the back pain guide - clarkshealthcare.com back pain guide... · 378 london road, benfleet, essex,...

The Back Pain Guide

Copyright © Clarks Healthcare 2012 www.osteopathy1.com

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Copyright © 2012, Clarks Healthcare All rights reserved. No part of this book may be sold or reproduced by any mechanical, photographic,

or electronic process, or in the form of a photographic recording, nor may it be stored in a retrieval

system, transmitted or otherwise copied for public or private use without the written permission of

the publisher. Requests for permission should be addressed to:

Clarks Osteopathic and Complementary Healthcare

378 London Road, Benfleet, Essex, SS7 1AX

The Back Pain Guide

1st Edition 2012

Author: Michael Clark

Cover and Interior Design: Clarks Healthcare

Disclaimer - Warning

The information in this book is not intended to replace a one-on-one relationship with a qualified

health care professional and is not intended as medical advice. The health and lifestyle related

recommendations and activities described in this book may not be appropriate for everyone. All

individuals, especially those who suffer from any condition, disease or are recovering from any injury,

should consult a medical professional regarding the advisability of undertaking any of the health,

lifestyle suggestions in this book and is not intended as a substitute for medical advice. The author is

neither responsible nor liable for any harm or injury resulting from the lifestyle recommendations or

the use of the exercises described herein. The author encourages you to make your own health care

decisions based upon your research and in partnership with a qualified health care professional.

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TABLE OF CONTENT

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

What is back pain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Common types of back pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Why do we get back pain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

The effects of diet in back pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Practical healthy food and drink options for healthy backs . . . . . . . 8

Is back pain genetic? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Office workers and back pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Practical office tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Manual work and back pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Exercise and back pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

The influence of age and arthritis on back pain . . . . . . . . . . . . . . . . 18

What can I do to reduce the pain of arthritis? . . . . . . . . . . . . . . . . . 19

The effects of weight on back pain . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Practical tips to improve posture and weight . . . . . . . . . . . . . . . . . . 20

Final Thoughts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

How to contact us . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

What can Osteopathy Help? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Our specialist Osteopathic clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Nutrition and holistic lifestyle coaching . . . . . . . . . . . . . . . . . . . . . . 25

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Foreword

Hello

I am Michael Clark, co-founder of Clarks Osteopathic & Complementary Healthcare. I would

like to thank you for downloading this e-book. I have compiled this book as a user-friendly,

easy to read guide to low back pain with minimal use of scientific terminology. It is based on

my clinical experience with thousands of patients along with my own studying from many

courses, books, dvds, and published research.

Statistics show that acute low back pain affects 80% of the UK population at some time in

their life. It is therefore my intention that by reading this book you will gain a greater

understanding of what constitutes a healthy back and have practical tips at hand on how you

can improve the health of your back. It is my strong belief that prevention is far better than

cure. I have therefore intentionally included repetition and a crossing over of themes.

In addition to finding useful information on back pain in this e-book, you will be pleased to

learn that you are now on our exclusive newsletter subscriber list. This entitles you to some

cutting edge information on health, wellness and injury prevention, all delivered to you at

regular intervals each month. Each edition will feature valuable tips, health plans, expert

advice, video and audio lectures and informative articles to keep you healthy and living

without pain. You can share this excellent resource of healthy living with your family,

friends, colleagues and acquaintances, by forwarding it to their email address or asking them

to sign up for FREE. This newsletter is my commitment to improving your health as your

preferred healthcare professional

Thank you!

Michael Clark BSc (Hons) Ost Med, HLCII, CMTA Co-founder of Clarks Osteopathic & Complementary Healthcare Registered Osteopath Nutrition & Holistic Lifestyle Coach Certified Metabolic Typing Advisor

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What is back pain?

The first thing to remember is back pain is a

warning signal that something is wrong!

