Get Back in Action

CHRONIC CARE

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ometimes it’s a dull nagging sensation that just won’t go away. In other instances, it’s an acute pain that can make every physical action — from sitting and standing to even lying down — an agonising and unpleasant one.

Ever heard of the phrase “a monkey on your back”? Well, just like an itch you can’t scratch, back pain is a condition that adds annoyance to your life, and occasionally may be symptomatic of something even more serious.

You don’t have to be hauling bricks all day to be stricken by back pains.

Long hours slouched in front of the office computer, a poor posture, sitting in badly-designed chairs and even improper weight training methods can do the damage just as effectively.

Back pain — especially in the lower back area — is a common ailment among adults.

But simple lifestyle changes and a regular exercise regimen can do wonders in alleviating the effects of this nagging condition.

By SHERALYN TAY

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WELLNESS FOR ALL

PHOTOS: Getty Images, Hong Chee Yan

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Whatever the cause, lower back pain (also known as lumbar strain) in most cases is, thankfully, a mild complaint that usually resolves itself without the need for treatment.

Research suggests that for about nine in 10 cases, the pain will subside within six weeks. In comparison, chronic or long-term back pain that lasts for more than three months may require medical attention.

According to Ms Sylvia Ho, Principal Physiotherapist at Core Concepts Musculoskeletal Group, a private physiotherapy group in Singapore, most of the cases she sees involves chronic lower back pain, also known as non-specific lower back pain. “[These refer] to back pains that are not caused by any muscle, ligament, joint or dysfunction of the spine,” she says. In comparison, specific chronic back pain usually signals problems in the spine such as cracks in the vertebrae (bones of the spine) or the compression of spinal nerves. These can usually be detected by imaging such as an X-ray or magnetic resonance imaging (MRI).

Despite the distinctions, Ms Ho adds that there is no difference in the kind of pain experienced in both conditions.

When to seek treatment

If your back pain lasts for more than three months or if the pain interferes

PHOTOS: Getty Images, Hong Chee Yan

There are many alternative treatments to resolving back pain. Here are two of them.

NEUTRAL SPINE

To achieve a neutral spine posture, your back should not be too arched or too flat.

FLAT BACK

OVER-ARCHED BACK

Some people may stand with a flat back or an over-arched back. This could be due to the pain a person experiences when walking, running or standing.

with your daily activities, it is important to seek medical help. Your general practitioner or family doctor will help you manage the pain and monitor your condition.

For mild non-chronic problems, your doctor may prescribe pain relievers,

anti-inflammatory medications and muscle relaxants that will help alleviate the pain while your back heals. If required, he or she may even refer you to see a specialist or a physiotherapist.

Watch out for signs of a serious problem, such as a fracture, tumour,

> Osteopathy

> Chiropraxy

Osteopathy is the diagnosis and treatment of muscle, ligament, nerve and joint problems.

The osteopathic philosophy is that pain usually stems from abnormalities in the body’s structure and function. It is a holistic philosophy that treats the body, including the musculoskeletal system, rather than concentrating on a specific area. Treatments are aimed at helping the body heal itself and usually include the gentle manipulation of muscles and stretching.

This refers to the diagnosis, treatment and management of health conditions using manipulative techniques that improve the function of joints. The tenet of chiropractic philosophy is that many health problems are related to misalignments in the musculoskeletal system. The practice is characterised by fast, precise thrusts to the spine or parts of the body that may result in ‘cracking’ sounds that are actually the sound of gas bubbles in the fluid of the joints ‘popping’.

Jan-Mar 19

CHRONIC CARE

A lack of knowledge over the causes and methods of alleviating back pain may result in a worsening of the condition infection or nerve damage. These include: • Increasing level of pain over time • The back pain coincides with pain that travels to the foot or numbness in the leg • Worsening pain when you bend over or cough “Chronic pain is harder and takes longer to treat. Therefore, it is imperative that you see a physiotherapist or a doctor for your injury as soon as possible. This will save you time and money in the long run,” says Ms Ho.

