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One of the darndest things about a bad back is the sheer helplessness and the fruitlessness of 'getting anything done'.
Here you have a simple rolled-up pair of socks to create a squashy ball (every so-called back ball gadget is either too hard or too big) which can be used to pierce in to the back and - yes, literally - get right into the faulty piece of machinery causing all the pain.
It costs nothing and its super-duper effective. Just try it.
HERE’S HOW TO MAKE DRIVING EASIER
Easiest to deal with is getting the driving postures right. To do this, make sure to dial the seat back several degrees back with the adjustment on the side of the seat. Initially, it feels as if you are straining to reach the steering wheel and pedals, so you may have to move the whole seat bodily forward to counter this. Many people with a bad back feel they should sit bolt upright (see previous post) so it seems counterintuitive to sit back and relax more, but this is mandatory.
Depending on the contour of the seat back (most cars have inadequate lumbar support) it is often necessary to place a pillow in the small of the back to maintain an S-shaped bend. Usually, the more bulky the pillow the more inviting it is to sit back and relax and let the belly go (I suggest all my patients have a pillow behind if travelling more than two hours). Remember also that you should NOT tip the base of the seat backwards towards the rear as this also forces you into a slumped C-shaped.
Dealing with the sustained compression of driving is a matter of interrupting the crushing forces. You can do this by getting out at least every 2 hours and squatting – preferably holding onto the mudguard, or if you have an Australian ute, the bull bar. Squatting is Nature’s way of decompression on the run and it will bring instant relief if you are starting to get stiff with the old familiar pain resurfacing.
But all drivers with a bad back should be decompressing their spine at the end of the day by using a BackBlock (in the UK, lorry drivers and taxi drivers have back problems at four times the national average).
You can also actively decompress a spine while driving by periodically drawing yourself upwards in your seat by co-contracting both spinal and core muscles (see this demonstrated another previous FB post). This elongates the spine as it pushes your head up towards the roof of the car and takes the pressure off the base. Learning to perfect this technique can make a huge difference in seeing off the pain caused by your spine settling. Pneumatic seats (in lorries and buses) and tyre pressures can make a significant effect in smoothing out vibration and slow the rate of disc dehydration. Getting the tyre pressure just right is even more important on rough gravel roads.
Having been in practice for over 40 years (did I hear right?) I have so much information to impart you could almost drown. So, I think the best thing I can do is give you a quick rundown on what each book contains and then take it from there:
I've been saying for years how cartilage does repair and for this reason, problem joints are very fixable. For some reason, another old wives' tale that has crept into modern Medicine and become gospel is that cartilage does not regenerate. The conventional wisdom is that you were given a quota for your lifetime and that if you wear it down, that's your lot. Wrong!
In an article in today's Times and Australian (July 2022) newspaper Peta Bee writes: “Dr Fiona Watt, consultant rheumatologist and clinical reader in rheumatology at Imperial College London, says it’s a misconception to consider them worn out beyond repair as we get older. Cartilage is not just a car tyre that wears out over time. [It is] a living and very active tissue with cells called chondrocytes that respond positively to normal mechanical signals, such as physical loading when we move and exercise,” she says. “Our joints thrive on being loaded regularly and cells respond by repairing and maintaining important tissues.” It’s when the balance of these processes goes awry that joint health deteriorates".
Hooray, hooray (though not before time)!
This is what I write about in my book 'Keep Your Joints Young' (sold in Australia and the USA as 'The Body in Action'). Joints responds to on-off loading, which is typically introduced to them by end-of-range movements, which alternately compress and release the cartilage under alternating pressures. The extreme pressure gradients not only stimulate the cells, as the good doctor says, and up-regulate their repair activities at a cellular level but they circulate nutritional fluids through the cartilage bed, squeezing out waste products and sucking in nutrients, keeping it nourished, springy and slippery/shiny resilient. With inactivity and general paucity of movement, joint cartilage doesn't get these benefits, so can't repair the scratches and gouges of its daily grind. Over time joint cartilage becomes roughened, chipped, drier and thinner as the joint clogs up. This is why yoga is so effective. Yoga typically pushes joints to their very extremes of range where the stretching of the inner lining of the joint capsules – the synovial membrane - is provoked and stimulated to release more joint lubricant (known as synovial fluid). Flushing the joints in this way also keeps the joints young.
