HEALTH SPECIAL...TAKE CARE OF YOUR BACK

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Cooking is more than a passion for travel marketing executive Manisha Sharma. The 36-year-old Sharma, who was trained as a chef, couldn’t unfortunately make a living utilising her culinary kills. “When I was 17, in the final year of college, with dreams of working in a five-star hotel, a searing

pain shot through my spine two days before my exams. Before that, I used to spend entire days experimenting with cuisine. After that, my back problem didn’t permit me to stand for 12 hours in a hotel kitchen.” "

Diagnosed with a benign tumour in the membrane of the spinal cord that blocked blood circulation to the hand, Sharma took medication, physiotherapy and surgery before a lengthy rehab process.
Sharma’s case is just one instance in the growing trend of young professionals battling spondylosis, lumbar pain and back problems.
And the age profile of the patients is getting younger. Consider South Delhi homemaker Kulpreet Kaur. Kaur, 26, approached Delhi’s Indian Spinal Injuries Centre complaining of a swelling above her right shoulder. “Her neck and back muscles had weakened owing to repeated stress when she was a student in Kolkata,” says Dr HS Chhabra, chief of spine services at the Indian Spinal Injuries Centre, Delhi. “Kulpreet spent a lot of time bent forward in a bad posture as she loves to paint. When the discomfort became too much, she came to us. A few simple exercises to strengthen her neck muscles are what she needed,” he adds.

Between each vertebra our body has shock absorbers called discs. When one is in a high-pressure job, these are constantly under stress leading to degeneration of the discs. In extreme cases a bad spine can lead to a slipped disc, as Anuj Tiwari, a cardiac surgeon with Jaipur’s Sawai Man Singh Hospital, discovered.
“My bad back had to do with my lifestyle. Spending four hours at a stretch conducting surgeries and bad posture meant I was tired by the time I reached home. So, where was the time to exercise?” he asks. Tiwari, 37, realised that at slipped disc in the cervical region was touching on the nerve roots in his neck, depressing a nerve. “This caused a pain in my left shoulder,” he recalls.
After consulting a specialist in Delhi, Tiwari learnt he doesn’t need a surgery, yet. Isometric exercises to correct his posture, strengthen his back muscles and change his lifestyle from sedentary to active are all that is required. The genesis of many spinal problems can be traced to our evolution, says Chhabra. “Our skeletons were built to carry our weight on all fours. When man stood up from four legs to two, natural evolution ensured our muscles became strong to support the neck and the back. But with lifestyles becoming sedentary, whatever you do, you end up putting some strain on the scapular muscles.”
Understanding the anatomy of the spine can help us understand why an inactive lifestyle can cause complications, says Dr Harshavardhan K Hegde, director, Orthopaedics, at the Fortis Group of Hospitals, Delhi and NCR. “The weight of our body is transferred through the spine. When muscle strength is low, the bones take the weight. A sedentary lifestyle leads to reduced muscular strength, bone deficiencies and aches.”
Lack of exercise can manifest itself at the most awkward movement. For instance, on a family vacation, when you have to lift a bag and you realise it is too heavy for you. “A sudden increase of work leads to extra burden on the muscles and if they’ve weakened the bones feel the brunt,” explains Hegde.
Desk-top diseases
Working long hours on desks that are not ergonomically designed causes loss of muscle tone, poor ligament strength, bad posture and back pain. Chhabra says most professions today involve working in a bad posture. “Our lifestyles have become so inactive that we end up not walking at home, drive to work and sit for long hours at the office. No laptop has been designed for a perfect posture. On top of it, if you slouch in your chair, you are obliterating the curve in the lower back. It accentuates the normal shape and the curve in the upper back and the nerve ligaments get stretched.”
A lot of this is owing to repeated stress at the workplace, particularly in professions with long hours such as call centres, journalism and banking, says Hegde. “Looking at a computer screen for more than 10 hours can put a person under tremendous stress. His or her muscles contract without the person even realising it. This leads to degeneration of muscles, which can be arrested with regular exercise,” adds Hegde.

