Back Problems

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Back problems afflict a large percentage of the population, more so nowadays than previously, because of the long hours spent sitting at computers and slumping in front of the TV.

Activity maintains flexibility in muscles and joints, while remaining sedentary for many hours every day leads to stiffness in joints and weakness in the supporting muscles of the spine.

Poor office ergonomics only add to the problem. Below, is an example of an ergonomically correct workstation.

Note the following:-

• The person in the picture is sitting against the back support of the chair
• The chair is pulled well into the desk
• The elbows are supported at right angles
• The wrists are supported
• The screen is at eye-height
• A document holder is being used so that the person doesn’t need to look down at the document from which he is working

Unless the chair is supporting the spine, the tendency is to slump. Studies show that the longest period for which people sitting unsupported, will sit up straight, is 10 minutes.

Slumping strains ligaments and puts undue pressure onto the fronts of the discs, which can then bulge backwards against the spinal cord and nerves

Facet joint pain

Jammed facet joint
The movement in the spine is a combination of the bones rocking on the discs, and small joints (facet joints) which lie on either side of the disc moving to share the load.

Sometimes, when the spine loses some of its flexibility, one of these joints can become stuck in a jammed up position, or slip slightly into an awkward position  before becoming jammed.

If a facet joint has slipped before jamming, there is a risk of it slipping further and becoming unstable, so back muscles go into spasm, and movement becomes difficult and painful.

Degeneration
As we age, our joints show signs of wear and tear. The joints in the spine are no exception, and they and the discs gradually degenerate as the years pass.
 As the discs degenerate they become drier and thinner, with less fluid inside (smoking, incidentally, is now known to accelerate this process), and the cartilage covering the joints becomes thinner.
This thinning of discs and cartilage leads to roughening of bone around the joints and the formation of bony spikes (osteophytes) which may reduce the size of openings through which nerves emerge, causing nerve root irritation and pain.

How would I know if I had a slipped disc, jammed or unstable facet joint, or simply postural pain?
Your physiotherapist will assess you and identify the source of your pain, but below, are some tell-tale signs to help you to identify what kind of back problem you may have.

Postural pain
This tends to be common in people who are in sedentary occupations or who habitually slump and have poor posture. Slumping and poor posture overstretches ligaments, which are sensitive structures and register pain if subjected to a prolonged stretching force. As we age, this can become more of a problem, as degenerative changes reduce spinal flexibility and posture deteriorates further.
                                     

Characteristics:

• Aching in the back relieved by altering posture and sitting or standing correctly
• Pain develops gradually, no sudden incident leading to pain
• Pain does not usually disturb sleep
• Absence of pain radiating into arms and legs
• No tingling or numbness in arms or legs
• Stretching and postural exercises relieve pain
• Massage temporarily relieves pain
• Hot baths or showers temporarily relieve pain

Jammed or unstable facet joint
Characteristics:

• Sudden onset of severe pain
• Pain worse on standing and walking (sometimes impossible to walk)
• Feeling of legs “giving way”/ instability in back
• Pain easier when sitting
• Pain worse on movement. Can be severe stabbing pain and muscle spasms even with only slight movement
• Pain on turning over in bed
• Can be pain radiating out from spine into the leg
• Spine may be shifted to one side and difficult or impossible to straighten without severe stabbing pain

Herniated (slipped) disc
A disc can herniate gradually or suddenly. A gradually progressing disc herniation (slipped disc) may be caused simply by sitting for prolonged periods in a slumped position. Alternatively, a disc herniation can occur suddenly, with no warning from simply bending forwards or lifting an object incorrectly.

Pressure on the front of the disc forces the gel (nucleus pulposus) inside the disc backwards, forming a bulge which presses on the spinal cord and nerve roots. The term “slipped disc” is very misleading, as the disc is attached to the bones above and below, and cannot slip. It is the gel inside the disc which causes the problem.
           

Discs can herniate in any part of the spine, but are most common in the lower back and in the neck. When the disc presses on a nerve root, it can cause pain to radiate along the arm or round the shoulder blade, if coming from the neck, or down the leg if coming from the lower back (sciatica

Characteristics:

• Sudden painful “tearing” sensation across back on bending forwards (with or without a twisting motion), followed by back muscles tightening and difficulty in straightening up. Or gradual insidious onset of low back pain, worsening steadily with prolonged sitting
• Pain worse while sitting, and eased by walking around
• Pain and stiffness on standing, after prolonged sitting
• Pain may radiate down one leg with no back pain (sciatica)
• May be a combination of back and leg pain
• Pain may be localized across back
• Back may be shifted to one side, with difficulty in straightening up
• Pain may disturb sleep
• Sleeping usually most comfortable lying on side opposite to pain, or on the back with 2-3 pillows under the knees
• May be tingling and/or numbness in leg, with or without pain (sciatica)

How do I prevent back problems from occurring?
Strength, flexibility and good postural awareness are the key to the prevention of back problems.

• Don’t slump! Always sit with good back support both at work and at home
• Good office ergonomics
• A regular routine of stretching and strengthening exercises. The stretching could be in the form of Yoga, and the strengthening could be in the form of Pilates or Tai Chi, both of which strengthen the core stabilizing muscles protecting the spine
• Correct lifting and carrying techniques