First of all, let's establish what it is that makes driving such agony for a bad back. It is all to do with three main factors:
1. Sitting postures
2. Fixed inactivity begot of concentrating on the road
3. Vibration of the vehicle
As with sitting on any chair, the main issue is the angle of the back support of the seat. The most comfortable chairs angle back in the same line as the transitional curve of your spine - at high waist level - making it easy for you to lean back slightly so you can keep as nearest possible the S-shaped curve of your spine. A seat-back that is too upright is purgatory as the bulkiness of the upper body forces you forward into a C-shaped bend. A straight-backed driving seat also invokes hectic over-activity of the long spinal muscles, simply to keep you up right, because the spine is so poorly balanced.
The pressures within the intervertebral discs at the base of the spine are greatest with sitting and these push fluid out. We all lose 10% of our discal fluid within the first two hours of sitting but this is greater if you cannot move significantly to relieve those pressures. A C-shaped (slumped) driving posture significantly increases the loading and dries the lower lumbar discs even faster, whereas an S-shape to bend distributes load more evenly across the lumbar vertebrae and slows deflation of the spine.
Early studies have revealed that certain pitches of vibration force fluid out of the discs at a greater rate.
People with a bad back tend to get into bad habits - usually in the belief they're doing what's right! Like many other areas of Medicine, backworld is littered with old wives’ tales, but some for the low back are drastically wrong . . . . either making you worse or stopping you getting better. The 3 back baddies are:
1. Sitting bolt upright in the belief you shouldn’t slouch
2. Rolling over like a log to get out of bed
3. Either not bending at all, or going down with a straight back and bending the knees
And strangely enough, all three things relate to over-activity of the powerful long back muscles - making the back ever-more brittle and difficult to move.
SITTING WITH A BAD BACK
I sometimes wonder if there’s something buried in our subconscious that suggests you deserve a bad back because of your slovenly ways. People feel that if they just sat up better they’d be more trim and everything would be okay. Sure enough, people with a chronic back tend to sit rigidly upright while driving and using chairs. Some won’t sit at all and hover round on their pins until they collapse into bed come the end of the day (a back should never dictate the rules in such a way). Too upright for too long causes untold mischief by invoking intense overactivity of the long back muscles. It requires huge muscle effort which increases spinal compression far greater than gravity. Their relentless switched-on state keeps the spine too still, drives fluid out of the discs while also throttling down the metabolic life of the discs. These backs feel stiff, tired and twingey all the time, with relief to be gained only from lying down. You will see from the Sitting pages below that the best way to sit is with a cushion in the small of the back and then leaning back (yes, letting the belly go) and relaxing. Imagine that, relaxing! (Incidentally, there’s not a chair I sit in that I do not use a pillow behind my own back.)
ROLLING OVER TO GET UP FROM LYING
I’m never quite sure where this directive came from, or why (perhaps the old humdinger fallacy about slipping out a disc at the back) but after doing countless core strengthening exercises (about the only therapeutic measure proffered these days) and then failing to put that newly acquired strength to good functional use (by getting up normally) the abdominal muscles go flabby again. Not curling forward, nose towards knees, in the normal automatic way means the abdominal muscles are sidelined and stay weak - and keep failing to support the lower back.
NOT BENDING PROPERLY
Believe me, bending is Nature’s way. We’re meant to bend and the spine is designed to bend. You could even say that one of the main roles of the lumbar spine is to lower the clever, useful upper part of the body - the hands, eyes, ears, mouth etc - to workable heights. It’s no kind of therapeutic solution to try not to bend! Just as misguided is trying to bend with a rigidly straight back and genuflecting the knees. It’s abnormal, unnatural and bottom-out awkward (anything that LOOKS that bad IS that bad!) and by letting the deep muscles between the individual vertebrae get weak, it actually makes your low back fragile - and the pain worse. The proper way to bend is bending normally - with the core and gluts switched on - and doing it with gusto. Being frightened to bend makes your back worse. Yes, you may be uncomfortable for a day or so while the back gets used to the new rules, but this is certainly the way to go.
