The back pain workout
Dan Roberts tried everything from drugs to shiatsu – but lived life in agony. When sciatica took his discomfort to a new level, he discovered a programme of exercise that promised to end his suffering for ever. Could it really cure him?
Tuesday 06 July 2010
A recent survey by the Confederation of British Industry found that, although British workers are taking fewer sickies – just 180 million sick days last year, the lowest number since 1987 – the usual suspects are keeping them away from the office: "mental health issues" such as stress, anxiety and depression, and good old-fashioned back pain. According to the Health and Safety Executive, back pain is a particular bane of workers doing manual labour, delivery work, repetitive tasks such as packing, and those in sedentary roles. As our economy is increasingly dominated by financial and other services, burgeoning numbers of white-collar workers fall into the latter category. And back pain is the inevitable consequence, with eight out of 10 Britons hit by a dodgy back at some point.
I feel their pain. Decades of spinal abuse have taken their toll recently, as my forty-something body finally ground to a halt. I have, it must be said, had a good run: years of joint-punishing marathons and general pavement-pounding, adventure racing, football, tennis and Thai boxing, all at full throttle, ignoring the niggly injuries. Then, the clincher: a stooping, slouchy posture and a decade's desk-jockeying, glued to my Mac for up to 12 hours a day.
And boy, have I paid for it. Decades of lower back pain finally graduated to full-on sciatica recently – a whole different order of agony. The evil sciatica (when the sciatic nerve that runs from the back of your pelvis, through your buttocks and all the way down both legs, gets compressed or irritated) struck last Christmas, after an especially stressful and overworked period, sending scalding pains shooting from my back, through the left buttock and down the hamstring into my calf. Not fun.
Over the years, I've enriched a wide variety of back-crackers, from osteopaths to chiropractors, physios to acupuncturists, deep-tissue massage bruisers to dainty shiatsu girls; yoga, hot packs, cold compresses, anti-inflammatory pills ... been there, done it, got the invoice. (It's worth noting that, of all these approaches, only osteopathy gets the nod in Edzard Ernst and Simon Singh's book assessing the efficacy of complementary medicine, Trick or Treatment: Alternative Medicine on Trial.) And even the best of these approaches share a common flaw: variously effective at relieving your symptoms, but when the pain's drained away you slip back into old, destructive habits. For me, that means walking with Chaplin-esque splayed feet; a terrible stooping habit I picked up as a shy, gangly teenager; forgetting to prise myself away from the Mac every now and then; and my passion for running, a seemingly healthful pastime that's actually a pounding assault on your musculoskeletal system, especially on London's unyielding pavements.
Luckily (sort of), this sciatica was the final straw. I'd heard about posture-correcting approaches such as Alexander Technique and Pilates but, like most blokes, imagined them to be rather dull. I then happened upon something called Health Through Optimum Movement, which combines a dual-pronged approach. First, osteopathy twists and kneads your crooked spine back into alignment. And then, crucially, you embark on a corrective exercise programme.
This biomechanically-based combination of muscle stretching and strengthening ensures you don't slip back into your old slouch and, exponents claim, will keep you pain-free for life. Intrigued, I dragged my battered bod to an assessment with Jeff Murray, whose clinic, Ambition Health and Performance, nestles on the ground floor of the Queen Mother Sports Centre in Victoria, London.
I was impressed by his rigorous checks on every inch of my body, testing flexibility, strength and the angles of major joints. He quickly diagnosed the problem: an overly tight left quadricep muscle tugging my pelvis out of position, thus squashing the sciatic nerve. After a few sessions with one of the resident osteopaths and blissfully pain-free again, we're now embarking on the corrective exercise bit.
We meet again in a small personal training area and, while I stretch that troublesome quad, the softly-spoken Scot outlines his philosophy. "When I set up the clinic I'd been in the fitness industry for 10 years," he says. "I was meeting a lot of people struggling with their weight and injuries who were let down by traditional gyms. I think we have to take responsibility for our own health rather than relying on personal trainers or physios. Everyone wants a quick fix, but long-term health and wellbeing depend on the choices we make."
These choices include some obvious stuff, like getting enough downtime and sleep (a key but undervalued component of physical and mental health); eating a balanced, junk-free diet; finding a happy medium between stress and "rustout", where we're under-employed and bored. But get Murray started on exercise and his eyes really light up. "Our bodies and minds crave movement – and especially the right type of movement," he says. "We are designed to move and if we don't we become ill and eventually die prematurely, as our vital organs, muscles, bones and tissue break down from underuse."
He rails against the gym, full of hi-tech machines that work single body parts – often poorly and with incorrect technique – while gym-goers sit, reading magazines. Instead, says Murray, we must use our bodies as evolution intended: "We need to do real, functional exercise: to squat, bend, lunge, push, pull, twist, walk or jog, sprint and jump."
