Electronic Bookshelf/Electronic Bookshelf.iso/referen/backache/curve.txt

Text File | 1992-12-04 | 22KB | 366 lines

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                     POSTURE, FATIGUE AND SPINAL CURVATURE
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       This chapter includes general posture information as well as a
       "secret" to greater comfort for computer users who suffer from
       back pain. I have put this little secret towards the end of this
       chapter since you need to absorb ALL of it rather than seeking
       only a "quick fix" for your back pain.

       Improper curvature of the spine and poor posture are the largest
       sources of most back pain. In fact if you wanted to read only
       two chapters of this tutorial to achieve fast relief from back
       pain, this chapter and the chapters on exercises would probably
       provide the most immediate relief.

       Posture governs the relation of the body's structures whether we
       are standing, sitting or prone. Obviously the shape of the spine
       is related to the muscle groups and is of critical concern.
       Things are not necessarily what they appear to be when you
       examine the topic of proper posture. For example, when a person
       stands we often think of the old advice to "put your shoulders
       back and stand tall." Good advice?

       Not really. When you force your shoulders back, the stomach
       usually moves forward to counterbalance the effort. This results
       in excessive curvature of the frequently painful lower lumbar
       area. Not a terribly good idea for optimum spinal curvature and
       back support.

       When a person is in an erect standing position a more ideal
       posture would display reasonably slight bending of the primary
       and secondary curves of the back. Good posture would provide a
       mild lumbar (lower back) curve, abdomen and buttocks not
       prominent or protruding, and head carried erect with shoulders
       not sagging or rounded. Obviously weight and height would adjust
       this picture which is for the most part an ideal. A person with
       reasonably good posture is also less likely to suffer sudden or
       chronic trauma when lifting, sitting or driving a car. Good
       posture tends to distribute sudden or chronic load on the back
       EVENLY rather than CONCENTRATING damaging forces in one region
       of the back which leads to eventual injury.

       An ignored principle of physics...

       When you apply a force to a curved surface, the greatest force
       buildup or stress is exerted on the CONCAVE or inner curve of
       the surface. Thus the inner curves of a poorly positioned spine
       suffer the greatest wear and risk for injury. The spine has
       cleverly evolved with specialized primary and secondary curves
       to counterbalance most of the forces of our erect existence;
       however, excessive curvature and poor posture contribute to wear
       and tear due to this imbalance. If you sit or walk with slouchy
       shoulders, rounded back or flabby abdominal and buttock muscles
       you WILL sooner or later experience back pain.

       Posture extends to other activities such as sitting and
       sleeping. This requires muscle tone and for some folks a
       conscious decision to lose weight and do some exercises. No
       amount of surgery, pain medications or good intent can have as
       much benefit as these simple changes in posture mixed with a
       dash of simple spinal exercises.

       Just what is good erect posture? While standing or walking this
       involves lifting your head up and tucking the chin slightly
       which flattens the upper cervical curve mildly. The crucial
       lower back (lumbar) curve where most back pain occurs needs
       special attention. Usually this means tilting the pelvis forward
       slightly as you walk or stand by contracting the powerful
       muscles of the buttocks. Relax your buttocks too much and the
       pelvis tilts rearward and the lumbar curve increases rapidly.
       Some involvement by the abdominal muscles may be needed to help
       the buttocks achieve the proper tilt of the pelvis. Simply
       taking a walk for 15 to 20 minutes twice a day may painlessly
       increase the strength of the buttocks muscles. A conscious
       effort to try the specific back-strengthening exercises
       described elsewhere will accelerate the process.

       Head forward and high, pelvis tilted forward and buttocks tucked
       in. Things may be a little stiff at first, but the relief in
       pain should be worth it.

       Try it right now: stand, tilt your head forward and tilt your
       pelvis forward by tensing your buttocks. Hold the position for a
       good 30 seconds and you should begin to feel a little tingling,
       almost pleasant feeling as your spinal muscles "stretch and wake
       up."

