Back Pain

According to Health Executive figures (2005/2006) 3.7 million working days a year are lost through episodes of back pain.  More than £1 billion of public money is spent by the health service each year on costs relating to back pain, with a further £565 million spent within the private sector (Maniadakis and Gray, 2000).  Yet most cases of back pain are non specific.

Back pain can be split into categories; specific back pain and non specific back pain.

Specific Back Pain

This is associated with an underlying health condition or damage to the spine such as sciatica, a slipped/herniated disc and ankylosing spondilitis.

Sciatica  – a condition caused by a nerve in the back (the sciatic nerve) being irritated or compressed

Slipped disc – where one of the discs of the spine splits and the gel inside leaks out

Ankylosing spondylitis – a condition where the joints at the base of the spine become inflamed

Non-Specific Back Pain

This condition is where the pain is not caused by serious damage or disease, but by minor injuries or a pinched or irritated nerve.  It is thought that in some cases the cause may be a sprain (an over-stretch) of a ligament or muscle,  a minor problem with a disc between two vertebrae, or a small ‘facet’ joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain. However, these causes of the pain are impossible to prove by tests. Therefore, it is usually impossible for a doctor to say exactly where the pain is coming from, or exactly what is causing the pain.  This article focuses on non-specific back pain.

What is the Pain?

Unspecific back pain is a very common condition and can affect adults of all ages. Your back is a complex and delicate structure that is made up of a combination of bones, muscles, tendons, ligaments, nerves and joints. Therefore, it does not take a significant injury or damage to disrupt the normal workings of the back and trigger an episode of back pain.

Back pain can be triggered by everyday activities at home and at work, or by poor posture. For example, back pain can occur as a result of bending awkwardly, lifting, carrying, pushing or pulling incorrectly, slouching in chairs, standing or bending down for long periods, twisting, coughing, sneezing, muscle tension, over-stretching, driving in a hunched position, driving for long periods without taking a break, being exposed to prolonged vibration and lack of exercise. You may also experience occasional episodes of back pain as a result of the normal ageing process of the spine, which can temporarily disrupt the normal function of your back. You may sometimes wake up with back pain and have no idea what has caused it.

To some people, not knowing the exact cause of the pain is unsettling. However, looked at another way, many people find it reassuring to know that the diagnosis is non-specific back pain which means there is no serious problem or disease of the back or spine.

What are the Symptoms of Non-Specific Low Back Pain?

Although non-specific back pain is sometimes called ‘simple’ back pain, simple does not mean that the pain is mild. The severity of the pain can range from mild to severe. Typically, the pain is in one area of the lower back, but sometimes it spreads to one or both buttocks or thighs. It is often made worse if you move your back, cough, or sneeze. So, non-specific low back pain is ‘mechanical’ in the sense that it varies with posture or activity.  Most people with a bout of non-specific low back pain improve quickly, usually within a week or so, sometimes a bit longer. However, once the pain has eased or gone it is common to have further bouts of pain  from time to time in the future. Also, it is common to have minor pains ‘on and off’ for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. Back pain can also be classified according to how long the symptoms last i.e. acute back pain – the pain does not last longer than six weeks and chronic back pain – the pain lasts for more than six weeks.

Risk Factors

Risk factors for back pain include:

• being 20 to 50 years of age – for reasons that are not fully understood, most cases of backache affect young and middle-aged adults
• being overweight or obese – extra body weight places more strain on the bones, muscles and joints of your spine
• smoking – it is uncertain as to whether this is a result of tobacco smoke damaging the tissue of the back or due to the fact that smokers tend to have unhealthier lifestyles than non-smokers (or it could possibly be a combination of both)
• being pregnant – as with being overweight, the excess weight of carrying your baby can place additional strain on your back
• the long-term use of medications that are known to weaken bones, such as corticosteroids
• stress – it is thought that people who are under stress may unknowingly tense the muscles in their back, which could trigger an episode of back pain
• depression (see below)

Depression does not directly cause back pain but it can be a major contributing factor. Many people with back pain and depression can fall into a vicious cycle. The pain makes them feel depressed, which means that they exercise less and do not take part in everyday activities.  The lack of physical activity and exercise means that the symptoms of back pain persist, which in turn makes symptoms of depression worse.

