Healthy People

Back Care Awareness Week: What you asked Jan Vickery, our back care expert on Monday 17 October

October 18, 2011 at 7:52 am

From a niggling ache that develops during your working day, to a long-term pain from a sports injury – back pain is something that can affect us in many different ways. And with an estimated 80% of adults expected to experience back pain at some point in their life, it’s an issue that many of us will probably want to know more about.

So to shed some light on the treatment and prevention of back pain, we asked our expert Jan Vickery, Lead Physiotherapist at AXA ICAS, to answer your questions on the subject – in a live health discussion, which coincided with the start of Back Care Awareness Week.

The chat began at 10am on the 17 of October, a massive 34 questions were asked on everything from back care exercises, to the finding right type of mattress for a pain-free night’s sleep. Thanks to everyone who took part! Find out what participants asked (and read Jan’s answers) below.

And if you’ve got another question – don’t worry! Jan will be back to continue the discussion with another live health chat on Wednesday 19 October. Simply join in between 10am and 12pm or 2pm and 4pm on the day, or just drop us a question in the comments below, for Jan to answer on the day.

Back care health chat with Jan Vickery – 17 September 2011

szlyons88: Hi there, I was just wondering if you had any tips for correcting posture? I have noticed that I slouch over quite a lot when walking or sitting at my desk. I’d like to fix this before it gets painful.

Jan_Vickery: Hi szlyons88 It’s great that you are aware of your posture and want to make sure its good. Bad posture is how many back problems begin so it’s good to sort it out before it turns into a bigger problem. Firstly it’s important to know what good posture is – you should aim for an s-shaped spine. The most important thing is to ensure that your lower back is slightly arched and your chin well tucked in, not poking forward – the opposite of a “c-shaped” slouch. When walking, keep your shoulders back (but not too much) and at the same time keep your tummy pulled in. When sitting the critical thing is to make sure your lower back is arched and supported. This means that your office chair should be well adjusted to support you in a good posture and be comfortable. It’s difficult to remember to sit in a good posture while you are concentrating on work, so make your chair do the work for you!

Captian_Cosmic: I have terrible back trouble but it seems there is nothing that can be done aside from put Voltorol on it, or at least that is all Physios and Osteopaths tell me to do.  Do you have any other suggestions?

Jan_Vickery: Hi Captian_Cosmic It sounds like your back is still troubling you. I would recommend that you see a physio who specialises in managing longstanding back pain (called chronic back pain) as they will have a slightly different approach and help you to manage your back trouble in a more effective way. How they would go about this will depend on your particular case. It worth phoning up a physio practice before you book an appointment to ask if they have someone who has specialised in this field. Good luck.

fiona1: Hi Jan, I often have back pain when I wake up in the morning, so I’m looking to buy a new mattress. What sort of thing should I be looking for?

Jan_Vickery: Hi fiona1 That’s a short question with a long answer! Most mattresses are only designed to last about 7 years. You should aim to find something that allows you to relax into a good posture (s-shaped spine) – it should be not too firm nor too soft (there’s probably a good Goldilocks and the three bears analogy there somewhere). The first thing is to try lots of different mattresses before you buy them. You want the bony parts of your body to sink in slightly and be comfortably supported but something too soft is likely to lead to poor sleeping postures.  You should also think of other aspects like how easy it is to roll over, getting onto and off the mattress (what base will it be on) and what ventilation would be like. Tempur foam (memory foam) beds can be very hot to sleep on. Also take a look at your pillows. Again, aim to keep a good spinal posture – ideal pillow height will depend on what position/s you sleep in.

mcdroid: Hello Jan – like many office workers, I spend a large amount of time during the day sitting at a computer screen, which can get rather uncomfortable at times. Can you recommend any simple exercises that I could do to ‘stretch’ my back during the day? Thanks

