Back pain: self help measures

So back pain is common and it’s quite likely that almost all of us will experience it at some point. Not the most cheerful note to start the conversation but a reality all the same!                                                  Most of the times it will be just the temporary muscle imbalance from a poorly judged weight or from the extent of excessive bending or stretching that goes into doing that activity and on other occasions it can be a recurring injury or a chronic problem.                                               So what are the things that we can do to help ourselves when we do land with these problems? And even better, what can we do to reduce our chances of running into these problems in the first place?                                           It’s time to get back to the basics:                                       1. The fundamental need of a healthy back is a good posture. The direct result of a good posture is less strain on your back for the simple action of holding you upright. A good standing posture is where your  head is up and chin in, shoulders are back but dropped ( initially you have to consciously do this by relaxing the shoulder and neck muscles), chest out and tummy tucked in. It seems like a lot of motions and a lot of things to remember for the simple act of standing! But if we don’t get this step right then the next ones will tend to yield lesser gains. When sitting we have to remember to sit back, preferably with some support at the small of the back, commonly known as lumbar support, with both feet resting on the ground. This is very important for those doing sitting desk jobs most of the times. If you’ve felt that nag in the lower back at the end of the day then monitor your posture actively for a fortnight and see the difference. Lifting weights with your legs and not your back is another part of maintaining correct posture – when bending to lift stuff, remember to bend the knees and feel the tension in the quads ( thigh muscles) and not the back.                                           2. Maintaining a healthy weight is crucial for a healthy back. Carrying excessive weight is like walking around with a backpack at all times. It’s going to tire you out quite easily, particularly if that weight is around the midriff.                                              3. Core muscle strengthening is very beneficial for the back. I get asked quite frequently about which exercises are the best for this and I’m a big advocate of exercises that increase your body awareness such as yoga, Pilates, tai chi, amongst numerous others. These exercises involve stretching, help muscle strengthening, improve balance, help improve posture and are calming for the mind. Swimming is great as well. But this doesn’t mean that other forms of exercises can’t help back. I’ll revisit this section as a separate topic to talk about at a later date as there are lots of simple routines that can be done even at home or work that can help strengthen the core muscles.                                     4. Relaxation – it’s all about maintaining the balance. So once you’ve done the hard yard of maintaining good posture and having done the exercises, do remember to relax. Massage is a wonderful way of doing it and is certainly quite helpful in relieving the tension from the muscles but just not adequate or enough on its own.                                                         5. Good diet – adequate calcium is important for the bone health. A cup of milk has about 300 mg of calcium and our daily recommended need is roughly about 1000mg. If you have low fat milk then the calcium content tends to be higher as the fat in the milk doesn’t contain calcium. A cup of yogurt has about 450 mg of calcium.  There are plenty of non dairy foods that are rich in calcium such as broccoli, spinach, figs, fortified orange juice, tofu, fish etc. Some fortified cereals can have up to 1000 mg of calcium in 1 cup. An average multivitamin has about 600 mg of calcium. So it’s quite easy to get your daily recommended dose of  calcium from diet only. And just as its important to have adequate calcium for optimal bone health, it’s equally important to avoid too much of it as it can be harmful for the heart muscle and can lead to kidney stones when taken in excess.             6. Adequate vitamin D – best source is sunlight but it shouldn’t come at the expense of risking skin cancer! The best times are before 10 am & after 4 pm on exposed or bare skin which soaks up direct sunlight for about 15-20 minutes. For those of us that stay covered up most of the times, have sun sensitivities or have jobs at desks from dawn to dusk, the best alternative is a good supplement – 600 IU to 1000IU, depending on what is the baseline status of vitamin D levels in the body.                                                        7. Some good studies have been done recently which have shown benefit from taking high strength fish oil. It’s effect has been shown to be similar to that of a mild anti inflammatory agent which is quite impressive.                                         Hope you’ll see and agree that these simple looking measures go a long way in avoiding and managing back pain. In the next section I’ll talk bit more in detail about some core exercises, physical therapy and other alternative methods of treatment such as acupuncture.

Back pain : Introduction and causes

I am consciously sitting up and straightening my back as I sit down to write this article.

Back pain is common and figures in the top seven conditions that bring people to consultation with their GP.

Estimates of figures show that 9 out of 10 people experience back pain at some time in their life and about 1 in 5 experience it at some time each year.

From a GP’s perspective, chronic back pain is 11th most common problem managed in primary care.

So just a quick glance at these figures shows that even though it has significantly high incidence, it must settle itself in quite a few instances and even in the cases that end up in GP’s consulting room, not  quite as many progress to chronic disease. Less than 10% cases end up requiring any surgical interventions.

From society’s perspective chronic back pain is one of the most common reasons of missed work in a given year.

Due to the vastness of the topic, I’ll break up the reading on this topic into separate segments over the coming days.