Chronic back pain is less common than acute back pain, but it is still very widespread. In England, chronic back pain is the second most common cause of long-term disability (after arthritis). After stress, it is the leading cause of long-term work-related absence. A recent study found that one in every 10 people reported having some degree of chronic back pain.

The rates of reported cases of back pain in England have doubled over the past 40 years – a trend that is seen in almost all Western nations. There are a number of theories to explain the rise in the number of cases. One theory is that the rates of obesity, depression and stress are now higher than they were in the past. These conditions are all risk factors for chronic back pain. Another theory is that people are now more willing to report symptoms of pain to their GP than they were in the past. It is estimated that one in five people will visit their GP in any given year because of back pain. And 80% of adults will experience at least one episode of back pain at some point in their life.

Outlook

The outlook for back pain can vary considerably between individuals. Some people have minor episodes of acute back pain before making a full recovery. Other people have long periods of mild to moderate back pain that are interrupted by periods of severe pain, which makes them unable to do their normal daily activities.

An Australian study which looked at people who visited their GP because of back pain found that:

• 40% were completely free of pain within six weeks
• 58% were pain-free within 12 weeks
• 73% were pain-free within one year

Psychological and social factors play an important role in the expected outlook for back pain, particularly for chronic back pain. For example, people who have a positive frame of mind and report enjoying a good quality of life tend to make a faster recovery than those who report symptoms of depression and are unhappy with one or more aspects of their life.

Treatment options for back pain include painkillers, spinal manipulation, acupuncture and exercise classes. Some cases of chronic back pain may also benefit from additional psychological treatment for the reasons discussed above.

 Information from NHS website and the Register of Exercise Professionals journal.

All About Pilates

Pilates exercises are commonplace at physical therapy centers, chiropractors are recommending Pilates, and “My back used to hurt all the time and now I don’t feel it anymore” is a phrase we hear a lot from people who do Pilates consistently. So what is it about Pilates that works so well for back pain relief?

What makes Pilates so effective is that it addresses the underlying structural imbalances in the body that lead to back pain. Issues like lack of core support, pelvic instability, muscular imbalances, poor posture, and lack of body awareness all affect back health. They are also issues that the Pilates method specializes in helping people improve.

Pilates Helps Correct Posture

In Pilates, we pay a lot of attention to how our body parts are lined up in relation to each other, which is our alignment. We usually think of our alignment as our posture, but good posture is a dynamic process, dependent on the body’s ability to align it’s parts to respond to varying demands effectively. When alignment is off, uneven stresses on the skeleton, especially the spine, are the result. Pilates’ exercises, done with attention to alignment, create uniform muscle use and development, allowing movement to flow through the body in a natural way.

For example, one of the most common postural imbalances that people have is the tendency to either tuck or tilt the pelvis. Both positions create weaknesses on one side of the body and overly tight areas on the other. They deny the spine the support of its natural curves and create a domino effect of aches and pains all the way up the spine and into the neck. Doing Pilates increases the awareness of the proper placement of the spine and pelvis, and creates the inner strength to support the natural curves of the spine. This is called having a neutral spine and it has been the key to better backs for many people.

Pilates Develops Core Strength

Good posture that goes beyond the “look” of being aligned requires core strength. Having core strength means that all of the muscles of the trunk of your body are strong, flexible, and working together to support and stabilize the spine.

Core strength is deeper than the big surface muscles that we are used to thinking of as those of the trunk of the body, like the rectus abdominis, the infamous 6-pack abs muscle or the beautiful big muscles of the back, like the lattisimus dorsi, popularly called “the lats.” The core muscles include the muscles that are below the surface musculature.