We have many different types of nerves in

our body which send information to our

brain about our internal and external

environment. Pain is detected by a group of

nerves called nocioreceptors. They inform

us when damage is occurring acting as our

safety feedback system preventing serious

injury. Many people have learned to live with pain, for others reliance on pain

management medication has become a way of life. Although medication can be of

benefit, it rarely addresses the root cause and often only masks it, eliminating the

pain without addressing the cause. It’s like having emergency lights flashing in your

car’s dashboard and either choosing to ignore them hoping the problem will go

away, or in the case of medication just taking the bulb out silencing the symptoms

and hoping it will get better. If you are experiencing back pain or you suffer with

recurrent back pain the cause should be addressed because statistics show that

unresolved back pain can deteriorate and may result in a need for surgery as a last

ditch effort to preserve the remaining healthy tissue.

Common types of back pain

There are many different types of back pain and no two people will ever be exactly

the same. However we can group different types of back problems. The most

common include:

Disc Injuries commonly known as a ‘slipped disc’. This is not a very accurate

description. It would better be described as a bulged, herniated or prolapsed disc.

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Disc injury pain can vary from mild to agonising. Sometimes the ‘bulging disc’ will

compress a nerve causing problems such as sciatica.

Other common back problems include: spondylitis, spondylosis, osteoarthritis, facet-

capsular irritation, postural muscle fatigue, ligamentous fatigue, spinal stenosis,

osteoporosis etc.

Why do we get back pain?

With all the advances in modern medicine it would be reasonable to expect that

‘back pain’ would have finally been ‘cured’. Sadly the statistics suggest otherwise

and the incidences of back pain are

actually increasing. Back pain affects

over 16 million people per year in the UK

alone and is the number one reason for

long-term time off work overtaking

problems such as the Flu. Acute low

back pain affects 85% of people at some

time in their life. This amounts to

thousands of hours of suffering, and millions of pounds in lost revenue from

absenteeism from work. But is back pain indeed unavoidable? Is it genetic? And how

did our ancestors cope without Osteopaths, surgery or pain medication?

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As recently as a few generations ago, back pain was relatively rare and was normally

the result of major trauma or extremely harsh living and working conditions. If we

step back in time even further, to our distant ancestors, back pain was rarer still. So

why was this? What were our ancestors doing different to us? When we compare

our modern lifestyles with those of our distant ancestors there is very little similarity.

We once lived as hunter gatherers in small communities which stayed within a local

region (there certainly was no possibility of flying to other countries). To live and

thrive as hunter gatherers we had to rely on our minds and bodies being healthy.

We moved our bodies in many different ways from climbing trees, walking, running,

squatting, jumping, twisting. We needed to have physical strength, suppleness and

quick reflexes, and to carry, push, and pull things and so on. This way of living

resulted in very strong, supple bodies with excellent posture and all this was

achieved without any need to consult Osteopaths, personal trainers, doctors or read

books on back pain.

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The effects of diet on back pain

When we compare a typical modern western diet with that of our ancestral diets, it

is clear that what we now choose to put into our body has changed more in the last

100 years than it has in all of human history. For example, the use of chemical

fertilisers, pesticides, herbicides, rodenticides and hormone treatments for cattle is

new. Chemical farming was in its infancy prior to World War 2 and was certainly non-

existent in the days of tribal communities. Therefore ALL food in distant times was

organic! I feel it is a shame that farming with chemicals is now called conventional

farming, it’s the organic farming which is conventional having subsisted before the

first ever human! Our ancestors never had fridges, freezers or sealed packaging

preserving their foods. Therefore everything eaten was fresh and based on the food

available in a specific geographic location and season. There were no fad diets, low

fat alternatives, or magic sports drinks.

You may be thinking, ‘what does diet have to do with back pain?’ Let me explain. It

is VITALLY important to look at what we are eating and drinking with regards to back

pain and our health in general. This is why I am discussing healthy eating as one of

the first chapters. Let me explain further. Our spinal discs, spinal muscles, ligaments,

tendons and indeed every cell in our body, are literally made from what we eat and

drink. Real organic food, particularly when it is very fresh, is far more nutritious than

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non-organic food. We need lots of different nutrients and in high quantities (and

quality) to rebuild damaged cells and to build healthy backs.

