November 24, 2014   3:54pm
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Bad Back? Impt to check this out!

There are many things you can do for that bad back — and some of them are going to surprise you …

Like many of you, off and on I get (mostly) lower back problems.  Mine stem from carrying a heavy shoulder bag, computer sitting (wrong way,  too long, many years), and from, sigh, getting older.  Now, just when I thought I’d figured it all out, along comes three different New York Times articles:   Lesley Alderman’s article “Sit Up Straight.  Your Back Thanks You.” has great (but expected) advice; a few days later Jane Brody wrote  “Forget About Crunches.  Here’s How to Protect Your Back.” which showcased things I do and had NO idea were damaging, i.e “Avoid thos infamous stomach ‘crunches’ and toe touches and any exercise or activity that involves twisting the spine or bending forward from the waist with straight legs.”  And, following those, was a story on “Stubborn Back Pain?  Massage Helps” by Nicholas Bakalar.  No one wrote mentioned Acupuncture (see what my expert acupuncturist Bruce wrote here), but acupuncture has been a back-saver for me.

We strongly suggest you print this post out for later reference!

The expected:

SIT UP STRAIGHT.  YOUR BACK THANKS YOU.

‘ “The majority of back pain is the result of muscle ligament strain or weakness and can often be prevented by developing core strength and proper posture,” said Dr. Daniel Mezanec, associate director of the Center for Spine Health at the Cleveland Clinic.  Maintaining good posture not only helps you look better, … it improves muscle tone, makes breathing easier and is one of the best ways to stave off back and neck pain, not to mention the dreaded dowager’s hump of old age.” ‘

THE D.I.Y. APPROACH

First, try correcting your slouching habits on your own. Stand up and lift your chin slightly; align your ears over your shoulders and your shoulders over your hips. Place your hands on your hips and pitch forward about two inches.  There should be a slight inward curve in your lower back, an outward curve in your upper back, and another inward curve at your neck. Maintain this posture and sit down.

When you are sitting or driving for long periods of time, place a cushion or rolled-up towel between the curve of your lower spine and the back of your seat. Supporting your lower back will maintain the natural curve of your spine; when the back is supported, the shoulders more naturally fall into place, said Dr. Wilmarth.

Maintaining good posture requires abdominal and back strength. “It’s not enough to just sit up straight if your core muscles are weak,” said Dr. Praveen Mummaneni, a spine surgeon at the University of California, San Francisco. Consider taking a Pilates class, which focuses on developing one’s core — the muscles and connective tissues that hold the spine in place — or hire a physical therapist to create a personalized exercise plan.

A CUBICLE CURE

If you sit at a desk all day, ask your human resources department if they have an ergonomics expert on staff (some large companies do) who can assess your work area. An ergonomist can make sure your chair, desk and keyboard are at the optimal height and can adjust your sitting posture.  If no expert is on hand, make adjustments yourself. The center of your computer screen should be at eye level, and the desk height should allow your forearms to rest comfortably at a 90-degree angle. Work with your feet flat on the floor and your back against the chair.

Whether you work in an office or at home, get up and stretch every 30 to 60 minutes. Sitting for long periods puts pressure on discs and fatigues muscles …“Stretching helps break bad patterns and allows your muscles to return to neutral,” said Dr. Wilmarth.

Stand up and place your hands on your lower back, as if you were sliding them into your back pockets. Gently push your hips forward and slightly arch your back. Sit back down and circle your shoulders backward, with your chin tucked, about 10 times.

Not likely to remember? Set your phone or computer alarm to remind you to stand up and stretch each hour. An iPhone app called Alarmed has a feature that allows you to create regular reminders throughout the day.

AN EXERCISE PLAN

Habits are hard to break. A physical therapist can show you how to align your spine and provide you with exercises to both strengthen your core and loosen up stiff neck, back, arm and leg muscles (tight hamstrings can contribute to back pain).  Most insurers cover physical therapy, although some may insist that you get a referral from a physician before they will authorize a visit.  If you decide to go out of network or to bypass your insurer, you’ll pay $150 to $250 for an initial assessment. Follow-up visits will be $50 or so less. Most experts say you can address basic posture issues in just one to three sessions.

NOTE from Snoety: My physical therapist uses my iPhone to video me doing exercises as she directs, providing a great reference for when I do them at home. (Yes, do them at home!)

A CLASS IN POISE

If you want a more systematic, long-term approach to posture change, consider the Alexander technique, a method that teaches you how recognize and release habitual tension that interferes with good posture.

Not all doctors in the United States are familiar with the technique, but recent research suggests that it can help with lower back pain as well as posture. A study published in The British Medical Journal found that lessons in the technique helped patients with chronic back pain. A 2011 study published in Human Movement Science concluded that the Alexander technique increased the responsiveness of muscles and reduced stiffness in patients with lower back pain.

Try one session to see if it’s for you. If so, consider committing to 10 lessons. Individual lessons cost $60 to $125, depending on the teacher’s experience. Insurers will not reimburse you; group lessons may be more affordable. To find a teacher, go to the Web site of the American Society for the Alexander Technique.

Still slouching? A study published in The European Journal of Social Psychology found that subjects who were told to sit up straight with good posture gave themselves higher ratings and had more self-confidence on a given task than those who were told to slouch.

Moral: Sitting pretty yields immediate, not just long-term, benefits.

NOTE from Snoety:  The photo in the article shows a 13 year old doing yoga exerccises to improve her posture – and she is NOT using her abdominals in the photo.  BAD!  See, even The New York Times can get it wrong.

The Unexpected:

FORGET ABOUT CRUNCHES.  HERE’S HOW TO PROTECT YOUR BACK.