So while many forms of exercise focus on strengthening the big surface muscles, Pilates trains the body so that all of the core muscles work together to support and stabilize the back. Part of developing effective core strength is to train the body to know when to release, as well as activate, it’s core muscles. So while core strength is the catch-all term, we might say that the core coherence that Pilates teaches is essential for back health.

Some of these less obvious but very important core muscles are the muscles of the pelvic floor; the psoas, which play a huge role in keeping us upright and in hip bending; the transversospinalis, which are small muscles that weave along the spine; and the transverse and oblique abdominal muscles. The diaphragm, our prime breathing muscle, is right in the middle of the core. All of these muscles play crucial roles in the support and stability of the spine.

“…the only real guide to your true age lies not in years or how you THINK you feel but as you ACTUALLY are as infallibly indicated by the natural and normal flexibility enjoyed by your spine…”
Joseph Pilates Return to Life Through Contrology

Pilates Promotes Flexibility

A healthy spine can curve forward and backward, twist, and move side to side, and do so in a way that reveals all the subtle articulations that our many vertebrae allow us to have. As core strength develops, the back muscles learn to work in harmony with the abdominal muscles, forming protective support for the spine that increase the potential range of motion of the spine. Pilates’ exercises are easy to modify so that we can develop spinal flexibility at our own pace. This is one of the things about Pilates that makes it easy for people with back pain to work with.

Pilates Increases Body Awareness

Whether the cause of pain is from an injury or as is often the case, a culmination of the effects of poor posture and inefficient movement habits, back pain is a messenger letting us know that we have to pay more attention to how we live in our bodies. The Pilates method is full attention exercise. You can’t do Pilates without becoming extremely aware of your alignment and the energy you bring to movement.

This kind of awareness practice is extremely powerful for people with back pain because we not only improve physical functioning, but as awareness increases, we move beyond the physical and mental holding patterns that back pain can create. Then, there is more room in one’s whole being for positive change.

Learn Pilates Exercises for Back Pain:

Back pain has many causes and Pilates may not be right for all of them. If you have back pain, especially serious or chronic back pain, please check with your health care practitioner before you begin a Pilates’ programme. If you do choose to begin Pilates, it is important to work with a fully certified instructor who is aware of exactly what challenges you are working with.

Helena Marron 

Research taken from About Pilates

Detox diets are seen by some as a quick way to shed pounds, especially among celebrities such as Oprah Winfrey and Gwyneth Paltrow. But what is a detox diet? Is it a healthy way to cleanse your body, or a dangerous way to lose weight? The American FITNESS magazine has reported on popular detox diets, how they work, and who’s doing them.

What is a Detox Diet, and Who Needs It?

Yo-yo dieter Oprah went on a 21-Day Cleanse back in the summer of 2008, singer Beyonce Knowles has admitted to following the same diet to shed 20 pounds for her movie role in Dreamgirls, and actress Gwyneth Paltrow sent out a newsletter this January from her lifestyle Web site, GOOP.com, recommending a week long elimination diet. “I need to lose a few pounds of holiday excess,” she wrote. “Anyone else?”

Such celebrities seem to buy into so-called “detox diets” as a way to drop pounds fast. But the real premise of a true elimination diet or cleanse program which are both types of detoxification diets, or detox diets for short is to facilitate the removal of toxins and pollutants from your body. How? By cutting out your intake of contaminants, so you’ll gradually eliminate unhealthy substances like pesticides, smog and pollution, alcohol, and caffeine from your body.