Jan_Vickery: Hi mcdroid Firstly, try to avoid long periods of sitting. Aim to be a fidget! The most difficult thing about “breaking” and changing posture for office workers is remembering. The best chance you have of winning this challenge is to “design them in”. This will depend on the nature and setting of your work. Perhaps use a printer that is a short walk away if you only print intermittently, do the coffee run, drink lots of water (no one can ignore the need for a comfort break) or walk over to colleagues rather than phoning or emailing. Breaking and changing posture keeps you more productive so its in your employer’s interests to take regular breaks. The general rule of thumb for intensive computer work is to break for 5-10 mins every hour. From a postural perspective, the best is to do something that changes your posture every 20 minutes or so. This needn’t mean a formal break away from your desk – it could be standing up whilst you chat on the phone or do some exercises, as you suggest. one of the best exercises is: scoot forward on your chair, place you hands in your lower back and bend your spine backwards over them. Repeat 10 times. There are lots of other different exercises that can be done. A well known exercise programme for computer users to do whilst at their desk is “Pause Gymnastik” – if you Google the term you will find many various sources. If you have a specific back problem it’s probably worth seeing a clinical practitioner to put something together especially for you.

223607: Hi, I get a sore back when sitting in lectures and was wondering if there is a better way to sit to prevent this from happening?

Jan_Vickery: Hi 223607. The most important thing is to get the arch in your lower back supported. This will encourage your spine into an s-shaped posture. Lecture halls have notoriously bad seating so you may need to improvise in order to improve what’s on offer! Use a rolled up towel (or even a rolled up jumper), or you could carry around a lightweight lumber roll – available from most pharmacies. See my previous post about exercises to do whilst seated to help prevent an achy back.

PM1: A car drove into mine on Saturday albeit at slow speed as we were all in a queue.  My neck and my back and arms are sore today – is there anything I can do to help this developing into a more serious problem?  I had a similar problem a few years ago, albeit more damage was done to my car and suffered for about two years and had to have several steroid injections in my neck, shoulders and back.  Should I go and see a physio now?

Jan_Vickery: Hi PM1 Sorry to hear about that.  It’s probably worth at least speaking to a clinical practitioner in a bit more detail in the first instance. They can either give you verbal advice or see you for further assessment if that turns out to be necessary. In the meantime, it’s really important that you keep moving. Any form of heat (hot bath or shower etc) is likely to improve your comfort. If you have difficulty in moving or if you start to experience unacceptable levels of pain or if you notice any pins and needles or numbness then you should see a physio so that they can help you to get things back to normal as quickly as possible.

stuarty987: Are there any exercises you can recommend to reduce the chances of developing back pain?

Jan_Vickery: Hi stuarty987 Aaah, now we’re talking. Prevention – that’s what its all about! Briefly: 1. Keep active. 2. Watch your posture (especially at work or during habitual activities/hobbies) by aiming for an s-shaped spine whenever possible and by avoiding long periods of staying in the same posture. 3. With respect to specific exercises – that would depend a little on whether you had any back problems (like pain or stiffness) and what your back postures and movements mostly are. In general, any pain free exercise is going to be helpful to your health.

Joanne_Ferris: My 26 year old daughter has excruciating lower back pain she think is related to lifting crates of wine at a restaurant where she does part time work while doing her PHD. She has been in bed for two days now and finds it difficult to move. This is most unlike her as she is always one to soldier on regardless. She’s using pain killers and heat but at what position should she get help, as I have suggested this on deaf ears and she is in Liverpool so it’s too far to get to see her first hand?

Jan_Vickery: Hi Joanne_Ferris I’m sorry to hear about your daughter – it must be frustrating that you can’t do anything to help her. The advice for back pain is always to try to keep moving and to avoid bed rest. If she is having difficulty in moving then she should see a clinical practitioner as soon as possible to help her. Movement might sound like the worst thing to her right now but a physio would firstly rule out anything worrying and then help her find the best movements and postures that will relieve her discomfort and get her back to normal as quickly as possible. The vast majority of back trouble is nothing to worry about.

