Back Pain Q and A


Bad backs Q&A

Back in business

Q

I’ve been a mechanic for about 25 years and my back is giving up. I find it harder to work in a bent position every day, and at weekends all I want to do is lie flat on my back to recover. Is there anything I can do to help my back last a bit longer?

A

It would be fairly safe to say you wouldn’t be the only person in a manual profession having this type of trouble. Unfortunately our spines tend to wear out over time and, to a large extent, genetics determines just how susceptible a person is to this damage. Beyond that, years of physical demand take their toll. The extremely repetitive nature of shearing in a stooped position is not the most back friendly of jobs, but there are a number of things that may be useful to you. This type of problem is often associated with tightness in the spine. You may find simple stretches like twisting your trunk and moving from side to side help take some of the tension out of your back during the day, allowing you to work more efficiently. A few repetitions several times over the day, without pushing into discomfort, are usually effective.

Sometimes simple stretching isn’t enough to reduce years of gradual stiffening. In this case our experienced chartered physiotherapists have many strategies to free up your back, which can then make simple stretching more effective. Beyond this, we could recommend specific strengthening activities to help provide better muscular support for your spine, thus improving its tolerance to a full day’s work. External support in the form of a back brace could also be useful for you. Remember, though, that a back brace shouldn’t be considered an alternative to using your own muscles.

Q

When I bend over to pick up my toddler I often hear a ‘click’ near my hips. There is no pain, so is this anything to worry about?

A

‘Clicking’ in this region may be associated with the hip joint itself or with tendons about the hip joint. In the absence of pain there does not appear to be any evidence that this is a problem. However, it could be considered a sign that the muscles surrounding this area, those which control movement, are not providing the support this region requires as you bend forwards. This is referred to as a ‘muscle imbalance’. A good analogy is to think of your car tires; if they are not balanced correctly they can wear unevenly, and if left unbalanced for long enough will start to affect the smoothness of your ride. In the same way, then, if a muscle imbalance exists about your hip it may eventually produce excessive strain and wear on structures in that region, possibly leading to pain and altered function. PhysioCare Chartered Physiotherapists are experts at assessing and correcting muscle imbalances. Correction of muscle imbalance may reduce the ‘clicking’ you are experiencing and, at least in theory, reduce the chance of pain developing. And an ounce of prevention is worth a pound of cure!
Q

I have a slipped disc that goes out occasionally and I often have to wait several days before I can get an appointment for someone to fix it. While I wait for treatment my back is always very sore and it is extremely painful to sit or walk. Apart from spending the time in bed, is there anything I can do to ease the pain while I wait?
A

Where did your disc go? Did it have a good time while you were left at home in pain? I don’t mean to tease you, but the simple fact is that there is no such thing as a ‘slipped disc’. It is a horrible term that implies something that just doesn’t happen. The disc can indeed be injured though. There can be tears in the disc, it can bulge and swell, and fragments can break away from the disc resulting in a herniated disc.

That aside, the feeling of something being ‘out’ in your back is a common one. Rather than originating from a slipped disc though, this sensation is usually due to muscle spasm. When a disc or any of the other structures in your back are injured, some muscles spasm in response. Muscle spasm can be extremely painful and disabling. Fortunately in many cases it can be reduced by various manual techniques which a physiotherapist can provide. While waiting for treatment it is generally considered that trying to keep mobile is the best option. If you are resting, get up frequently and move about to help relieve muscle spasm. If you have been given exercises previously for these acute episodes of pain, reverting to these can be useful. Don’t try to force it with the movement though. Muscle spasm can react to excessive movement by spasming even more. Heat or ice, depending on the individual, could be useful for the pain. Try both to find what is best for you, but the majority of people I deal with find heat the most soothing. Consulting your pharmacist for advice on anti-inflammatory medication and possibly analgesics (pain killers) is also useful when in acute pain.

