Back Pain

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Back on Track

Frequent travellers are at increased risk of back pain, but you don’t have to spend your working life dreading those long-haul business trips, for fear of the resulting back pain you will suffer. In fact, simple strategies can help to prevent it, says Sally Brown.

Ever got on a plane feeling fine, and got off with a sore back? Although it may seem impossible to hurt yourself while sitting down, a long-haul flight can be riskier for your back than hauling bricks.

“What your back hates more than anything is ‘static loading’ – sitting in one position for a length of time, which you inevitably end up doing when travelling,” says back pain specialist Kyle Blackburn, from the Kent Sports Injury and Physiotherapy Clinic (KSIPC) in the UK. “It puts an incredible amount of pressure on the spinal discs. We evolved to be hunter-gatherers, so we function best when we’re moving.”

If you’re travelling overnight in Economy Class, count yourself lucky if you walk off the flight twinge-free. Physiotherapist Sammy Margo, author of The Good Sleep Guide, says: “A large number of my clients come for treatment straight after a long-haul flight, cancelling out the money they saved by flying Economy. Lying flat gives your body a rest from gravitational forces, so it can recover from the day’s activity. If you’re sitting up all night, it misses out on this recovery, so it’s vulnerable to damage.”

Delays and cancellations are also bad news for backs, says Dr Brian Hammond, chairman of the charity, Backcare. “Stress hormones can cause muscles to tighten, which reduces blood flow and, therefore, the provision of nutrients and oxygen to tissues. The result is spasm and a build-up of waste products and, eventually, muscle pain and weakness.” A 2004 study in Spine journal showed that people suffering psychological distress were three times more likely to develop back pain than those who weren’t.

Add to this the fact that you probably spend more time hunched over your laptop in an airport lounge or hotel room than at your ergonomically-designed desk, and you can see why your back periodically goes on strike.

“There’s no way around it – if you travel a lot, you need to pay more attention to your back,” Margo says.

But if your back is the bane of your life, be consoled that you’re not alone – according to Backcare, 80% of us are affected by back pain at some point.

What Puts You at Risk

You’re most likely to be a sufferer if you are aged between 35 and 55. Smoking and eating unhealthily also increases the risk (both affect blood circulation, which can lead to disc degeneration). But it’s a myth that only the unfit are affected, says chartered physiotherapist Paula Coates, a clinical lecturer at King’s College London. “You are just as likely to develop back pain if you exercise regularly,” she says. Being overweight puts you at higher risk, but so does being tall, owing to the length of the spine.

Given the complexity of the spine, it’s not surprising that what causes pain can vary hugely. Although many people feel it in the lower back, pain can occur anywhere along the spine, from the neck to the hips. Stress-related pain tends to affect the neck and upper back, as muscles and joints are smaller and more likely to tighten.

Only 2% of cases are caused by a serious condition, such as infection or a tumour in the spine, while in 85% of cases, backache is labelled “non-specific”. Hammond says: “The pain mechanism alerts you to damage in your body, but in some cases of persistent, chronic pain, the signals go into overdrive and can be alerting you to damage that isn’t there. Or in some cases, there is damage, but it’s not possible to pinpoint the site of it.”

Check Your Posture

Most of these cases can be related to posture, believes Noel Kingsley, an Alexander Technique teacher and author of Free Yourself from Back Pain. “Poor habits such as slouching or stiffening interfere with the working of our muscles, creating unnecessary strain,” he says.

We are all born with perfect posture (watch a two-year-old move around if you’re not convinced), but we pick up bad habits as children, such as carrying a heavy bag on one shoulder or slouching in front of the TV. A poor mattress can also be detrimental – 82% of experts said the right bed could help to prevent back pain, in a survey conducted by Backcare and the Sleep Council in 2001.

But it’s a myth that a hard mattress is better. According to a study published in 2008 by Denmark’s Back Research Centre, people who slept for one month on a water bed or memory-foam mattress experienced less pain and got more sleep than those using a firmer futon. “Changing your mattress every eight years and investing in the best one you can afford can make a significant difference,” Margo says.

The Power Of Self-Help

You’re advised to always seek help for backache that is a result of a recent injury, that increases or that comes with other symptoms such as numbness or tingling in the lower body, or problems with bowel or bladder control. It’s also worth seeking an expert opinion if you find the pain gets too severe. But if you’re the average sufferer of non-specific back discomfort that comes and goes, your best course of action is self-help.

According to UK advisory body NICE (National Institute for Health and Clinical Excellence), your GP should recommend exercise as a first course of treatment before painkillers or physiotherapy. “Movement helps to pump nutrients into the discs in your spinal column, which naturally don’t have a good blood supply,” says the KSIPC’s Blackburn. “It also helps to keep cartilage nourished, strengthens bones, and conditions the muscles that act as the spine’s support system.” It’s okay to exercise even when your back feels sore, but the golden rule is to stop if the pain spreads, particularly to the legs.

