getting out of Bed: Simply reverse the process by which you got into bed. While getting in and out of bed, you should avoid bending or twisting your back.

Walking

Remembering the same mechanics I gave you for standing properly should be all you need to know about walking with good posture. I should mention, though, that if you are carrying a bag in your hands or from the shoulder, move it from one side to the other now and then.

Prevention of Back Pain

Lift with your legs, not your back.

Good Body Mechanics in Everyday Tasks

As I've stressed a few times so far, most back problems are not a result of injury, but are instead caused by wear and tear on the spine. This does not mean that you cannot hurt your back through using it improperly. The body mechanics described in

the following section on using your back in everyday tasks can avoid both injury and unnecessary stress on your back.

Lifting

I've chosen to discuss lifting first because most back injuries,

Push and perform other
strenuous activities with
your back straight.

Four Weeks to a Better Back

such as sprains and strains, are the result of improper body mechanics while lifting. You will remember from the chapter on biomechanics that an item doesn't have to be heavy to apply a lot of pressure to the back. The stress on your back, depending on how you lift a load, can often be multiplied by as much as 20 times. You can, however, reduce the load considerably by taking a moment to practice good lifting habits.

Before you lift anything, decide where you are going to carry it to, and make sure you have an unobstructed path before you lift the object. heft or check the object to make sure it's not too heavybefore you pick it up. If it is too heavy or too large (you don't have to prove anything), get help. After you've decided the object is not too heavy, stand close to it and set your feet apart to insure good footing. Bend your knees. Keep your back straight and try especially not to bend at the waist, since this increases the stress on our back. Tighten your abdominal muscles as you liftremember that your stomach muscles help support your back. Lift with your legs rather than your back. Hold the load close to your body and try not to bend while you're carrying your load. Avoid twisting and move evenly, without sudden jerks. And finally, when you get the load to the destina

Prevention of Back Pain

tion, set it down the same way you picked it up.

Lifting objects from tables and from overhead can also be dangerous. Keeping the load close to your body without extending your arms cannot be stressed enough. When reaching for objects from shoulder-level or higher, don't lock your knees. This can put up to 15 times the weight on your lower back. If an object is too high, get something secure to stand on.

Sweeping, Mopping, Vacuuming, Shoveling, Hoeing and Other Drudgery:

All these tasks have a few things in common. For the most part you stand and move similarly for all of them. Many of these chores require bending and stooping, as do thousands of other actions, such as cleaning out the refrigerator or mowing the lawn. The rules of good body mechanics apply to everything you do. Here are the basics:

As with lifting, other actions should be performed while keeping in mind and maintaining the curvature of your back. When using a tool, keep it close to your body. Try not to bend over while working. Avoid twisting, especially with some-thing heavy in your hand, like a shovel full of dirt or a vacuum. If you have a choice between pushing and pulling an object, push it. It's much easier to twist your back with a pulling action. Always try to pivot your body on your feet, rather than turn your back.

Sports and Exercise

Many people hurt not only their backs but several other parts of the body while participating in sports or exercise. Of course, it's difficult to be mindful of your posture and body mechanics

Four Weeks to a Better Back

while involved in a hot tennis match or chasing a fly ball during a softball game. But that doesn't mean that just because you have back pain now, that you will no longer be able to participate in the physical activities you enjoy.

You can use some common sense when exercising, though. For example, many injuries can be avoided by simply doing stretching and other warm-up exercises before you start the activity. And, you can be conscious of your back while engaged in an activity. Unfortunately, depending on your back problem, there may even be physical activities you will not be able to participate in anymore. Jogging, for instance, is aggravating to some kinds of back problems.

But such is life. Right?