Luisa: Hi, I’m currently 6 months pregnant and finding that I’m starting to suffer with low back pain which stops me getting a decent night’s sleep and causes a lot of discomfort when standing up.  Can you suggest any exercises etc. that may help prevent or ease the pain?  Many thanks

Jan_Vickery: Congratulations Luisa. You may know back pain is pregnancy is not uncommon. Pregnancy causes your joints to become a bit more flexible in the Sacro-Iliac joints (where you back joins your pelvis) – this is to allow your pelvis to open up a bit more as you move towards the birth. This increased flexibility, in addition to increased loading and all the normal demands of life can result in back discomfort. Some expectant ladies find it helpful to wear a re-enforcing belt to add support to their joint. You could try tying an inelastic belt like a dressing gown belt around your hips and under your bump. You can get specific maternity belts from pharmacies. Some expectant mums find that it helps to sleep with pillows in between their knees or around their bump to keep the spine in a more neutral posture. Some find pelvic tilts helpful (lie on your back, with your knees bent up and “tuck in your tail” by pulling the front of your hip bones towards your chest). If you find your back pain too much to cope with you should seek more specific advice from a clinical practitioner. Remember, pregnant people are not immune from all the normal aches and pains that could have happened when they were not pregnant!

zoonie: What is bone cement?

Jan_Vickery: Hi zoonie Bone cement is usually used in joint replacement surgery to anchor in artificial joints.

TobyML: Hi, Every so often, the muscles in my back tighten up, just to the left of my spine – I work at a computer all day – is this related? It’s not all the time but often enough to wonder what might be happening.

Jan_Vickery: It’s difficult to comment on whether your left back pain is related to work. However, if you are sitting at a computer all day then this is definitely relevant to your discomfort. Make sure that you are sitting with an s-shaped spine and are well supported by your chair. Also, make sure that you are not twisted whilst working – your screen and keyboard should be directly in front of you and you should not be over-reaching for your mouse. Remember to change your posture often!

beth_p: Hi, my boyfriend has recently had an exercise related back injury – 2 slipped discs. This was in June/July this year. He would like to get back into exercise but isn’t sure how much he can do or what exercises can strengthen his core and back. Any advice would be greatly appreciated

Jan_Vickery: Hello beth_p There is no reason for your boyfriend to hold back from returning to exercise sensibly – start slowly and build up. If he enjoyed what he did before, it would make sense to aim to return to that (although this would depend a little on what exercise he was doing before…). Most forms of exercise will use the core muscles to some extent but probably the most specific exercise form is Pilates. This has worked wonders for many people with back discomfort as it focuses on the core muscles that stabilise the spine.

Dowager_Counte: I am concerned about my posture which I know tends to be round shouldered, but I cannot go around all the time with a straight back as it is uncomfortable. Any tips for a more natural way to improve?

Jan_Vickery: Hi Dowager_Counte Yes, it is hard to remember one’s posture all the time! Try to make it easier by building in other influences. For example, when sitting make sure the chair encourages a good posture so that you don’t have to think about it. If you are on a sofa, use a cushion in the small of your back. Some forms of exercise like swimming backstroke, yoga, Pilates and Alexander technique may also help to improve slouched forward shoulders. Remember to aim for the arch in your lower back – this makes it much easier to un-slouch your shoulders.

A question from one of our blog readers, Frank Dyson: I have pain in lower back & pins and needles in left & right leg when walking. Sitting or laying down for 15 to 20 minutes relieves it and can then walk for another 600 to 800 yards before pain returns. Pain killers have little to no effect.

Jan_Vickery: Hi Frank Its worth seeing a physio to have them assess you. They will want to figure out what’s causing your pins and needles and whether it’s coming from your back. There will probably be 2 elements to your assessment: asking you questions and then examining you. They will speak to you about what they think is causing the trouble and then give you advice and treatment according to their findings. It’s not unusual to have pins and needles linked with back pain – because nerves can irritated where they leave the spine. But it’s important to have pins and needles looked into.

jessica: Hello…what do you know about having nerves burned in L3L4. Is there a good success rate?

Jan_Vickery: Hi Jessica The evidence around this is scant. It certainly isn’t a mainstream treatment and would not be indicated in the vast majority of cases.

