Treating Shoulder Pain Part 1

There are several types of treatment for shoulder pain. The main treatment options include:

• Avoiding activities that make your symptoms worse
• Painkillers
• Anti-inflammatories
• Physiotherapy – where physical methods, such as massage and manipulation, are used to promote healing
• Surgery (in some cases)

The treatment that you have may depend on the cause of your shoulder pain (see Shoulder pain - causes) and your symptoms. For example, as well as pain, you may also have reduced strength or movement in your shoulder. In this case, a combination of different treatments may be used.


Avoiding Activities

Depending on what is causing your shoulder pain, your GP may recommend that you avoid certain activities or movements that may make your symptoms worse.
For example, in the early, painful stage of frozen shoulder, your GP may suggest that you avoid activities that involve lifting your arms above your head. However, you should continue using your shoulder for other activities because keeping it still could make your symptoms worse.
If you have shoulder instability, your GP may recommend that you avoid any movements that are likely to make the instability worse, such as overarm throwing.
If you have sprained your acromioclavicular joint (the joint at the top of your shoulder), your GP may suggest that you avoid moving your arm across your body. You may also be given a sling (a supportive bandage) to wear to support your arm for up to a week after your injury.

Painkillers

If your pain is mild, taking painkillers such as paracetamol or codeine may be enough to control it. Always follow the dosage instructions on the packet to ensure that the medicine is suitable and that you do not take too much.
If your shoulder pain is more severe, your GP may recommend or prescribe a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, diclofenac or naproxen.


As well as easing the pain, NSAIDs can also help to reduce swelling in your shoulder capsule. They are most effective when taken regularly rather than when your symptoms are most painful.
Cautions

Side effects can sometimes occur when using NSAIDs. They may include:

• Nausea (feeling sick)
• Diarrhoea
• Headaches
• Dizziness

Before taking NSAIDs, you should speak to your GP if you have any of the following:

• asthma – a long-term condition that can cause coughing, wheezing and breathlessness
• high blood pressure (hypertension)
• kidney problems 
• heart problems

Oral Corticosteroids

Corticosteroids are medicines that contain steroids, which are a type of hormone. Hormones are powerful chemicals that have a wide range of effects on the body, including reducing swelling and pain.
You may be prescribed corticosteroid tablets for frozen shoulder. Some evidence suggests that these may provide short-term pain relief for a few weeks. However, it is not clear whether corticosteroid tablets are any better than the other treatment options, such as corticosteroid injections.

Read Part 2 Here

Treating Shoulder Pain Part 2

 Treating Shoulder Pain:Part 2

Corticosteroid Injections

If your shoulder pain is very severe, such as in certain cases of frozen shoulder, painkillers may not be enough to control the pain. In this case, you may have corticosteroids injected into and around your shoulder joint.
Corticosteroid injections can help to relieve the pain that is caused by frozen shoulder and increase your range of movement for several weeks at a time, particularly during the first stage of symptoms. However, the injections cannot cure your condition completely, and your symptoms will gradually return.
Research also suggests that corticosteroid injections can provide pain relief for up to eight weeks for tendonitis (inflammation of a tendon). They may also improve your ability to use your shoulder, although they may not be as effective as some other treatments, such as NSAIDs.
One study found that corticosteroid injections may be most effective if they are used within 12 weeks of tendonitis symptoms starting. However, some experts believe that the use of corticosteroid injections should be delayed for as long as possible.

Cautions

After having a corticosteroid injection, you may experience a number of side effects at the site of the injection.
Possible side effects can include:

• Temporary pain
• Depigmentation – when your skin becomes lighter 
• Skin atrophy – when your skin becomes thinner as some of the skin cells waste away

Having too many corticosteroid injections can damage your shoulder. Therefore, you may only be able to have this treatment up to three times in the same shoulder in one year.


Hyaluronate Injections

Hyaluronate is another medicine that can be injected into your shoulder to treat shoulder pain. One review of a number of studies found that hyaluronate was effective at reducing pain.
However, the National Institute for Health and Clinical Excellence (NICE) does not recommend hyaluronate to treat osteoarthritis (a condition that affects the joints). It found that hyaluronate only had small benefit and that corticosteroid injections were a better treatment choice. Therefore, hyaluronate may not be used.

Physiotherapy

Physiotherapy, often referred to as physio, uses a number of different physical methods to promote healing. If you are referred to a physiotherapist, they should explain to you what treatment they will use and how it will work. Possible treatments include:

• Massage – where the physiotherapist uses their hands to manipulate your shoulder
• Laser therapy – where the energy from lasers (narrow beams of light) are used to stimulate your nervous system and reduce pain  
• Transcutaneous electrical nerve stimulation (TENS)

TENS is a type of physiotherapy where small electrical pads (electrodes) are applied to the skin over your shoulder. The TENS machines delivers small pulses of electricity through the electrodes, which numb the nerve endings and control your pain.
As well as these treatment methods, your physiotherapist may also recommend shoulder exercises. These will be specific for your needs. For example, if you have shoulder instability, you may be given exercises that will strengthen your shoulder.

Shoulder Exercises

If you have shoulder pain, it is important to keep your shoulder joint mobile by doing gentle, regular exercise. Not using your shoulder can cause your muscles to waste away and may make any stiffness worse. Therefore, if possible, you should continue using your shoulder as normal.
If your shoulder is very stiff, exercise may be painful. Your GP or physiotherapist can give you some exercises that you can do without further damaging your shoulder.
You may be given exercises to carry out on your own or you may complete the exercises with supervision from your GP or physiotherapist. You may also have manual therapy, which is when the healthcare professional moves your arm for you. Manual therapy uses special techniques to move the joints and soft tissues in your shoulder.
One review of a number of studies found that long-term physiotherapy was equally as effective as surgery for impingement syndrome (any type of damage to the tendons in the rotator cuff).

Surgery For Frozen Shoulder

If other treatments for frozen shoulder have not worked, you may be referred for surgery. There are two possible surgical procedures, which are explained in more detail below.

Manipulation

Manipulation involves having your shoulder moved while you are under general anaesthetic. General anaesthetic is a painkilling medication that makes you unconscious. During the procedure, your shoulder will be gently moved and stretched while you are asleep.
Afterwards, you will usually need to have physiotherapy to help maintain mobility in your shoulder. Manipulation may be used if you are finding the pain and disability from your shoulder difficult to cope with.