The root of the problem

Often, the root of chronic back pain can be traced to lifestyle choices — in particular, poor posture when sitting or standing. Inactivity can also be a contributing factor. Ms Ho notes that one reason why some people suffer from chronic pain is the misconception over its causes and solutions. A lack

of knowledge over the causes and methods of alleviating back pain may in fact result in a worsening of the condition.

“Because of mistaken beliefs or behaviours, the sufferer may unwittingly continue to execute certain movements or adopt postures that affect the back negatively,” says Ms Ho. For example, someone with a back injury may believe that bending his back is bad and that keeping his spine straight is the best posture for his condition. According to Ms Ho, some people may continue to adopt this posture even after the original pain has gone. People like these continue to avoid postures that require them to bend. In doing so, their back muscles are activated constantly, and they do not allow the back to relax.

This lack of movement can stress the back and cause it to lose the

ability to flex, causing more risk of future strain.

“The constant contraction of back muscles to keep the body upright will tighten these muscles, and further load the spine,” Ms Ho explains. “This means that there will be an increase in compressive forces on the structure of the spine which leads to pain.”

As a physiotherapist, Ms Ho’s job not only involves relieving the pain with stretches and exercises, but also changing the mindsets, lifestyles and even the way patients stand and sit.

“Sometimes, we need to see the posture that patients adopt, and whether that aggravates the pain. If it does, we will try to change that.” This could mean relieving the tight muscles in over-archers or strengthening the muscles in slouchers and showing patients how they can be more aware of their posture as well as maintain the spine’s natural arch (see p19).

Ultimately, Ms Ho says that it is essential that treatments solve the underlying cause of the pain. “Massage or manipulation in isolation will not work in the long term as the trigger for the pain still exists.”

GUARD AGAINST INJURY

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PHOTOS: Hong Chee Yan

Extreme sports such as skate-boarding, long-boarding, wakeboarding and mountain biking come with a high level of adrenalin-fuelled fun, but can also increase the risk of injury, including back injuries. Keep safe and active with these tips: h Wear your safety gear. h Be conscious of your environment and don’t take unnecessary risks. h Build your core muscles with a functional training regime. This builds your stability and helps your body support and protect itself. h Make yoga or stretching exercises an integral part of your training. Good balance and flexibility means joints and muscles can react, adapt and recover from falls and injuries.

KEEPING IT NEUTRAL

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Let’s get things straight — good posture is not about keeping the spine stiff as a board, but rather in keeping the natural curve in the spine when standing, sitting, or lying down. Slouching or sitting cross-legged while on a chair disrupts the neutral spine position, misaligns the vertebrae and can cause strain on muscles, joints and ligaments.

A neutral spine maintains the three natural curves in the back.

YOUR NEUTRAL SPINE Lie on your back with your knees bent and feet flat on the floor. Your hips, knees, heels and toes should line-up. Place your hands by your side.

Relax and gain an awareness of your body.

Breathe in deeply into your diaphragm, expanding the ribcage.

Form a diamond with your index fingers and thumbs and place your hands on your pelvis (This is known as a pelvic diamond). Your fingers will be parallel to the floor if you are in the neutral spine position.

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ARCHED BACK Tilt the pelvis down to create an arch in your lower back. Place your pelvic diamond on your lower tummy so that your thumbs rest at the belly button and point towards the pubic bone. Your fingers will be tilted down and your thumbs will face towards the ceiling.

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FLAT BACK Tilt your pelvis up to flatten your lower back against the floor. Place your pelvic diamond on your lower tummy so that your thumbs rest at the belly button and point towards the pubic bone.Your fingers will be tilted up and your thumbs will face towards the floor.

PHOTOS: Hong Chee Yan

This exercise not only releases the back, but also helps you understand your ‘neutral spine’ position. This is when your lower back is not too arched or too flat, but somewhere between these two ranges and is comfortable and pain-free. This is the ideal spine position to maintain when standing or sitting.

Source: Core Concepts Musculoskeletal Group

Jan-Mar 21