Posture

• Good low back support is essential.  Place a rolled up towel, pillow or purpose made support in the small of your back.  There are a range of products for sciatica, lumbar spine, full body, neck or bottom support that can help keep your natural “S” shaped curve of the spine.
• Ensure you don’t sit on a purse, phone or anything that may disrupt your posture.
• Sit close to the steering wheel to reduce reaching which places a strain on your lower back, neck, shoulders and wrists.
• Sit erect whilst keeping your chin tucked in and your knees level or a little higher than your hips.
• Keep moving.  Adjust your position slightly every 15-20 minutes.  You can keep wriggling and fidgeting on a regular basis.
• If hiring a car ensure that it is high enough and that you do not need to bend excessively low to get in and out.

Ice and heat therapy

• Use ice and heat therapy. Ice therapy helps reduce inflammation and pain.  Take an ice gel pack or frozen peas, wrap them in a thin cloth and apply to the affected area for 5 minutes at a time.  These items can be carried in a small inexpensive cool bag.
• Heat therapy helps relax muscles and increase circulation.  Options for applying heat during a car journey include:
  • Taking a hot water bottle which can be refilled during rest stops.
  • Buying a heating pad with a car adaptor that can be plugged into your vehicle’s cigarette lighter.
  • Utilising heated seats.
  • Using warm gel packs or wraps for example a ThermaCare pad.

• Do not apply heat directly to the skin.  Try alternating between ice and heat in 5 minutes cycles.  It is usually best to finish with an application of ice.

Take a Break.

• Gentle, careful exercise and movement helps counteract back pain.  Exercise promotes circulation thus providing nutrients to the disc, ligaments, joints and muscles of the back.  Walk around and stretch.    Make sure you stop at least every couple of hours.
• Utilise the Back Seat. At a rest stop if the back seat is available lie down and rest with a slight bend in the knees.  Put a pillow/support in the small of your back and under your head and relax.

Use Medication

• Either go to your doctor to obtain a prescription muscle relaxant or anti-inflammatory or speak to your pharmacist about a suitable over the counter.NSAID (non steroidal anti-inflammatory) medication such as Ibuprofen or Advil.

Relax, Rest and Sit Back

• If you are a passenger in a car sit in the passenger seat, recline, making yourself as comfortable as possible with supports and try to get some rest or sleep.  Support your head and neck with a travel or normal pillow.   Getting some sleep  can provide much needed refreshment and pain relief.

Sitting

• Alignment.  Maintain an upright posture with the head vertically in line with the shoulders and hip.  It is essential to sit in an upright chair to achieve this posture.
• Low back support is essential for achieving and maintaining an upright posture as described above.  If your chair doesn’t provide adequate support a purpose made support can be used that slides over the back of the chair.  Optionally a rolled up towel or small pillow can be employed.   The low back support should be inserted just above your hips in the small curve at the base of the back.
• Chair Depth.  You bottom should touch the back of the chair when sitting in an upright position.  If this is not the case either use a different chair or insert cushions to fill the gap between the back of the chair and your back.  If necessary use a final small cushion in the base of your back to provide good low back support.
• Chair Height.  When your knees are bent with the hips slightly above the knees your feet should touch the floor.  A foot rest should be  utilised if your feet do not reach the floor.
• Standing up.  Slide your bottom to the front edge of the chair placing one foot slightly ahead of the other.  Use your leg muscles to stand keeping your back upright and using arm rests if available.
• Keep moving.  Ideally take a break, move around or perform a non sitting task every 20 minutes.

Standing

• Posture.  Remain upright when standing with your ankles, hip and shoulders in vertical alignment.  It may help to imagine that you have a string attached to the top of your head that is pulling you upwards.
• Work surface height. If working in the standing position the surface should be at the height of your elbows.  If the surface is not high enough consider sitting on a high chair or stool with good back support.
• Work surface orientation. When working at a surface ensure you remain square on to it and don’t work in a rotated position for any length of time.
• Avoid over-reaching.  Ensure any frequently used items are within easy reach.  If picking up an object  move towards it instead of bending forwards.

Carrying

• Carrying on the back.  The best option is to utilise a rucksack with a strap on either shoulder.  The heaviest items should be placed at the bottom on the rucksack.  When using a shoulder bag change the bag from side to side every few minutes.
• Carrying in the hands.  If carrying something in your hands, for example shopping, balance the weight evenly between the left and right hand sides.
• Carrying and holding. Objects should be keep as close to the body as possible with the heaviest side adjacent to the torso.  For example a TV or monitor should be carried with the screen next to the torso.  Ensure that any load carried is stable and contents inside are not free to slide around.
• Ready to drop? If you think you cannot hold on to a heavy object and it is getting out of control let it fall.  A sudden muscular contraction or and bending forwards is likely to cause an injury.