Arthroscopic Capsular Release

An alternative procedure to manipulation is arthroscopic capsular release. This is a type of keyhole, or non-invasive, surgery. The surgeon will carry out the procedure after making an incision (cut) that is less than 1cm (0.4in) long.
During arthroscopic capsular release surgery, your surgeon will use a special probe to open up your contracted shoulder capsule. They will then remove any bands of scar tissue that have formed in your shoulder capsule, which should greatly improve your symptoms.
As with manipulation, you will need to have physiotherapy after arthroscopic capsular release surgery. This will help you regain a full range of movement in your shoulder joint.

Surgery For A Rotator Cuff Tear

Surgery may be used to treat rotator cuff tears if the tear is very large or if other treatment options have not worked after three to six months. It is possible that having surgery earlier will lead to a quicker recovery, although at the moment there is not enough research into whether early surgery is beneficial or not.
During the procedure, a small amount of bone may be shaved off the bones in your shoulder. Damaged tendons and bursae (fluid-filled sacs that are found over joints and between tendons and bones) may also be removed. This creates more space within the joint to allow your rotator cuff to move freely.

The Operation Can Be Performed As:

• Open surgery – a large incision is made in your shoulder
• Mini-open surgery – a small incision is made in your shoulder 
• Arthroscopic surgery – a type of keyhole surgery that uses a camera to look inside your shoulder joint

Evidence suggests that people return to work about a month earlier if they have mini-open surgery rather than open surgery.
As with frozen shoulder surgery, you will need to have physiotherapy after your operation to help you regain a full range of movement in your shoulder joint.

Surgery For Shoulder Instability

If your shoulder dislocates (the ball comes out of the socket) regularly or severely, you may need to have surgery to prevent it happening again and to prevent the surrounding tissues and nerves from becoming damaged. Depending on the type of instability that you have, surgery may involve:

• Tightening stretched ligaments or reattaching them if they have torn – ligaments are tough bands of connective tissue that link two bones together at a joint
• Tightening the shoulder capsule by using heat to shrink it or tightening it with sutures (stitches)

Surgery for shoulder instability can either be done using keyhole or open surgery. After the operation, your shoulder will need to be immobilised (prevented from moving) using a special sling for several weeks. You will also need to have physiotherapy to improve your strength. Full recovery may take a number of months.

Read Part 1 Here

Frozen Shoulder:Symptoms

A frozen shoulder is a painful, persistent stiffness of the shoulder joint, which makes it very difficult to carry out the full range of normal shoulder movements.





You May Find It Difficult To Carry Out Everyday Tasks, Such As:

• Dressing
• Driving
• Sleeping comfortably

Some people find they are unable to move their shoulder at all, which is why the condition is known as a frozen shoulder.

Stages Of Frozen Shoulder

The symptoms of a frozen shoulder advance slowly and are usually experienced in three separate stages that are spread over a number of months or years. However, the symptoms of frozen shoulder can vary greatly from person to person.
The three stages of frozen shoulder are described below.

Stage One

During stage one, your shoulder will start to ache and will feel stiff before becoming very painful. The pain is often worse at night and when you lie on the affected side. This stage lasts two to nine months.

Stage Two

Stage two is known as the adhesive stage. Your shoulder may become increasingly stiff, but the pain will not usually get worse. Your shoulder muscles may start to waste slightly because they are not being used. This stage lasts four to twelve months.

Stage Three

Stage three is the recovery stage. During this stage, you will gradually regain movement in your shoulder. The pain will begin to fade, although it may recur from time to time as the stiffness eases.
Although you may not regain full movement of your shoulder, you will be able to do many more tasks. Stage three can last five months to three or four years.

Shoulder Pain:Over View

Shoulder pain is a symptom rather than a condition in itself

Shoulder pain is a symptom rather than a condition in itself. Shoulder disorders are the most common causes of shoulder pain.


Examples Of Shoulder Disorders Include:

• Frozen shoulder – a painful condition that reduces normal movement in the joint and can sometimes prevent movement in the shoulder altogether 
• Rotator cuff disorders – the rotator cuff is a group of muscles and tendons that surround the shoulder joint and help to keep it stable 
• Shoulder instability – where the shoulder is unstable and has an unusually large range of movement (hypermobility) 
• Acromioclavicular joint disorders – conditions that affect the acromioclavicular joint, which is the joint at the top of the shoulder

How Common Are Shoulder Disorders?

• Shoulder disorders are fairly common. About 3 in 10 adults are affected by these types of conditions at any one time.
• Frozen shoulder and rotator cuff disorders are most common in middle-aged and older people. 
• Shoulder instability and acromioclavicular joint disorders tend to affect younger people, particularly men who play certain sports.

For Example:

Sports that involve repetitive shoulder movements, such as overarm bowling or throwing
contact sports, such as rugby, where you may injure or fall on your shoulder

Outlook

Shoulder pain can be a long-term problem. Up to half of people still have symptoms after 18 months. It is therefore important to obtain the correct diagnosis so that you can receive effective treatment for your symptoms.
Several treatment options are available for shoulder pain. They include:
painkillers – such a paracetamol
physiotherapy – where physical methods, such as massage and manipulation, are used to promote healing
injections of corticosteroids – corticosteroids are a type of medication that contain hormones
surgery (in some cases)

Lumbar Decompressive Surgery - Who Needs It?

1. Healthy disc
2. Nerve root
3. Extruded disc protrusion
4. Disc bulge
5. Spinal nerves (cauda equina)

Conditions that may require lumbar decompressive surgery include:

Spinal Stenosis:

Spinal stenosis is the narrowing of the central spinal canal or side root canals of the spine. This narrowing causes pressure on the nerves in the canal, leading to pain, usually in the lower back and legs.

Causes Of Spinal Stenosis Include:

Age-related degeneration of the spine. The main cause of spinal stenosis is natural age-related degeneration. This is often linked to osteoarthritis. As the vertebrae (bones) of the spine begin to weaken and deteriorate, they rub against each other. This causes bony growths called bone spurs, which can cause the spinal canal to narrow.

Changes in the ligaments of the spine. Like the bones of your spine, the ligaments in your back degenerate over time and can become stiff and thick. This loss of elasticity can have the effect of narrowing your spinal canal.
Diseases of the bone. Diseases that affect bone growth, such as Paget’s disease and achondroplasia, can cause malformation of the bones of the spine and a narrowing of the spinal canal.

Slipped (herniated) Disc

A slipped or herniated disc is when the tough coating of a disc in your spine tears, causing the jelly-like filling to seep out. The torn disc can press on the surrounding nerves causing pain in your back and legs.
A slipped disc can happen at any age, but is more common in people between 20 and 40 years of age. It is usually caused by a combination of minor degeneration in the disc combined with trauma. The trauma can be minor, such as a cough or sneeze.
A slipped disc can press on the nerve sac in the spinal canal causing back pain, or on the surrounding nerves causing pain in the back and legs.