       Now slouch back into the old bad position and notice the
       difference. Try to memorize the sensation of how it FEELS and
       repeat this "reminder" when you are standing at the supermarket
       checkout or waiting for an elevator, after a while it will
       become your normal correct posture. Practice and good muscle
       tone goes a long way to relieve back pain. The idea is to
       slightly flatten excessive lumbar (lower back) and cervical
       (neck area) spinal curvature.

       Back pains from all other causes such as trauma, pregnancy, disc
       injury and other causes are frequently traced to poor posture
       and spinal curvature which weakened the structure of the back
       and led to the related problem. In the study of back pain,
       posture really is the starting point.

       Here's a simple test to check your posture. Stand with your back
       against a wall and your feet about 10 to 12 inches apart. Bend
       your knees slightly and lean forward just a bit so that only
       your buttocks touch the wall. Now slowly tilt backwards so that
       vertebra by vertebra you flatten each inch of your back against
       the wall. As you start to press your middle back against the
       wall you will notice that the lower lumbar section tends to lift
       or pull away from the wall. Temporarily try to hold the lower
       lumbar section against the wall as you continue to press the
       remainder of your spine against the wall as well. Keep your
       knees slightly bent during this time. Finally straighten your
       knees and keep your back flat. Finally walk away from the wall
       slowly while you maintain this position for a few moments.

       Study the sensation. This posture is probably too exaggerated
       for most people to hold for very long, but it will give you an
       idea of the "feeling" of a more erect posture. A little exercise
       and conscious effort to maintain a more straightened, less
       slouchy posture goes a long way to relieve pain.

       What about sitting? Good posture suggests sitting in a
       relatively firm chair with your back snug against the back rest
       and both feet flat on the floor or slightly elevated. If you
       have a tendency to lean, it is better to lean slightly forwards
       rather than backwards since the latter increases the lumbar
       lordosis or swayback curvature which is so damaging and painful.

       The excessive curvature of the lower lumbar area or "swayback"
       inwards towards the stomach of is probably the most common
       damaging posture misalignment.

       Swayback sufferers tend to be unusually susceptible to lumbar
       (lower back) pain. Remember that the spine is a vertical stack
       of bony vertebrae each cushioned by a shock absorbing disc. When
       a swayback condition persists, the rear or back edge of each
       vertebra is forced closer together and, over time, nerves which
       lie in that region can be painfully compressed and add to muscle
       spasm. A painful "locking" or "catch" in the lower back may
       develop, commonly referred to as lumbago. Shooting pains can
       sometimes radiate downwards into the legs (sciatica) as the pain
       intensifies and the compressed nerves react. Swayback or
       excessive lumbar lordosis is a condition which obviously should
       not be allowed to persist for these reasons. It can usually be
       corrected by conscious attention to posture, and mild exercises
       to strengthen weakened muscles.

       When driving, sit close to the wheel so that your legs do not
       stretch out. Another trick which relieves back pain on long
       drives is to occasionally lift your left foot and rest it on the
       edge of the door-jam next to the driver's door. This slightly
       raises your left knee and surprisingly adds comfort. While you
       drive occasionally tense your buttock muscles and try to reduce
       the swayback curve of the lower back if it is sagging due to
       fatigue.

       Sleeping posture is also important. Unless specifically
       recommended by a doctor, NEVER sleep on your stomach. This
       exaggerates the lumbar curve of the lower back and is the worst
       sleeping position. A relatively firm mattress is recommended for
       most people. Waterbeds and overly soft mattresses usually are
       generally not good for the curvature of the spine. Especially if
       you suffer from back pain in the first place.

       The best sleeping posture is to lie on your side with both knees
       slightly pulled upwards and tucked together. A small pillow or
       towel between the knees can lesson the bony contact between each
       knee joint. If you must sleep on your back, a slight elevation
       of the knees is the preferred position and some people place one
       or two small pillows underneath both knees to elevate them
       properly and thus flatten the lower lumbar curvature. During the
       night you will move and toss a bit, but if you train your body
       to sleep either on your side or back (or a little of both),
       gradually this will be the position you will adopt and your back
       will be more comfortable in the morning.

       Speaking of awakening in the morning, another trick which is
       useful for some people is to try to do the back exercises we
       will present in a later chapter upon arising from bed and
       perhaps soon after a "warm up" shower.