Back pain is said to be acute in the first 12 weeks and thereafter it is termed chronic.

It is termed cervical (neck), thoracic (truncal), lumbar (lower back) or sacral (tail bone), depending on which anatomical part of the back is affected.

It can originate from soft tissue structures of the back which comprise of muscles, ligaments and the protective sheaths called fascia. This tends to be the most common cause of back pain we encounter.

This pain is typically localized only in the area of the back affected which tends to feel quite stiff with significantly reduced range of movement. Those mornings when you wake up with painful and stiff neck or lower back, which seems to come out of nowhere, is the most commonly encountered example of this type of back pain. As the main problem lies with the muscle component, it tends to improve with activity as the day goes on and the gradual warming up of the muscle but then gets worse towards the end of the day due to the fatigue of the injured muscle.

The other possibility of origin of pain may be from the intervertebral discs which are fibrous and cartilaginous structures which lie between adjacent bones of the spine called vertebrae and allow slight movement of the vertebrae and also act as shock absorbers.

These discs can slip (medically termed herniation) at times of unbalanced mechanical pressures such as unusually high demand physical activity, accident or trauma, and the most common cause – chronic low grade trauma which results from poor posture.

This pathology commonly tends to cause radiation of pain down into the buttocks, thighs, legs and even up to the feet. It generally feels different to muscle pain and may be described as burning, stabbing or tingly in nature. It has higher likelihood of being associated with numbness or altered sensations.

It there is any association with problems holding full control of bowel or bladder then it is a very worrying sign and warrants urgent review with your GP.

The remaining possibility of the origin of pain is from the bones called vertebrae. This is uncommon and seen in < 2% cases.

In the next section I will write about treatment modalities with focus on self help strategies.

Relaxation

Today I went to watch the musical Aladdin. It was a joyful experience! The genie had the audience in stitches on more than one occasion:)    The atmosphere in the theatre, the glamour of the stage, the artistry of the performers and the general cheerfulness of the theatregoers was infectious.                                                        Relaxation is not only fun but also an integral part of our health and wellness. It plays an equal role, along with good diet and regular exercise, in helping us maintain a sound physical and mental health.           When we are stressed our body releases stress hormones like ephedrine/adrenaline, cortisol which act to stimulate us by increasing our heart rates, increasing our blood pressure, increasing blood sugar levels ( remember that ‘crash’ you always feel when an important and urgent task is done?), diverting attention away from ‘non urgent’ body responses like immune system (and making it weaker in the process – may remind you of the tendency to catch every cold going when you’re overworked) stimulating energy levels – this explains how we seem to get superhuman strength and stamina at times of stress like preparing for exams or meeting important work targets, or just the simple daily routine ( but stressful nevertheless) of early morning rush of getting the kids and yourself ready, fed and dropped to school in time & somehow managing to get yourself to work in time! And so on and on…..                              What should normally happen is that after the stressful event the hormonal change in the blood should go back to normal. But if there is constant stress, as we tend to experience in most of our lives nowadays, then this normal fight or flight response always stays active. This results in us experiencing various physical effects of persistently high levels of these hormones, such as headaches, concentration and memory disturbance, sleep disturbance, abdominal disturbance, depression, anxiety, weight gain.                     That’s why it’s very important to find ways to counter the continuing effect of these stress hormones. Exercising and relaxation stimulates release of happy hormones such as endorphins, dopamine, serotonin, oxytocin. That heady feeling we feel when we win first place in a race or competition is dopamine, that mushy feeling we get when we are with a loved one is oxytocin, that ‘I own the world and the world is a happy place’ feeling we get after sweating it out for an hour in the gym is endorphins and serotonin. So make sure that in your pursuit of health, you don’t just focus on the latest fad in the diet but also on an enjoyable form of exercise and having some down time doing something you totally love – it may even be doing nothing! Or try spending an afternoon in the company of a genie who behaves like a pop diva at every given opportunity:)

Constipation in Children

Constipation is a fairly common problem in children. In roughly every 100 children encountered in a given population about 30 are likely to have some issues relating to constipation. It causes not insignificant amount of worry to parents.

Constipation can either be defined in time frames – the acceptable norm is to have at least 3 bowel movements a week; and the other definition, which is also more applicable medically, is the consistency of the stool and the discomfort it causes to the child whilst passing it.

So a hard and difficult to pass stool is more likely to fit the bill of constipation rather than how frequently it is passed.

The good news is that even with this high rate of occurrence, it is rarely related to a serious medical cause – over 90% cases are related to diet and behavioral issues.

Diet – A diet that is lacking in fluids or fiber is more likely to cause constipation but it must be said that the studies done so far have only shown a weak link with this. What it means is that its important to review the amount of these in child’s diet but just focusing on increasing the water consumed is unlikely to resolve the problem fully.

