It is very difficult to find someone aged forty five years or more who has not experienced at least one episode of back ache. Worldwide, millions of healthy people suffer from back pain on a daily basis. It is also known as one of the commonest causes of sick leave worldwide. In this article I will give you some tips on how to avoid back ache without using medication.

Why is backache so common?
If we consider the structure of the spine there are mainly two areas which are thought to be weak. The neck and lower (lumbar) spine are these two areas which could easily get damaged. The same areas are subjected to lots of wear and tear throughout the aging process because of excessive mobility or bendability. It is said that 80 percent of spinal pain is associated with neck and lower back region. The two segments that undergo such intense stress throughout our lifespan can either collapse / break down suddenly. 

What are the correct ways to stand?
Proper posture is very important for anyone who routinely mobilize themselves.  I always emphasise the importance of being alert to the spinal posture when standing. The first figure (1) shows the usual correct standing posture. Always keep the lower part of the spine slightly bent backwards with your neck kept straight. Do not shrug your shoulders. Instead, pull the shoulders back slightly. It is also important to keep your knees straight.

An easy day to day standing posture is to bend one knee in such a way that the body is bent in three places, with the weight on the other knee (Figure 2). It is better to switch sides / knees intermittently to avoid excess weight on one leg. This is one of the most preferred standing postures.

What is the proper sitting posture?
The modern tech era comes is linked with numerous unhealthy postures which did not exist a century ago. Our ancestors never had smart devices, laptops or for that matter even desktop computers which might be the root cause of spinal pain. The key to a correct sitting posture lies within the design of the chair. When seated the lower (Lumbar) spine should be slightly bent backwards. The back of your chest should be well supported.  Similarly, the neck/head area should be kept at the level of the hips. The height of the chair should be adjusted so that on the feet are flat on the floor. The thighs should have one finger breadth space above the front part of the seat. (Figure 3). When using a computer, the screen should be slightly raised if the neck is bent forwards. (Figure 4) A foot rest can be used to achieve this posture if the seat is not adjustable. Arm rests of the seat should be at the table level.

What are the harms of lifting weights?
People who do physically demanding jobs lift weights on a daily basis. Many, adopt bad postures when lifting heavy objects or people. Lifting weights and manual handling are themes that have specific guidelines in the west but unfortunately not in countries like ours. Depending on the weight of the object/ person there are specific rules on the number of people involved. Unfortunately in Sri Lanka there is no legislation to impose at least some of the overseas guidelines on workplace /occupational health and lifting weights.

In this article, I will briefly introduce some useful tips on weight lifting. First, identify the weight that you have to handle. If you cannot lift it, ask for another person’s help. Secondly, check to see whether there are places for you to hold on to when lifting the weight. All modern electronic devices which are somewhat heavy have pre-marked areas to hold on to when handling. Avoid lifting slippery weights as the end result could be disastrous. Thirdly, keep in mind that all the bending your body over when lifting objects from the ground can cause serious stress to the spine.

Always bend your knees to the fullest without bending your back, when lifting weights kept at a lower level. With the spine straight, using the knee muscles lift the object slowly and steadily. This method does not usually damage a healthy knee. Always keep the weight on your arms close to the upper abdomen or chest. This weight pressure will then transmit through the spine to the hip area involving the centre of gravity of your body. (Figure 5).

Many patients whom I meet on a daily basis suffer from back injuries as a result of looking after small children. Lifting children is difficult because they constantly change their posture. The child-minders then have to move about the spine corresponding to those movements of the child. This can damage the spine. The elderly should especially take precautions when allocated the task of looking after a youngster. 

Exercise and back pain
One of the most common concerns our patients have is about damage to the spine during which might occur during exercise. My answer is simple. Exercising without weight lifting (aerobic exercise) is known to have great health benefits. Walking, cycling, and swimming are among the most common soothing types of sports you could consider. It should be said that regular (at least daily) exercise can improve blood circulation, cure high blood pressure and many joint ailments. Try to engage in 5 sessions of exercise per week with each session lasting for 30 minutes or more.
(The writer is a Fellow of American College of Rheumatology
Consultant in Joint Disease, Rheumatology and Rehabilitation)