Spinal Tumours

Abnormal growths and tumours can form along your spine. These are usually benign (not cancerous), but growing tumours may compress your spinal cord and nerve roots causing pain.
Injury

Injury to your spine, such as dislocation and fractures, or the swelling of tissue after spinal surgery, can put pressure on your spinal cord or nerves.

When To Consider Surgery

Lumbar decompressive surgery is considered as a treatment for spinal stenosis when:
pain relief medication and other treatments have failed to help your symptoms,
the pain is so severe it is interfering with your quality of life, including work and sleep,
you have had an MRI scan that shows you have a disc, bony spur or thickened ligament pressing on a nerve, or
you have cauda equina syndrome, a rare and severe form of spinal stenosis. Pressure on the nerves in the lower back causes numbness in the buttocks and prevents you from urinating. In this case, emergency surgery is needed.

Lumbar Decompression Surgery

Lumbar decompressive surgery is an operation to relieve pressure on the spinal nerves in the lower back. It is often used to treat a condition called spinal stenosis.
Spinal stenosis is the narrowing of areas of the spine. It occurs when the bones, ligaments or discs of the spine squash the nerves of the spine causing pain, usually in the lower back and legs.

Causes Of Spinal Stenosis Include:

• Age-related degeneration of the spine,
• Changes in the ligaments of the spine, and
• Diseases of the bone, such as Paget’s disease.
• Other conditions that may require lumbar decompressive surgery include:
• A slipped (herniated) disc,
• Spinal tumours, and
• Spinal injury.

Lumbar decompressive surgery is recommended when the pain in your back and legs is affecting your quality of life and alternative treatments, such as pain relief and physiotherapy, have not worked.
Types of surgery

There Are Two Types Of Lumbar Decompressive Surgery:

A laminectomy or partial laminectomy removes or trims the bony arch of a vertebra (bone) or ligaments of the spine to relieve the pressure on the spinal cord.
A discectomy removes the damaged or bulging part of a slipped disc to relieve pressure on the spinal cord.

Outlook

70% and 75% of patients experience a significant improvement in leg pain after lumbar decompressive surgery. 20-25% of patients experience an improvement, but still have some pain.
The success rate for microdiscectomy (keyhole surgery) is slightly better, with 80-85% of patients experiencing an improvement in their leg pain.

Preventing Back Pain In Children

Preventing Back Pain In Children

Back pain in secondary school-age children has been linked to heavy schoolbags and ill-fitting classroom seating. Nearly half of all teenagers in the UK have had occasional backache from poor posture, carrying overloaded bags, and leading an unhealthy lifestyle.



The best schoolbag for your child is a well-designed backpack.
This should be worn over both shoulders to balance out the weight. A heavy satchel or shoulder bag can put stress on your child's spine.

Encourage your child to exercise regularly or plan joint activities, such as a walk in the countryside or a trip to a swimming pool.

Back pain is a very common condition, affecting about 80% of people at some point in their lives. A physiotherapist demonstrates some simple back stretches to help prevent aches and pains.

Warning Over Co-Codamol Tablets

The stronger version is a prescription-only drug

The UK medicines regulator has issued a warning after the wrong strength of tablets was put into some packets of the painkiller co-codamol.





Some packs in batch LL11701, expiry date of September 2014, which should contain 8mg/500mg strength tablets have the higher strength 30mg/500mg tablets.

Wockhardt UK Ltd, which makes the medicine, is recalling the batch.

The Medicines and Healthcare products Regulatory Agency (MHRA) said there may have been a manufacturing error.

The medicine is used as a painkiller for the short term treatment of acute, moderate to severe pain which cannot be relieved by paracetamol, ibuprofen or aspirin alone. It contains codeine.

The MHRA has issued a drug alert to health professionals.

The different strength tablets can be identified by their markings.

The 8mg/500mg tablets are marked on one-side only as "<AB>" - these can be bought over-the-counter.

However the higher strength 30mg/500mg tablets - marked on one side as "CCD30" and marked as "CP" on the second side - are a prescription-only medicine.

Packs, which contain 32 tablets, from the affected batch were first distributed on 30 December 2011.

Just under 39,000 were distributed to pharmacists and wholesalers for onward sale in the UK.

Ian Holloway, MHRA head of the Defective Medicines Report Centre said: "If you have a packet of the affected medicine, return it to your pharmacist who will replace it.

"If you think you have taken the wrong strength tablet, and in the unlikely event that you feel unwell, speak to your pharmacist or GP promptly."

Neal Patel, pharmacist at the Royal Pharmaceutical Society, said: "Patients who may have taken a larger dose of codeine than anticipated may feel more drowsy so should not drive.

"Other possible side effects include confusion, headaches, nausea and vomiting.

"People with pre-existing long term conditions, the elderly or those taking other medicines may be particularly vulnerable to adverse effects and should speak to their pharmacist for advice. However for most healthy adults if only a single dose has been taken there should not be any long term problems."

People with concerns about an affected packet can also speak to the Defective Medicines Reporting Centre on 0203 080 6574.

Original Story bbc.co.uk/news

Paget's Disease

Paget’s disease is a condition where the normal cycle of bone renewal and repair is disrupted. In some cases, this can cause the affected bone (or bones) to become weakened and deformed.

Bone pain is the most common symptom of Paget’s disease. It most commonly affects the pelvis or spine and it is usually worse when lying down.
However, in many cases Paget’s disease does not cause any noticeable symptoms, and it is only diagnosed during tests for an unrelated medical condition or when an affected bone is fractured.

There is no cure for the condition but the symptoms can be controlled by painkillers and a range of medications that help regulate bone growth.

Following treatment for Paget’s disease many people will have long periods of remission (where symptoms disappear) provided that the disease is picked up at an early stage. If the disease has progressed to an advanced stage by the time it is discovered, treatment is much less effective.

Complications of Paget’s disease are uncommon, but they can be potentially serious.

They Include:

• Fractured bones
• Deformed bones
• Deafness
• Bone cancer

How Common Is Paget's Disease?

After osteoporosis (brittle bones), Paget’s disease is the second most common type of bone disease.
Paget’s disease occurs among people of white British descent, possibly due to genetic factors. It is very rare among other ethnic groups, such as Asians and Africans.
Paget’s disease is most widespread in Britain and it is also relatively widespread in countries where there have been high levels of migration from Britain, such as Australia, New Zealand and South Africa, and to a lesser extent the USA.

