Sunday, November 25, 2001		Keeping fit

HOMO-SAPINES have achieved a lot by assuming an upright posture. Evolution was meant to free the fore limbs for various fine tasks and achieve much more than quadrupeds could. The upright posture makes the spine rather vulnerable, although it serves us well if we take care of it by keeping its bones, ligaments and muscles in good health. Law back pain is the most common affliction has result.

In various surveys carried out in developed countries, low back pain was one of the most common cause of disability in adults under the age of 45. Half of the working adults were found to have some kind of back injury every year. The economical cost in USA alone has been estimated to be close to $ 50 billion. In a survey published in the British Medical Journal last year, the incidence of back ache has increased over the years and was as much as 36 per cent in the working class sometime or the other during the year. It appears to be a common cause of absenteeism from work.

Our spine or the back bone is the main support of our torso and has a contour with two conexitus and two concavitus in profile (Figure). Our spine consists of pieces of cylindrical bones known as vertebrae distributed as seven in the neck (cervical), 12 in the chest region (thoracic), five in the low back (lumbar) and five in the pelvic region (sacrum) and a tail bone known as coccyx. In between, the vertebrae is the disc which is strong and elastic in structure, with a central gelatinous portion and a hard fibrous outer ring. The disc adds to the length of spine as well as acts as a shock absorber. The posterior part of the spine consists of a number of projections from the vertebrae, which form a canal-like running space hosting the spinal cord, from which nerves rise all along and go out to supply to various parts of the body.

The spine is supported by strong ligaments and muscles which hold it together and also keep it mobile in various directions. The spine, thus, is not merely a strong bony structure ,but a delicately-designed mobile support in the body and contains a delicate network of nerves which provide two-way communication with the brain. Any injury to the back, therefore, not only produces pain by hurting various structures, but can also produce serious problems including paralysis of individual nerves or the lower back, a common injury during accidents and war.

As stated above, low backache is a very common occurrence and there will be no adult who would not have experienced it. The injury to the back, including the spine, can be due to serious diseases like trauma, infections, tumours, various kinds of arthritis, vascular diseases, congenital malformations and pain which is referred to the back from other visceral organs. These causes of backache are basically medical problems and should be dealt by the doctors.

We are dealing the backache which arises out of poor maintenance and wear and tear of life mentioned below.

As age advances, the disc looses it elasticity and the bone becomes osteoporotic (loose its calcium) and thus becomes more prone to injury.

Osteoporosis can also be the result of poor nutrition, lack of exercise and various hormonal disorders.

Excessive weight is a very important risk factor in backache. The bulging middle in the front is a drag on the back.

Prolonged and slouchy sitting, whether on the desk, sofa, in front of the TV or computer, in the car or in the aeroplane are all conducive to back injury.

Prolonged standing, without proper posture of the spine, also tires out the muscles and ligaments.

Lack of exercise makes the muscles lose their tone and thus unable to keep the spine in its natural shape. In fact the upright posture of human being is maintained by graded contraction of the strong para-spinous muscles.

Without proper training, jumping and twisting (particularly on the hard surface) can be very injurious to the spine.

The often-mentioned word, spondylosis, both in the neck and the low back, is a degenerative aging process made worse by the poor upkeep and results in a large amount of morbidity in form of back pain, prolonged periods of rests. Sciatica — pain that travel from the low back towards the back of the thigh and leg — can result from backache. Besides physical factors, there is often an overtone of psychological factors like a feeling of anxiety, depression, maladjustment, low self-esteem and various addictions. The feeling of hostility and element of malingering ned to be kept in mind specially in medico-legal cases.

Sudden bending, lifting of weight, twisting and unusual physical work can at times produce a severe backache and the disc may actually protrude from its normal space and cause pressure on various structures like the nerves and the spinal cord. This kind of disc protrusion can also come by a slow degenerative process, a common recurring problem with many individuals.

Prevention of backache Prevention is the key to minimise or cure existing backache. Adospicate posture, exercise and nutrition will take care of most of the usual backaches. This is not to say that the help of physicians and surgeons (orthopaedics and neurosurgeons) would not be required at times. Normally there is a gentle curvature in the lumbar spine with convexity in front. Good posture should aim to keep the curve in a proper fashion, neither too far back nor make it completely flat. Advice is to keep it in the normal neutral position. Well-designed chairs are now available for supporting the low back. A simple cushion at the proper place can help. The elegant sofa in which one slouches is the enemy of the back. Avoid flat, prolonged sitting. Get up and move around. This advice holds good during long flights as well. While getting up from the chair, move forward, use the limbs rather than back for rising up. During driving, pull your seat as forward as the leg space permits so that the wheel and the pedals are at a comfortable distance. It is advisable to break your driving every three to four hours. While standing and walking, the back should be in the neutral position and the ears, shoulders, hips, ankles should be more or less in line. Try not to stand for a long time at one spot. A firm bed is better than a soft one the back should be in the neutral position during the sleeping posture also. A small cushion or a thin pillow under the knees will help. While rising up from the bed, it is safer to roll over to the side and put the feet on the floor first and get up with the help of limbs rather than the spine. While lifting even a small weight from the ground, it is extremely important to bend the knees rather than to stop down. Use your arms and legs to do the work. Keep the load as close to the body as possible. Don’t turn or twist while lifting the weight. Exercising the muscles of the abdomen, back and limbs is extremely important in order to maintain the tone and strength. Various manuals for these exercises are available and a professional’s advice can be taken before starting these exercises. A brisk walk, stretching exercises and swimming are good exercises to start with. Good nutrition to maintain the health of muscles and bones is important, particularly after menopause for women and men in their 60-70s. One of the common causes of backache and fractures in the vertebrae at this age is osteoporosis. An early medical consultation is advisable when a back injury or pain occurs for the first time. It is very important to rule out any underlying diseases. Good general physical and psychological health is needed for a strong back (spine). The description "spineless fellow" is a psychological counterpart of weak physical spine.