To demonstrate the effect of a poor diet, if you have the opportunity I suggest you

watch the documentary ‘Super-Size Me’. In this documentary a very brave man

began an experiment observing the effects on his health of eating only fast food for

one month. The results were incredible! The experiment was stopped early due to

the damage it was causing to his organs and his overall health. It took a further

fourteen months to recover his original health. Now most of us don’t choose to

solely eat fast food, however most modern diets are still very low in nutrients. For

some they are low in nutrition and high in additives, artificial flavourings,

preservatives, and colourings etc. This affects the health of our organs but will also

affect the strength and integrity of the physical substance our joints and spinal discs

are made of. Would you build a house with low quality cheap materials and wonder

why cracks and weakness start to show? If you are still unconvinced of the effects of

a poor diet then I suggest you read the book ‘Nutrition and Physical Degeneration’

by Western A Price.

Practical healthy food and drink options for healthy backs

Increase your water intake and reduce caffeine and alcohol

Water is vital for healthy backs (this does not include caffeine, juice or

alcohol). Water supports many

important functions for our

musculoskeletal system including

our backs. Lumbar spinal discs

are composed of 70-80% water.

It provides the discs with

strength and flexibility. It acts

much like the air in a car tyre.

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Water provides over 80% of the lubricating service between all joints. In

order to stay hydrated it is advisable to reduce caffeine and alcohol intake as

they act as diuretics and deplete minerals.

The effects of dehydration are very well documented. In summary when we are

dehydrated even by a small amount the body has to ration the water inside us to

prevent organ damage. It does so by drawing water from our muscles, joints and

discs and diverting it to the vital organs resulting in what I call a ‘dehydrated spine’.

Adequate hydration is therefore an important component to back pain prevention.

In addition to prevention I have seen many patients with long term chronic back pain

have their problem completely resolved just by increasing their water intake.

Eat the highest quality food possible

As I have already stated, every cell in your body

including the discs, joints and muscles of your

spine are literally made from what you eat.

Therefore the higher quality of food consumed,

the higher the quality and more robust your body

will be. Soil Association organic food,

biodynamic foods, free range meats, wild caught

fish, or home grown produce from your garden

are best! With a quick internet search you will be

able to find quality food providers in your area.

Food intolerances/allergies

Food allergies & intolerances such as gluten, wheat and dairy are known to

cause joint inflammation including low back pain. Any food that inflames or

irritates the bowel will weaken the low back and abdominal muscles by what

is known as viscera-somatic reflexes. Stop eating ANY wheat or gluten for 3

weeks and see if you notice an improvement to your muscles and joints.

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Is back pain genetic?

Our genetic make-up is being implicated for almost every possible health complaint.

The truth is only a very small portion of people are born with genetic abnormalities

of the spine such as spina bifida etc. For most the problem is not genetic. Our

genetic make-up indicates ‘tendencies’ towards back pain and is not set in stone. If

you study the field of epigenetics you will learn, what we do in our day to day lives

can determine if these ‘genetic tendencies’ will develop.

Some families may have a history of back pain which would appear to indicate a

genetic problem. However, most families develop a similar problem not because of

genetics but through a similarity of lifestyle choices. For example many patients

present to us with a ‘dowager’s hump’ which is a hump in the lower neck along with

a forward head posture. They may report that the whole family have this. However

usually if you look back at family photos the entire family have a very similar posture

since childhood, this faulty posture over many years developed into this condition.

Research has shown a very similar frequency of orthopaedic problems with adopted

children into a family who have a history of back problems. In these cases it is

clearly not the genes as they are not genetically related. It is the environment and

lifestyle they live within. In summary the more positive the lifestyle choices you

make, the less likely or less severe will the effect of your genetic tendencies.

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Office workers and back pain

More people work sitting in an office than any other type of occupation in the UK. If

you also include the number of other occupations which require us to sit for

extended periods of time such as taxi drivers, couriers or those that commute to

work, the number is even higher still. Sitting for long periods is unequivocally very

straining on your spinal discs.