Most exercise – such as cycling or swimming – will help, but there are also classes specifically designed to reduce pain and prevent problems in the future. “Going to a class held by a specialist instructor can be a big confidence builder if you’re worried about hurting your back,” Blackburn says.

Being fit doesn’t guarantee you a future without back pain, but it does reduce your chances of suffering from recurring bouts, says Coates at King’s College. “Muscle strength and general fitness prevent the recurrence of lower back pain and reduce the impact of chronic discomfort on day-to-day life,” she says.

There is also a psychological element involved in managing pain. “Improving your mood will reduce the pain you are feeling,” Coates says. Backcare’s Hammond highlights the need to keep stress levels in check: “Stress hormones have an effect on our perception of pain, increasing sensitivity to it and making it appear amplified. The psychological aspects of stress can cause back pain sufferers to believe the pain is worse than it is and to feel negative about the situation.”

There isn’t a single cure that will alleviate backache for everyone, but by taking a trial and error approach, it’s possible to find the treatment or lifestyle change – or a combination of several – that works for you.

Avoid The Ache

Cut back on treatment bills with these simple tips from the experts:

Wheel your luggage A heavy bag that is constantly carried on the same shoulder can compress the muscles on one side, while simultaneously stretching the muscles on the other.

Move every hour Never sit for more than an hour without getting up and moving around for at least a few minutes.

Put your laptop on some books “You put the least pressure on your neck if the centre of the screen is at eye level,” says Backcare’s Brian Hammond. So if you are going to do a lot of work in your hotel room, make sure you take along a wireless keyboard and adjust your screen to the right height.

Sit on a wedge “When you sit down, your pelvis tilts backwards to allow your legs to stick out in front of you, but this puts strain on the lower back,” Hammond explains. “A simple piece of foam on your chair tilts the pelvis and allows the lower back to assume its natural ‘S’ shape.”

Go hands-free A University of Surrey survey (quoted in Safety and Health Practitioner in May 1999) found that 50% of office workers who used a telephone for at least two hours a day suffered neck pain, while 31% suffered lower back pain.

Use the pillow menu “Goose or down pillows are better than foam, if you’re not allergic,” says physiotherapist Sammy Margo. Add a foam pillow underneath for extra support. “Ideally, your head should follow the natural alignment of the spine while lying down,” she adds.

Recline your seat  “It takes pressure off the spine,” Margo says. If possible, don’t work on flights – sitting forwards puts the most pressure on the spine of any position.

Check your mattress Lie down on your back and slide your hand between your mattress and the small of your back – if there is a large gap, the bed is too hard, if it’s difficult to push your hand through, it is too soft, and if your hand slides through but remains in contact with your back, the bed is just right.

Top 10 Treatments for Back Pain

Exercise “You can have shorter and fewer flare-ups if you exercise to improve your fitness,” says King’s College London’s Paula Coates. See her book Back Pain: Exercise Plans to Improve Your Life for a fitness programme.

Pilates A study from Queen’s University in Ontario, Canada, found that only four weeks of resistance exercise classes could take the edge off a bad back for up to a year.

Yoga This is more effective at treating back pain than osteopath or chiropractic treatments, according to the results of the largest trial ever carried out on the subject, published by the University of York in 2011. In the trial, people still felt the benefits a year after having 12 weeks of yoga classes.

Hot or Cold Packs Applying a heat pack, spray or gel (known as thermotherapy) increases blood flow and oxygen, which promotes healing. By sending heat signals to the brain via the spine – the same pathway pain signals travel – it can dilute pain. For acute pain, such as from a sports injury, applying an ice pack or cold analgesic spray can reduce tissue bleeding, swelling and inflammation.

Alexander Technique The pain-relieving benefits of six lessons of AT last a year if you also keep active, according to a study in the British Medical Journal published in 2008.

Acupuncture Several studies say this is more effective for back pain than drugs. It is thought that inserting needles into the skin stimulates the immune system into releasing pain-relieving chemicals, so it’s useful if your back has gone into spasm.

Cognitive Behavioural Therapy There’s a big psychological aspect to pain and your GP can prescribe CBT – with a therapist or via an Internet programme – to help you manage the way it makes you feel. If there’s a waiting list, try a respected self-help book such as Overcoming Chronic Pain: A Self-Help Guide Using Cognitive Behavioural Techniques by Frances Cole et al.

Physiotherapy Physiotherapists use a range of treatments, including massage, manipulation, ultrasound and exercise plans, to treat muscle and joint problems. Your GP can refer you.

Osteopathy/Chiropractic A 2004 study into back pain published in the British Medical Journal found that chiropractic spinal manipulation followed by an exercise plan provided “significant relief of symptoms and improvements in health”. Osteopathy (hands-on rebalancing of bones, muscles and joints) is recommended by health body NICE as a treatment for lower back pain.

Painkillers “Many people don’t like taking tablets because of worries about side-effects or becoming dependent,” Coates says. “But if your drugs control your pain and allow you to exercise, this will reduce the pain further, allowing you to take less medication.” Standard anti-inflammatories help, as can painkillers. If this doesn’t work, discuss prescription drugs with your doctor.

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