Here is Sarah briefly explaining about each of the downloadable videos on her site.
Although 'passive' spinal decompression is the mainstay and critical first step of do-it-yourself spinal treatment, you do have to get down on the floor and drape yourself passively backwards over a BackBlock. Although you may be in the grip of pain, it may not be quite convenient to dive to the floor - if you are at a friend's place for dinner say, or in the ailses of a supermarket, or indeed hoping to soon to to sleep in bed at night - so you can also decompress your spine 'actively' on the run, so to speak. Yes, admittedly it is not as effective but YOU WILL see off the pain and be immediately more comfortable.
You can buy your BackBlock here.
Scoliosis - particularly in it milder forms - is extremely common. One of the reasons for this is that spinal curvature is invariably associated with inequality of leg length and this too – together with a small discrepancies in foot size – is almost ubiquitous. (Slight curvature of the thoracic spine concave right is also extremely common and it is thought that this is related to dominant right-handness, where the relative power of the right arm/chest muscles has a tendency to bow the spine laterally.)One of the most unwelcome manifestations of spinal scoliosis is its propensity to cause symptoms from all parts of the spine – lumbar, thoracic and cervical. In some extremes, patients may complain of headaches, neck angle pain, arm tingling, chest pain and low back pain, sometimes associated with sciatica. With leg length inequality, the spine usually adopts a concave curve to the side of the longer leg in the lumbar area and this is usually the primary curve. There is always a compensatory or secondary curve in the thoracic area, concave in the other direction and finally, another curve the other way in the neck (although this may be very small). The fact that the spine bends back and forth across the central line of gravity creates significant loading problems where one side of the spinal column is more compressed and laterally pinched at the vertebral segments.
Usually, the concave side is more symptomatic (although in the thoracic spine the convex side may cause problems where the ribs have trouble keying in to the sides of the spine). In each scoliotic curve, the apical segment – meaning the segment at the peak point of curve-buckling – is always the most compressed and likely to cause painful symptoms. Pain is created both by the physical pinching on one side of the intervertebral disc – in effect, excessive one-sided compression – and also by jammed loading of the facet joints on the compressed side. Remember, facet joints have a superlative nerve supply – indeed they are ‘wired for pain’. With scoliosis, they can cause sharp back/trunk/neck pain as well as referred pain to the leg or the arm (consistent with where in the spine they are affected). Mobilisation of jammed spinal segments throughout the S-bend of scoliosis can bring about almost miraculous pain relief. Just tinkering away with the hands brings results by the tactile input lessening the protective hold of defensive spinal muscles, while at the same time more direct pressures to the nub of the problem at the apex of the curve helps to physically loosen this jammed vertebra. With mobilising, the physio is never looking to physically straighten the spine but to simply ease it apart more to let it ride more freely out of it’s fixed S-shaped compression. But even in the absence of effective spinal mobilisation it is possible for patients to do a lot themselves to help their spine out of its compressive strictures. There are several pages on simplebackpain.com where scoliosis and spinal decompression treatment is discussed, as well as a downloadable video to take you through the A-Z of self treatment for scoliosis.
Read more pages on scoliosis here:
If you start losing fluid from an intervertebral disc two things start to happen:
1. The disc loses bounciness and becomes a more sluggish spinal connector and this allows the outer wall of the disc (the annulus fibrosis) to shrink and lose stretch. The simple stiffness of a spinal segment sets it up for trouble.
This shrunken outer ’skin’ of the disc is easily traumatised by the myriad jolts and jinks of everyday activity and since this is the ONLY part of the intervertebral disc with a nerve supply the local inflammation registers as pain.
