Combat Back Pain, Don’t Believe These Myths

With 84% of us worldwide feeling back strain at some point, Dr Mary O’Keeffe looks at the popular myths, ways to avoid pain, and how to cope when it strikes

Disc bulges, weak cores, joints out of place; if you suffer from back pain, you may have heard these words as the reason for your discomfort. Moving when your back is locked is sore, and you will do anything to avoid it. However, not moving feels worse. Back pain can be managed sensibly enough without resorting to drastic measures. Here five back experts offer their solutions for pain.

Back pain is common

Attention Yvonne Hogan. Editor, Health & Living magazine. Photographed is Dr Mary O'Keeffe, Physiotherapist, Clinical Therapies Dept., UL. The Irish Research Council funded Mar's PHd in low back pain treatment. Photograph Liam Burke Press 22
Photographed is Dr Mary O’Keeffe, Physiotherapist, Clinical Therapies Dept., UL. The Irish Research Council funded Mar’s PHd in low back pain treatment

While back pain can be very painful and worrying, it is very common and rarely dangerous. A total of 84pc of people worldwide will experience back pain during their lifetime. It is equally common across all age groups; from young to old and doesn’t get worse with age. Therefore, it should not be seen as a result of ageing or “wear and tear”. Mostly people recover reasonably quickly, and many recover without the need for treatment. Some people experience repeated episodes of back pain which can be distressing, but again these are rarely dangerous.

Scans for back pain are rarely needed and can be harmful

Most people believe that a scan (for example an X-ray, MRI) will identify the cause of their back pain. However, the scientific research shows that scans are only needed when a serious condition is suspected (cancer, fracture/broken bone, infection). Luckily, these serious conditions are rare and account for approximately 1pc of all back pain worldwide.

The problem with having a scan is that it will almost always show something and much of this ‘stuff’ is poorly linked with back pain. Research has shown that people who don’t have back pain have disc bulges (30pc of 20-year-olds, increasing to 84pc of those 80 years of age), disc degeneration (37pc of 20-year-olds increasing to 96pc of 80-year-olds), disc protrusions (29pc of 20-year-olds increasing to 43pc of those 80 years of age) and facet joint degeneration or arthritis (4pc of 20-year-olds increasing to 83pc of 80-year-olds).

Back pain now affects one in 10 people
Back pain now affects one in 10 people

The scientific research is now suggesting that these are normal findings that increase with age, are not dangerous and often not painful. So think twice about getting a scan; and if you do get a scan and receive a long radiology report with scary terms, be clear that many of these things are common in people without pain.

The back is NOT that vulnerable to damage

Most people think the spine is something that needs to be protected. This is incorrect and has led to the provision of information and treatments that promote fear, protective guarding, avoidance and disability. Common examples include: “Your joint/pelvis/disc is slipped/out of place.”

People often move differently when in pain, giving the impression that something has gone out of place. However, scientific research has clearly shown that these structures do not go ‘out of place’ or ‘slip’. Some health professionals tell people that they are putting their structures back into place through treatments like manipulation. While many will experience short-term relief after these treatments, any benefit is due to changes in the nervous system and muscle relaxation – not due to realigning of discs and joints.

Exercise is recommended for those suffering from lower back painExercise is recommended for those suffering from lower back pain

While exercising the core (planks, sit-ups, Pilates) has become very popular, core- stability programmes are not more effective than other types of exercise for back pain (for example walking). In fact, research has shown that many people with back pain over-work their core muscles. This is a bit like clenching a fist with a sore wrist, which in fact can put more pressure on the back when it is sore.

The ‘weak core’ or ‘your back/pelvis is unstable’ theory has not been supported by science, and can create a lot of unnecessary fear and needlessly complicates exercise treatment of back pain. Instead, moving in a relaxed, confident manner is more efficient.

Contrary to popular belief, there is no evidence that an ideal posture exists. While slouching is often blamed, there is no scientific evidence to support this as a cause of back pain. In fact, many people with back pain adopt very rigid upright postures and can’t relax. The next time someone suggests to you that back pain is caused by slouching, look around and observe all the people without any back pain that can sit in a wide range of relaxed postures, in contrast to people with back pain who often sit in very rigid, uncomfortable looking postures.

Inactivity results in discomfort, so taking breaks from sitting is very important.