If you have not suffered a vertebral fracture, adopting an exercise routine that improves posture and strengthens back muscles can go a long way toward preventing one. And if you are already plagued by back pain due to vertebral fractures, the exercises and protective movements described below may bring relief and prevent the problem from getting worse.These guidelines and exercises have been adapted primarily from recommendations published in the medical journal Osteoporosis International.  First, it is critically important to know what not to do. Avoid those infamous stomach “crunches” and toe touches and any exercise or activity that involves twisting the spine or bending forward from the waist with straight legs.

Next, recall a mantra you may have heard often as a child: Stand up straight. Good posture — proper alignment of body parts when you stand, sit or walk — reduces stress on the spine. Lift your breastbone, and keep your head erect and shoulders back, all the while gently tightening abdominal muscles and maintaining a small hollow in your lower back.

More advice from the experts:

¶ When sitting for long periods, place a rolled towel or small pillow at the small of your back. Walk with your chin in and head upright.

¶ Learn to bend over safely from the hips and knees, not the waist. Start with your feet shoulder-width apart and keep your back straight. Do not twist; turn to face the object you wish to reach before you bend.

¶ To reach your feet (for example, to tie your shoes), sit on a chair and cross one foot at a time over the opposite knee, or stand with one foot on a stool.

¶ Lifting an object can be problematic. If possible, first get down on one knee and lift the object to your waist; then stand up, holding it close to your body.

¶ When carrying packages, use two bags with handles packed as evenly as possible, and carry one bag in each hand. If you have recently had a vertebral fracture, limit the weight you carry to 10 pounds.

Another option: Use a backpack, preferably one with straps that snap in front at the chest and waist. In fact, according to Dr. Kristine Ensrud of the University of Minnesota, one of the recommended back-strengthening exercises involves wearing a small backpacklike device containing a two-kilogram weight.

¶ Avoid overreaching. Don’t reach for objects on a shelf higher than one you can touch with both hands together.

¶ Protect your back when you cough or sneeze. Tighten your abdominal muscles, and place one hand on your back or press your back into a chair or wall for support. Alternatively, gently bend your knees and place one hand on them.

Additionally, exercise that strengthens abdominal muscles will also protect the back. Try this one: Lie on your back with knees bent, feet flat on the floor and a small pillow under your head. Tighten your abdominal muscles by pulling your pelvis and ribs together (push your rib cage toward the floor and tilt your pelvis toward it) while flattening your lower back toward the floor. Hold for five seconds, relax for five seconds, and then repeat 5 to 10 times.

Also helpful is strengthening your core. The Pilates plank exercise, which looks like the “up” part of a push-up, is excellent if you can do it. Lie face down, and raise your body into a benchlike posture, supporting it with your hands and toes and keeping your back flat. Hold the position for a count of 10, or as long as you can without undue strain. Over time, build up to a one-minute plank.

If posture is a problem, a suggested corrective exercise involves sitting or standing as tall as you can with your chin tucked in, stomach tight and chest forward. With your arms extended in a “W” position and shoulders relaxed, bring your elbows back to pinch your shoulder blades together. Hold for a slow count of three and relax for another count of three. Repeat 10 times.

And lastly, seems massage helps:

STUBBORN BACK PAIN?  TRY MASSAGE

Massage is a common alternative treatment for chronic low back pain, but most recent studies have found little evidence that it works. A group of researchers designed a study to see if they could find a difference between back pain sufferers who got massage and those who did not.  The scientists recruited 401 members of a large group health plan who had moderately severe back pain unconnected with any disease and generally related to strains and sprains. Three quarters of the volunteers had had pain for more than a year.

The volunteers, average age 46, two-thirds of them women, were randomly assigned to one of three groups. Some got relaxation massage, a full-body technique intended to induce a generalized sense of relaxation to ease low back pain. Others got structural massage, which aims to identify specific musculoskeletal contributors to pain and to release restrictions on muscles causing the distress. The third group received no special care and served as controls.

The three groups were similar in the other kinds and frequency of treatments they used, including painkillers or sedatives, back exercises and bed rest.

Each of the massage groups received 10 weeks of treatment, and at the end of that period, all three groups had some improvement, as measured by their answers to 23 questions about performing routine activities without help — for example, climbing stairs without using a handrail or getting out of an easy chair by themselves. They were also asked to rate the degree of their back pain symptoms on a 10-point scale.

Those who received massage scored significantly better on both symptom and function tests, and they spent less time in bed, used less medicine and were more satisfied with their current level of back pain.

At 26 weeks after treatment, those in the usual care group continued to function less well than those who had gotten massage. But there were no significant differences in the pain scores in the three groups, either at 26 or at 52 weeks.

Daniel C. Cherkin, the lead author and an epidemiologist with the Group Health Research Institute in Seattle, mentioned some of the study’s considerable strengths. It had a randomized design, a high follow-up rate, good adherence to the treatment and a large sample size. Still, he said, the study was done on a mostly white, middle-class population in otherwise good health, which may limit its applicability to other groups. The study appeared online Monday in Annals of Internal Medicine.

It is unclear how massage eases back pain, but the researchers suggest it may stimulate tissue locally or cause a more generalized central nervous system response. It is also possible that just spending time in a relaxing environment or being touched and cared for by a sympathetic therapist could have led to improvement. Also, those in the control group knew that the other groups were getting massage, and the knowledge that others were getting the treatment while they got none may have led them to underestimate their own progress.

Still, the researchers conclude that massage has few adverse effects and is a reasonable treatment for low back pain. There is no evidence, though, that it lowers the cost of health services related to back pain.

“We tested this on people who had not been getting better from the usual medical approaches, Dr. Cherkin said. “If you’ve tried other things and you’re not getting adequate relief, then massage is a reasonable thing to try.”

Goooooooood luck!

Harriett@snoety.com

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