Keeping Your Back in Action

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From mobile apps to exercise balls, there are more ways than ever to keep your back in shape.

It happens once an hour during my workday. The step-counter app on my phone, that electronic tyrant that nags me unless I walk at least 10,000 steps every day, sends me a berating alert: “You’ve been sitting too long. Get moving.”

Sedentary jobs are to back health what an unripe tomato is to a perfect Caprese. Sitting on your bum is the nemesis of a conditioned body and especially deleterious to maintaining a healthy back. The next time you’re out walking, take note of how many of your fellow homo sapiens are hunched forward, round-shouldered, leading their ambulation with a neck jutting unnaturally towards 12 o’clock. The result of habituated poor posture, this sad state of affairs takes a toll on eight out of 10 people over the age of 18, according to the National Institutes of Health.

In his practice at the Atlantic Spine Center, which has locations across New Jersey, physical therapy specialist Shridhar Yalamanchili sees many patients whose posture is more akin to a comma than an exclamation point. When he works with a new patient, the first goal is toward mindfulness and behavior modification.

“We analyze posture as he or she is going through the workday,” said Yalamanchili, who takes an integrated approach to applying a variety of clinically relevant treatments to manual orthopedic physical therapy. “Think about how you use your back during the day,” he said. “Make a list of all activities where you are hunching over, holding static positions for a prolonged time and twisting your spine. That’s the first step to changing and avoiding these behaviors.”

In a perfect world, a person working at a desk would take a break every 45 minutes and move around — a simple fix that decreases the stress on soft tissues, discs and nerves caused by the static posture that defines so many computer-related occupations. And since our bodies don’t operate in a vacuum, making one shift affects other parts of the whole. “These breaks also serve to decrease eye strain, which then usually causes postural deviations in a desk job environment,” he explained. “Give your eyes a break by focusing on a distant object to help relax the eye muscles.”

Posture is paramount, agreed sports medicine practitioner Dr. Rose Boehm, who practices at Moss Rehab.

“One of the most important things is sitting with your knees slightly higher than your hips for good lumbar support,” she said. The knees should be at about a 90-degree angle, even if you need to rest those tootsies on a footstool to make that happen. That takes the pressure off of your spine.

The way in which we lift heavy objects is another contributing factor to a sore skeleton. About the worst thing a person can do is reach into an overhead compartment on a plane to wrangle a heavy bag. Yet for many frequent travelers, this is a daily grind. Bags with wheels help on the transport end, said Boehm, and when you do need to lift, use two hands and keep the bag or item close to your body. Young backs aren’t immune to problems, she added. Children with still-developing bones and muscles shouldn’t be toting backpacks inappropriate to their height and weight. A backpack on wheels is not a bad idea at any age.

Whether someone has a desk job and sits hunched over the computer, carries heavy equipment or walks around in high heels all day, there are simple things to change and check to reduce and eliminate pain, according to Dr. Todd Sinett, author of The Truth about Back Pain and a second-generation chiropractor based in New York.

“The first thing that you really need to understand with back pain is that most of it isn’t caused by sudden trauma,” said Sinett. “Most people’s back pain evolves, little by little, until one day, they reach for something or turn a certain way, and that’s the tipping point. Posture and daily habits are the first factors to take into consideration. Coming up with a stretching and exercise routine that aligns your spine and helps you stand tall is key to achieving better vitality and flexibility, he added.

Reversing that hunched-over stance might be as simple as stretching on a large exercise ball, belly button pointed up to the ceiling for a few minutes at time. Sinett devised something he calls the Backbridge System for people in need of more stability than an exercise ball provides, a stretching system that he believes gradually brings the spine back to its normal curvature.

Sinett takes a holistic approach to his specialty, using a head-to-toe appraisal of his patients in the diagnostic process. One of what he calls the “spinal choke points” is shifting your balance by wearing shoes that don’t fit the activity or don’t fit your foot right.

“Good shoes are key,” noted Boehm. “You want to wear heels, that’s fine. But wear your sneakers walking to and from work. Use gel inserts for extra cushion. And realize that your sneakers aren’t meant to last forever — replace them on a regular basis. Skimp on shoes and you’ll pay the price with back, hip and knee pain.”

