Correct and Incorrect postures

If your kid’s school bag is too heavy for you to carry and if the pencil you dropped on the floor seems to be a kilometer away, then you’re not alone. Your one of the 9 out of every 10 people who experiences back pain at some point or the other in their life. Lifestyle and nature of jobs are making back aches one of the most common complaints after common cold. In a country like India, where the fastest growing sector is IT, this has serious repercussions on productivity.

Diagnosing the pain
Back aches can be amongst the most difficult to diagnose. In most acute cases, one might be able to pinpoint the exact moment when it occurred such as while lifting something heavy or getting up off the wrong side of the bed so to speak. In some cases, more so in chronic conditions, a benign ache could be indicative of a whole host of conditions.

Chronic or acute
The first step would be to categorize it into chronic or acute. Acute or sub-acute conditions can last from a few days to up to 3 months. These are most commonly due to a muscle pull or damage to ligaments. Chronic pain can be life long and may require surgery. Persistent or intermittent pain for more than 3-6 months necessitates further investigation.

Radiating pain: in one or more extremities is indicative of more serious nerve-related problems like sciatica. These are very tricky to diagnose because the pain may not always be in the actual affected area. Another tricky case is frozen shoulder. In many cases, even X-rays and MRIs are not conclusive.

Pregnancy: too puts great pressure on the back and a doctor’s advice should be constantly sought on how to mitigate this.

Other disorders include osteoporosis, osteo and rheumatoid arthritis, spinal herniations, neuralgias, spondylitis, disc compression, bladder problems (more common in women) etc.

Even with MRs and X-rays, diagnosis isn’t always straight forward.

Psychological? There is increasing evidence that many cases may be due to psychological reasons. Anxiety and depression, especially work-related may actually lead to back aches and aggravate already existing ones. One theory is that a disturbed mental state causes muscles of the back to tense up continuously leading to pain.

The architecture of the back
The back is a complex arrangement of bones, muscles, tendons, ligaments and nerves which can work in concert to produce great power. At the same time, all these ingredients can also produce pain if out of balance. The upper back supports the torso and any movement of the arms. The lower back helps in bending forward and backward. All these movements if done with high intensity, improper form or hyper-extension can pose a risk.
The back is by no means a delicate structure but in an age when increasingly every activity is facilitated at the push of a button, it is suffering as much from neglect as under use.

The epidemic
Having said that, back aches are one of the most common complaints physicians receive and also the cause of the most workers’ compensation claims and loss of man hours, it follows that this new age epidemic also presents great business opportunities. Sales relief ointments and sprays have shot through the roof in India. Many people also rely on common pain killers such as Paracetamol, Ibuprofen and NSAIDs. The web is replete with sites dedicated solely to back pain, offering every conceivable remedy from Meditation to Homeopathy. What this feature aims to do in this sea of sermons is to create some awareness of the seriousness a back condition may represent and offer some tips on mitigating the run-of-the mill variety of back pain.

Common remedies:

  • Such as hot bags or ice packs
  • Some stretching exercises
  • Popping a pill
  • Or only doing those physical activities that are tolerable for a few days may take care of common niggles. However, if your work and lifestyle in general are sedentary, the problems can be more lingering.
  • Most common complaints can be narrowed down to 3 causes:

  • Obesity
  • Poor Posture
  • Weak Muscles
  • Obesity: If you’ve been visiting HealthJockey regularly, you would have come across newer reasons to avoid obesity every week. Obesity can cause and/or accentuate everything from back aches to heart attacks. This is because being obese simply means carrying more weight than you are supposed to carry. It puts extra pressure on the knees, the back and all joints in general. Concurrently, if you are overweight, you are probably saving yourself from toil like physical work, especially exercise. Weaker muscles and joints make you that much more prone to back pain. For eg, a potbelly would pull the entire body forward, putting extra strain on already weak back muscles. How to tackle obesity has already been done to death so we move on to…

    Posture: You were probably wondering when I was going to use the term posture! It is one of those things that have been hammered into our heads by everyone from the school gym teacher to the friendly neighborhood aunty. And it would always be ‘sit straight, don’t slouch.’ But newer studies are suggesting otherwise. A recent widely publicized study suggested that while sitting at work, an angle of 130 degrees of the torso with the thighs with the feet touching the ground is the least stressful for the back.