Milk – too much of a good thing can be bad applies to this case well. Children that have diet rich in milk tend to suffer more constipation. It is linked with high milk consumers also being fussy eaters and hence consuming less fiber.

Behavior – children can develop the behavior of avoidance quite quickly. If the child has experienced difficulty passing stools on occasions then child can learn to associate passing poo with pain. So they tend to hold it back until they can. These are the children that run away and hide under the tables or in the corners when they need to poop! Once they have done it long enough the amount of poo in the end part of the gut, called rectum, increases in size and becomes increasingly hard to pass. This creates an ongoing cycle of hard poo –> child holding back –>stool getting harder and larger –> more painful to pass –> child holding back even more. In some advanced cases it may even lead to leakage of small parts of soft stool in the child’s undies without them being aware of it.

The things that can help parents is intervening with diet where possible, reduce milk and help the child when they observe the behavior of avoidance of passing stool in the child. Some strategies are to teaching the child to have regular times to sit on the toilet seat with a foot stool – recommendations is for about 4-5 minutes at a time and about 3 times a day, reward charts and stickers, if child noted to be displaying  stool holding behavior (crossing legs, straining and simultaneously running to hide etc) then encourage them to sit on the toilet.

It is safe and in fact encouraged to use laxatives to help the children to transition from a phase of constipation to passing a soft, easy to pass bowel movement. Your GP can help in the matter of guidance of which and how  much laxative to use.

Although laxatives are not the long term solution but sometimes you have to use laxatives for months, occasionally even years, before full treatment is achieved.

Adjustment

We are constantly adjusting. As we move through different phases of our life, we experience diversity of changes – in our bodies, our ways of thinking, our social role and our relationship to our environment. Each such change is accompanied with adjustment.

Some instances of adjustment that we witness on daily basis are: transition from infancy to childhood (when we witness and experience this adjustment from the other side of the fence as a parent we often term it as ‘terrible twos’),  childhood to adolescence (this adjustment is well known and accepted in our society as ‘typical teenage behavior’), from teenage to young adulthood when we adjust to our changed role in the society, new work related roles and responsibilities, financial independence related challenges etc. New relationships and parenthood can be one of the most significant of these adjustments. Some adjustments can be at a much smaller but more personal level eg adjusting to a change in routine or adjusting to something someone has said etc.

Adjustment can be easy and smooth in some instances and bit difficult to understand and undergo at others.

When this adjustment is difficult to understand or comprehend it can potentially create a sense of dissatisfaction and disharmony in our internal environment. This can then manifest in symptoms of low mood, irritability, lack of motivation or concentration, sleep problems, apathy towards self with neglect of such simple basic activities as eating a balanced and healthy diet, exercising, relaxation – the core three elements of maintaining good health.

There is always a risk of medicalising this adjustment disorder as depression or anxiety and turning towards medications to help the symptoms. But as you can perhaps see that all that is needed to restore health and well-being in these situations is adjusting. Adjusting can be achieved by recognition of what the problem is (self awareness), what are the steps you can take to solve this problem (critical analysis) and how are you going to implement these steps(cognitive and behavioral therapy).

It may seem complicated at first but what you have to remember is that you are already an expert at adjusting – haven’t you already navigated your way through the adjustment from infancy to the stage where you are reading this blog? We mostly do great things without knowing we are doing them. The key in adjusting is gaining the awareness. That’s all.

 

Health and wellness

I feel strongly about this issue so I thought I’ll start this platform to share my thoughts, insights and ideas about understanding and taking steps towards achieving and retaining it. Everyone has a fundamental right and need to feel healthy and well. But let’s start the conversation with defining what is health? Health is not only a feeling of wellness relating to the body but also to the mind and to your environment. Your environment is your family, work, social circle that you move in, society that you mingle with and larger political aspects that have direct or indirect impact on you. So there has to be a harmony in all these elements for you to feel happy. This will probably explain why so many of us nowadays feel stressed and struggle to find the state of happiness. This then has an impact on our mental health and state of well being. It’s not uncommon for this to then present with non specific tiredness, aches and pains, unexplained weight gain, difficulty sleeping etc. It’s very common for people to present with problems like to their doctor who then runs battery of tests diligently and finds nothing wrong! In these cases the body is merely displaying symptoms of disharmony with the mental state or the environment and the answers do not lie in running scientific tests but in taking time to recognise these triggers and working out individual strategies to address these.

First blog post

Health is my passion. And this is a medium for me to connect to you to share some thoughts, tips and insights about staying healthy and well. Disease and illness is an integral part of health as minimising it’s impact on you is essential to attain and maintain health. To eliminate or defeat something you have to know and understand it well so I will try to demystify some common illnesses and ailments as we go along… welcome to the journey to finding the healthier you!