The back is designed for bending and lifting

Like other body parts (for example the knee), the back is designed to move and adapt to many activities. It is important to be conditioned to lift; and shown how to lift heavy things correctly and safely. The back is designed to move and adapt to many activities. In the same way that a person can get a sore knee after doing an unaccustomed activity, people can get back pain when they lift something awkwardly or something that they aren’t used to.

People will use different techniques to lift that they find more comfortable and efficient; like people will have a different running technique. The key thing is practice and letting your body get used to different loads and weights. A coach/trainer may be helpful.

You can have back pain without back damage or injury

The traditional view is that pain is a sign of injury or damage. While some back pain may be related to a sudden, repeated or heavy-loading event, we now know that the volume switch for back pain can be turned up by many other factors also. These include physical (minding/guarding the back, avoiding movements), psychological (fear of damage/pain or not getting better, low mood/depression, stress), health (being tired and run down, low energy), lifestyle (sleep problems, low levels of physical activity, being overweight), and social (poor relationships at work or home, work satisfaction, stressful life events like a death or illness) factors.

This means that you may feel more pain when you move or try to do something, even though you are not damaging your back. Ever have a headache when you are stressed, sad, tired or run down? Back pain is no different. For many people, back pain can occur from just a minor mechanical trigger, like picking something up from the ground or rolling over. In this situation it is due to the spinal structures being sensitised due to other factors such as sleeping position or stress.

Back PainBack Pain

Crucially, all back pain is 100pc real. It is unique to each person and it is not ‘all in the head’ or imaginary, even if things like stress, mood or poor sleep are a part of the problem. Being aware of all the different factors can give you a better understanding of your pain and what things need to be addressed to turn down the volume switch for back pain.

Don’t take back pain lying down and don’t rush for surgery

Since people often think they have done damage when they get back pain, it is common for people to go to bed and rest until all pain is gone. However, there is very strong evidence that keeping active and returning to all usual activities gradually, including work and hobbies, is important in aiding recovery. While you may feel relief from rest initially, prolonged rest is unhelpful, and is associated with higher levels of pain, greater disability, and longer absence from work.

Surgery is rarely an option for back pain. There are some uncommon back conditions where there is pressure on the nerves that supply the leg and the patient gets leg symptoms such as pain, pins and needles or numbness. For these conditions surgery can help the leg symptoms but it is important to understand that surgery is not always required.

Unfortunately, many people are sent too quickly for surgery such as lumbar fusions and these are very expensive. You also need to know that on average, the results for back surgery are no better in the medium and long-term than non-surgical interventions, such as exercise. So a non-surgical option, which includes activity/exercise, should always come first.

Exercise is good for back pain but people are often afraid

Contrary to popular belief, exercise is helpful for back pain, and the best is the type you enjoy. For example, walking, running, cycling, swimming, yoga and pilates all have similar effects for back pain.

Unfortunately, many people are given frightening information about exercise. People are often told to avoid running on the road, avoid swimming the breast-stroke, and to stick with low-impact activities like walking. Scientific research does not show that any of these activities are bad for your back, or wear out your joints. Like the sprained ankle example, these activities may be sore initially but they are not damaging to your back. Doing them in a relaxed manner (moving normally, not bracing and not breath-holding) and progressing gradually is more important.

Back pain is now one of the major causes of people being out of work for long periodsBack pain is now one of the major causes of people being out of work for long periods

It is emerging that the amount of exercise you do is more important than the type of exercise. More than 30 minutes per day has the greatest health benefits but any amount you can manage will result in benefit. The benefits of exercise even include reducing the risk of developing back pain.

Most importantly, you should do an exercise that you enjoy, that is affordable and easy to access.

Feeling stiff and sore after exercise does not indicate damage to your body – it simply reflects your body not being used to the activity. You can start with gentle activity and then increase your levels.

Strong meds do not have strong benefits for back pain

Many people think strong pain needs a strong painkiller. This is not true. If you have a new episode of back pain, you should start with a simple over-the-counter painkiller and not rush for prescription medications. Scientific research has shown that strong painkillers such as those containing an opioid do not provide greater pain relief over simpler options, and actually have greater potential for harm. Harms associated with opioids include dependence, overdose, falls, fractures, depression, and sexual dysfunction. If you do start on a painkiller, start with a small dose and make an agreement with your GP about when to review/stop taking the painkillers.