“There are a lot of people who believe that because we live in a world with so many environmental pollutants and medications that people are taking, the liver is overstressed,” explains Mary Jane Detroyer, a New York-based registered dietitian and exercise physiologist. “The whole idea of a detox diet is to rid toxins from the body, because the liver is overloaded and needs some outside help.” But do our bodies actually need a special diet to cleanse itself? “Not really”, says Dawn Jackson Blatner, an American Dietetic Association spokesperson and FITNESS magazine advisory board member. “Our bodies have organs such as the liver, kidneys, skin, lungs, and digestive system to remove these unnecessary substances every day without the help of any special detox diet or potions to help it along.” Compared to how many people try fad detox diets, few people actually need it. To see if you do, Detroyer recommends getting your liver enzymes checked out by your physician. “If they’re elevated, that means your liver is stressed,” she says. Several factors can cause elevated levels, such as medication, excessive alcohol consumption, or being overweight.

However, if you still feel inclined to embark on a detox plan, please be careful. “For most healthy people, doing a detox for a few days won’t lead to any long-term health problems,” says Blatner. “However, for someone who has conditions such as diabetes, heart disease, kidney disease, digestive issues, or women who are pregnant, children, teenagers and the elderly: these extreme changes to their diet can mean anything from dizziness to fainting to coma, since the diets affect electrolyte and blood sugar balance.” And, even if you don’t suffer from any of those conditions, taking on a long-term cleanse can lead to a host of other problems, such as vitamin and mineral deficiency and muscle breakdown, which is not really surprising when you are doing something extreme like drinking nothing but lemon water with maple syrup and cayenne pepper for 10 days, as one detox diet recommends. However, there may be one good side effect from starting a detox plan. “A healthy person following a short-term detox diet may get a bit of a mental jump start into eating more healthily and exercising for the rest of the year,” Blatner concedes.

Personally I would always talk to my doctor or a registered nutrition before embarking on anything other than a healthy eating programme.

Helena Marron

Information taken from online research

Build Better Eating Habits.

Let’s face it: We are busy, distracted, overwhelmed by bigger challenges. Eating healthily tends to get pushed down the priority list when your work commitments are high, your children are demanding, your friends are breaking down your resolve. And somehow our minds are always capable of justifying those spur of the moment cakes and take away indulgences – it’s PMS! I deserve it! My body needs it! But eating correctly is what your body is truly craving; good nutrition is the best way to help the mind tackle those bigger priorities. And it doesn’t have to be about punishing or depriving yourself either. “Overall good eating is not about dieting, but about making small lifestyle changes,” says San Francisco-based nutritionist Kaley Todd, MS, RD. “I’ve found that people who focus in on small changes tend to have larger success and lifelong success.” Begin now by making small changes.

Break Down the Walls.

Begin by taking a hard and honest look at your current eating habits and readiness to change them, says Deborah Kesten, a certified wellness coach and author of The Enlightened Diet. “Are you really ready to change or just making token gestures? If you’re staying with bad habits, ask yourself what you’re getting out of them.” Breaking down your psychological state will help you overcome any mental barriers that are keeping you from embracing an exercise routine. Says Kesten, “Once you decide you’re ready to make a change, you can start to envision it and act on it.”

Rethinking your Plate.

Many nutritionists today are urging people to rethink the core of their diets. Instead of a fatty cut of meat taking the spotlight on your plate. Why not shift the focus to vegetables, fruits, and whole grains – with the fat and protein being the side dish. One of the biggest keys to healthier eating is to add more fruits and vegetables,” says Jackie Newgent, RD, CDN, culinary nutritionist and author of The Big Green Cookbook. “You don’t need to be a vegetarian; small amounts of meats are fine. But I try and incorporate a fruit and vegetable in every recipe. I like to tell people to think of it as adding excitement to your diet, not subtracting from what you’re eating. And that way you’ll enjoy it that much more.” Vegetables also help you bulk up with minimal calories. They’re very filling so you feel like you’re getting a lot more food preventing you from overeating later. Try switching to smaller size plates for meals to help keep portion sizes reasonable. It’s a psychological trick, but with a small plate, your eyes tell you you are getting more food.

How Much Should You Be Eating?

