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Low Back Pain
A brief outline and some self-help tips for farmers
by James Wilson BSc (Hons) Ost Med. DO - find out more about James.
Lambing time is here again! With all the pressure (and sleepless nights) that this brings and all the variables that can determine whether you have a good or a great season the last thing you need is your back playing up.
Low Back Pain (LBP) is unfortunately a very common source of pain, restriction and misery. About 80% of the adult population is expected to experience Back Pain at some point and it is most likely to first occur between 35 – 55 years of age.
Due to the huge number of stresses placed on your back during the working day Farmers are more likely to experience problems than most and for many these problems are likely to be recurring. Sheep farmers are particularly at risk from certain types of LBP as throughout the year physical tasks such as foot trimming, shearing and dagging, lambing and docking all place your back in it’s most vulnerable position (forward bent with rotation or twisting) time and time again.
Mechanical LBP (uncomplicated)
The most frequently experienced type of LBP. Sufferers are normally aware of having done something awkwardly or have felt “a tweak,” “a twinge” or “felt it go.” The pain can be pretty immediate and is normally followed by restriction and stiffness which increases over several hours. The severity mostly reflects the degree of damage (although this isn’t always so) and can range from a bit of discomfort to absolute agony.
The pain is primarily due to tearing of one of the soft tissues initially, with the formation of subsequent inflammation accountable for increased pain, stiffness and restriction.
This type of LBP is normally due to disruption of Muscle or Ligamentous tissue or a strain of one of the Spinal, Sacro-Iliac (where pelvis meets spine) or Hip joints. The pain normally remains localised to the affected area and doesn’t normally cause radiating pain (pain in the legs or further up the spine.)
For the purposes of this article any LBP accompanied by pain which moves up the spine, changes sides from the original area or goes into the leg(s) should not be considered uncomplicated and therefore should be investigated by a professional.
What can we do about uncomplicated mechanical back pain?
LBP such as that described above is likely to gradually clear on its own. Sprains and strains of the soft tissues should heal in 6-8 weeks, but doing the right things at the right times can help speed recovery.
What to do immediately / first day if you experience LBP:
- Initially try to stop the activity that caused the pain.
- Where possible lie on your back with your knees bent and feet flat on the floor (see Exercise 1) for about 10 minutes at a time and whenever the back feels like it’s tightening up more again.
- ASAP place a cold pack (e.g. bag of peas wrapped in a damp tea towel) on the sore area for about 10 minutes. This can be repeated hourly and will help decrease inflammation.
- Carefully try doing single knee hugs (see exercise 2) before attempting to stand again.
Don’t:
- Continue with vigorous activity or “push through the pain” especially if you’ve taken anti-inflammatory or pain killing drugs.
- Sit for very long (including operating machinery or driving) or stop moving altogether.
- Bend forward or especially bend forward and twist.
What to do / Day 2 onwards:
- Continue exercises as of first day.
- Gradually try to increase movement (see exercise 3, 4, 5) and gentle walking.
- Rest (ex.1) if you feel the back getting tired, aching or pain increasing.
- Hot and cold treatment instead of ice packs (ex.6) can help improve blood supply, disperse inflammation and promote healing.
- If your hips and knees feel comfortable try exercise 7.
- Osteopathic Treatment can be very effective from day 2 onwards to speed recovery, certainly if there is significant discomfort after the fourth day treatment is recommended.
Don’t:
- Do any one activity for more than 20-30 minutes as far as possible, even if you don’t feel uncomfortable at the time. If you feel ok an hour or so later you’re probably fine to repeat short durations of the same activity.
YOU MUST SEEK PROFFESSIONAL OPINION ASAP IF YOU EXPERIENCE ANY OF THE FOLLOWING. These symptoms are suggestive of nerve compression and must be investigated:
- LBP that is accompanied by leg pain, symptoms of numbness, pins and needles or weakness in the legs.
- Feeling you can not go to the toilet normally (urine or faecal.)
- Change in sensation or numbness in the Saddle region ( the area around the anus and genitals)
- Pain that is constant with no relief at all from change in position or medication or pain that is worse at night.
Prevention is better than cure!
Frequent stretching and some forethought before carrying out any job or task can go a long way to preventing you getting LBP in the first place.
The first thing in the morning is a vulnerable time for your back. Your back needs to “warm up” before exercise like any other joint / muscle complex in your body. Try to do a few of the exercises before going out in the morning. Failing this try to have a good walk around before embarking on any bending, lifting etc. Where possible in the evening before trying to do things like bagging feed or if you feed small bale hay move it close to where you’ll feed it rather than going straight into lifting it in the morning.