Lifting

• Do you need to lift? The first question is, do you really need to perform a lift?  If at all possible push/pull the target object or use a mechanical lifting aid.
• Get assistance.  If the object is large get some assistance.  It is very important not to overstretch yourself.
• Correct alignment. Ensure that the spine is kept in a vertical alignment with the shoulders, hips and ankles all in line.  The spine is resistant to direct compression but far more vulnerable when we bend forwards.
• Lifting technique.  Position your feet as close as is possible to the target object and in a wide stance to provide a stable base.  Bend at the knees with the back upright whilst picking up, holding and putting down the object.  Keep it as close as is possible to the body.
• Bending and rotating.  If you need to bend or rotate when lifting perform these movements separately i.e. only move in one plane.  Ideally you should not bend from the waist or rotate but should instead bend the knees or rotate around by moving the feet.  If you do combine bending and lifting movements whilst lifting this puts the back under very high stress and may lead to a slipped disc.

Pushing and pulling

• When possible push an object instead of pulling it as this puts less stress upon the back.  The legs can be employed more effectively when pushing than pulling.
• If you think an object is too large get help or employ a mechanical aid.
• Alignment.  Always keep the ankles, hip and shoulder aligned in a straight line.
• Grip target object at elbow height
• Be careful to compensate for any sudden change of resistance to pushing/pulling.
• Plan ahead to gradually stop your movement of the target object

Do I need a new bed?

The first question is do I really need a new bed, if the answer to any of the below questions is yes you may well need a new bed.

• Is the bed more than 8 years old?  A beds characteristics may reduce by up to 70% over a ten year period
• Are you not sleeping as well as you used to?
• Do you sleep better when you are away from home?
• Do you wake up feeling stiff and sore?
• Are there signs of deterioration e.g. protruding springs, a lumpy floppy mattress?
• Do you and your partner ever unintentionally roll together?

Test out your new bed

Everyone is different so you will need to test different beds.  What is comfortable and supportive for one person will be unsuitable for the next.  Larger, heavier individuals required firmer beds than smaller people.  Also the firmness rating given by different manufacturers is not standardised.  This includes the term orthopaedic which simply means an extra firm bed.  If you and your partner have different needs then it is possible to either buy a mattress with two separate zones or two individual mattresses that zip and link together.  If the weight difference between you and your partner is 3 stones (20kg) or more you may well need a dual mattress as described.  To test your bed lie down with your partner in comfortable clothes for a minimum of 10 minutes or up to an hour if possible.  The ideal situation is to trial a bed with the option of exchanging it if does not match your needs.

What to look for?

Correct Support

The correct bed has to be supportive but not necessarily hard.  The mattress should mould to the shape of your body whilst providing positive support.  If the bed is too soft your muscles and ligaments may get stretched and strained contributing to back pain.  If too hard certain pressure points will develop causing pain and discomfort.  There are two tests you can perform to ascertain whether or not a bed offers the correct support for you.  First lie on your back.  Try to slide you hand into the small of your back, it should slide in snugly.  If you hand slides in with minimal contact with the back the bed is too hard.  If you have difficulty getting your hand in the bed is too soft.   Second, when lying on your side your spine should remain horizontal and not sag down towards the bed.

Size

It is very important to choose a bed that is the correct length, width and height.  Having enough space to lie in the correct posture and not too close to your partner is very important.  As a general guideline, the bigger the better.  Bed sizes are not standard to either test the bed or check its dimensions.

• Length. The length of the bed should be 4-6 inches or 10-15cm greater than the tallest person in the bed.
• Width.  When testing the bed both partners should be able to lie on their backs with their hands clasped behind the head without any contact.  A standard double is 4’6’’ allows only 2’3’’ per person which is about the width of a baby’s cot.
• Height.  For people with existing back problems a higher bed is both easier to get in and out of and easier to make and change.

Price

It is advisable but not necessary to buy an expensive bed.  The quality and durability determine the price of a bed but not its level of support.  Supportive beds are available at all price ranges but cheaper beds will not last as long.