If you look at your spine from a side view, you will see several distinct spinal curves.

There is an inward curve in the low back (the lumbar lordosis) then a long outward

curve in your mid back (the thoracic kyphosis) and finally another inward curve in

your neck (called the cervical lordosis). These curves enable our spines to act like a

spring. Absorbing and dissipating forces. As we walk, jog, run and sprint the spine

lengthens and compresses. This creates a pumping action to the discs and joints,

drawing nutritious fluid into our backs as it lengthens and conversely pumps used

fluid out as it compresses. Sitting stops this mechanism resulting in what I call a

‘stagnant spine’. Furthermore when we sit, our hips are at approximately 90

degrees. This is an unnatural position which further loads the spine. Sitting will over

time result in weakness of the postural muscles and progressive degeneration of the

lumbar discs.

Our ancestors instead of using chairs squatted with an upright back. We are all born

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with an ability to squat like this but normally lose it over time. When a child squats

they are able to maintain a very straight back, when a typical adult squats you can

instantly see the difference (see below). The adult is on his tip toes with his back

rounded

So what’s the answer to the sitting problem? Sadly in my opinion there is no perfect

answer and no matter how good an ergonomic setup, in my opinion it will never stop

the pressure on the back only reduce it. The most obvious solution is therefore to

avoid sitting for extended periods. Obviously for some this is unavoidable, what we

can do in these circumstances is to minimise the effects.

Practical office tips

If you sit for long periods ensure the office and chair setup is as ergonomic as

possible. Most companies will be able to provide an ergonomic assessment

if you ask! Computer screens should be at eye level and everything you use

close to hand without the need to continually rotate to reach for something.

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Stand up and move around regularly and go for a walk at lunch time.

Something as simple as walking to get a glass of water while only short in

itself, when added up through the week can make a difference.

Remember not to slouch, instead sit upright with good posture. I have

observed many people with excellent ergonomic set-ups slouching. Some of

this is due to bad habits. Remembering to sit upright can be difficult. Having

‘postural reminders’ such as post it notes or having your computer remind

you regularly to sit upright can drastically reduce the frequency of slouching

and the pressure on our backs.

Schedule quality daily ‘movement exercises’ such as walking or swimming to

get your spine pumping.

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Manual work and back pain

In general an occupation which requires you to

move is better than a stationary job. However

most manual occupations require the use of

only a small group of muscles and use them to

excess while other muscle groups may not be

used enough. For example a carpenter may

excessively use their dominant hand through

repeatedly hammering nails, sawing wood and

using a screw driver. Using a dominant side in

this manor commonly results in strained, tight,

fatigued muscles in one area coupled with

weakness in the unused area. I usually see this

type of muscle imbalance in patients who can lift something heavy with ease whilst

standing but then damage their back bending to pick up the morning post.

Practical tips for manual workers:

Always stay hydrated and eat properly (as discussed earlier). Manual work is

like going to the gym all day. Staying hydrated and eating correctly will leave

you less vulnerable to injury.

Schedule breaks throughout the day. I have had conversations with many

self-employed builders over the years who have told me they are too busy to

have breaks. If this sounds like you then try this little test. For 3 days in a row

structure in a 30 minute lunch and two 15 minute breaks. Ensure they are

real breaks, no phoning or multi-tasking. You will feel far more refreshed,

alert and work more efficient, getting the same amount (If not more) work

done and at the same time reducing the chance of injury and time off work.

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Manual workers are usually very strong but ‘stiff as a board’. This is like

having a powerful car with no shock absorbers. Flexible back muscles are

more capable of absorbing stretching forces than an inflexible one. If you are

very inflexible the chances of you ‘tearing something’ is significantly higher.

Spending 5-10 minutes a night performing some light structured stretching

will improve suppleness to go with that power.