This is the most likely explanation for ‘simple back pain’ that accounts for 90% of cases of back pain. We as physios can feel these stiff links in the spine with our hands (and spinal mobilisation treatment strives to gently loosen and rehabilitate such stiff links).
2. With continued loss of discal fluid and sluggishness of mobility the disc loses height, the unfortunate consequence of which is that the facet joint at the same spinal level start to shoulder load. Now, whereas the discs are stoic old plodders, the facets joints couldn’t be more different; they’re electrified with nerves and are right prima donnas.
They squeak and complain at the slightest insult. In normal circumstances the facet joints only bear about 16% of load but with advanced disc thinning they can take up to 70% and so you can imagine the prima donna carry on with all this extra baggage.
Facet joint inflammation (and swelling) can also be felt by experienced hands and is the most common cause of persistent back pain on one side of the spine. It is also the most common cause of leg pain or sciatica. Facet joint arthropathy is the second most common form of back pain.
So you can see that warding off back pain and dealing with existing pain the clue is interrupting spinal compression. You do this by providing quite marked pressure changes through the spine, which help keep the the discs hydrated and bouncy.
They stimulate the discs internally by jazzing up its biosynthetic repair processes but they also help in a direct way by sucking and squirting fluid in and out, just like a simple pump. The mechanical water-bellows effect pulls nutrient-laden fluids in and pushes waste products out, which keeps the discs thick and healthy.
Using the BackBlock is a great way of doing your own pressure-change therapy at home.
The passive hyperextension backwards over the block eases the spinal segments apart (decompressing) which pulls fluid in to the discs and you do this for 60 seconds.
This is followed by 30 seconds of gentle knees-rocking, which compresses the discs at the front and pushes disc fluid out, while the same pressure-difference stimulates the discs. At the same time it decompresses the facet joints at the back. The third step of the BackBlock routine is the abdominal strengthening reverse curl ups, 15 in number.
Read more here: https://www.simplebackpain.com/spinaldecompressionexercises.html
The human spine is an amazingly versatile structure, if you consider that you can reach up to the ceiling to change a light bulb and bend down to the oven to reef out the roast dinner. Yet its vertical stack of spinal segments is subject to one major drawback - COMPRESSION.
Spinal compression is caused not only by the weighing down effects of gravity but the clenching caused by muscle activity.
This spinal compression takes a toll on all the spinal structures, but particularly those of the lumbar area which bear the most ‘superincumbent load’. For the most part, the intervertebral discs - the spine’s bouncy shock absorbers between each bony vertebra - shoulder the load and help us whip and sway about picking things up and putting them down with nerry a thought.
But for the spine to work properly (and painlessly) the intervertebral discs need looking after if. It’s not that the discs are all that pain-sensitive . . . . indeed they’re really quite dumb and sleepy old structures with barely a nerve supply.
They can suffer all sorts of mechanical assault and show any number of features of wear and tear but if there’s no nerves there, there’s no way to feel pain (which is why MRIs showing disc degeneration are really not that important).
The thing that’s really important about intervertebral discs is that they keep their width (disc height) by virtue of being chockablock full of fluid. By and large, the more water held within each intervertebral disc the better that spinal segment works and the better the spine works.
As you will read in this paper, in New South Wales only one in five workers who have spinal fusion returns to work after two years and one in five have another spine surgery within two years. I'm sure you'll all agree, these are disastrously poor outcomes, besides telling nothing of the pain, misery and desperation - and isolation - along the way. True, conservative spinal therapy is also in the doldrums, which is why self-education and self-treatment is so essential if you are to beat this yourself. The good news is that the simple act of decompressing your lumbar spine on a daily basis is the first essential of lower back pain treatment, as is lessening the hold of clenched spinal extensor muscles and strengthening of the lower abs to help shore up and support the lumbar spine. Read here about a simple home regime that will start the ball rolling and bring cure within your reach:
Most people submit to spinal surgery in desperation. After weeks, months (sometimes years) of a crippling pain and - alas! often quite useless - ineffectual conservative treatment, they're simply too worn out to keep on fighting. They're looking for a quick fix. In the following article you will read that simply getting a second opinion may spare you inappropriate surgery but most patients feel committed; too dazzled by the surgeon's hard sell, caught like a kangaroo in the headlights, to put up any kind of fight on their own. Besides, they often think 'who am I to judge' and many feel a nuisance to their family. They may have misgivings that it's 'all a bit hasty' but on the other hand they feel they want to get on with their life. And the surgeon . . . . well, he seems to know what he's talking about. Of course, surgery seems even more plausible when the surgeon flourishes MRIs showing some dire-looking problem. So why delay? Why not just get it cut out!? Trouble is, it ain't that easy. All joints - be they knees, shoulders or spines - particularly spines - are finely tuned, beautifully coordinated mechanical systems that you hack things off and generally jigger around with at your peril.