There is also a marked variation in the number of cases of Paget’s disease in different regions of Britain. For example, the condition is less common in the south of the country, where an estimated 1 in 100 people over the age of 55 is affected, and it is more widespread in the north, particularly in the county of Lancashire where 1 in 50 people of this age may be affected.

Who Is Affected By Paget’s Disease?

Paget’s disease is an age-related condition. It is estimated that 1-2% of white adults aged over 55 have the condition. This figure increases to about 7% for white people who are over 80 years old.
Paget’s disease is thought to be caused by a combination of genetic and environmental factors.

Stem Cells:The Cure?

Chronic back pain could be cured by a revolutionary treatment which allows patients to "grow" a new spine.
Scientists have discovered how to regenerate the damaged discs in the back which cause agony to sufferers.

The condition, common among older people, occurs when the discs between the vertebrae wear away, leaving them to rub against each other.
Until now few treatments have been available other than surgery — which has a high failure rate — or a lifetime on painkillers.

Doctors feared it was impossible to repair the cartilage in the discs and have written off many patients as no-hope cases. 

But now researchers have found that stem cell therapy could help the discs to self-heal. Stem cells are the body's building blocks and possess a unique ability to repair damaged tissue and bone.

Scientists do not fully understand how they function and are busy exploring their potential as a cure for several conditions.

In the latest study at Gothenburg University in Sweden, researchers found there were areas on the edge of the discs which have similar properties to stem cells.
Their experiments on animals showed healing in the discs and they hope to repeat the results in human tests.

Chief researcher Helena Barreto-Henriksson said: "It is generally believed that cartilage has very little or no capacity to heal. "Our study found the transplanted stem cells survived and that there was a certain degree of healing in the disc." She added: "The advantage of such treatment over today's surgical approaches is that it would be a much simpler and less serious procedure for the patient."

Sciatica

Sciatica is the name given to any sort of pain that is caused by irritation or compression of the sciatic nerve.
The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.
When something compresses or irritates the sciatic nerve, it can cause a pain that radiates out from your lower back and travels down your leg to your calf (see Sciatica – symptoms for more information). Sciatic pain can range from being mild to very painful.
A slipped disc is the most common identified cause of sciatica, but in some cases there is no obvious cause (see Sciatica – causes for more information).

Types of sciatica

There are two types of sciatica:

• Acute sciatica, which lasts up to six weeks
• Persistent (chronic) sciatica, which lasts longer than six weeks

Most cases of acute sciatica will pass without the need for treatment. A combination of self-help measures such as over-the-counter painkillers, exercise and hot or cold packs can usually relieve the symptoms.

For persistent sciatica, you may be advised to try a structured exercise programme under the supervision of a physiotherapist. In very rare cases, surgery may be needed to control the symptoms.

Outlook

Most people find their sciatic pain goes away naturally within a few days or weeks. However, see your GP if:

• you experience any other symptoms together with your back and leg pain, such as weight loss or loss of bladder or bowel control
• You experience increasingly more pain and discomfort
• Your pain is too severe to manage with self-help measures
• In these cases, your GP should check whether there is a more serious problem causing your pain.

How The Spine Works

 Your spine extends from your skull to your pelvis. It is made up of 24 individual bones called vertebrae, which are stacked on top of each other.

• The front of each vertebra is solid and is called the vertebral body. Behind the body of each vertebra is an arch of bone called the lamina. 
• The arches form a hollow channel known as the spinal canal or vertebral canal, which protects the spinal cord and nerves. 
• A pair of spinal nerves branch out (one to the left and one to the right) from each vertebra. 
• These nerves are called nerve roots and pass through gaps in the arches where they join up to provide sensation and movement to parts of the body. 
• The gaps are called foramens. 
• The vertebrae are separated by soft pads or discs that act as shock absorbers. 
• Each vertebra also has two sets of joints called facet joints which, with the discs, allow the spine to bend. The nerve root foramens are covered by the discs at the front and the facet joints at the back. 
• The vertebrae are also held together by tough bands called ligaments. 
• Together with the spinal muscles, these give the back its strength.

Can Exercise Help Back Pain?

Make sure you're doing the right kind of activity to help protect your spine.

Keeping Fit

Gentle exercise can build strong back and stomach muscles to support your spine and maintain flexibility.

Walking and cycling are easy to incorporate into your daily lifestyle. Swimming is particularly good for backs, because it strengthens the muscles while supporting the body with water. However, some strokes may not be suitable, so get professional advice.

Getting Started

Following a regular exercise routine is a good idea, but if you have a bad back you should consult your doctor or physiotherapist about what exercise is safe.

Try to get a personal assessment - a qualified physiotherapist, osteopath or chiropractor can give you an exercise routine tailored to your own needs.

If you go to an exercise class, check it's run by a qualified teacher and that the teacher knows you have a bad back. A lot of commonly performed exercises may not be suitable for you.

Exercise Dos And Don'ts

When exercising, make sure you do:

• Choose exercises suitable to your level and work up gradually
• Take things at your own pace
• Drink water before, during and after exercise
• Do gentle warm-up stretches before and after exercising
• Wear good footwear and appropriate clothing
• Enjoy yourself

Don't:

• Continue with an activity if it hurts your back
• Eat a large meal before exercising
• Perform exercises on a stone or concrete floor
• Exercise if you feel ill
• Do exercises that put weight or excessive strain on an acutely painful joint or spine

Back Pain: Posture Checklist

Good Posture Is Good For You

A good posture can greatly improve and prevent back problems.










Follow these simple rules.


How to stand

• Don't round your back - imagine you are being lifted by a string fixed to the top of your head
• Avoid hunching your shoulders and tensing your neck when stressed
• Wear comfortable, low-heeled shoes - high heels put pressure on the lower back

How to sit

• Use an upright chair that supports your lower back
• Support the small of your back with a small cushion or rolled up towel
• Stand up and stretch every 20 to 30 minutes

How to lift

• Always look at alternatives to lifting - can you push or pull?
• Lift only what you can handle and get help if you need it
• Bend your knees and keep your back straight and your feet apart when lifting
• Avoid lifting and twisting at the same time
• Always lift and carry close to your body
• Bend your knees rather than your back when putting a load down

Back Care At Work

Back Pain

About 9.3 million working days were lost due to work-related back pain and other musculoskeletal disorders in 2008/9. The main causes of it are poor posture or an awkward twisting movement (bending or reaching), or a combination of the two.
In most cases, the best treatment is to stay active and, if necessary, use over-the-counter painkillers. You may feel like going to bed, but this won’t help and could make things worse. The longer you stay immobile, the weaker your back muscles will become and the more they'll hurt in the long term. For tips on keeping a healthy back,  read more HERE



Sitting

If you spend a lot of your time at work sitting at a desk, make sure you're sitting in the right position in relation to your computer. If you're unsure about correct posture, ask your line manager for a workplace assessment.
If you work on a computer a lot, it's important to take regular breaks. That means for every hour at your keyboard you should rest for at least 5 to 10 minutes.