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Exercise and back pain

It is vital for our backs and overall health to exercise regularly. First you need to be

clear if your intention to exercise is to prevent injury or reduce pain? Exercise for

relief care is very different from

preventative care. When we examine

patients who are ‘in pain’ we structure

exercises to calm the inflamed tissues and

promote mobility. After successfully

providing relief care and reversing the pain,

only then do we progress the patients’

rehabilitation program to an appropriate

higher intensity (relative to their health and

fitness) to strengthen the injured area. If

you are in pain contact us or any other

suitable medical practitioner for an

examination before exercising.

As I discussed earlier, our distant relatives and ancestors had no choice but to

exercise, just washing clothes by hand was a workout in itself. Regardless of your

physical health there is a level which is appropriate for you. For back care

programmes to be truly successful in the long term they should incorporate a

healthy balance of resistance training, cardio, stability exercises and stretching with

an emphasis on your weakest areas. It’s common to choose exercises you feel most

confident with instead of the exercises you need. For example most builders are

very strong as they are technically lifting weights all day via their job. If they choose

to lift weights every night as the primary exercise choice, they will likely develop

improved strength but at the detriment to their flexibility. Increasing strength

without flexibility will increase the possibility of back injury. It’s like having a

footballer with powerful legs but stiff hamstrings, what do you think the chances are

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of tearing a hamstring? This person would likely benefit from a greater emphasis on

a structured stretching programme.

Some people can easily touch their toes, are ‘very

bendy’ but have little strength e.g. they cannot

perform one press up. For this person performing

only yoga will probably make their already supple

joints become unstable and lax. It’s like loosening all

the wheel nuts on a car, as soon as the car produces

some power it will shake, become unstable and increase the risk of injury. This

person is unlikely to need to perform stretching as the primary form of exercise. For

optimal results it’s more likely they would benefit from a greater emphasis on

strength training.

Just as a little side note for anyone who is concerned that weight training will result

in large muscle gain. It is easy to improve strength whilst avoiding gaining heavy

muscle bulk and maintaining a smaller frame. We regularly treat dancers and other

professionals who require increased strength without increased size. When given the

right exercise programme they will gain excellent strength while maintaining a

certain aesthetic look.

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The Influence of age and arthritis on back pain

I am pleased to inform you that age and arthritis has less to do with back pain than

you may think. Yes with age comes a certain level of degeneration of the spinal discs

and joints (the facet joints) or as I like to call it ‘normal wear and tear’. However if

you have been told that you must learn to live with back pain this is frequently

untrue. The majority of back pain from arthritis is not due to the level of the

degeneration but is directly proportional to the level of friction between the arthritic

joints. Let me explain further, a person who has a mild ‘wear and tear’ but whose

joints rub and grind a lot will likely experience a lot of pain, discomfort and disability

even though their x-rays show only mild degeneration. When we compare this to a

person who has more marked degeneration but is able to minimise the friction

between the affected joints they will likely have minimal pain, discomfort and can

normally work around the problem area. It may be hard to believe, but I have seen

many patients with marked degeneration who have almost no symptoms and are

able to be active and play regular sports.

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What can I do to reduce the pain from arthritis?

Drink adequate amounts of water

Within our arthritis clinic we always assess our patients’ fluid intake. As I

explained earlier the water we drink provides the large majority of the

lubrication between all joints in the body. When we are dehydrated the body

will ration water drawing lubricating fluid out of joints and cartilages and

diverting it to the vital organs. The spine of a dehydrated person is like the

engine of a car without oil. You cannot have optimal joint lubrication if you

are dehydrated.

Develop good posture

Good posture can be defined as the optimum mechanical position of the

spine to provide the optimal muscle efficiency. Do you have good posture?

If you are unsure have a photo taken of yourself from the side. The ear, edge

of your shoulder, the hip bone, the knee joint and the ankle bone should be

in approximate alignment. The further you are from this ideal, the more

friction there will be to your joints and the more tension there will be in you

postural muscles, joints, cartilage, ligaments and tendons to support you. It’s

like the Leaning Tower of Pisa, it requires a lot of additional support to stop it

falling, it’s the same in the spine. Simple tricks such as remembering to stand

up straight, and walking with good posture, looking forwards not down when

walking will all help. Posture can also be significantly improved with the

appropriate treatment, exercise and lifestyle changes.

