Back of beyond
Lower back pain (LBP) is a common problem in both the civilian world and the ADF. FLTLT Scott de Havilland looks at what you can do to reduce and prevent LBP.

Maintain Correct posture

1. Sitting

You maintain your lower back curve, which is concave, by sitting straight in your chair. Avoid slumping back in the chair or leaning forward. If working at a desk, it is recommended that you break from sitting for at least five minutes every half-hour or 10 minutes every hour to complete another non-sitting task. During long trips; break from sitting at least 10 minutes every two hours. Stretching exercises are a great idea for those who work at a desk; see your physiotherapist for exercises to suit you.

2. Lifting

Always keep the load close to you and do not twist when lifting. Use your legs to lift and lower, not your back. Finally, ensure you have a good base of support with your feet about shoulder width apart.

Standing

Essentially, you need to stand tall yet relaxed. You should avoid sustained standing positions particularly when leaning over workbenches or vehicle engines. Vary what you do if your work involves standing and seek advice from your physiotherapist if needed.

Sleeping

Sleeping may seem a very harmless activity, however it can adversely affect your lower back if you do not use the correct mattress. The mattress and pillow need to be firm enough to support your spine in its natural position or natural curves. Commonly, very soft or sagging old mattresses can lead to back pain. Similarly, very soft water beds inadequately filled with water can initiate back pain.

About 70 to 80 per cent of us will experience at least one episode of LBP in our lives. For the majority of us, this back pain will resolve itself within six weeks. Unfortunately, for a small number of us this back pain will not be remedied despite the use of several treatment options.

The ongoing or chronic back pain may be mild, moderate or severe. Severe chronic back pain can result in an inability to adequately perform your work duties and also affect your home life.

It is essential that we try to prevent the problem of back pain by understanding the causes.

What does a back consist of?
THE spine is very complex. Essentially it is made of bones known as vertebrae with a disc for shock absorption between the vertebrae.

Associated with each vertebra are two small joints known as facet joints that assist in guiding the movement of the spine. Holding the bones together are ligaments with further support coming from nearby back and abdominal muscles.

What causes back pain?
BECAUSE the spine is very complex, there are many things that can cause pain.

Soft tissues such as discs, ligaments and muscles can be injured. A strain to a muscle or ligament may result from incorrect lifting. Poor sitting posture may cause injury to a disc.

Harder tissues such as bones and joint cartilage can degenerate as a result of arthritis. For both medical officers and physiotherapists it is often not possible to make an exact diagnosis despite a patient’s wishes, however treatment is still able to proceed.

Currently it is believed that discs and facet joints are the most common cause of back pain. Contrary to popular belief, you cannot “put your back out” or “slip a disc”.

Discs are held firmly in place, though they may tear or degenerate with wear and age.

Who is at risk of LBP?
WE are all at risk of back pain. Those at greater risk include people who do not lift correctly, people who sit or stand with poor posture for long periods of time, people who are unfit and those who are overweight.

How to do back exercise
THERE is good evidence to support the effectiveness of exercise in reducing LBP severity and leave from work due to LBP. Exercise first includes cardiovascular fitness work such as swimming, exercise bike or walking.

Which fitness activity you choose will depend on many factors. Seek advice from your medical officer, physiotherapist or PTI if you are unsure about where to begin.

Secondly, flexibility exercises for the back are needed to maintain spinal mobility. Speak with your physiotherapist or PTI for guidance on which exercises are suitable for you.

Thirdly, muscular strength of both lower back and abdominal muscles will provide support and stability for your spine, sometimes known as core stability. The exercises required for core stability are very specialised and require instruction from a physiotherapist.

What do I do if I have injured my back?
IMPORTANTLY, seek advice or treatment as soon as possible as this can dramatically reduce recovery time. Generally, the longer you leave a back injury the more difficult it is to treat.

It is very important to rest from aggravating activities and see your medical officer as your pain may require medication.

Gradually increase your activity as pain allows. Finally, by seeing a physiotherapist you will be given exercises to help prevent re-injury.

Conclusion
BACK pain can seriously interfere with your ability to work and your life at home. To look after your back remember the following four points:

• maintain correct sitting, standing, lifting and sleeping postures;
• improve cardiovascular fitness;
• ensure flexibility of the spine; and
• improve the strength of both back and abdominal muscles.

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