Lifting

One of the biggest causes of back injury, especially at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent back pain.

Here are some key points to lift safely:

• Think before you lift.
• Start in a good position.
• Keep the load close to your waist.
• Avoid twisting your back or leaning sideways.
• Keep your head up.
• Know your limits.
• Push, don't pull.
• Distribute the weight evenly.

For more information on correct lifting techniques and safe manual handling, read our guide to lifting safely.HERE

Slipped Disc

1. Healthy Disc
2. Nerve
3. Slipped Disc
4. Damaged Disc
5. Spinal Cord

A slipped disc, also called a prolapsed or herniated disc, occurs when one of the discs of the spine is ruptured (splits) and the gel inside leaks out. This causes back pain and can also cause pain in other areas of the body.

The spine 

The spine is made up of 24 individual bones called vertebrae, which are stacked on top of each other. Discs are the protective, circular pads of cartilage (connective tissue) that lie in between the vertebrae. The discs are responsible for cushioning the vertebrae when jumping or running.

The spinal cord is a collection of nerve fibres that are attached to the brain and are protected by the spine. Nerve fibres from the spinal cord pass between the vertebrae as they take and receive messages to and from different parts of the body.

A slipped disc

The discs are made from a tough, fibrous case, which contains a softer, gel-like substance. A slipped disc occurs when the outer part of the disc ruptures (splits), allowing the gel inside to bulge and protrude outwards between the vertebrae.

The damaged disc can put pressure on the whole spinal cord or on a single nerve fibre. This means that a slipped disc can cause pain both in the area of the protruding disc and in any part of the body that is controlled by the nerve that the disc is pressing on.

How common is a slipped disc?

Slipped discs are most common in people between the ages of 30 and 50. The condition affects twice as many men as women.

A slipped disc occurs most frequently in the lower back, but any disc can rupture, including those in the upper back and neck. Around one-third of adults in the UK have lower back pain, and a slipped disc is responsible in less than 1 in 20 cases.

Outlook

It can take around four to six weeks to recover from a slipped disc. In most cases, treatment involves a combination of physical therapy, such as exercise and massage, and medication to relieve the pain.

In severe cases, or if the pain continues for longer than six weeks, surgery may be considered. A number of different procedures can release the compressed nerve and remove part of the disc. The success rate for surgery on the lumber (lower) spine is around 60-90%.

Dealing With Back Pain Out And About

When You're Shopping:

• Don't shop until you drop - take regular rests or make several short trips
• Don't overload your trolley and use a high 'tray' trolley rather than a large deep one
• Distribute your shopping evenly between both hands or hold a bag in front of you, or use a small backpack (not large or over-filled)
• Wear comfortable shoes

In The Car:

• Adjust your seat properly so your arms have a slight bent at the elbow when your hands are on the steering wheel
• Support your lower back with a small cushion or rolled up towel
• Take regular breaks on long journeys and get out of the car for a stroll and a stretch

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Straighten Up

Straighten Up is a simple, three minute exercise programme for all ages, designed to help strengthen the spine and improve posture.

The British Chiropractic Association wants everyone to incorporate this simple exercise routine into their daily lives.

Why not view the Straighten Up film clip below? You can then see just how simple and easy the exercises are.

Dealing With Back Pain At Home

The best way to sit down is to do it without bending your back. Stand in front of the chair with one foot behind the other, almost under the chair. Bend your knees, and at the same time place your hands on the arms or seat of the chair. Lower yourself gently into the seat. A chair with arms makes this much easier.

The following can also help back health in the home:

• Make sure work surfaces are a comfortable height so you don't have to bend your back
• Use a ladder or stable chair when painting or cleaning - don't stretch too far
• Squat or kneel when cleaning the bath or reaching low shelves
• Use an upright vacuum cleaner and keep it close to your body
• Ensure easy access to each side of the bed so you don't have to stretch when making it, and kneel or squat to tuck in sheets and blankets.
• Take regular breaks from time-consuming tasks

If you have children, make sure you:

• Bend your knees to pick up a baby - don't twist
• Kneel down to talk to toddlers rather than picking them up
• Adjust the height of the cot so you don't need to bend, or choose one with drop sides
• When unloading a pram's shopping tray, always bend from the knees
• When getting into bed, sit on the edge, lower your body on to one elbow and shoulder and draw up your knees and then feet. Reverse the procedure to get out.

The wrong sleeping arrangements can put additional strain on your back. If you're experiencing back problems, you might want to try the following:

• Replace a sagging mattress
• Lie on your back with a pillow under your knees or on your side with a pillow between your bent knees
• Don't have too many pillows - they support your neck, not strain it
• When buying a bed, try any you are considering for as long as you can. Your bed should allow ease of movement but mould to the contours of your body. Don't assume a bed marked 'orthopaedic' is what you need - the word can sometimes be used as a marketing tool.

To test if a bed is giving you the correct level of support, lie on your back and slide your hand, palm down, between the small of your back and the mattress.

If you can:

• Work your hand through with some resistance, the bed support is probably about right
• Slide your hand easily through a large gap, the bed is probably too hard (or saggy)
• Hardly force your hand through at all, the bed is probably too soft

If you're in pain, the easiest way to turn in bed is to bend your knees, bringing your heels up towards your buttocks. Let your knees fall to one side and as the weight of your legs takes you over, bring through your hip and shoulder - don't twist.

Ortho Royale 4.6ft Double Mattress Orthopaedic Mattress

Life Style Adjustments

Four in five adults experience back pain at some point, but the back is so complex every person needs individual treatment options. Discover more about how your back works, what can go wrong and how you can prevent back problems.

Back Pain: Making Adjustments

Making small changes to your lifestyle can reduce your risk of back pain.

Back pain can be caused by many factors. Run through your daily routine and examine the amount of strain you place on your spine.Read our causes of back pain article HERE

Stress

Stress can also create muscle tension, causing a loss in flexibility that can lead to back pain. To reduce stress, try:

• Exercise
• Yoga
• Meditation
• Getting more sleep or listening to music.

If you smoke, stop. It puts you at increased risk for back problems since your blood has trouble delivering oxygen to working tissues, making your back weaker.

Making small changes to your lifestyle can reduce your risk of back pain.

Laptops & Backache ?

Laptops make us more mobile but they're blamed for a rise in back, neck and shoulder problems.

