Monday, August 24, 2009

A Holistic Approach to Back Pain

  • Frequent changes of position are natural and healthy. At work, try to take regular breaks and set up your office so that you have to get up to file or answer the phone.
  • When lifting heavy objects, use your legs as much as possible. If you need to bend forward, don't bend at the waist. Fold forward from the hips without allowing your lower back to round. Try to maintain a normal curvature in the lower and upper spine and avoid twisting and bending simultaneously, as this is a common mechanism of back injury.
  • Wear the right shoes. Narrow-toed shoes lead to tension in the legs and back. High heels shorten the calf muscles and hamstrings and can contribute to back strain.
  • Topical creams containing capsaicin or arnica and liniments based on methyl-salicylate, menthol, and camphor are soothing and very safe.
  • Many people find applications of ice helpful and, once the injury is starting to heal, switch to moist heat, either alone or alternating with ice. Heat can also be useful to reduce stiffness before attempting to exercise.
  • Willow bark tea (which contains the active ingredient of aspirin) may be useful.
  • If your pain is severe and does not respond to over-the-counter or prescription anti-inflammatory pain relievers, ask your doctor about prescribing opioids. They are generally more effective and safer than many other pain medications, but due to exaggerated fear of addiction, they aren't used as often as they ought to be.
  • The evidence on acupuncture for back pain is mixed, but it is very safe and worth considering.
  • Hands-on bodywork approaches, such as chiropractic, physical therapy, therapeutic massage, and osteopathy can help you through a flare-up of back pain (though not all osteopaths do spinal manipulation, so ask before making an appointment).
  • Judith finds many people with back pain get better results if they combine their yoga with bodywork such as myofascial release designed to iron out the kinks in muscles and connective tissue, and free up scar tissue and other residuals of past injuries.
(Judith Hanson Lasater calls herself a yoga teacher who also happens to be a physical therapist. She also holds a doctorate in East-West psychology, and is the author of six books on yoga, including Relax and Renew: Restful Yoga for Stressful Times, on the practice and therapeutic aspects of restorative yoga. She teaches in the San Francisco Bay Area and worldwide.
  • Judith has found the Alexander Technique, which stresses postural education, particularly effective for back problems, both as prevention and treatment.
Source from Yoga as Medicine by Timothy McCall, M.D.

Examples of bad posture and back support:

The following are examples of common behavior and poor ergonomics that need correction to attain good posture and back support:
  • Slouching with the shoulders hunched forward
  • Lordosis (also called "swayback"), which is too large of an inward curve in the lower back
  • Carrying something heavy on one side of the body
  • Cradling a phone receiver between the neck and shoulder
  • Wearing high-heeled shoes or clothes that are too tight
  • Keeping the head held too high or looking down too much
  • Sleeping with a mattress or pillow that doesn't provide proper back support, or in a position that compromises posture

Examples of bad posture while sitting in an office chair

The following bad habits are especially common when sitting in an office chair for long periods of time.
  • Slumping forward while sitting in an office chair
  • Not making use of the office chair’s lumbar back support
  • Sliding forward on the seat of the office chair

Guidelines to Improve Posture

Sitting posture for office chairs
  • Be sure the back is aligned against the back of the office chair. Avoid slouching or leaning forward, especially when tired from sitting in the office chair for long periods
  • For long term sitting, such as in an office chair, be sure the chair is ergonomically designed to properly support the back and that it is a custom fit
  • When sitting on an office chair at a desk, arms should be flexed at a 75 to 90 degree angle at the elbows. If this is not the case, the office chair should be adjusted accordingly
  • Knees should be even with the hips, or slightly higher when sitting in the office chair
  • Keep both feet flat on the floor. If there's a problem with feet reaching the floor comfortably, a footrest can be used along with the office chair
  • Sit in the office chair with shoulders straight
  • Don't sit in one place for too long, even in ergonomic office chairs that have good back support. Get up and walk around and stretch as needed
Standing posture
  • Stand with weight mostly on the balls of the feet, not with weight on the heels
  • Keep feet slightly apart, about shoulder-width
  • Let arms hang naturally down the sides of the body
  • Avoid locking the knees
  • Tuck the chin in a little to keep the head level
  • Be sure the head is square on top of the neck and spine, not pushed out forward
  • Stand straight and tall, with shoulders upright
  • If standing for a long period of time, shift weight from one foot to the other, or rock from heels to toes.
  • Stand against a wall with shoulders and bottom touching wall. In this position, the back of the head should also touch the wall - if it does not, the head is carried to far forward (anterior head carriage).
Walking posture
  • Keep the head up and eyes looking straight ahead
  • Avoid pushing the head forward
  • Keep shoulders properly aligned with the rest of the body
Driving posture
  • Sit with the back firmly against the seat for proper back support
  • The seat should be a proper distance from the pedals and steering wheel to avoid leaning forward or reaching
  • The headrest should support the middle of the head to keep it upright. Tilt the headrest forward if possible to make sure that the head-to-headrest distance is not more than four inches.
Posture and ergonomics while lifting and carrying
  • Always bend at the knees, not the waist
  • Use the large leg and stomach muscles for lifting, not the lower back
  • If necessary, get a supportive belt to help maintain good posture while lifting
  • When carrying what a heavy or large object, keep it close to the chest
  • If carrying something with one arm, switch arms frequently
  • When carrying a backpack or purse, keep it as light as possible, and balance the weight on both sides as much as possible, or alternate from side to side
  • When carrying a backpack, avoid leaning forward or rounding the shoulders. If the weight feels like too much, consider using a rolling backpack with wheels.
Sleeping posture with mattresses and pillows
  • A relatively firm mattress is generally best for proper back support, although individual preference is very important
  • Sleeping on the side or back is usually more comfortable for the back than sleeping on the stomach
  • Use a pillow to provide proper support and alignment for the head and shoulders
  • Consider putting a rolled-up towel under the neck and a pillow under the knees to better support the spine
  • If sleeping on the side, a relatively flat pillow placed between the legs will help keep the spine aligned and straight.
It is important to note that an overall cause of bad posture is tense muscles, which will pull the body out of alignment. There are a number of specific exercises that will help stretch and relax the major back muscles. Some people find that meditation or other forms of mental relaxation are effective in helping relax the back muscles. And many people find treatments and activities such as massage therapy, yoga, tai chi or other regular exercise routines, or treatments such as chiropractic or osteopathic manipulation, etc. to be helpful with both muscle relaxation and posture awareness and improvement.

Source from Dr. David Tio