    ‘Good posture’ per se is when the body is most stable and most relaxed and able to perform a task with most efficiency.
    It allows for the three natural curves in the spine: inward lumbar curve in the lower back, outward thoracic curve and inward cervical curve near the neck. This should be taken care of while sitting, standing, driving and sleeping. Here are a few tips to get you going:

    While Standing:

  • Distribute weight equally on both legs.
  • Keep both knees straight; don’t put more weight on one leg.
  • Relax your shoulders, tuck in your stomach.
  • Do not stand in one position for too long.
  • While sitting:
    (Not assuming a simple or ergonomic chair)

  • All three curves mentioned above should be maintained.
  • Do not stoop forward.
  • Do not sit at the edge of your seat.
  • Keep shoulders relaxed, use arm rests.
  • Most important is not sitting in the same position for more than 30 minutes. The human body is not made for long periods of such sedentary activity. Change positions, move around a bit, do some stretching. Slowly move your neck from side to side; also focus on objects farther away than your computer screen or desk.
  • Driving for long periods can also be stressful for your back. Public transport drivers and truck drivers report back pain the most. Even if your routine does not involve driving for long periods:

  • Assume the same position as indicated for sitting otherwise.
  • Move forward so that the steering wheel is close enough for your back to be totally supported by the seat.
  • Knees should be at the same level or slightly higher than your hips.
  • While sleeping or simply lying down:

  • Use a pillow but only under your head so that the three curves are maintained.
  • One can use a pillow under the knees or bend the knees slightly when lying on your side but not up to your chest.
  • Use a firm mattress.
  • While lifting weights or stooping:
    (At home, work or the gym)

  • Get a firm footing, with legs shoulder-length apart or slightly wider.
  • Remember, bend at the knees, use your legs, not your back to lift weight.
  • Look forward as you bend, keep your back at an angle of 70 degrees and straight.
  • Always keep the weight close to your body, do not swing it or keep it far from the body.
  • Avoid carrying the weight on one side of the body.
  • Try to pull weigh rather than pushing it.
  • Weak Muscles: for those of us who do not regularly engage in some form of exercise or scoff at it altogether, weak muscles may be a leading cause of back pain. The lower back muscles and abs work in concert, like the biceps and triceps. Strength in one strengthens the other and vice versa. Simple exercises like yoga, swimming and even everyday housework would be helpful.

    Even if you can’t commit yourself to what can be called a respectable training program, doing simple exercises such padmasana and varasana for a few minutes a day can improve posture. Standing backbends can also help relieve pain:

  • Stand with feet shoulder length apart.
  • Place your palms on your hips, fingers pointing downwards.
  • Breathe in and arch your back backwards from the waist slowly, palms moving down to your thighs.
  • Try to look as further back as possible right down the center.
  • Slowly come back to normal position, breathing out.
  • *Remember, all exercises requiring bending forward have to be accompanied by breathing out, all exercises requiring bending backwards have to be accompanied by breathing in.

    Exercise-related injuries: even if you do exercise regularly, chances are you have not achieved the right balance between lower back and abdominal strength. An ideal work-out should include exercises that strengthen both. Various exercises or lifting too much weight can also lead to excess stress to your back. The body becomes to an extent indifferent to pain when adrenalin levels are high. So if you are involved in high-intensity work-outs, the seriousness of an injury would only become apparent gradually. In case of upper or lower back sprains or neck sprains; the best thing would be to avoid exercise for a few days or only engaging in moderate exercise. If pain persists or re-occurs, try to isolate the exercise or movement that is causing it or is most painful. This might also be helpful in diagnosis. The first thing to remember is to:

  • Gauge your capacity: While you would not want to restrict yourself to lesser weights, lifting beyond your capacity is counter-productive as you end up cheating to complete the motion.
  • Wear a weight-lifting belt while lifting heavy weights (this would even help at home or if you job involves physical hardship)
  • Maintain perfect form in all exercise. This naturally strengthens abdominals.
  • Stretching adequately before and during the work-outs is very important.
  • Remember, the most important thing is maintaining perfect form. Even exercises that put maximum strain on the lower back such as squats strengthen it if done correctly. Most injuries result from poor form.
  • In conclusion:

    More than a condition in itself, back pain erodes quality of life. It limits many activities and effects professional life. Apart from keeping you from doing major physical activities, even routine chore and movements can become a burden. Coupled with age and lifestyle-related illnesses like diabetes and osteoporosis, a bad back can lead to serious complications that need surgical interventions. Drinking, smoking and an unhealthy ‘diet’ leach out calcium from the bones, further increasing risk. This feature by no means aims to discourage or act as an alibi to avoid strenuous work. On the contrary, some activity and good old-fashioned house work maybe all that you require. So remember, all that may be keeping you from playing cricket with your old buddies on Sunday is resistance to getting off your behind!

    By -Punit G. Pania