Care for your Back Back pain is very common and most of us will get it at some time. How you use your back, both at work and home, can determine whether you will have to learn to live with back pain. With the right approach, basic back pain could be avoided. Experts now recognise that the increasingly sedentary lives that we lead contribute greatly to the back pain epidemic that is now being experienced in the western world. An office worker can spend anything from 25 to 40 hours a week in a static position working at a computer. Travelling to and from work may involve long journeys either sitting (or more likely standing) on a train or bus with no room for movement. When we get home, it is far easier to sit and eat dinner in front of the TV, spending the rest of the evening sprawled on the sofa, than it is to go out and get some exercise. If you want to keep your back healthy, it is important to keep it moving and to support it properly when you are not. This section will describe some of the ways you can reduce the likelihood of back pain and other related health issues. A bit about your back The spine is made up of 33 small bones called vertebrae with discs that act as shock absorbers in between. These bones are given a code to show where they are in the spine. (see the diagram) C  followed by a number from 1 to 7 will refer to the vertebrae in the neck. T 1-12  refers to the thoracic spine (from the bottom of the neck to the lumbar region). L  followed by 1-5 refers to the lumbar (or lowest) section of the spine. Beneath the lumbar spine there are another 5 vertebrae fused together, forming the sacrum with the coccyx (or tail bone) underneath. The discs are made up of a soft jelly like substance (the nucleus) which is held inside a tough, elastic and fibrous outer casing (the annulus). If the outer casing of these discs is damaged in any way and causes the nucleus to protrude, or even leak out, it causes what is commonly known as a 'slipped' disc, but correctly known as a prolapsed disc. The muscles of the back support this structure and when these muscles go into spasm the most common form of back pain occurs. This often happens when you have been doing something strenuous or that involves a lot of bending like gardening, or when you have been in an awkward position for a long time and go to move. There are other more serious causes of back pain such as disc prolapse and diseases of the spine, but if your pain has subsided and there are no unusual symptoms such as numbness, pins and needles or pain down the leg, muscle spasm would usually be the culprit (if your pain lasts longer than 48 hours and is getting worse, or if any of the signs previously mentioned appear, you should consult your GP immediately).

The lowest region of the back - the lumbar region - is the most vulnerable area, and back pain often occurs here. This is because the lower part of the spine bears the entire weight of the upper body, and is flexed, twisted and bent more than any other part of the spine. It therefore, inevitably, suffers more wear and tear.

You will notice that your spine is not straight, but is actually an 's' shape. Not all backs are the same 's' shape but they are usually curved with a hollow in the base of your neck and another in the small of your back. This shape should be kept in mind as it is important to keep the natural curves in your spine whatever you are doing.

First aid

If you have an attack of back pain, you won't do your back any harm by moving around even though it hurts - in fact you will help it get better faster by keeping as active as possible. Bed rest is not a cure. If you have back pain, lying in bed will not help, it may even make it worse.

Lie down during the day only if your pain is unbearable, and if it is still bad after two days see your GP. Carry out your normal activities, like going to work, walking your dog, or shopping and cooking as best you can, but try not to overdo things. Pace yourself and you will be able to do much more.

Strengthening you back muscles and keeping fit is important. Walking is usually helpful - start slowly on flat ground, building up to longer walks and gentle slopes. Swimming is excellent exercise - use back-crawl instead of breast stroke which can strain your neck. When your back pain has settled, using an exercise bike is a good way of getting fit. Keep the saddle high (to keep the natural curves in your spine), start gradually and build up.

BackCare's booklet Active Back Care which is on exercise for a better back may be helpful to you. If you smoke, cut down (or give up!). Smoking affects the blood supply to your back, reducing the nutrients getting to your muscles.

Posture

Try to maintain a good posture by not slumping in your chair, hunching up over a desk or table or walking around with your shoulders hunched up. Instead, imagine there is an invisible cord from the top of your head to the ceiling lifting you into a tall, relaxed posture rather then a short, hunched one. (See BackCare's leaflet "Back to Posture".)

What you can do to help yourself

There are a range of BackCare booklets and books to help you to avoid pain if you are lucky enough not to have it, and how to manage it if you do.

The following tips come from some of our publications.

Lifting and carrying 
Wherever possible, avoid lifting and carrying as these can cause back pain. If you do have to lift something, bend your knees not your back. Keep your feet wide apart to help you feel stable. In this way, you are using your strong leg muscles and not straining your back. Carry the object against your body (so that its centre of gravity is close to yours). Bend at the knees to put the object down.

Basic Back Care at home
There are a number of ways that we can do jobs around the house to limit damage or further damage to our backs.

• Try a rolled-up towel or jumper in the small of your back to help support the natural curve ('Lumbar support rolls' are available from some shops)
• Stand your washing up bowl on the draining board so that you don't have to slump over the sink, straining your lower back, sit down to prepare vegetables etc.
• Check the suitability of your mattress with a simple test. Lie on your back and slide your hand (palm down) into the small of your back. If there is a large gap, the mattress is probably too hard. If you have to squeeze your hand in, then it is probably too soft. If your hand slides in fairly easily, the mattress is probably just right.
• If you have neck pain, try making a butterfly pillow. Tie a bandage or stocking around the centre of the pillow and place your neck in the middle.
• When vacuuming, keep your upper body upright, and with the cleaner close to your body use short sweeping movements.
• Only iron essential items. Make sure your ironing board is at waist height (most people have the board too low).
• When making beds, kneel down to tuck in corners rather than stooping.

Out and about
Try making several short trips over the week rather than one big supermarket shop. Use the tall, waist-high, shallow-sided shopping trolleys, many stores now offer. Try to use one of these instead of carrying heavy items in a basket. For the journey home, if you do not drive, a rucksack, used over both shoulders, is useful for carrying tins, leaving your arms free for lighter goods like cereals. Try to carry goods in both hands so that your load is balanced.

Gardening
Gardening can be particularly hazardous, BackCare produces a booklet (Back in the Garden) of hints and tips to help avoid injury with ideas such as using raised beds or kneeling to work at ground level to prevent stooping. Try doing some warming up exercises before commencing any physical work such as digging and try using the adapted garden tools there are available to help you with tasks such as weeding.

In the office
Try not to slouch, keep your chair unlocked most of the time and make full use of the chair movement (especially when reaching behind you or for the phone). Try to alter your position when using the keyboard for long periods of time, move your feet forwards and behind. Make the effort to adjust any other chairs you sit on in the office so that they are comfortable for you. If you are uncomfortable, move. Changing your posture and taking frequent breaks from your desk will help keep your muscles working. Operate your keyboard when it is directly in front of you and have your monitor square on so you don't have to turn your head to look at it. Use a document holder so that your work can be closer to you and try to minimise glare on the screen. Re-arrange the items on your desk according to the frequency that you use them - things used often kept closest, least often furthest away. (See BackCare's leaflet - Back in the Office)