       This is because in the morning the spine is at its greatest
       anatomical length and is most supple and flexible at this time
       of the day. Also, the spine is usually not fatigued and tense
       from standing or sitting all day. Try this wakeup idea and see
       if it reduces back pain for you. It may take one or two weeks to
       adopt to these "new" postures and exercise suggestions; but they
       are medically sound and your only recourse is more pain and
       intervention by a physician or surgeon.

       Back to standing posture. Most folks notice that after standing
       for extended periods of time gradually a lower (lumbar) backache
       appears and to a small extent an upper backache. This is almost
       ALWAYS caused by the gradual unconscious relaxing of the muscles
       of the buttocks and abdomen. You sag and slouch into a "more
       comfortable" position only to find it less comfortable in the
       end.

       A simple trick to avoid this if you must stand for long periods
       of time is to place a small stool or footrest in front of you
       and alternately put one foot or the other on the footrest as
       time passes. This small trick takes a little strain off the
       lower back and keeps the lumbar curve somewhat straight and thus
       prevents fatigue. Bars and taverns usually have footrests in
       front of bar stools because it is more comfortable on your lower
       back so you will usually stay longer and perhaps buy a few extra
       drinks. No kidding!

       Here is my "secret" to back comfort for those of you who spend a
       lot of time with computers. Computer users will do just about
       anything to alleviate back pain. It is our most constant
       complaint. Here is my unorthodox method to reduce backache:

       I frequently spend 8 to 10 hours daily working with computers.
       Obviously, I am a good candidate for backaches. First, I sit for
       perhaps half an hour in a good quality chair with my feet just
       slightly elevated, torso slightly leaning forward. After half an
       hour I move both my monitor and keyboard to an elevated platform
       (old piano bench placed on the desk) which sits to one side of
       my desk. I then stand with both feet on a shock absorbing pad
       and alternately move either my left or right foot onto a small
       footrest as I stand and type. Periodically (every ten minutes or
       so) I consciously tense my buttock and abdominal muscles to keep
       the lumbar curve comfortable and tilt the pelvis forward into
       correct position.

       The footrest and shock absorbing footpad go a long way to
       alleviating back pain and lately I spend about 40% of my time
       standing and typing and the remainder seated. I have found that
       these adaptations to life with the computer produce better
       attention, more work and are comfortable at the end of the day.
       Computing while standing has become a fairly comfortable
       regimen. It also has the advantage of allowing me two positions
       (seated and standing) from which to work rather than one. I
       usually find the standing position workable at the beginning of
       the day and gradually move into a seated position as the day
       progresses and fatigue sets in. But I still try to alternate
       between the two positions regardless of the time of day. Try
       these ideas yourself, but allow a week or two of "practice" to
       achieve pain reduction results. There are no fast cures for
       heavy computer users and office workers.

       Lifting and proper posture is a neglected topic. Most folks
       generally recall something about "lifting with your back
       straight." But there is a lot more to it than that.

       Generally locking your knees straight and bending from the waist
       to pick up anything is an invitation to to increase stress as
       the critical lower lumbo-sacral joint. The heavier the object,
       the greater the chance of stressing a muscle or joint either
       temporarily or permanently.

       To lift something heavy, squat to the floor, both feet about a
       foot apart and "hug" the object close to your body. One way to
       visualize this is to pretend you are hugging a small child who
       wants attention but does not want to be picked up - the child
       wants you to SQUAT and come down to its level.

       Keeping the object "hugged" close to the body minimizes the
       leverage applied on the lower back. Lift STRAIGHT up with the
       powerful leg muscles and NOT the back muscles. This is one
       procedure you should practice a few times when you can
       concentrate on the fundamentals and not when you have to lift a
       heavy truck tire in the pouring rain some dark evening. You have
       to discipline yourself to lifting properly since all of us
       unconsciously lift the wrong way (bending at the waist) because
       it is quick and easy. And dangerous.

