Thursday, 09 December 2021
WHEN one thinks of the human body, it can be easy to forget just how remarkable it is.
I often marvel at the workings of our eyes, the complexity of our immune system and the intricacies of our own DNA — and that’s nothing compared with the infinitely complicated wirings of our brains.
Yet, while evolution has given us such marvellous ability, some things are still struggling to catch up, such as our inconveniently narrow birth canals (I’ll admit those of you who are mothers reading this may feel that “inconveniently” doesn’t quite cover it), our single set of adult teeth (for which dentists are eternally grateful) and our poor, overloaded lower backs.
Having evolved from ancestors that once walked on all fours, when we moved on to just two legs our large heads then had to balance precariously on rather ill-equipped apparatus.
To compensate, we developed the characteristic S-shape when viewed from the side, giving rise to the inward curve at the base of the spine we call lumbar lordosis.
Although it distributes our balance well, from an engineering point of view this produces a less than ideal amount of pressure and stress on this region — the greater the lordosis, the greater the strain.
It is perhaps unsurprising, therefore, that eight out of 10 of us will have some form of lower back pain in our lifetimes with peak incidence between the ages of
45 and 59 years.
Every year, one third of the adult UK population experiences such issues, of whom 20 per cent go to see a GP. That’s
2.6 million people a year. It’s a big problem and, in terms of absence from work, one of the worst.
What actually causes the pain? Well, unfortunately, the answer is lots of things but here I will address two of the most common causes — muscular strain and disc prolapse. Sometimes, rather unhelpfully, it is a mixture of the two.
Both can result from heavy physical work, frequent bending and twisting, poor lifting technique, repetitive work, static posture and stress and anxiety.
The muscles in this area are key in helping to reduce any pressure moving through the spine itself. If they seize up, then it can be very painful very suddenly but often the slower onset back pain can result from strain over time with little micro tears gradually taking their toll.
If our core muscles are not up to the task of resisting the everyday forces our backs experience, the underlying vertebral column itself then comes under fire.
At this point, it may be worth just acclimatising ourselves to the basic anatomy. The image above shows a section of the spine. Between each bony vertebra (the large rectangular blocks) sit spongy discs (coloured blue) which help to absorb shock and give an element of flexibility to the spine, among other things.
The yellow coloured vessels poking out at each level are the nerve routes, each one sprouting directly from the spine, which is hidden from view.
In this image, the two discs at the top are quite healthy but the two at the bottom are not. An unhealthy disc can sometimes herniate or prolapse, slipping out of its normal position and sometimes pressing on the nerve routes.
This particular situation will often give rise not only to back pain but also to burning and shooting pains down the legs, which is the area these nerve routes ultimately supply.
As you may begin to appreciate, there’s quite a lot that can go wrong with such a complicated area but don’t despair.
Most acute back pain (up to 90 per cent) will resolve within six weeks and most people will not need to be off work for more than a month.
For pain not resolving beyond this point, more specialist treatment may be required as pain can become a real issue if left alone so I would recommend coming to see us if this is the case.
In the meantime, here’s what you can do if your back does suddenly give out:
• Keep active – staying still for too long will cause your muscles to contract and seize, making the problem worse. Check for exercises and stretches on the NHS choices website to help you.
• Take anti-inflammatory medication such as ibuprofen.
• Apply heat pads to alleviate some of the discomfort.
• Limit the exacerbating factors (in other words, don’t rush back to doing the heavy lifting until you’re completely recovered).
• If the pain is particularly bad, see your GP who may be able to prescribe some stronger pain relief.
You must seek immediate help if your experience any of the following:
• Numbness or tingling around the buttocks or genitalia.
• Loss of bowel or bladder control.
• Pain associated with a high temperature.
• Pain associated with unexplained weight loss.
• Swelling or deformity over the back.
As with many things, prevention is better than cure and here are my top tips to prevent lower back issues:
1. Exercise — core strengthening and low impact is best, e.g. walking, swimming, yoga and Pilates.
2. Lose weight — the heavier you are, the more pressure your back has to deal with.
3. Avoid long periods of sitting — your muscles will become tight and more prone to injury.
4. Drink lots of water as good hydration is important for disc health.
5. Stop smoking.
6. Avoid tight hamstrings — stretching these regularly will reduce the knock-on tension in your lower back muscles.
7. Posture. This is extremely important and requires a list of its own:
While sitting at your desk, ensure your computer screen is at eye level and your feet are not crossed and rest firmly on the floor, with your knees just below hip level.
Things that may help include back rests for chairs and foot rests. Monitor stands are also useful to keep your screen level.
Smart desks are even available that allow you to stand or perch rather than sit if you spend long hours in the office.
Position your phone and frequently used objects within near reach to avoid repetitive reaching. Use a headset if you spend a lot of time on the phone.
To my shame, as I write this, I realise I am not practising what I preach, so I will endeavour to change my ways, as I hope others will.
If you see me perched on an exercise ball the next time you visit for your routine medication review, you’ll know why.
⚫ Next time: Have a healthy Christmas.
⚫ If you have a suggestion for a subject for the doctors, please write to: An apple a day, Henley Standard, Caxton House, 1 Station Road, Henley, RG9 1AD or send an email to email@example.com
11 December 2017
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