Thursday 30 October 2014

For spine health, it's best to go back to the basics

More than two thirds of us will suffer from back pain at some stage, and it can take a toll on our mental health and lifestyle. But adopting good posture and controlling our weight can help

FUNNY BONE: Frankie Howerd’s character Francis Bigger ended up in hospital with a back problem in Carry On Doctor, but in real life back trouble is no laughing matter

'OH, ME aching back!" I can still remember the 'cat-chy' TV ad campaign aimed at safer lifting practices in the workplace in the 1970s. And if you're old enough to suffer from low back pain, chances are, you do too.

About 70 per cent of the adult population will suffer from back pain at some stage and until recently (when 'stress' finally passed it) it was the most common illness written on sick certs nationally.

And it can be debilitating. People who miss more than six weeks work with back pain have up to an 80 per cent chance of not returning to employment at all. That's partly due to the nature of back pain – ruling out many people from manual jobs, or jobs involving prolonged sitting or driving – but also partly due to the fact that protracted absence tends to have quite damaging psychological effects.

I remember one man who'd been out of work for about two months with back pain, which had now settled, describing how, when he tried to return to work, he got as far as the gates, became panicky, and started to cry – and had to leave again. That's not an unusual story. Lengthy absence is very difficult to overcome, as we lose routine and become fearful of the work environment and its social interaction.

So if you have a 'bad back' what can you do? I know barely a week goes by when I don't mention obesity – but obesity, particularly central obesity, is a huge causative factor.

Beer bellies and pregnancy cause your centre of gravity to be pushed forward, putting strain on the back muscles and, over time, causing wear and tear on discs and vertebrae. So, being normal weight is absolutely key for long-term back health.

After my own last pregnancy made even climbing the stairs an ordeal, I felt every single pound I lost, lighten the burden on my lower back. Denial of the fact that extra weight is part of the problem will result in lifelong back trouble.

Posture is hugely important too. I generally know when someone's presenting with back pain before they're even in my room, as the Thunderbird gait (I really am showing my age) is often evident from the moment they rise from the waiting room seat. Like many things, we tend to pay attention to posture while we're suffering with back pain and revert to slouching once it's settled. This results in a continuous cycle of relapse. Pilates, yoga and stretching can improve posture and strengthen core muscles which support our back. Bad posture results in a bad back.

Lifting techniques: "Bend the knees!" It's true that a huge number of back issues develop on the foot of poor lifting – be that in work, or at home with the three-year-old. It's really important you lift carefully, use your leg muscles, not your back muscles, and also to move symmetrically.

Generally, activity such as walking is good for the back, as it stretches and mobilises the muscles and, provided you wear good shoes and walk erect, it's often therapeutic. But in the first day or two of severe back pain you may have to rest.

Physiotherapy plays a big role in alleviating back pain, and is recommended in almost all cases where pain lasts more than a week or two.

Medications such as anti-inflammatories or painkillers have, of course, a role in the acute stage, and sometimes in getting you back on your feet. But for lifetime back health, you need to look after your back and treat it like the asset it is. I never like to see people on medications that they could avoid, if they altered their lifestyle. So it's back to basics!

Dr Ciara Kelly is a GP in Greystones, Co Wicklow

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