Spinal fusions are much less readily performed these days and there's good reason for this: residual pain. The pain may be just as bad or worse after surgery (with or without sciatica) or the back may be passably okay for a few years but then starts to become problematic again.There are several reasons for lingering back pain after spinal fusion.
1. The spinal fusion was done for the wrong reasons
2. Post-operative scar tissue chokes the spinal nerves.
3. The next level up above the fusion suffers excessive movement strain.
Modern Medicine is just as susceptible as many other disciplines to groupthink and fashionable mindsets of the day, otherwise known as zeitgeist.
A recent zeitgeist in back world has been the diagnosing of spinal stenosis or vertebral stenosis (same thing) for rather murky looking radiology scans when in fact vertebral stenosis is quite rare and specifically related to difficulty (‘lead legs’) walking shorter and shorter distances.
A previous fashion was ubiquitous diagnosis of ’slipped disc’ for almost any type of back pain when true slipped disc is exceedingly rare (see https://www.simplebackpain.com/discectomy.html). Another recent fashion has been surgically fusing a spine at a problem level, simply because that level is painful. In point of fact, a spinal level should only be fused if it has become loose, or or unstable. Spinal instability is rare and has distinct, easily recognisable features.For a clear and concise summary of the indications (and contraindications) for spinal surgery read Sarah’s small e-Book BE CAREFUL ABOUT BACK SURGERY
The fancy neck pillows with a raised ridge along the front are also bad, although they do attempt to address one aspect of need - and that is support for the neck itself. Supporting the neck (as well as the head) is essential and much better brought about by tucking a pillow in around the neck to support the angle between shoulder and neck and this is critical to good neck relaxation. The best pillow-filling medium is feathers and it’s been that way for centuries! Why would we think that some modern material could do it any better? The best feather pillows are a combination of 80% feather 20% duck down although in their new state they’re almost over-stuffed. Before sleep you must punch a hole in the pillow with your fists to create an indentation that you nestle your head into, while the rest of the pillow bulk cradles around your neck. The neck MUST relax! At the other end of the spectrum, feather and down pillows lose their stuffing as they get old, so you literally have to plump them up from either end with your fists to get the support.
What happens as you get older is that you inadvertently forget to push off with the knee by bracing the knee back hard. Before you know it, you have lost this propelling forward function of the knee straightening. The vastus medialis muscle - the medial quadriceps muscle on the inner side of the thigh – wastes away and get weak incredibly quickly (this is why you have wobbly knees when you get up after spending a day or so in bed with the flu). After failing to walk by squeezing the knee back you find you can’t, because the inner quads muscle has wasted away. Not only does this give you a plodding, trudging walk typical of lack of propulsion, but the knee imperceptibly wobbles left to right as it fails to lock, which dramatically accelerates the knees wearing out. The good news is that you can regain a youthful walk easy as pie. It’s best to practice it on a seemingly endless flat pathway. As you relax and literally get into your stride, you will become aware at the sheer magic of it all. (Forget about the miracles of walking on water; he miracle is plain walking!). Focus but don't concentrate too hard – because if you do, everything will go unco and discordant. All you have to think about is pushing the knee back straight as you push off. If you're doing it properly you will feel the inside of your thighs working hard to brace the knees back. Make sure to relax, let your shoulders down, let the arms swing, let the hips swing . . . . and enjoy the magic.