Almost 215,000 workers suffer from upper limb disorders (ULDs), also known as repetitive strain injury (RSI), according to the 2008/9 Labour Force Survey. The increased popularity of laptops may be adding to the problem.
Laptop computers were once used mainly by busy business people who had to work on planes or trains, but not any more.
Thanks to low prices, the rise in home working and wireless internet access, laptops are everywhere. In 2005, laptops outsold desktop computers for the first time ever.
About 8% of the workforce are teleworkers (working from other locations, using the home as a base or working from home). This figure is expected to rise.
The Health and Safety Executive’s 2006 Horizon Scanning paper reports that by 2015, 70-80% of workers could be, at least partially, working away from the office.
“I've seen many people with neck, back and shoulder problems caused by excessive laptop use,” says Tim Hutchful, a British Chiropractic Association-registered chiropractor.

Posture Advice

Bad posture is inevitable because of the way laptops are designed, says Levent Caglar, senior consultant ergonomist at the Furniture Industry Research Association (FIRA).
“The main problem is the keyboard being attached to the screen,” he says.
“You need the screen at arm's length but you need the keyboard near you, so you push the laptop further back, then your hands stretch out, then you hunch your shoulders.
"That creates bad posture. If I were designing a laptop, I’d do it with a detachable screen.
“The average human head weighs quite a lot. If it’s in the ideal position, balanced above the shoulders, it’s fine.
“But when you use a laptop, your ears are further forward than your shoulders. That’s like taking a weight and holding it out at arm's length.
“The load through your spine is much greater and, even worse, it’s a static load. You’re not moving. This causes neck, upper back and arm problems."
Tim says that laptops are fine when used properly. "There are plenty of ways you can make your laptop safer and more comfortable,” he says.

Laptop Use Tips

Use a separate keyboard and mouse so that the laptop can be put on a stand and the screen opened at eye level.

• Use your laptop on a stable base where there is support for your arms, and not on your lap.
• Take regular breaks. If you’re moving, there’s a lot less stress on your muscles and joints.
• Adopt good sitting posture with lower back support, and ensure that other desk equipment is within reach.
• Get into good habits before the aching starts. Neck, shoulder and back problems gradually build up over time.

Stay Mobile & Keep Working

If you have long-term pain, it's important to keep active. If your body stiffens up it can make the pain worse, so resting is not always the best way to deal with pain.

Things You Can Do

Painkillers:
If painkillers help you, take regular pain relief. Use paracetamol as it's safer than anti-inflammatory drugs such as ibuprofen, unless you have a clear injury that occurred in the past few days. Pharmacists can advise you on pain relief and what to do if you're having side effects.

Pain Gone:The Drug Free Pain Relief Pen

Exercise:
Try to do gentle stretches, movements and warm-up exercises throughout the day. Take care not to overdo it. Ask your GP about Exercise on prescription schemes. Your GP can refer you to a fitness instructor at a local leisure centre who will design a fitness programme that is adapted for you.

Pace Your Activity:
Do something active every day instead of only on the good days when you're not in so much pain. This may reduce the number of bad days you have and help you feel more in control.

Osteopaths And Chiropractors Specialists:
May be able to help with short-term pain relief, but it's not recommended that you use these treatments in the long term. It’s important to be able to manage the condition yourself.

See A Physiotherapist:
Physiotherapists use a wide variety of treatments for pain. They also help with posture. For instance, if you have a painful condition, you may lean away from the site of the pain (for example, using a stick or crutch). The longer you lean away, the more difficult it is to get upright again. This can put pressure on the other side of your body and cause problems there. It’s important to use your muscles rather than relying on collars, braces, corsets, tubigrips and wrist splints.
You need a referral from your GP to see a physiotherapist. Physiotherapists are often based in hospitals, but some are available in GP surgeries.


Occupational Therapy Occupational Therapists (OTs):
These are specialists who work with people with long-term pain and give expert advice on how to carry out day-to-day activities in spite of pain. They can assess your home to identify whether devices such as stair rails could help you lead an independent life. They can also advise you on how to get back to work gradually. They can produce a 'graded return-to-work' plan for you and liaise with employers.

Work

It's important to try to stay in work. Research shows that people become less active and more depressed when they don't work. This, in turn, leads people to take even more time off. If your employer is not sympathetic you may need a letter from your GP explaining your condition.
If you've been off work, you could go back to work gradually. This is called a 'graded return'. You may start with one day a week and gradually increase the time you spend at work.
When you do go back to work, take care not to overdo it. Change your position at regular intervals and take proper breaks.

Go On A Course

The Expert Patients Programme is a six-week course for people with chronic or long-term health conditions. You'll work with health trainers who themselves have long-term health conditions. They will help you relax, develop new life goals and work on ways of building up your stamina. Together with the tutors you will develop a plan to help you live with your pain.

When To See Your Doctor

Back pain: When To See Your Doctor

Many people with back pain never need to see their doctor. But you should feel able to call or visit your GP if you're worried about your back or feel unable to cope with the pain. As a general rule, people with back pain are advised to contact their doctor if the pain is no better after about a week.

You should certainly see your GP as soon as possible if you have any of these symptoms:

• Difficulty passing urine, or if you are passing blood
• Numbness around the back passage or genitals
• Numbness, pins and needles or weakness in the legs or arms
• Pain running down one or both legs
• Unsteadiness when standing

These are associated with uncommon conditions, but ones that need treatment immediately.

What can Your Doctor Do ?

What doctors can do for back pain

There's no quick fix for most back pain and your doctor is unlikely to be able to 'cure' you. However, they will be able to:

• Check you don't have a serious condition
• Discuss your posture and activity level
• If needed, help with a weight-loss programme
• Prescribe another type of painkiller
• Refer you to other health practitioners who can help
• Your doctor will probably give you a physical examination and ask you about your back pain.

Here are some probable questions your GP will ask. Think them through to make the most of your medical examination:

• When did your back pain start?
• What were you doing when it started?
• Have you had any back problems in the past?
• Where is your pain?
• What sort of pain is it - dull, piercing or shooting?
• Does it stay in the same place?
• What makes the pain better, or worse?
• Do you have any other symptoms, in your back or elsewhere?
• What does your back pain stop you doing?
• What have you been doing which might have contributed to giving yourself a bad back?
• What can you do in the future to try and keep your back healthy in the long term?
• If you're not happy with your doctor's diagnosis or if your symptoms keep coming back, go back to your GP or ask another health expert for their opinion.

Which Painkiller?

The type of drugs that you need to treat your pain depend on what type of pain you have.