Q

My neck is very sore in the morning and I find it difficult to turn my head before I’ve had a shower. Why would this be? Is there anything I can do free it up?
A

Morning stiffness is often associated with arthritic conditions; osteoarthritis is the most common form, where your joints become stiff. This is just like the back gate that rarely gets used and becomes rusty and stiff. Put some oil on the gate, start swinging it back and forward, and it loosens up. Movement is nature’s oiling can for your joints. During the day you are moving around, using your neck, so it stays lubricated and loose. At night you don’t have anywhere near as much movement, so the joints get a little ‘rusty’, resulting in stiffness and discomfort in the morning. The number one thing you need to do then is keep your neck moving. Sometimes though just moving it isn’t enough to free up joint stiffness completely. This is where physiotherapy, via a number of methods, can be extremely helpful to stimulate extra ‘lubrication’ and movement of the neck. Your physiotherapist can then provide you with expert instruction on the best methods to maintain this looseness as much as possible. Maintaining looseness and flexibility in your neck generally means a brighter start to the day.
Q

My bad back makes it uncomfortable to sit in an office chair and a friend has suggested that I sit on a fitball instead. Would this help?
A

A recent study compared sitting on a fitball with sitting on a stable surface and found no differences between the two in terms of muscle activation and spinal load; this suggests there is no scientific evidence to support the proposition that sitting on a therapy ball is better for your back than sitting on an office chair. Interestingly, the subjects in this study found sitting on the ball for 30 minutes less comfortable than sitting on a wooden stool. Importantly the ball will not magically correct poor posture. In fact it is possible to sit with poor posture in even the most supportive of office chairs. Imagine bending your finger back as far as you can and leaving it there all day. Not many people would want to do that as it is going to get sore after a while. Sitting with poor posture is doing exactly that to your spine; improved posture is critical to improved sitting tolerance. We are able to assess your posture and prescribe corrective measures for postural problems. For some people the ball may be helpful, but it can’t be considered a cure all. Frequent breaks from sitting are also advisable.
Q

Over the past six months I have developed a constant ache in my back which is getting worse. A friend told me that strengthening my stomach muscles would fix my back. I have been doing sit-ups for four weeks but my back is still sore. Why isn’t it getting better?
A

My job would be so much easier if simply doing sit-ups to strengthen the abdominal muscles was a cure for back pain. However the muscular support system for your back is very complicated. The stomach muscles are only one of many muscle groups that support your spine. On top of that there are four major stomach muscles to consider. Even different regions of these individual muscles have different functions. Also the demand on these muscles can be totally different for different tasks. Are you starting to see the complexity?

In general, muscles can be divided into those which support your spine and those which move it. If the problem lies in the moving muscles, using those muscles under load (ie, sit-ups for the outer abdominals) will strengthen them and improve the problem. With back pain though, it is often the supporting muscles that stop working in the presence of pain. Interestingly when the pain goes away it doesn’t necessarily follow that these supporting muscles start working again. If they don’t, we have a problem as now activities may not be accompanied by adequate spinal support. This can mean that the spine becomes overloaded and sore. Exercising the moving muscles can occur without getting to the holding muscles. Think of athletes who generally have fantastic outer or moving muscles. Despite this, athletes still get back pain. They may have excellent moving muscles, but perhaps poor supporting muscles. Very specific exercises are required to improve the function of the supporting muscles. This is commonly referred to as working on ‘core stability’. Working these muscles often starts as a ‘brain’ exercise, learning to activate these muscles correctly, rather than a traditional movement-based exercise. This requires expert assessment and instruction. Physiotherapists are the experts at assessing muscle dysfunction of this nature and implementing corrective measures. No single musical instrument can play a symphony. Intricate co-ordination of a multitude of instruments is required. In a similar manner rarely can exercise of a single muscle cure back pain.

Disclaimer
Physiotherapy and you articles are provided for general information only and should in no way be considered as a substitute for the advice and information your chartered physiotherapist will supply about your particular condition.
While every effort has been made to ensure that the information is accurate, PhysioCare and the authors and the editors of the articles in this magazine and on this web site accept no responsibility and cannot guarantee the consequences if patients choose to rely upon these contents as their sole source of information about a condition and its rehabilitation.