Buyer beware: internet, fads, fashions and bandwagons

Be wary of commercial sites that are selling a product. We hear daily claims about miracle cures and best treatments for back pain in the media and on the internet. These include electrical devices, magnets, needles, fancy exercise machines, colourful tapes, cupping therapy, herbal supplements, fancy shoes/insoles, stem cell injections and many other potions and lotions. A lot of these things have not yet been tested so you are potentially just wasting your money, and when they have been tested the results are very unimpressive.

Back pain can be cured

We really need to change the thinking around back pain. The thinking around the spine is distorted and infused with panic. Of course you can injure the back – but be confident that it will get better. It is common for people to be told that they cannot change their pain and they have to live with it. The evidence doesn’t bear this out. The back can also recover.

Think of it like an ankle sprain. It is incredibly painful at the start but it gets better with graduated activation. Avoiding movement would not help an ankle sprain, and the same goes for a back injury or back pain. The pain experience is unique to you and can involve an interplay of many different factors. It therefore makes sense that all of these factors must be considered in addressing your back pain. This could explain why many different treatments for pain fail in the long term as they only look at one piece of the puzzle.

Setting personal goals, addressing your relevant factors (lifestyle, health) and engaging in activities you enjoy like exercise, relaxation, socialising with friends and family, are all important for improvement and recovery. If a flare-up happens, do not panic. It is time for a change in the management of back pain.

Does What You Eat Affect Your Memory? Eat Like the Mediterraneans Do!

It is never too late to start eating a Mediterranean diet.

Research shows that consuming plenty of fruit and vegetables, olive oil, and even the odd glass of wine could slow shrinking of the brain among people in their 70s.

The study found that for pensioners on the diet, brain shrinkage – which is associated with memory loss and Alzheimer’s disease – was less than half that of others their age.

The benefits are believed to come from the antioxidants in the diet, which is most closely associated with Italy. These are thought to reduce damage in the brain from oxidation, which leads to neural degeneration.

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Lead author Dr Michelle Luciano, from the University of Edinburgh, said: “As we age, the brain shrinks and we lose brain cells which can affect learning and memory.

“This study adds to the body of evidence that suggests the Mediterranean diet has a positive impact on brain health.” The latest study, published in the journal Neurology, looked at the dietary habits of almost 1,000 people in Scotland in their 70s.

A Mediterranean diet was judged as one high in fruit and vegetables, beans and grains, and the mono-unsaturated fats found in olive oil. It even allowed for drinking the equivalent of one large glass of wine a day for women or two for men.

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People of this age would be expected to lose around 18ml of their brain volume in the three years between 73 and 76. But those found to have most closely stuck to a Mediterranean diet when questioned about it by researchers experienced less than half of that shrinkage, MRI brain scans showed.

More research is needed on which parts of the brain are protected, but brain shrinkage has been linked with dementia, backing up previous research that this diet, which is also low in meat and dairy products, could protect against Alzheimer’s.

Is Your Junior Staff Happy? Check on Their Wellbeing

WITH RESEARCH REVEALING JUNIOR STAFF ARE THE UNHAPPIEST SECTION OF THE UK’S WORKFORCE, WE TAKE A LOOK AT THE CAUSE OF THE PROBLEM, AND WHAT CAN BE DONE TO PUT IT RIGHT

The influx of young staff entering the workforce are increasingly expecting employers to provide fulfilment and work-life balance alongside a good salary. Yet, many managers are seemingly failing to acknowledge the shift in staff expectations with junior staff members ranking as the least happy within the workforce.

Your organisation’s future stars may very well be within your junior ranks, as previously demonstrated by rise of the likes of celebrity chef Gordon Ramsey, former General Electric boss Jack Welch and shelf-stacker-turned-Tesco boss Terry Leahy.

“UnhappyWorker"

‘Junior’ and ‘assistant’ roles within companies are an important way for many ambitious career starters to forge their career in a particular industry or company. Meanwhile, for employers, hiring junior staff provides support to key existing staff on administrative and low touch tasks, allowing them to focus on important profit-driving duties.

Their energy, youthful insight, skills and growth prospects are also important to giving company growth a boost.

