Treat your own back

Sleeping

Postural Advice:

The human body does not like its moveable (parts) joints to be kept at end range for long periods of time. Examples would be how sore the neck becomes after painting a ceiling. To do this requires keeping your neck in full extension for too long. The chances of people, who habitually sleep face down, getting neck problems including headaches, are very high. This is because the head is kept fully rotated to allow them to breath. Professional gardeners who spend day after day fully bent over, dealing with plants, can end up with sore degenerative back joints. Sitting daily at a desk with the neck in full flexion can result in degenerative lower neck joints. When older and entertaining guests, do not sit beside them too long with your head turned towards them. Sit opposite and you will not be troubled. I could go on and on….

The Lower Back

Many people with lower back complaints have problems in bed. When you have pain in bed at night the cause can be due to a chemical or mechanical process.

Chemical pain is felt when there is some inflammation irritating nerves and causing pain. Examples would be arthritis or appendicitis. Some chemical pains can be treated with drugs, acupuncture, forms of heat or ice etc.

Mechanical is easier to understand. Examples would be a dislocated joint that has to be physically put back. A torn piece of gristle (meniscus) in the knee mechanically interfering with movement, or a disc in the spine bulging and pressing on a nerve is two further examples. Mechanical pain can be dealt with using surgery or some form of manual therapy e.g. manipulation.

Fig1 – "Try sleep with a small soft pad under your waist."

When pain in bed is of mechanical origin there are several things you can try to see if they resolve the problem. The following suggestions must be beneficial. If they increase your pain or discomfort then do not use them.

1. The mattress. Is it firm enough? Lying on a sagging surface for any length of time can most certainly cause back pain. These days there are such a lot of excellent mattresses on the market and one should check these out. Some companies will often let you trial one of their products for a night or two. Take advantage of such a service and see if it makes a difference.
   
   
2. If you always sleep on the same side, as many of us do, try sleeping on the other side. Initially it may mean a few restless nights until you get used to it.
   
   
3. When you lie on your side your waist tends to sag downwards because your hips and shoulders are much wider. Try sleeping with a small soft pad under your waist. This has proved useful with many patients. See Fig 1
   
   
4. The safest way to sleep if you get night pain is to lie on your back with a very small pad under the curve in your lower back to maintain the curve. An alternative when lying on your back is to place two or three soft pillows under your knees. See Fig 2 & 3
   
   
   Fig 2 "Pad under curve in lower back"
   
   
   Fig 3 "Two or three pillows under knees"
   
   
5. If you get pain down the leg in bed, try lying on the good side with the knees and hips at right angles. Now place under your feet at least two pillows to tilt your spine to the painful side. Try not to rotate your shoulders. If this pillow positioning increased the pain the technique is not for you. However it often takes many minutes lying in this way for the leg pain to subside. See Fig 4.
   
   
   Fig 4 "Place two pillows under your feet"

Sitting

Postural advice

Sitting is a big problem for those with spinal disorders. We are all encouraged to sit up straight and maintain the curve in the lower back (lumbar spine). When we do this our head and neck can be straight and not jutting forward. Lumbar supports are built into many chairs, car and plane seats etc. Many types of portable lumbar supports are on the market.

The best advice that anyone could give of course, is never sit for too long. If your job involves sitting, get up frequently and stretch out. When watching TV, every time the advertisements come on, stand up and walk around the room.

The added advice I give my patients is to 'ensure that the knees are lower than the hips when sitting'. Most cars, for instance, position the hips below the knees, which can make a lumbar support ineffective. It makes long car journeys an ordeal for back pain sufferers. Inspect the lateral profile of your car seat? See Fig 1. Lounge chairs etc. are guilty of doing this.

Fig 1 "Inspect your car seat"

The simplest way to get a better sitting posture is to fold a bed pillow in
half lengthwise and place it on the back half of the chair's seat. See Fig 2

Now sit on the chair ensuring that the sitting bones are comfortably settled on the folded pillow. Immediately, the hips are now higher than the knees and the posture is improved.

You should not feel that you are rolling forward on the pillow. See Fig 3.

Fig 2 "Place folded bed pillow on chair's seat"

A lumbar roll, if also needed, will now be more effective. Place a pillow thus folded on a dining chair at night and sit on this when watching TV. When seated properly the neck posture is also taken care of. If you sit before a computer, take a pillow to work and sit on it as described. The taller you are the greater the problem becomes when the height of the chair cannot be altered. For tall individuals, even with a folded pillow, the knees will be higher than the hips. A folded pillow may be too wide for an easy chair with the sides built in. Choose another chair.

When sitting, a folded pillow should be tried if you have a sore tail-bone (coccyx). It is often called coccydynia. This condition can persist for several weeks and sitting is always a problem. Most of my patients have found the use of a folded pillow on the chair as described above very satisfactory.

Fig 3 "Not feel you are rolling forward"

Another way of sitting with knees below the hips is to sit astride the chair with feet tucked back. See Fig 4.

Not an elegant idea for the fashion conscious woman wearing a mini skirt.

There are of course chairs of the kneeler type. These are great for the back in that knees are below hips but can prove to be uncomfortable on the knees. The other point is that it is always nice to have something to lean back against and this is not the case with the knee chair.

Fig 4 "Tuck feet back"

That computer screen really 'is a pain'. It draws our heads forward like a magnet and the end result, with regular computer usage, is upper back and neck pain and even headaches. See Fig 5.

To stop this, I ask patients when sitting before a computer or TV screen to do the following …..

Firstly, sit on a pillow as described and minimally tuck in or lower the chin. Now be aware of the distance from the chin to the front of the neck and ensure that this distance does not change when staring at the screen. The head will not now be poking forward. Ensure of course, that the centre of the screen is just below eye level.

Fig 5 "Regular computer usage"

On rare occasions you will meet patients who are pain free when 'sitting badly', so be it. If the advice given does not make an immediate change for the better, ignore it.

Most people working over a desk bend their lumbar spines, which can lead to problems. See Fig 6. I give further advice to the patient who is using a flat desk's surface for reading, studying or writing.

In addition to using a folded pillow always flex over the desk by bending at the hips. For a change instead of sitting on the folded pillow when over a desk, come forward on the chair and flex your knees so that the feet are under the chair. See Fig 7. This keeps the back and neck straight.

Fig 6 ""Working over a desk"

If your lower back does not have its natural curve backwards it is virtually impossible to keep your head in a sensible posture. Ideal for those who are desk bound is to have an upward sloping surface to work on. See Fig 8.

Fig 7 "Keeps back and neck straight"

Sometimes back pain with sitting comes from a sacro-iliac joint. If this is the case, fold a small guest towel and place it under your buttock on the good side. When indicated your pain with sitting will stop as it reduces the pressure on the side of pain.

Fig 8 ""Working at a desk"