       A few words about posture and women. Although a woman's pelvis
       is slightly wider than a man's, the principles are the same when
       is comes to a discussion about posture. During pregnancy, as we
       will discuss in a later chapter, the tendency of the lower back
       to bend into a "swayback" position with an exaggerated lumbo-
       saccral curve can be pronounced. Additional lower back exercises
       may be prescribed by a physician to bring the spine back to its
       normal curvature after the woman has given birth.

       Another sensitive area of discussion concerning posture concerns
       the formative teenage years during which some young women can
       develop psychological sensitivity and embarrassment about
       developing breasts to the point that a pronounced "slumping or
       hunching" of the shoulders takes place. This psychological
       reaction produces poor posture (shoulders slumped forward) to
       "hide" developing breasts and may unconsciously continue into
       adulthood. This posture adjustment can produce back fatigue and
       severe pain and should also be corrected by consultation of a
       woman or teenager with her physician. In most cases simple back
       exercises and posture adjustments are sufficient as corrections.

       Severe back pain has also been reported in medical literature as
       occasionally related to breast implants and their effect on
       posture. In these reported cases, women who have poorly
       conditioned muscles of the back, abdomen or buttocks suddenly
       suffer extreme backaches with the additional weight or size of
       enlarged breasts. The reaction is not metabolic or based on the
       immune system, but is simply mechanical fatigue of the back and
       lower lumbar region due to the additional breast weight. In most
       cases a proper exercise regimen will correct the back pain. This
       is obviously a sensitive topic but might be considered by some
       women and discussed with a physician.

       Curiously, shorter people tend to have the best posture and, on
       average, a lower frequency of back pain. Perhaps this is due to
       decreased weight loads placed upon the back which is inherently
       an unstable structure. This may also be due to the psychological
       tendency to "stand tall" as a mild psychological compensation
       for short stature. Tall people typically suffer greater chance
       of backaches.

       Additional posture-related diseases have also been reported in
       the medical literature. Poor posture can affect the primary
       dorsal curve of the upper back and the higher cervical curve of
       the neck region.

       This usually develops from the same poor habits of standing or
       walking with stomach protruding, chest in and buttocks muscles
       out of tone. If the primary dorsal curve in the upper back
       begins to curve strongly for these reasons it can negatively
       affect the cervical curve and lower lumbar curve as well.
       Excessive dorsal kyphosis describes this condition. Also
       associated with this defect in the dorsal curve is a condition
       known as Scheuermann's disease which, although rare, is noted
       most frequently in teenage males. It is not entirely clear if
       this disease is caused by poor posture, genetic defects, diet or
       if in fact the disease causes the poor posture.

       Another relatively rare disorder is scoliosis which does not
       affect the front to back curvature of the spine but the side to
       side or lateral curvature. This condition is found most
       frequently among teenage girls, as reported within medical
       literature. When seen from the front or back, the spine of
       scoliosis sufferers bends in an S shaped curve which may vary
       from mild to extreme. The cause of the disease is not entirely
       understood. Back braces and physical therapy are frequently
       prescribed. Surgical correction is also attempted in some cases
       and bone to bone vertebral fusion is the usual procedure.

       Historically, polio also caused some forms of scoliosis. If
       scoliosis is allowed to run its course in advanced cases,
       impairment of pulmonary (breathing) and cardiac (heart)
       functions take place as the chest cavity assumes a
       characteristic sunken shape and compresses internal organs.

       Good posture begins in two primary areas: the pelvis (controlled
       by buttock and abdominal muscles) and head (neck and shoulder
       muscles.) Align those two and the rest of the spinal structure
       usually falls into line. The lower lumbar region of the back
       usually causes the most pain, so it is the area to work on. This
       means exercise and conscious effort to strengthen these areas
       plus conscious posture changes.

       This tutorial is merely a starting point! For further
       information on back care and back pain, be sure to register this
       software ($25.00) which brings by prompt postal delivery a
       printed, illustrated guide to back pain written by a physician
       plus two software disks. From the main menu select "Print
       Registration Form." Or from the DOS prompt type the command
       ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO
       Box 1506, Mercer Island, WA 98040. If you cannot print the order
       form, send $25.00 to the above address and a short letter
       requesting these materials. End of chapter.