Types of mattress

The two basic types of mattress and sprung and non-sprung.  The majority of mattresses are sprung either being open coil, continuous of pocket sprung.  The property of these beds is determined by the construction, arrangement and number of springs.  As a rule of thumb try to buy a bed with as many springs as possible to give the best support.

Sprung Mattresses

• Open coil aka open sprung or Bonnell spring consist of a collection of individual springs connected at the top and bottom and held together in a frame.  Typically 325 coils in a 5ft wide bed, with springs ranging up to a very firm 12.5 spring gauge (spring wire thickness).  Priced budget to mid range.
• Continuous spring consists of one continuous wire knitted into a series of interwoven springs.  Generally the gauge of the wire is softer and the size of the coil smaller than open coil giving a higher spring count and a more responsive feel.  Priced mid range.
• Pocket sprung consist of small, softer springs housed in individual fabric pockets allowing them to work independently of each other, profiling the body shape to prevent pressure points.  Independent support means that there is minimal transmission of movement from one sleeping partner to another.  Spring counts are typically 600-2,500 and sometimes up to 4,000.  Priced mid to high end.

Non Sprung Mattresses

The three types are foam, flotation and futon.  Foam mattresses are particulary suitable for use with slatted bases and adjustable beds.  The three types of foam mattress are Latex, Visco-elastic and Polyurethane.

• Latex is very durable with anti-mircrobial properties that is of benefit to allergy sufferers.  Latex has good elasticity and recovers its shape as soon as pressure is removed.  It has a very good point elasticity resulting in an even distribution of pressure for independent support.
• Visco-elastic aka memory foam responds slowly to body weight and temperature assuming the shape of the user.  It has good pressure relieving properties and is available in a variety of densities and quality rating.
• Polyurethane’s foam performance and price vary according to the density and quality.  Widely available and very versatile.

Flotation Beds

Support is determined by the amount of water used and the level of motion is adjustable.  Offers pressure free support and a good choice for allergy sufferers.

Type of base

Don’t put a new mattress on an old base as it may invalidate some warranties and new mattress can take on the faults of the old base.  When buying a mattress and base separately, ensure that they are a suitable match and check the dimensions are compatible as sizes are not standard.

1. Divans

Divans are the most common option.  They are essentially an upholstered box on castors.  The four types are.

• Solid platform bases that have a rigid top panel are the firmest and cheapest option.  These bases offer good support when sitting on the edge and make it easier to get on or off it.
• Full sprung edge divans feature an open coil or pocket spring unit mounted on a frame.  They provide even support across the whole mattress and act as a giant shock absorber, increasing the mattress’s durability and lifespan.
• Firm edge divans feature a smaller number of larger heavy duty springs within a rigid wooden sided frame.  Combines good edge support with increased lifespan of mattress placed upon it.
• Flexible slatted divans use slats of wood mounted in a frame.  The tension of the slats can be adjusted to give more support in certain areas as required e.g. the lower back and hips.

2. Bedsteads

The most common form of support in bedsteads is wooden slats, either rigid or flexible.  Cheaper bases have a larger space between slats so ensure the gap is not greater than 10cm or 3’’.   Larger gaps between slats create greater wear and tear on the mattress.  Check that the slat gap matches the requirements of the mattress to be placed upon it.   It is also possible to get bedsteads with fully sprung bases or wire mesh support.

3. Adjustable beds

These beds can be especially useful for people who have trouble getting in and out of bed or for specific requirements e.g. sleeping with legs in an elevated position.

Mutual responsibility

Your employer has a responsibility to ensure that your body is not put under undue physical stress at work.  These rules apply to those working from home as well as at the office and to temporary staff.  Employers are liable to prosecution if certain standards are not met.

Employees also have the responsibility to take care of their own backs.  They should receive proper training in back care from their employer.   Those working at a desk are entitled to a minimum standard of office chair and a work station assessment.  Anyone who does any sort of manual task should receive the appropriate training.