The type of drugs that you need to treat your pain depend on what type of pain you have.
Dr Alf Collins, a consultant in pain management at Musgrove Park Hospital, Taunton, says everybody who has pain should consider taking painkillers. But different painkillers work better for different types of pain.

For pain associated with inflammation, such as acute back pain or headaches, paracetamol and anti-inflammatory medicines work best.
If the pain is caused by sensitive or damaged nerves, as is the case with shingles or sciatica, it is usually treated with tablets that are also used for epilepsy and depression. These tablets change the way the central nervous system works.
The aim of taking medication is to improve your quality of life. All painkillers have potential side effects, so you may need to weigh up the advantages of taking them against the disadvantages.
Paracetamol, anti-inflammatories and aspirin

Paracetamol: 

Paracetamol is used to treat headaches and most non-nerve pains. Two tablets of paracetamol up to four times a day is a safe dose for adults. Side effects are not common and this dose can be taken regularly for long periods.
Overdosing on paracetamol can cause serious side effects. If the pain is severe, do not increase the dose.
If the pain lasts for more than three days, see your GP.

Anti-inflammatories:

Ibuprofen, diclofenac and naproxen seem to work better when there is clear evidence of an inflammatory cause, for example arthritis or an injury.
They should not be used for a long period unless you have inflammation. When taken for long periods there's an increased risk of stomach upset, including bleeding, and kidney and heart problems. Don't take more than the recommended dose as this will increase the risk of serious side effects.

Aspirin:

Aspirin produces the same type of side effects as other anti-inflammatories, but is not as effective as a painkiller, which means it is not usually prescribed for pain. It is dangerous for children under 12.

Codeine And Other Medium-Strength Painkillers:

Codeine doesn’t work very well on its own. It works better when combined with paracetamol in a single pill. You can buy co-codamol (paracetamol and low-dose codeine) over the counter. Higher dose codeine has to be prescribed.
Other medium-strength prescribed painkillers include tramadol (Zydol) and dihydrocodeine.
All these painkillers can cause dependency, which means that when you stop taking them you may feel unwell for a short period. If you need more and more of these drugs, contact your GP or other healthcare professional for advice.

Amitriptyline and Gabapentin:

Amitriptyline is a drug for depression and gabapentin is a drug for epilepsy. Each of these tablets can also be used to treat pain caused by nerve sensitivity or nerve damage, such as shingles, diabetes nerve pain and sciatica. You don’t have to have depression or epilepsy for these tablets to help nerve pain.
Amitriptyline and gabapentin both have to be prescribed by a GP. Side effects include drowsiness and dizziness.

Morphine:

Morphine and morphine-like drugs (for example, oxycodone, fentanyl and buprenorphine) are the strongest painkillers there are. Some come as a patch, but they all work in similar ways and should only be used for severe pain.
They will only be prescribed after consultation with your GP or a pain specialist. The dose and your response will be closely monitored. These drugs should only be used as part of a long-term plan to manage your pain.

Back Pain & Nutrition

Degenerative discs are a significant cause of lower back pain

Back pain and disc health 'linked' to lack of nutrients

Heavy lifting, twisting and bending can do damage to the discs in the back by reducing the flow of nutrients to the disc cells, a study says.

Disturbing the balance of nutrients in the discs can then lead to the onset of degenerative disease.

Writing in PLoS Computational Biology, Spanish experts say a normal level of physical activity helps cell nutrition.

Lower back pain, which is linked to degenerative spinal discs, could be caused by this lack of nutrients.

Previous research has shown that 80% of the active population suffers from low back pain at some point in their lives.

But little was known about the chain of events which changes normal, healthy ageing discs into degenerative discs.

Using computer models of the human disc in their study, a team of scientists from Barcelona's Institute for Bioengineering looked at the nutritional and mechanical effects of stress on the discs of the lower back.

By using the models, the researchers were able to see what happened when they changed disc height, cell density and made degenerative changes to the disc.

It would not have been possible to carry out this quality of research in a living person.

'Collapsed Sponge'

The results showed that external loads on the disc influenced the solute concentration - the amount of glucose and lactate present in the disc.

The cells need glucose but do not want too much lactate, an acid which hinders the nutrition process and can kick-start the degenerative process.

Dr Jerome Noailly, study author and expert in the biomechanics and mechanobiology group at the Institute, said the study showed that nutrients could be the key factor.

"If we know that lack of nutrition is involved in accelerating the degenerative process and the properties of a degenerative disc hinder nutrition, then this will increase cell death and the disc tissue will start to degenerate more and more.

"In order to bring back the function of the degenerated disc, we must address the nutrition problem.

"This means restoring the water content of the disc and the volume of the disc. A degenerated disc is like a collapsed sponge which needs to be restored to its normal size."

The research team says the findings could open up new areas of research in the field of disc regenerative medicine.

Dr Brian Hammond, chair of the charity BackCare, said: "We are what we eat and the spine is no exception. A balanced diet, adequate fluid intake and regular exercise are essential for a healthy back and neck.

"There is little doubt that poor diet, being immobile for long periods and bad habits like smoking contribute to spinal degeneration and the high incidence of back and neck pain in the UK."

Types Of Back Pain

Neck Pain

Neck pain refers to any pain experienced in the area from the base of the skull to the shoulders and can spread to your upper back or arms.

This can include feelings of stiffness or tightness, as well as sharp pain and, in severe cases, can reduce the movement of the neck and head. Neck pain can also cause tension headaches.

Most muscles in the body will relax completely when they are not being used, but the muscles in the neck are permanently tensed in order to support the head. Although most common in people over 50, neck pain can develop at any age as the result of excess strain on the neck. This could include slouching, sleeping in an awkward position or working at a computer for long periods of time without a break.

Neck pain can also develop as the result of an accident. Perhaps the best known is whiplash; an injury sustained as a result of the head being thrown forward and back in a car accident.

Neck pain is rarely the result of a serious injury and will often lessen after a few days. If you are suffering from neck pain, try to keep moving and maintain your normal routine as best you can. Over-the-counter painkillers may also help.


Upper And Middle Back Pain

The upper and middle back refers to the section of vertebrae, known as the thoracic vertebrae, which runs from the base of the neck to the bottom of your ribcage. This type of back pain is less common than neck or lower back pain as the bones in this area are not required to move and flex as much.

Like many other types of back pain, upper and middle back pain can range from aching and stiffness to a sharp or burning sensation. Pain in this area is often the result of pinched nerves in the spine by the ribs.

One cause of back pain in this area is poor posture. Try to keep your back as straight as possible and balance your weight evenly on both feet. When sitting, keep your shoulders rolled back and be sure to adopt suitable positions when driving, sitting or using computers.