NickB: Hi Jan, I often receive pain along the top of my back and up into my neck. I was advised that a reason for this could that my shoulder/neck muscles aren’t as strong as they could be. Could you recommend any types of exercise to strengthen these muscles or do you think it is possible this is the completely wrong diagnosis? Thanks

Jan_Vickery: Hi NickB The explanation sounds feasible but it’s difficult to comment without further assessment. I would want to know which muscles need strengthening (and there are likely to be some that need stretching too). From there you could put together an exercise programme.

Chris: Hi Jan. My wife had a discectomy 10 days ago and still has some numbness in her foot. Is this normal? Also she has received very little information so far, on what she can and can’t do, apart from being told not to sit for 3 weeks, only stand or lie. She has a follow up appt in 3 weeks with the consultant. I just wondered if you had any advice please. Also, she is getting pins and needles in her fingers and toes during the night, which prevents her from sleeping?

Jan_Vickery: Hi Chris Things can take a while to settle after surgery. If you are worried you should contact the hospital. If your wife’s sleep is being affected i suggest following up with the hospital. It’s really important to get good sleep.

EmsGlasgow: Hi Jan, I tend to get pains above my right shoulder blade when sitting at my desk, whilst I’m sure this has to do with my posture more than anything else, are there any exercises that I could be doing to help prevent this?

Jan_Vickery: Hi EmsGlasgow Firstly, try to address your posture. If you are right handed, check that you are not over-reaching for your mouse. Also check that you are not twisted when working – make sure that your screen and keyboard are straight on. And make sure that you never cradle your telephone handset between your ear and your shoulder. It’s difficult to give specific exercises without looking at you in more detail. You could try: with your arms by your side and your elbows at right angles, push your elbows down towards the floor. Hold for 20-30 secs. This can be effective at “unloading” the area you are talking about. (Obviously don’t keep doing if it increases your discomfort.

sammy: Is there any correlation between the length of your back and the likelihood of getting back pain? Also – can the number of vertebrae differ between individuals?

Jan_Vickery: Hi sammy No I am not aware of any research linking length of back with back pain. Most people have the same number of vertebrae. There are 24 vertebrae (7 neck, 12 thoracic and 5 lumber) that have joints between them which allow movement and 9 fused vertebrae in the sacrum and the coccyx. Some people have an extra vertebra or one less vertebra. This is present from birth and is less common in the neck region. Vertebra can also have different shapes in some people. Different numbers and shapes of vertebra is often not clinically significant as it doesn’t cause problems.

yash.joshi@bti: I suffer from prolapsed disc condition for a number of years. Lately as long as I am careful, I seem to manage my pain with occasional use of dicofenic tablets. My question is that I have noted my private intimate relationship change in so much that I cannot last long enough to satisfy her. Any tips?

Jan_Vickery: Hello yash.joshi@bti I am pleased to hear that you are managing your back well. I suggest seeing your GP about your other problem as there may be different causes and may not be related to your back.

A question from one of our blog readers, Mo: Both sides of pelvis are down and right side has anterior tilt. Left shoulder has also dropped slightly. Using orthotics which are very useful as this condition is very painful but need exercise regime to stabilize and strengthen. Unable to hold core muscles to do Pilates exercises properly. Any advice/exercises would be most welcome.

Jan_Vickery: Hi Mo I would suggest that you see a physio for further assessment – it’s difficult to comment without seeing how your posture has been affected. My advice would be different depending on whether your posture is mildly affected or more significantly.  It’s great that you are doing exercise, perhaps some targeted strengthening exercise would be helpful to get you to the point of being able to participate in Pilates independently. Good luck. It’s great that you are being proactive in managing things through exercise.

A question from one of our blog readers, Bobby_Boy1: Hi Jan. About 10 years ago I was doing some gardening and went to pick up a heavy bag. I did everything wrong posture-wise and felt something snap in my lower back, followed by extreme pain. I visited a consultant orthapaedic surgeon and, following x-rays and MRI scan, he told me that my #1 disc was disintegrating and there was nothing that could be done. I continue to have back pain on and off and to this day. I wondered, has there been any advancement in this field and is it worth having my back checked again?