Of course, few of us possess the kind of lithe, injury-free bodies that allow this kind of movement. Take mine: along with the inflexible thigh I have a pronounced curvature in the lumbar spine, resulting in a muscle-stressing protruding belly. Years of back pain, says Murray, have "switched off" my transversal abdominus (TVA), one of the internal muscles that make up our spine-supporting core.
Along with a daily regime of stretching, I'm told in no uncertain terms that unless I strengthen my TVA the dreaded sciatica could return at any time. Chastened, I stick to the routine – greatly assisted by Optimum's online instructions and how-to videos. After a few weeks not only has the pain become a distant memory but my stomach's flatter, I feel looser and my posture's more Masai-like than its old, stooping self.
It really seems to work, but I wonder why we're all so "backy" these days? An osteopath, Danny Williams, says technology's partly to blame. "The biggest problem right now is smartphones and laptops," he says. "Loads of my clients complain of 'BlackBerry thumb', with RSI because of all the emailing. And because so many of us are hunched over laptops or have poorly set-up desks, we sit in a rounded, hunched position that creates severe pain across the shoulders, neck and back."
Does he agree that corrective exercise is the answer? "I think exercise of any kind that restores the body to a more natural position has to be the way forward. So anything that looks at how the body works in an integrated, dynamic, functional approach will bring more benefit to your muscles and nerves in the long term than just simple stretching or strengthening exercises."
Another approach making a big noise at the moment (with celebrity devotees including Claudia Schiffer and Jemima Khan) is Dynamic Pilates. Neil Dimmock, a master trainer at west London's TenPilates, says men put off by traditional Pilates are more receptive to this more vigorous approach. "We generally find girls dragging their men along to sort out their sore backs. The guys say they do loads of crunches in the gym, so their abs are pretty strong. Then we ask them to hold a static position and they just fall apart, because their core is really weak."
This is a key, if rather counterintuitive point – just because you've sculpted a six-pack doesn't mean you have a strong core. I'm a case in point, with overdeveloped outer abdominals disguising a weak, under-trained core. Like Murray, Dimmock says it all comes down to the TVA. "It's hugely important," he admits, "especially for people sat at a desk all day. The TVA's job is as a postural muscle, but it switches off when it's not needed. Nine out of ten people who come here don't even know where their TVA is because it's so inactive, so our job is to kickstart it again."
This involves a blend of Pilates with circuit training, moving from one position to the next in quick succession, rather than holding a single, static posture for ages. Class attendees "reprogramme" bodies that have fallen into bad habits, deactivating tight muscles that are causing problems through stretching and self-massage. You then focus on muscles that are weak and under-used, strengthening them with twice-weekly classes.
Dynamic Pilates has much in common with corrective exercise, and sounds worth a try. For sedentary, spinally-challenged workers like me, it also makes more sense than spending a fortune on back-cracking that doesn't address the underlying problem.
And I'm happy to report that, after the initial osteopathy and a few sessions with Murray, not only has that horrid sciatica vanished but I'm pain-free for the first time in years. It's hard to overstate how liberating this is: not only the absence of chronic pain, which makes life a misery, but being able to jog or kick a ball around with my son. As fellow sufferers know only too well, when the back goes so do most of life's pleasures. The only downside is my slightly dreary daily routine of stretching and core-strengthening. But that's a small price to pay for the blissfully pain-free future stretching out before me.
Danny Williams: 07703 459426; www.thetravellingosteopath.com; Ambition Health & Performance: 020 7630 5930; www.ambitionfitness.com; TenPilates: 020 8969 9677; www.tenpilates.com
Back care in the office
Sitting at a PC for hours a day can wreak havoc on your back, but these simple strategies from charity Back Care will save you a fortune in osteopaths' bills:
Make sure your feet are flat on the floor and your upper leg is horizontal. The back rest of your chair should support your lower back too. And your desk height should be just below your elbows when they're at 90º. Ask your HR department for an ergonomic assessment.
The top of your screen should be at eye level and an arm's length away. When you're typing, the keyboard should be placed so your shoulders are relaxed, elbows at 90º and wrists straight. And don't overuse your laptop! If you must, hook up an external mouse/keyboard.
* Take breaks
Get up regularly and move around to avoid muscles becoming tight. Stretching works wonders too (see www.backcare.org.uk for office-based stretches/exercises).
* Tackle stress
Stress is a back's worst enemy because it leads to tense, rigid muscles. As are long periods of repetitive work. If you have a history of back pain it's vital that you avoid long working hours – tell unsympathetic bosses that sensible working hours avoid far more time wasted on sick leave.
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