For more advice on ways you can protect your back, see the 'preventing back pain' section of this guide.

Lower Back Pain

This is the commonest type of back pain with around 8 out of 10 people affected at some time in their lives. The lower back is defined as the area between the bottom of the ribcage and the top of the legs. Symptoms range from tension and stiffness to pain and soreness.

Most people's back pain is described as non-specific, meaning it is caused by structures in the back as opposed to rare conditions such as cancer or a fracture.

The back is a delicate area of muscles, nerves, bones and joints and is continuously working hard to support the weight of the upper body. Lower back pain is often triggered by everyday activities such as bending awkwardly, lifting incorrectly, standing for long periods of time, slouching when sitting and driving for long periods without taking breaks.

The 'preventing back pain' section of this guide has advice on guarding against these common causes of back pain and includes tips on lifting correctly, sitting properly, using computers and avoiding back pain caused by driving.

Buttocks And Legs (Sciatica)

Sciatica is pain caused by irritation or compression of the sciatic nerve. The sciatic nerve is the longest nerve in your body and runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.

When something compresses or irritates the sciatic nerve, it can cause a pain that radiates out from your lower back and travels down your leg to your calf. This can be mild to very painful.

The most common cause of sciatica is a slipped disc. This occurs when one of the discs that sit between and cushion the vertebrae is ruptured. Most cases of sciatica will pass without the need for treatment. A combination of the self-help measures described in this guide such as over-the-counter painkillers, exercise and hot or cold packs can usually relieve the symptoms.

For persistent sciatica, you may be advised to try a structured exercise programme under the supervision of a physiotherapist. In rare cases, surgery may be needed to control the symptoms.

Urgent (Red Flag Symptoms)

Most cases of back pain will usually get better without medical help. However, there are a number of warning signs, known as 'red flags', which may indicate that your back pain is serious.

These red flag signs include:

·         A high temperature (fever) of 38C (100F) or above
·         Unexplained weight loss
·         Constant back pain that does not ease after lying down or resting
·         Pain that travels to your chest or that is high up in your back
·         Pain down your legs and below the knees
·         A recent trauma or injury to your back
·         Loss of bladder control
·         Inability to pass urine
·         Loss of bowel control
·         Numbness around your genitals, buttocks or back passage

If you have any of the signs or symptoms listed above, contact your GP immediately. If this is not possible, you can telephone NHS Direct on 0845 4647.

You should also seek medical advice if you are having back pain and:

·         You are under 20 or over 55 years old
·         You have taken steroids for a few months
·         You misuse drugs
·         You have or have had cancer
·         You have a weakened immune system as a result of chemotherapy treatment or a medical condition such as HIV or AIDS

Also contact your GP if your symptoms fail to improve within three days or you have persistent pain that lasts longer than six weeks.

Preventing Back Pain

To avoid back pain, you must reduce excess stresses and strains on your back and ensure that your back is strong and supple.
If you have recurring bouts of back pain, the following advice may be useful:


Lose Any Excess Weight

You can use the body mass index (BMI) healthy weight calculator to find out whether you are a healthy weight for your height.
Wear flat shoes with cushioned soles, as these can reduce the stress on your back.
Avoid sudden movements or muscle strain.
Try to reduce any stress, anxiety and tension.

Posture

How you sit, stand and lie down can have an important effect on your back. The following tips should help you maintain a good posture.

Standing

Stand upright, with your head facing forward and your back straight. Balance your weight evenly on both feet and keep your legs straight.

Sitting

You should be able sit upright with support in the small of your back. Your knees and hips should be level and your feet should be flat on the floor (use a footstool if necessary). Some people find it useful to use a small cushion or rolled-up towel to support the small of the back.

If you use a keyboard, make sure that your forearms are horizontal and your elbows are at right angles.

Driving

Make sure that your lower back is properly supported. Correctly positioning your wing mirrors will prevent you from having to twist around. Foot controls should be squarely in front of your feet. If driving long distances, take regular breaks so that you can stretch your legs.

Sleeping

Your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight. If your mattress is too soft, place a firm board – ideally 2cm thick – on top of the base of your bed and under the mattress. Support your head with a pillow, but make sure that your neck is not forced up at a steep angle.

Exercise

Exercise is both an excellent way of preventing back pain and reducing any back pain you might have. However, if you have chronic back pain (back pain that has lasted more than three months), consult your GP before starting any exercise programme.
Exercises, such as walking or swimming, strengthen the muscles that support your back without putting any strain on it or subjecting it to a sudden jolt.
Activities such as yoga or pilates can improve the flexibility and the strength of your back muscles. It is important that you carry out these activities under the guidance of a properly qualified instructor.
There are also a number of simple exercises you can do in your own home to help prevent or relieve back pain.

Wall Slides: stand with your back against a wall with your feet shoulder-width apart. Slide down into a crouch so that your knees are bent to about 90 degrees. Count to five, then slide back up the wall. Repeat five times.

Leg Raises: lie flat on your back on the floor. Lift each heel in turn just off the floor while keeping your legs straight. Repeat five times.

Bottom Lifts: lie flat on your back on the floor. Bend your knees so that your feet are flat on the floor. Then lift your bottom in the air by tightening your stomach muscles while keeping your back straight. Repeat five times.

At first, do these exercises once or twice a day, then gradually increase to six times a day, as your back allows.
These exercises are also useful for 'warming up' your back. Many people injure their back when doing everyday chores at home or work, such as lifting, gardening or using a vacuum cleaner. 'Warming up' your back before you start these chores can help to prevent injury.

Read Here for more information and advice about Exercises for back pain.


Lifting And Handling

One of the biggest causes of back injury, especially at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help to prevent back pain.
Think before you lift: can you manage the lift? Are there any handling aids you can use? Where is the load going?

Start In A Good Position: your feet should be apart, with one leg slightly forward to maintain balance. When lifting, let your legs take the strain – bend your back, knees and hips slightly, but do not stoop or squat.
Tighten your stomach muscles to pull your pelvis in.
Do not straighten your legs before lifting as you may strain your back on the way up.

Keep the load close to your waist: keep the load as close to your body for as long as possible with the heaviest end nearest to you.

Avoid twisting your back or leaning sideways, especially when your back is bent. Your shoulders should be level and facing in the same direction as your hips. Turning by moving your feet is better than lifting and twisting at the same time.

Keep Your Head Up: once you have the load secure, look ahead, not down at the load.
Know your limits: there is a big difference between what you can lift and what you can safely lift. If in doubt, get help.

Push Rather Than Pull: if you have to move a heavy object across the floor, it is better to push it rather than pull it.

Distribute The Weight Evenly: if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body.