15 Secrets from a Back Care Expert

More than half of UK adults suffer back pain in any one year,  but these insider tips will keep you pain free!

1 Don’t be afraid of painkillers (or doctors)
Yes, painkillers will mask the pain – but that can be a good thing. They’re not a long-term solution and no substitute for expert attention. But they play a valuable role in keeping you mobile, which experts agree is far better for backs than bed rest, as was once advised.

If you have red-flag symptoms – crippling, unrelenting pain, numbness, incontinence – you’ll need to get to your doctor, if not A&E. Don’t expect miracles; medics are unlikely to cure you. But they should be able to give pain relief, restore some mobility and send you in the right direction for ongoing care. This will usually be a good physiotherapist who will give you an understanding of what caused your problem, and a tailored set of exercises to keep you strong for life.

2 Pregnancy back pain isn’t always hormonal
Pregnant women expect back pain because they’re told it’s part and parcel of the nine months. But rather than being caused by hormones, it often occurs because your body is undergoing such unbalancing physical changes. If your posture was already poor prior to pregnancy, you’re unfortunately likely to suffer more. But you don’t have to put up with it. It’s a mechanical problem, and a good physiotherapist can show you how to adjust to your new shape to relieve pressure on your back. Pregnancy Pilates can be helpful, but make sure you have instruction from a physio.

3 Chances are, it’s not a pulled muscle
In 16 years of practice, I’ve only seen about 10 people who have pulled muscles in their back, yet most people assume that’s what their problem is. The majority of back pain is actually a muscle spasm, caused by a damaged or trapped nerve, or irritated joint. When a joint is too flexible, the muscles tense up to protect your body from injury.

People think their spine is stiff when in fact it’s the muscles. In about 15 per cent of cases, the pain is caused by a prolapsed or ‘slipped’ disc. This is when the tissue that acts as a cushion between vertebrae ruptures or bulges out, trapping a nerve. Surgery should be the last option – many people can resolve the problem through physio and core strength work.

4 It’s probably posture
According to a Europe-wide survey by the British Chiropractic Association, the single biggest cause of back pain is poor posture. It accounts for 70–80 per cent of all the back problems at my clinics. At least half of these patients have been to see other practitioners without success, because they didn’t get to the real cause of the problem: posture. If someone has injured themselves playing sport or lifting a heavy load, say, it sounds simplistic – even insulting – to tell them it’s because they weren’t ‘standing up straight’. But trust me, if they had correct posture, which comes from strong core muscles, they wouldn’t have injured themselves.

5 Mood affects your back and vice versa
It’s a chicken and egg situation. Research at the University of Alberta found depression ups your risk of back pain fourfold. But as anyone who’s suffered chronic and long-term back problems will know, it doesn’t exactly put you in a positive frame of mind. A study at Manchester Metropolitan University found negative feelings in back care patients often led to clinical depression.  And this, in turn, exacerbates pain. Don’t be afraid to talk to your GP about both sets of symptoms.  Exercise is proven to both boost your mood and  protect your back.

6 The best sleeping position is the one  that’s most comfy
In the British Chiropractic Association study, lack of sleep was one of the top three complaints from back pain sufferers. Doctors and practitioners have recommended various sleeping positions. The problem is, if you’re not used to sleeping like that, you’ll toss and turn all night. Sleep is essential for your wellbeing, so my advice is to nod off however you like. Stand with your shoulders, bottom and feet against a wall. Ask someone to measure how far your head is from the wall. This is the approximate size of pillow you need.

7 Killer heels and oversized bags aren’t all bad
I wouldn’t dream of suggesting women should avoid high heels. But avoid wearing them round the clock? Yes please! Wear your trainers to and from the office, then slip into your stilettos, wedges or platforms when you’re there.

If huge tote bags are fashionable – fine, but remember you don’t have to fill them! A handbag audit wouldn’t go amiss for most women. Do you really need to carry round all that stuff, all the time? If you don’t mind the look, a rucksack that distributes the weight of what you’re carrying evenly across your shoulders and back is the best option. A decent one with padded straps is a must for children, who are having to lug more and more school books around with them these days.

8 It doesn’t matter what type of practitioner you choose
Chiropractor, osteopath, physiotherapist… what’s important is they know their stuff. Never just walk into a surgery off the street – ask for recommendations. You need to understand the cause of your pain in order to overcome it. A good practitioner should provide clear clinical reasons for any treatment they suggest, in simple English, without medical gobbledygook.