Experts agree that weight control and exercise deliver a one-two knockout punch to chronic back pain. “Weight control is important for everything,” said Boehm. “Even five to 10 pounds adds extra strain” on your back. Cross-training, as opposed to focusing on only one sport, gives your muscles a more balanced workout. “You need all of your muscles to hold your back upright,” she said. “But the most important are your big core muscles. We are all about our quads, biceps and triceps, but developing a strong abdominal core is the single most important thing we can do to help maintain a healthy back.” Boehm likens the back to a transmission belt — if you don’t keep that belt stretched and in good working order, it’s going to break. She’s also a firm believer that smoking, which restricts blood flow, is a contributing factor in chronic back pain. “Nothing good comes out of smoking — nothing at all,” she emphasized.

“No matter what kind of occupation you are in, most people benefit from stretching programs that help loosen muscles that tighten during the workday. Hamstrings and hip flexors are muscles that can get tight and affect your lower back alignment,” said Yalamanchili. “There is scientific evidence to show that people of various fitness levels in all kinds of occupations benefit from strengthening their core muscles. Core muscles help support the spine and stabilize it when we use our upper and lower limbs for any activity. This, combined with a cardiovascular exercise program like brisk walking, can maintain a healthy spine.”

As for diet, a bulging waistline not only affects the core muscles that support the spine but is unhealthy for your heart. ”Focus on eating a healthy, balanced diet for your overall well-being.  Whole grain-based, nutritious meals that keep you full longer will also help you avoid diseases caused by obesity,” said Yalamanchili.

Sinett takes the idea of good nutrition a step further by recommending that his patients avoid inflammatory foods, including sugar, caffeine, processed white flour and alcohol. “Think about how you feel when you’re hung over — your muscles feel tight and achy. What you eat affects your musculature as much as it does your other body systems. Everybody is different — you just have to listen to your body and see what you can handle.” Stress is another factor. “ ‘Uptight’ is the perfect descriptor,” said Sinett. “When you’re stressed out, your muscles contract and feel tight.”

The emphasis is as much on wellness as it is on rehabilitation at Conshohocken Chiropractic & Rehabilitation Center. “Basically half the people I see on every given day are wellness patients,” said Dr. William Tsoubanos, whose calm, no-nonsense approach has been guiding patients to better back health for more than 30 years. “Once we get problems resolved, then we talk about exercises, stretches, how to prophylactically deal with back issues.”

Most of what Tsoubanos and his partner Dr. Michael Morgan treat isn’t traumatic — it’s positional. “It’s pronicity — being in the wrong position for too long,” said Tsoubanos. “A lot of it is common sense. If you’re holding the phone in the crook of your neck taking notes, it’s time to get a headset. It’s not a great idea for kids to study lying on their bed. Don’t wait until you have a problem; think about good healthy habits. If you’re at your desk for hours at a time, it makes sense to walk to the water cooler. Don’t twist your neck looking at your screen, keep a neutral angle to your wrist on the keyboard and be sure your back conforms closely to the back of your chair. It’s all about the core, keeping your lower abdominal muscles strong and the hamstrings stretched. My patients tell me they exercise, but they do what they like doing, not always what they need to do to stay healthy.”

People with pre-existing back pain or other serious health issues that might be exacerbated by a new regimen should get clearance from their doctor and exercise under supervision, at least in the beginning of their program. It’s important to also remember that if you have back or neck pain that lasts more than three to five days, see your doctor, advised Yalamanchili. Surgery, for most people, is the very last resort. “Many causes of back pain can be addressed using conservative methods like physical rehabilitation and pain management procedures,” said Yalamanchili. “If you have been told that you need back or neck surgery, consider a specialist who is trained in using minimally invasive techniques for faster recovery and better outcomes.” 

Beth D’Addono is a longtime contributor to Inside and Special Sections of the Jewish Exponent. This article originally appeared in Inside Magazine, a Jewish Exponent publication.