However, research into workplace happiness from office search engine  OfficeGenie.co.uk suggests that employers are not doing enough to cater for their junior staff.

The survey of 2,000 UK office workers found poor remuneration levels, overworking and the low quality of work on offer were among the major factors causing disgruntlement among junior staff.

Some 62% of junior staff feel they deserve to earn a higher wage and 75% want a pay rise and, despite feeling overworked, nearly a third (32%) of junior staff admit to not feeling fulfilled while 29% felt they weren’t being challenged in their role.

The denial of flexible working opportunities is also denting the morale of junior employees, with 46% believe working from home would improve their happiness.

When nearly half of junior staff report feeling overworked (46%), flexible working could provide a welcome solution. It may also help to prevent the presenteeism found among junior staff. Some 64% admit to going into work when they are ill – compared to 47% of senior management and 43% of business owners.

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CMI’s own Quality of Working Life 2016 report found that managers put in 29 extra days of work a year which cancels out the typical holiday entitlement of 28 days, with 54% of managers saying their working hours have a negative effect on their stress levels.

Sometimes, however, all that is wanted may even just be a bit of recognition from their colleagues. Almost a quarter (23%) of junior workers wanted more praise to help improve their motivation – more than any other level of seniority.

Peter Ames, head of strategy at OfficeGenie.co.uk, said: “The fact junior staff are the least happy is alarming but not surprising when you consider they appear to be underpaid, undervalued and denied basic rights such as flexible working.

“While junior staff may expect a lack of experience to result in a slightly lower paycheque – flexible working is a fairly universal right. It comes down to trust, I’d suggest that the more you trust employees by allowing things such as flexible working, the more you will get out of them.”

THE POWER OF HAPPINESS

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From tech giants Google to sportswear firm Under Armour to medium-sized healthy fast food chain LEON, companies are increasingly investing in ‘staff happiness’ programmes to boost employee morale and engagement and are seeing results.

LEON, for example, achieved a 46% growth in earnings totaling £2.26million this year, and its founder John Vincent attributed the rise due to the company’s good relations with its staff.

In addition to paying its 600 staff the National Living Wage three months before legislation made it compulsory, LEON has also established a £600,000 programme of wellbeing and development events and training, equating to almost £1,000 per employee, which has seen employees receive massages and mindfulness classes.

Are You an Unhappy Lurker? Time to Ditch Facebook

As the time for New Year resolutions has arrived yet again, factoring prominently on many lists is “spend less time on Facebook.” According to new research out of Denmark, this may well turn out to be a good idea.

A study by the University of Copenhagen suggests that taking a break from the popular social network can boost emotional wellbeing, with the effects especially pronounced among passive users who “lurk” on Facebook without actively engaging with others.

The research showed that the effects of quitting for a week were also notable among heavy users and those who envied their Facebook “friends,” which suggested that people who dwell enviously over other users’ posts may benefit the most from time offline.

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Morten Tromholt, from the Danish university’s sociology department, and the author of the report, said the findings suggested that changes in behaviour – for example “lurkers” actively engaging, or heavy users reducing their time spent on Facebook– could yield positive results.

Tromholt nevertheless indicated that changing behaviour could be difficult, with 13 percent of the study’s participants who were supposed to be taking time out admitting to continuing use of the social network. In such cases it was thought that quitting may be necessary.

The study, which was published in the journal Cyberpsychology, Behavior, and Social Networking, involved 1,095 participants, 86 percent of whom were women.

They were randomly assigned to two groups: one that stopped using the social network for a week, and one that continued using Facebook as usual.

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On average, the participants had 350 Facebook friends, were aged 34, and spent just over an hour each day on the social network.

Questionnaires conducted at the beginning and end of the week indicated that taking a break from the site increased positive emotions and life satisfaction.

The effects of quitting were found to be greater among heavy users, passive users and those who envied others on the social network.

According to Brenda Wiederhold, editor-in-chief of Cyberpsychology, Behavior, and Social Networking: “This study found that ‘lurking’ on Facebook may cause negative emotions. However, on the bright side … previous studies have shown actively connecting with close friends, whether in real life or on Facebook, may actually increase one’s sense of wellbeing.”

Tromholt suggested that future studies should investigate the effect of quitting Facebook for a greater length of time and look at other social networks.