Many people wake up with a stiff back; this can be helped a lot by doing the exercises routinely before bed time.
So called perfect posture is almost impossible when dealing with livestock–a struggling ewe doesn’t make for easy work! You can still help yourself a lot though if before lifting, reaching or twisting you try to “prepare” your back. As far as possible bend your knees and keep your back as straight as possible whilst engaging your abdominal muscles. The more you lean forward or to the side the more gravity will cause the ligaments and muscles to be over stressed and the more likely you are to injure them.
Try not to do any one thing for too long. Longer periods of repetitive activity should be broken up every 30 minutes by changing position, a quick stretch or a bit of a walk about for a few minutes. With things like sweeping and forking try to change the side you work from regularly.
Should you suffer repeated episodes of LBP a visit to a professional (such as your local osteopath) is advised. They can help you with preventative measures through treatment and advice on further exercise, strengthening and rehabilitation measures.
Other less frequent causes of LBP:
These do not normally present in the same way as uncomplicated mechanical back pain and need investigating by a professional
Disc damage / degeneration - the shock absorbing pads between the vertebrae can be strained, bulge or prolapse (leak) into the surrounding tissues often causing Nerve Irritation. Where the lower discs of the spine are concerned this can lead to Sciatic Nerve Irritation (sciatica,) where pain is felt in the back of the thigh which can extend to the calf and foot. The people most at risk of developing disc problems are those with a family history, that smoke, are age 35-55 and have occupations involving repetitive bending and lifting and vibration (e.g. operating machinery.) Disc problems once aggravated will frequently last 3 months or more.
Spondylosis / Wear and Tear – all spines from 30years of age will start to exhibit some signs of wear and tear. As we get older this process can become a problem as the discs narrow and bony changes occur around the joints causing primarily stiffness (especially in the morning for an hour or so) and reduced movement. If aggravated, localised inflammation and pressure can cause nerve irritation, giving local pain and sometimes pain to the leg(s).
Rarer causes of LBP:
- Inflammatory arthritic conditions
- Fractures
- Pain referred from a problem with the Kidneys and Bladder, Bowel, Prostate and Ovaries / Uterus.
- TB
- Spinal tumours
Exercises
For all movement based exercises: Don’t push too hard to start with – ease the movement into the area you’re stretching, don’t force it.
1. Rest Position: lie on your back, knees bent. 5-10 minutes at a time as needed.
2. Single knee hugs. Pull knee toward chest gently using arms. Hold ten seconds, repeat 4 times each side.
3. Knee hugs. Hold both knees, timing as in Exercise 2.
4. As Exercise.1 add gentle spinal rotation by dropping legs slowly to one side. Hold five to ten seconds, slowly return to start position and then repeat other side. Do this a further four times each side.
5. Standing side bends, start away from painful side and gently slide your arm down the side of your leg. Care not to bend forward or backwards with this. Repeat this movement slowly at least ten times and to both sides if comfortable. Don’t push too hard to start with – ease the movement into your back do not force it.
6. Hot and Cold treatment. 2 minutes fairly warm and 1 minute cool: applied locally either in shower or with e.g. hot water bottle and cold pack. Repeat 3 times and do twice per day.
7. The “Child Pose.” Kneel on floor, tops of feet flat on floor. Carefully sit back onto your heels. Slowly work your hands down your thighs and onto floor, and if comfortable keep going. Gradually your chest will be able to come toward your thighs. Hold 30 seconds or so and slowly return to start. Repeat 3 times.
8. Standing quad (front of thigh) stretch. Hold your toes and try to point your bent knee towards the floor. Care to tuck tummy in, don’t let your low back arch. Carefully pull heel towards your bottom. Hold 10-20 seconds. 3 times each side, twice per day.
9. Standing hamstring (back of thigh) stretch. Put your heel onto a step, keeping your leg straight and your pelvis square with your leg (don’t let yourself twist.) Keep the low back arched gently, don’t slump in your low back. Increase the stretch by pulling your foot towards your shin. Hold 10-20 seconds. 3 times each side, twice per day.
10. Standing calf stretch. Keeping leg straight, stand with ball of foot on edge of step. Carefully let your weight drop into your heel so that your heel drops below the level of the step. Hold 10-20 seconds. 3 times each side, twice per day.
Further information is available on our website www.molfordhousesurgery.co.uk. Alternatively I am always pleased to answer any questions you may have. You can call me at Molford House Surgery on 01769 574830.
The information provided on these pages is intended as a general guide only and in no way constitutes a complete service for diagnosis or treatment. You must not rely solely on this information and it is therefore your responsibility to seek a professional opinion should you be concerned about your particular case.
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