To read more about exercises to keep the knees young see these pages:
So we're not talking about the upper body here (because what makes the old person look old in the upper body is being stooped forward like a boomerang – bottom at the back and head bent low at the front). Here we're talking about what it is in the leg department that characterises an old person’s walk. There are three joints to consider – the ankles, the knees and the hips. But in the modern era it is the knees that give us the most bother (and that wear out first). And believe it or not, in a typical case of chicken and egg, it's very much the way we walk as we get older that speeds up knee breakdown. Specifically, it's old people walking on bent knees that gives that incredibly old and decrepit look.To explain this further I have to go into the mechanics of walking. Walking is broken up into the weight-bearing and swing-through phases. As you swing the leg through and strike the ground with the heel, the knee should take your weight slightly bent. This is a good thing as it allows you to absorb shock coming up from the pavement. But then, as you go to push off in the weight-bearing phase that follows, it's really important that you push the leg back at the knee into a fully extended or locked-knee position. This action of the knee occurs simultaneously with the thrusting forward action of the gluteal muscles at the hip. So, strange as it seems, the knee going back fully straight, at the same time as the hip is thrusting forward gives you a duality of push off from both hip and knee of the same leg. See here Sarah’s pithy video about preventing knee arthritis
This video takes you carefully through self-treatment of one-sided back pain and sciatica
With so many injuries associated with them, the question has to be asked: are deadlifts bad for you.
But the main benefits of a night on the tiles are mechanical and this is why: dancing – particularly if you are a better than average dancer, light on your feet and twirling about in space - makes you inadvertently but nevertheless very effectively switch on the very muscles that have been switched off due to the bullying effects of the long spinal muscles. Moving and gliding over the floor means that you are deftly switching on your abdominal muscles, as you keep your abdominal torso braced (making you light on your feet so that you can lift and place your legs). This has the welcome effect of helping to switch off the muscles at the back thus lessening the compressive hold of the long spinal back muscles. At the same time, perhaps with a different sort of music, any shimmy-shaking of the hips similarly wakes up the deep spinal muscles that have an undulating-torso affect on the spinal segments moving in concert. This segmental spinal movement penetrates through the suffocating hold of the long spinal muscles and helps switch them off, while at the same time creating a delicious suck and squirt effect on the lumbar intervertebral discs – helping to squirt stale waste product out and suck fresh nutritional fluids in. Eliminating inflammatory toxins has an immediate and dramatic affect of easing discomfort from the very discs that have been flattened in the state of the perpetual lockdown for so long; another reason your back feels better at least in the short term after getting up and throwing yourself about. Of course, you may be a little stiff and sore the next day from the recent recruitment of muscles that have been out of action for a very long time but this is something to be stoical and philosophical about as all in a good cause. This is not a time to get anxious again and go rigid, as this will send you straight back to square one. Better to go for a walk - briskly, as you gird up your tummy and let your hips swing - and remember what a good time you had on that dance floor!See https://www.simplebackpain.com/back-muscles-anatomy.html
This goes to the very heart of what makes bad backs bad. The kernel of the problem is always a function fault, greater or lesser, at one of the spinal links. Whatever the cause, the automatic response is for the long spinal muscles is to go into protective mode automatically switching on to splint to the back – making it stiff – which wraps it up (should be) temporarily and takes it out of action. If it stays longterm there are a couple of unwanted consequences that make things worse, namely the reflex inhibition or switching off of two other important muscle groups – the deep spinal muscles of the lower back called 'multifidus' and at the same time 'abdominal muscles' at the front (this is why when your back is bad you find it harder to hold your tummy in). If the situation remains unchecked this can lead to a spiralling downturn with your lower back. It feels progressively more stiff and sore, more achy and then it eventually starts to grab on unguarded movement giving you screeching slices of pain that cobble you up in pain all the more. Eventually, you become locked in to an ever-more restricted frame of movement; so that can hardly make a move in any direction before the back lets you know again who's boss. Of course, this is made dramatically worse by you becoming more and more fretful and fearful of your back; afraid of the next painful move, dwelling on it all the time as you inexorably become more locked in and incapacitated.Strangely enough, or not so strangely, getting onto the dance floor can be just what the doctor ordered. Needless to say, it often coincides with carefree imbibition of alcohol which is no bad thing either (because it is a muscle relaxant, a slight sedative and creates that initial feeling of well-being).