Jan_Vickery: Hi Bobby_Boy1 Yes, things have moved forward a lot in the last 10 years – evidence is now even more supportive of avoiding surgery than 10 years ago. The emphasis now is on helping people to manage their own back themselves. You have probably figured out a lot of this yourself over the last 10 years. But it might be useful to see a specialised back pain physio as there is plenty of good evidence around effective strategies. They would be able to give you specific advice based on your specific case.

rossiscurious: Hi Jan. I was wondering… I regularly commute from Glasgow to Aberdeen and find that whenever I get out the car, my back is sore for a couple of hours. Then sometimes at night I can get sharp pains almost like cramp in my back. Is there anything i can do? I have tried all manner of seat attachments and such.

Jan_Vickery: hi rossiscurious Driving for more than 4 hours a day is linked to increased back pain. You should take regular breaks during long commutes and ideally do some exercises. It’s also important to check that your car seat has been adjusted correctly. if you struggle with this, it may be worth getting a vehicle assessment from a physiotherapist who has specialised in this. There is some great advice available from www.drivingergonomics.com

fiona1: Hi again Jan, I just wanted to check what you thought about exercising with back pain? I’ve been getting pain in my lower back – nothing too severe, but I still continue going to my regular exercise classes whenever it happens. Is this healthy? Or should I be avoiding exercise when this happens?

Jan_Vickery: Hi Fiona It sounds like continuing with exercise is not making things any worse so I would be in favour of continuing. I’m not sure what type of class you are going to but it would be worth asking the instructor to take a look at your posture during the class. It also might be worth doing some targeted exercise for you back – depending on what needs strengthening and stretching so it might be worth having a session with a physio to put something together for you.

A question from one of our blog readers, Chris Hough: My 12 year old daughter has been diagnosed with Scoliosis and we have been informed she will need to have an operation to correct the curve in her spine. The curve is about 45%. I don’t like the idea of an operation, is there anything else that can help with this please?

Jan_Vickery: Hi Chris I am sure that the advice regarding surgery for your daughter would not have been made without carefully considering the need for it. Nowadays, guidelines and protocols around spinal surgery means that is not recommended lightly. There are different types of scoliosis and your daughter is likely to have the type that needs surgical correction. If it were my daughter, I would want to be reassured too. It’s really important that you discuss this in detail with whoever has made the decision. Make sure that you understand the reasons behind the decision, as well as what the outcomes may be with and without the surgery.

A question from one of our blog readers, Mr Alan Guy: I have pain and pins and needles and numbness in lower back and both legs and feet. I had an operation laminectomy on L4 and L5 and where nerve exits spine, June 2010. Still same problem and starting pain management course end of October. Had an MRI to check and everything has been done ok, so do I need to experience, this debilitating pain for the rest of my life

Jan_Vickery: Hi Alan sorry to hear that you have had back trouble. The pain management course is likely to help you a lot. You will get lots of information and advice about how to manage your back so that it interferes less with your life. They will teach you is how to think about your pain, how pain works and how to manage it. It’s all about focusing on what you can do rather than what you can’t do. They will pass on some useful strategies. It’s great that you are due to start soon as it will go a long way to help you gain control of things. Good luck.

carolynb: I am a hairstylist standing up for more or less 45 hours a week. I have trouble with my upper back and shoulders, for which I have been getting regular massage to soothe. Does anyone have any better treatments or maybe even a way I could prevent the pain?

Jan_Vickery: Hi carolynb i have lots of work with hairstylists – the biggest problem is that they tend to think about their client and forget to look after themselves! It’s important to make sure that you work on height adjustable equipment. Make sure that you adjust the height of chairs and do this during a cut – you will be working at different heights when you’re doing a fringe vs other areas. long hair and short hair means different work heights – adjust between them. Cutting and drying also has different height demands. It might be helpful to use a perch stool to unload your back at times (for example if you are doing foils). This is a type of chair that lets you sit-stand. Look at your trolley height too. Place the most frequently used items on the top where it’s easy to reach. Your long hours mean that you need to break often. Try to alternate different hair treatments if that is possible. Finally, avoid high heels! You may benefit from being shown some specific stretches that you could do during your work day.