TIPS:

1. The top of the screen should be at eye level
2. Use the arms and push yourself to the back support. A gap between the back of the chair and your hips, will make the back sag
3. The arms should be parallel to the floor and elbows at 90 degrees to keyboard
4. The soles of your feet must be flat on the floor. If possible, use a foot-rest.

It’s all in the head
The human head weighs about six kg. When one bends forward, the muscles at the back of the neck should balance this weight. In a standing position these muscles don’t need to work, but if you are bent forward they work overtime, leading to pain. “The pain causes muscles to go into a spasm,” says Dr Deepak Raina, consultant, orthopaedic surgery at the Indian Spinal Injuries Centre. “In extreme cases a disk prolapsed may impinge on a nerve that can lead to neurological deficit. Even in these cases, we first recommend an exercise programme, medicines and only then go in for a surgery,” points out Raina.
Despite India being a sunny country, a lot of us still don’t spend enough time outdoors, says Dr Bipin Walia, head of spine surgery at Max Hospitals, Delhi. “In younger people, pain in the spine is the result of sedentary lifestyle, poor ergonomics, bad posture and vitamin D deficiency caused by staying indoors all the time.”
To prevent spine problems, Walia recommends physical activity which could be as simple as walking. “Also, if you have a desk job, take a break every hour or so by walking to your co-workers. Of course, a good posture at work and at home helps.”

Chained to your desk?
Watch your back Get a good quality chair. The backrest should support the entire spine. The angle between the seat and the backrest should be fixed at about 100 degrees. Don’t slouch The monitor of your workstation should be at eye level. Push your butt right back to the backrest. Use the arms and push yourself back. Remember, if there is a gap between the back of the chair and your hips, the back will tend to sag within a couple of minutes.

Be on the move
Change your sitting position every 45-50 minutes if you have a desk job. Walk up to your co-workers, rather than using the phone. Posture, posture, posture Whether you are sitting or lying down, your spine must maintain the curvature nature has given us. A common misconception is that if you have cervical spondylosis, you shouldn’t use a pillow even when lying on your side. The spine is straight and needs to be supported by a pillow even when you’re lying on your side.
What is a slipped disc, exactly?
The spine is divided into the neck (cervical vertebrae), chest (thoracic vertebrae) and the lower back (lumbar vertebrae). Between each of the 33 vertebra are shock absorbers called discs, structures that resemble jelly doughnuts. When subjected to stress, the discs degenerate or break down.  The term ‘slipped disc’ is a misnomer – the disc doesn’t slip out of place, but bulges out towards the spinal cord. A slipped disc is when the soft part of the disc bulges through the circle of connective tissue. This may put pressure on the spinal cord or on the nerve roots.

Is yoga advisable for patients of cervical or lumbar spondylosis?
A few yoga poses and sequences can help lumbar spondylosis. Surya namaskar is good for back strengthening and flexibility. The cobra pose, or bhjungasana, stretches the lower back. The locust pose, or shalabhasana, strengthens the lower back because it requires lifting one’s upper and lower body off the ground from a prone position on the floor.  Spondylosis can be cured by practising yoga. The postures strengthen the back muscles and improve their flexibility.

Usually cervical spondylosis is aggravated by extending (bending backwards), and side-bending of the head. If you have cervical nerve irritation associated with spondylosis, then you should avoid positions of your head that increase these symptoms. Yoga activities, therefore, should be tolerated as long as you are careful with the position of your head.
Are there any asanas to prevent spine problems?
The most effective asana is dhanurasana as it increases strength and flexibility along the entire length of the spine. It stretches the neck, shoulders, arms and legs, expands the thoracic region of the chest and helps alleviate hunchback. It is the best asana to correct ones posture.
Any asanas that shouldn't be practiced at all to avoid injury?
Do not try any posture, asana or pranayama without a teacher’s advice.

Aasheesh Sharma, HTBR 120617