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The effects of weight on back pain

Yes weight does have implications on back pain. However it’s less the weight itself

and more its effects on posture and overall muscle health. Let me explain, if a

person is 2 stone overweight but has good posture and a strong supple physique

they will put less strain through their back compared to a person at ideal weight with

poor posture, who rarely exercises and works at a computer. That being said, being

overweight or underweight is undesirable for our backs.

We all have different body types and store excess weight differently putting different

strains on our backs e.g. someone who stores excess weight on their belly normally

has an increase in the curve in the low back (the lumbar curve) straining the low back

muscles, likewise a lady who puts excess weight on her breasts will likely slouch

loading a different area of her spine straining the muscles of the neck and shoulders.

Practical tips to improve posture and our weight

Develop positive postural habits.

Much of our posture is habit. It takes approximately 100 repetitions to

develop a bad habit and about 700 repetitions to undo a bad habit and

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ingrain a good one. It can be laborious work to keep remembering to stand

up straight but it will be worth it in the long run.

Control your weight but don’t diet!

I repeat, don’t diet! Instead eat properly in a way you will continue in the

long run. Typical fad diets are very difficult to maintain long term and

normally result not in a loss of body fat but a loss of water and muscle. These

are the muscles needed to support our backs. A whole book could be written

just on the negative effects of dieting on our backs, in brief depriving the

body of something it needs such as calories, protein, fat etc. will result in use

of the body’s stored nutrient reserves over time leading to chronic mineral

depletion, slowing of the metabolism and an inability to maintain a healthy

weight.

Have a comprehensive assessment

It may be necessary to seek a comprehensive assessment and have a

structured programme developed to improve long standing postural

problems. You can call us or any suitable local practitioner for an

assessment.

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Final Thoughts

I hope you have enjoyed reading this book and have gained a greater insight into

some of the areas that may help you improve the health of your back. Prevention is

the best place to start. It is better to invest your time creating a healthy back than

trying to repair a damaged one. I hope you appreciate that pain is a warning signal

and the cause should always be addressed. Never accept that you just have to live

with pain, in my experience it is always possible to achieve some level of

improvement.

I wish you good health!

Michael Clark BSc (Hons) Ost Med, HLCII, CMTA Co-founder of Clarks Osteopathic & Complementary Healthcare Registered Osteopath Nutrition & Holistic Lifestyle Coach Certified Metabolic Typing Advisor

How to contact us Benfleet Branch Clinic Address: Clarks Osteopathic & Complementary Healthcare ® 378 London Road, Benfleet, Essex, SS7 1UE www.osteopathy1.com Tel: 01268 795705 www.osteopathy1.com

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Bibliography

Scientific Back Training by Paul Chek

Orthopaedic Physical Assessment by David Magee

Clinical Sports Medicine by Peter Brukner and Karim Kham

The Metabolic Typing Diet by William Wolcott

Nourishing Traditions by Sally Fallon

Cooking Without by Barbara Cousins

You are what you eat by Paul Chek (8 hour audio series)

Adrenal Fatigue by James L Wilson

The Fungus Link 1, 2 and 3 by Doug Kaufman

Biochemical Individuality by Roger Williams

Dangerous Grains: Why Gluten Cereal Grains May Be Hazardous To Your Health by James Braly

Your Body's Many Cries for Water: You Are Not Sick, You Are Thirsty by Dr F Batmanghelidj

Nutrition and Physical Degeneration by Western Price

Pottenger’s Cats by Francis Pottenger

Know Your Fats by Dr Mary Enig and Sally Fallon

Eat Fat Lose Fat by Dr Mary Enig and Sally Fallon

Super Size Me documentary directed by and starring Morgan Spurlock

http://www.amazon.com/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&sort=relevancerank&search-alias=books&field-author=Fereydoon%20Batmanghelidj

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