Workstation Set-up

Back alignment: Remain upright keeping the head vertically above the shoulders and the hips.  Good low back support is very important to maintain the upright posture and natural S curve of the back.  This support should be placed in the small of your back just above your hips so adjust your chair accordingly.  If the chair does not have good support you can buy a purpose made product to fit onto the chair or use a pillow or rolled up towel instead.
Chair depth: Your backside should reach the backrest with the back upright.  If not, either change the chair or use a cushion or cushions to fill the space between the back and the backrest finishing with a small cushion to place in the small of the back.
Chair height: With shoulders relaxed, your arms hanging vertically by your side and your elbows bent at 90 degrees your hands should rest on the keyboard with the backs of the wrists in line with your forearm.  You may use a wrist support placed under the wrist on the desk to maintain the alignment of your wrists.  Arms rest are useful to support the arms only if they can be adjusted to the correct height.  Your feet should reach the floor with your hips being slightly above your knees.  If your feet do not reach the floor then use a foot rest.
Chair position: Move close to the desk so that you can reach the keyboard with your arms hanging by your side with the elbows vertically below the shoulders.  If the armrests on your chair prevent you moving close enough either remove them or change the chair.
Keyboard Position: The keyboard should be directly in front of you with no objects between you and it other than a wrist support (if required).  If you are tall and the keyboard is below your wrists with your elbows at 90 degrees you should change the desk height (if it is adjustable) or raise the keyboard up on blocks/books.
Monitor Position: The monitor should be directly in front of you at arm’s length with the top of the screen at eye level.   Don’t put the monitor in the corner of your desk.
Mouse use:  Position the mouse as close as possible. Keep your elbow vertically under your shoulder, and close to your side or on the armrest.   A narrow keyboard can help you keep your arm close to your side.  If your mouse tends moves away from you secure it in position.  If it doesn’t stray away from you try using the mouse on both right and left hand side to reduce the strain on your dominant hand.
Frequently used items:  Keep frequently used items within easy reach to avoid overstretching.
Typing: Don’t hammer the keys, use a light touch.  Learn to touch type if possible as you will not have to constantly look down at the keyboard.  If you touch-type use a copy holder to reduce the strain on the neck.
Telephone use:  If you use a telephone frequently whilst using the computer use a telephone headset.  Cradling a phone between your ear and shoulder places a lot of stress on the neck.
Eye care: Eliminate glare and reflections on your monitor.  Close blinds and or change the position of the workstation so that the monitor is at right-angles to the window. If possible switch off overhead lights and use a desk lamp for reading. Reflections from overhead lights can be reduced by raising your monitor then tilting it down to make the screen vertical.

Take Breaks and keep moving

Try to either take a break or change your position every 20 minutes or as often as possible.  Consciously break up the time at the computer by performing other tasks e.g photocopying, filing or talking to a colleague.  If your job does not permit you to take breaks at will then you are entitled to regular scheduled breaks.  Be as active as you can throughout the day.  Walk up the stairs instead of taking the lift.  Get out of the office at lunch time and go for a walk or participate in a physical activity e.g. running, the gym or yoga.

Manual tasks

For advice on lifting see lifting advice.  If your job involved manual handling and physical activity your employer should give you the appropriate training.  Avoid unnecessary bending by putting frequently used items within easy reach and less used items out of the way.  If you need to reach down either squat down or ease down onto one knee.

Keep your backs natural curves

When looking at the back from the side we see that it has a gentle ‘S’ curve with a hollow in the neck and the base of the spine.    The middle of the back curves outwards in the opposite direction.  You can minimise wear and tear in your back if you maintain this gentle ‘S’ curve in everything you do.

Avoid bed rest

If you back is painful avoid resting in bed for any length of time.  Gentle exercise and general activity if done with good posture as described above will not cause damage and will speed up recovery.  Your back and abdominal muscles will get stronger if you keep active and get fit.

Keep moving

Try to avoid performing any given activity for prolonged periods of time, especially rigid fixed postures or any activity that produces pain.  Try to vary your activities if you are experiencing back pain, taking breaks on a regular basis.   If you have to perform a repetitive activity experiment with the duration for which you can perform the task without pain and ensure you do not exceed this pain free time limit.

Develop core strength

Good muscle strength in the muscles of the abdomen and back helps support good posture and lessen the strain on your back.   General exercise and activity will develop some strength, improve circulation and promote general health.  Specific exercises to strengthen your back are required with yoga and Pilates providing a good combination of strength and flexibility.  If you are experiencing pain, walking is a good exercise to start with.  Ensure that you wear supportive footwear with a cushioned and flat sole.  Swimming is good for your back but avoid too much breast stroke as this places a compressive strain on your neck.  If using breast stroke ensure that you immerse your head in the water during the stroke.  Cycling is a good choice of exercise as long as you maintain an upright posture.

Avoid bending

Try to avoid bending over as this puts a high stress on your intervertebral discs.  This is especially important when lifting.  Instead of bending your back bend at your knees keeping your back straight.  If you try to bend, rotate and lift at the same time this puts the maximum strain on your back and can cause a slipped disc.