The latest food pyramid often serves as a general guideline to healthy eating. The 2005 United States Dietary Guidelines gives a general guide which is detailed below. Recommendations vary and obviously quantities will depend on the height, weight, gender and physical acitivity of the individual.

Fruit group: 2 cups (4 servings)

Vegetable group: 2.5 cups (5 servings)
Dark green vegetables: 3 cups/week
Orange vegetables: 2 cups/week
Legumes (dry beans): 3 cups/week
Starchy vegetables: 3 cups/week
Other vegetables: 6.5 cups/week

Grain group: 6 ounce-equivalents
Whole grains: 3 ounce-equivalents
Other grains: 3 ounce-equivalents

Meat and beans group: 5.5 ounce-equivalents
Milk group: 3 cups
Oils: 24 grams (6 teaspoons)

“Other” calorie allowance: 267 calories

As far as serving sizes go:
Fruit: about the size of your fist
1 piece of fresh fruit, 1/2 cup of chopped fruit, 3/4 cup of fruit juice, 1/4 cup dried fruit
Vegetables: about the size of your fist
Sample: 1/2 cup of cooked or cut-up raw veggies, 1 cup raw leafy veggies
Grains
Sample: 1 slice of whole-grain bread, 1 ounce of prepared cereal, 1/2 cup of pasta or rice, 1 computer-mouse-size baked potato, one CD-size pancake or waffle
Meat: about the size of a deck of cards
Sample: 2 to 3 ounces of meat, such as one chicken breast, 1/4-pound hamburger patty, medium pork chop
Other proteins: 1 tablespoon of nut butter, 1 egg, 1/3 cup of dry beans
Milk
1 cup of milk, 1 1/2 ounces of cheese (the size of 6 dice)
In general, a serving of snacks (like pretzels) can be measured as a rounded handful, says Todd.

What about Fat?

Many nutritionists also point to the Harvard Healthy Eating Pyramid as a reference, which places a stronger emphasis on exercise, whole grains, and healthy plant oils, such as those from nuts and avocados. The key to a healthy diet is to substitute good fats for bad fats, and to avoid trans fats. This means replacing saturated and trans fats such as burgers, chips, and buttery foods that increase the risk of certain diseases, with the healthy fats such as those found in avocados, fatty fish, olive and vegetable oil, soya beans, and nuts. The USDA suggests total fat intake be limited to between 20 and 35 percent of daily calories, with less than 10 percent of calories coming from saturated fat. Other studies, like those focused on the Mediterranean diet, are finding that higher quantities of “good fats” (the unsaturated kind) may be healthier for our hearts.

Pacing, Calories, and Vitamins.

As a general rule, aim for three meals with two snacks in between, so that you’re eating something every three to four hours. This will help maintain blood glucose levels, so you won’t get famished and make poor choices. Daily calorie intake should be tied to your current weight and your goal. If you are aiming to lose weight, a general rule of thumb is to multiply your pounds by 10. So if you weigh 150 pounds, 1,500 is your cap for the day. If you’re trying to maintain your weight, multiply your weight by 10 and add 300, bringing you up to 1,800 calories for the day. If you’re moderately active, however, add in another 300 calories, but note that moderately active means heading to the gym for approximately an hour most days of the week, not walking the dog around the block every morning (nice try, though). If you are following a well balanced diet, it is not necessary take supplements. However it does not harm to take a multi-vitamin daily to make sure you are getting adequate nutrition.

Don’t Neglect your Fluid Intake.

Be sure to get at least six 8-ounce glasses of water or fluids per day. Tap water is fine and you may include other fluids in that total. Try adding slices of lemon, orange or lime to water to make it more interesting.

Remove Temptation.

Before you start your healthy eating plan, go through the house, the car, and the desk and get rid of all your enemies. Bin biscuits, cakes, pastries, crisps, salted nuts and all processed food. Finally learn to say no thank you. Respect your body, look after it and it will look after you.

Helena Marron

Information taken from online research