A question from one of our blog readers, Rachel Bromily: I had increasing lower back pain which started in the summer of 2009. I was 38. The pain got progressively worse and I had constant sciatic pain whilst standing, I couldn’t sit on hard chairs, couldn’t pick up my two year old daughter and I was in agony. I visited a physio in November and December which didn’t help at all. I was also taking very stron painkillers and anti-inflammatries. I continued to work full time throughout all this and eventually in January 2010 I visited a superb spinal consultant surgeon in Bath who requested an MRI. The MRI revealed that I had L4/5 disc rupture, so the vertebrae were rubbing and the disc was putting pressure on my sciatic nerve. A week later I had a spinal decompression and fusion operation whereby he removed the entire disc, placed a spacer in between the vertebrae, added some artificial bone graft and then screwed the two vertebrae together with a titanium plate each side and four screws. 4.75 hours of surgery, 5 days in hospital and four weeks off work but worth every minute. I’m completely cured of all pain and just get the very occasional ache if I’m on my feet too long. I’m ecstatic with my results and can’t thank my surgeon enough. It’s not all bad news where backs are concerned.

Jan_Vickery: Hi Rachel. Pleased to hear that you have found the back surgery so successful. Make sure you keep active and enjoy your pain free mobility!

A question from a blog reader, George Jeffrey: Hi, 6 months ago I had yet another problem with my back. I am 66 and retired. I have had problems since my thirties. I had a MRI scan and saw a neurosurgeon. He advised that I should not have an operation but should see if time and a sensible lifestyle would sort the problem.

His diagnosis states that I am “suffering from a L4 radiculopathy secondary to a disc lesion in his lumbar spine”. When my back “went “I was in Holland driving home from 2 months skiing in Switzerland. It was 12 days before I could make it to the car (my wife drove!) for a fairly unpleasant ferry trip home to Scotland. Since then the pain and disability has improved but still 6 months on I can only walk for about 15 minutes before the sciatic pain in my right leg forces me to look for a seat and a rest. I have low level pain a lot of the time. I have swum all my life but can now only manage 20 minutes of very gentle exercise before the pain creeps back into my lower back and leg.
This is not a happy situation as I was very active in the past. I walked, swam, did a lot of work around the house / farm. I skied for a month or two every winter and groomed / backstepped for my wife’s carriage driving during the summer. I find that I am now putting on a few pounds – something that has never been a problem before – and I am missing aerobic exercise and basically doing things as I have in the past.
After 6 months and visits to 3 physios I am at the “what do I do now” stage. I am doing exercises daily, based on suggestions from two of the physios. I wonder are they helping or only sops to stop me getting depressed.

At my last visit to the physio who I have stuck with (Tom Craig ex Rangers Football Club and a bit of an institution locally) he suggested a return to Bill Taylor the Neurosurgeon. Is this necessary? I am wary of surgery. Tom has also looked at the MIR and tells me that the ligament is badly fibroses? And that in my back the space where the nerve passes though is small. There is also lots of old wear and tear. Any suggestions, help with exercises, or general advise of what I do now will be much appreciated. I feel at 66 it is too early to become an old man who can’t go out and walk 12 / 15 miles in a day or swim for an hour.

George Jeffrey: I would take your physio’s advice to go back to your neuro-surgeon. I would ask him about pain management programmes. As both you and the neurosurgeon feel that surgery is a last option I think it would be well worth joining a pain management programme. They will help you to manage your pain and find a level of activity that works for you. They will give you strategies that depend on your particular presentation. It should help you to feel in control of things again. Good luck – you should do well because you sound like a really positive person who would like to be more active. So that’s already the hardest part done!