If they pull out any electrical equipment, walk out. I feel very strongly about this! Electrotherapy (interferential) or ultrasound does not get you better quicker, or even better at all. It’s a waste of time and a good bail-out for those who don’t know what they are doing.

9 Laptops are the devil’s work
Laptops cause users to hunch even more than a poorly set-up desk at work. Forget using it on your lap, for a start. If you’re going to be on it for more than 20 minutes a day, you need to attach a separate keyboard and mouse, and raise the screen so it’s level with your eyes.

The same goes if you’re on a standard computer. And it should be in front of you, not to one side. You don’t need to spend a fortune on an office chair, but it does need to be adjustable so your feet are flat on the floor and your knees slightly lower than your hips. It should have good support for your lower back and its arm rests should fit under the table. Advanced Seating Designs has a good range (www.asd.co.uk).

Sitting on a Swiss ball or using a special kneeling chair isn’t the back boon it seems, as both cause you to sit too rigidly. Your mother may have told you to sit up straight but researchers at Woodend Hospital in Scotland found sitting at 90 degrees strains the spine more than reclining at 135 degrees. I’d say the ideal is about 110 degrees.
Most important? Don’t sit there all day – make sure you take regular breaks, move around and stretch.

10 All activity is good, if done properly
Recent Korean research found working out three times a week or more reduces risk of chronic back pain by 43 per cent. It will also keep your weight in check – you’re almost three times as likely to end up in hospital with a back injury if you’re overweight, says a study in the journal Spine.

Be mindful of how you’re exercising. Getting into yoga poses, for example, can overextend joints, causing pain. Swimming can strengthen your back or, if your technique is poor, damage it. One-sided sports like golf, tennis or archery can set up imbalances. It pays to have an expert look at your technique from time to time, be it a personal trainer, sports coach or specialist physio. The cross trainer in the gym uses a reciprocal motion which puts a twist in your middle back and is good for increasing mobility and relieving tension.

11 You don’t need gadgets
Take a towel, roll it up, then lie on top of it, so the towel runs the length of your spine, from the bottom of your neck. Place a small pillow under your head, feet flat on the floor, knees raised. Relax for 10 minutes, feeling the tension fall out of your upper back, your chest open, your shoulder blades drop. The ideal time to do this is when you arrive home from work, so you can reverse bad posture habits from the day and face the evening relaxed and refreshed. It’s an essential daily habit.

12 You won’t regret learning Pilates
It strengthens the core muscles around your lower back and abdominals, allowing you to keep your body in better alignment and stabilise overflexible joints. Trouble is, there are countless Pilates teachers around, not all of them good. If you already have back pain, seek out a physiotherapist who teaches Pilates – many of them do. If prevention is your aim, start with one-on-one lessons to perfect your technique before joining a class. A combination of mat and machine work is best and a good teacher will take it slowly, not letting you progress until you’ve mastered control of the moves. Avoid large classes if you want to defeat back pain.

13 Lower back pain starts higher up
Should you suffer acute, locking lower back pain, the best thing to do is relax your neck, shoulders and upper spine. Stand up tall, slowly, and get better posture. Shrug your shoulders. Nine times out of 10 it will help. One of the most effective ways to ease an aching back is with a good walk.

14 Certain supplements can be helpful
I’ve known patients get good results from omega-3 fish oils (which look after your joints), glucosamine (particularly useful if you have arthritis), MSN, chondroitin and collagen. There have been some promising studies into the herbal supplement devil’s claw, showing it helps improve range of movement and reduces muscle spasm and pain, particularly in the lower back.

15 Acupuncture and massage offer pain relief
Acupuncture and acupressure have been shown to reduce pain by decreasing muscle spasm. Likewise different forms of massage offer relief. But it should never hurt. Pain will cause you to tense up, worsening the problem. I can’t condone any treatment without also advising you to uncover the cause of the problem, strengthen your core, and break the cycle. It’s all very well walking out of a therapy room feeling better, but success is when a patient comes back to you feeling better.

-For more advice, visit BackCare at www.backcare.org.uk
-To find a physiotherapist, visit the Chartered Society of Physiotherapists at www.csp.org.uk