2. Spinal fusion surgery uses screws and bolts not too dissimilar to that of a carpenter. The associated drilling and chopping of spinal bone and the dividing and cauterising of soft tissues and muscle in and around the spine causes massive bleeding and weeping at the operation ground zero. This must be dealt with by the surgeon before he closes up. The more careful surgeons quietly and patiently dab away at the tissues mopping up this traumatic exudate until it is virtually dry before sewing up each tissue layer on the way out. If this is not done - or if the procedure is unnecessarily traumatic and bloody- post-operative scar tissue proliferates as these fluids gradually thicken into sticky goo and then harden into stringy strands of fibrous scar tissue. It becomes like space occupying living junk that gets in the way, clogging the spinal machinery and clagging the spinal nerves. Excessive adhesions in the spine can cause back pain but more commonly causes chronic post-operative sciatica or leg pain, as they choke the nearby spinal nerve. 3. In cases where the spinal fusion has been done for the right reasons and there is not a problem with adhesions the results from spinal fusion can be excellent. The back feels as solid as a rock after the surgery (no longer prone to giving way or a ‘painful arc’ on bending). Typically unfortunately, there is a fair deal of attrition at the next mobile segment up, which suffers excessive movement strain in compensating for the obliterated movement at the fused level (see https://www.simplebackpain.com/back-fusion-surgery.html). This usually comes about approximately six years after the surgery and often manifest initially as discomfort in bed, particularly when turning over. You will see from the following pages of the book ‘Be Careful Of Back Surgery’ that the way to avoid this is to perform specific spinal intrinsic muscles exercises that keep the upper lumbar segment strong. Better still, read Sarah’s short e-Book BE CAREFUL ABOUT BACK SURGERY
Spinal fusions are much less readily performed these days and there's good reason for this: residual pain. The pain may be just as bad or worse after surgery (with or without sciatica) or the back may be passably okay for a few years but then starts to become problematic again.There are several reasons for lingering back pain after spinal fusion.1. The spinal fusion was done for the wrong reasons2. Post-operative scar tissue chokes the spinal nerves.3. The next level up above the fusion suffers excessive movement strain1. Modern Medicine is just as susceptible as many other disciplines to groupthink and fashionable mindsets of the day, otherwise known as zeitgeist. A recent zeitgeist in back world has been the diagnosing of spinal stenosis or vertebral stenosis (same thing) for rather murky looking radiology scans when in fact vertebral stenosis is quite rare and specifically related to difficulty (‘lead legs’) walking shorter and shorter distances (see https://www.simplebackpain.com/spinal-stenosis.html ); a previous fashion was ubiquitous diagnosis of ’slipped disc’ for almost any type of back pain (see https://www.simplebackpain.com/discectomy.html)). A recent fashion has been that a painful spine should be fused at a problem level, simply because that level is painful. In point of fact, a spinal level should only be fused if it has become loose, or or unstable. Spinal instability is rare and has distinct, easily recognisable features (see https://www.simplebackpain.com/lumbar-instability.html.) It is also quite common to see the wrong spinal level fused since surgeons are not particularly clever at deciding which segment is over-mobile (instability is best diagnosed manually with the hands through what is known as PIVM’S or passive intervertebral movement testing). Generally speaking, surgeons have a field day doing whatever procedure is the fashion of the day, or that they feel reasonably competent doing, and patients far too glibly prostrate themselves to oblige.
For people with a painful neck, it's a peculiar type of debility. Perhaps because the neck is so close to the brain - where it’s quite possible that muscle tension chokes the blood supply to the brain - that a stiff and painful neck can be a totally all-consuming affair; distorting one’s consciousness and clouding one’s entire waking hours.
And this is why we see patients ever more desperately searching for magic miracle cures; anything from home traction gadgets, to micro-massaging machines, to trigger point guns.
Invariably, this odyssey includes trying all sorts of miracle cure pillows. The plain fact of the matter is that there’s nothing better for a neck than an old-fashioned feather-and-down pillow. The reason for this is simple: it supports the head so totally that the muscles of the neck relax.
On the other hand, pillows made of microfibre - or worse still rubber - mean the head never completely relaxes. It bounces minutely throughout the night with catastrophic effects of escalating muscle stiffness, swollen neck joints, crepitus (grating sounds on movement) head cloudiness, altered mental states, labile emotions - and that dreadful gnawing pain - not to mention headaches.
The fancy neck pillows with a raised ridge along the front are also bad, although they do attempt to address one aspect of need - and that is support for the neck itself. Supporting the neck (as well as the head) is essential and much better brought about by tucking a pillow in around the neck to support the angle between shoulder and neck and this is critical to good neck relaxation.
The best pillow-filling medium is feathers and it’s been that way for centuries! Why would we think that some modern material could do it any better?
The best feather pillows are a combination of 80% feather 20% duck down although in their new state they’re almost over-stuffed. Before sleep you must punch a hole in the pillow with your fists to create an indentation that you nestle your head into, while the rest of the pillow bulk cradles around your neck.
The neck MUST relax!
At the other end of the spectrum, feather and down pillows lose their stuffing as they get old, so you literally have to plump them up from either end with your fists to get the support.
Although this page is about shearers' back pain, it is just as applicable to farriers, carpenters, plumbers, bricklayers, floor tilers and gardeners
Sarah Key recommends these 7 lower back exercises during pregnancy to relieve pain.
Sarah Key's Masterclass physiotherapy courses are designed to make graduate physiotherapists more confident treating back problems
World leading authority on back pain, Sarah Key, provides self-help for a bad back without surgery. Relief from back pain is now at your finger tips.
Meet Sarah Key, the back treating physiotherapist, in the game for over four decades. Information and advice from the guru of bad backs promises to be a life-altering experience
Learn about the two spinal conditions, lumbarisation and sacralisation, and what to do about them. Sarah Key describes the best treatment options. . . .
Lumbar facet syndrome is one-sided low back pain from an inflamed facet joint. It may also cause leg pain (sciatica), numbness, coldness, weakness and hypersensitivity as far down as the foot.
The best mattress for back pain depends how stiff your spine is.
These neck pain exercises from Sarah Key are specifically designed for using at home. Follow her video or on-page instructions to stop that pain in the neck!
The Complete Back Pain Relief Video Package from world acclaimed physiotherapist, Sarah Key will solve your back pain and related issues for good!
Upper Back Pain when breathing can be relieved and treated. Renowned expert Sarah Key explains the causes and what to do about it.
Sarah Key says "Of course bed rest for back pain has its place!" Find out why here . . . .
Learn what is causing your back pain and how to treat it yourself with Sarah Key's best-selling Back Sufferers' Bible
Here are Sarah Key's three best stretching exercises for back pain. They are all decompressing for the spine. Just doing these simple exercises each day will make your life worth living again.
Sarah Key explains all you need to know about sciatica symptoms and treatment
Just because you have adult scoliosis doesn't mean you're beyond help!
Many people are wary of back surgery, and rightly so. Here are Sarah Key's non-surgical options for spinal stenosis treatment
It's important to know the correct way to do deadlifts, simply because there are so many injuries due to bad technique.
Physical therapy for scoliosis consists of decompression, straightening and spinal strengthening exercises. Proper treatment can be highly effective.
Knowing something about the back muscles anatomy makes it easier to understand where you might be going wrong with an exercise regime for back pain.
Sarah Key's 7 best sciatica stretching exercises are tailored to coaxing the spinal nerve root free of its adhesions and then mopping up afterwards.
As well as masses of useful information, Sarah Key's sciatica treatment video shows you in real-time how to use the Ma Roller and BackBlock
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