Hadjimichael Lambros, cert. MDT Physiotherapist

The spine consists of bones (vertebrae), intervertebral discs, muscles and ligaments. This structure houses inside an important nerve structure (spinal cord), from which the nerves that reach various organs of our body, including the upper and lower extremities. When the spine is viewed from the side, has three curves: cervical lordosis, thoracic kyphosis, and lumbar lordosis.

In the spine, vertebrae and articular surfaces support and guide the body to produce movements. The intervertebral discs are like pads. The links are used to keep discs and vertebrae together. The muscles, which are controlled by the nerves, assist in performing movements and to maintain posture.

 

Diseases of the Spine

In Particular:

  • Cervical syndrome, with neck pain.
  • The cervical syndrome presents with pain in the neck area or in the wider back area or in one of the two hands
  • Ischemia, is the condition in which pain presents along the root of the sciatic nerve. The feeling is characterized by the person with numbness or pain in the thigh, calf or even the toes.
  • Back pain is the combination of the two previous cases.

Epidemiology

Frequency of intervertebral disc disease

  • Cervical 36.1%
  • Chest 1.96%
  • Lumbar 61.94%

Epidemiology of cervical cancer

By the age of 60, women are more likely to be affected than men. However, at the age of 60, men are more likely to develop cervical cancer.

The incidence peaks between the ages of 40 and 50 and then decreases.

Degenerative changes in the cervical spine increase with age.

After the age of 70, 95-100% the population have spinal changes.

Epidemiological factors related to low back pain:

    • 50-80% of the adult population will experience low back pain at some point in their lives.
    • 40% of the rest population has lower percentage of back pain every year.

    Effects of low back pain:

    • Back pain is the most common cause of functional disability in employees.
    • Ιts total cost is higher than any other disease for which financial analysis is available.
    • Health costs account for 7-34%of total social costs.
    • 25-40% of patients with low back pain seeking treatment.
    • 3-5%of medical advice in primary care is for low back pain.

    Predisposing factors for reoccurrence of lower back pain:

    1. The most well-known aggravating and predictive factor for future back pain is the history of previous low back pain.
    2. Lifting heavy objects.
    3. Exposure to vibrations.
    4. Prolonged or frequent bending or twisting (eg wiping, mopping).
    5. Static loads.

    The most important points for the treatment of the Spine are: The correct posture of the body during upright and sitting position.

    Perform the activities and exercises in the right way without stressing the spine.

Children instinctively adopt a correct posture and instinctively move so that they get as little tired as possible. However, as most people age, bad habits tend to be adopted. By adapting an incorrect posture it will negatively affect our body. Over time, these bad habits can overwhelm the body and can lead to pain which may affect or damage and even tear the spine. If we learn to stand correctly, sit and move properly, we protect our backs from such damage.

Body posture indicators

It is important to make sure that your position is correct during standing as well. Imagine that an invisible string is stuck on the top of your head and helps you to stay in a relaxed upright position. The following tips will help you to ensure that your standing position is correct. During the day, just stop doing it at that time and check your body position. If any tension or lack of comfort is voted then change position to relieve. At the same time, take a few deep breaths: this will help the body to relax before returning to work. Eventually, you will start to notice when you are positioning your body in the wrong way and you will change your position automatically.

Our most common mistakes every day

What is the right seat? According to experts, this is what does not violate the normal curves of the spine, i.e cervical lordosis (in the neck), thoracic kyphosis (from the end of the neck to the chest) and lumbar lordosis (in the middle). The spine has a lot of flexibility. Therefore, can be found in different positions, during the day. These positions can change the normal curves temporarily. However, this does not mean that problems will rise immediately. In general, the muscle conditions that are involved, the length and the frequency of time that the spine is loaded can be contributing factors.

Driving:  Whilst driving, wrong positioning of the car seat can be a major contributing factor. 

The most common are:

The forearm of the neck.

Whilst driving, the driver “pulls” the neck forward, while the back does not rest on the back of the seat. In that way the waist, the back and the vertebrae of the neck are charged, with high pressure. This position is mainly seen in those who feel insecure during driving because they believe that in this position they will have a better field of vision. The pain that occurs in this case lasts only during the driving period (bad posture syndrome), and stops  after driving because the body returns to its proper position. However those who have been driving in this way for many years, are certain to adopt a neck problem (cervical syndrome) at some point in their lives.

  • The “slip” in the seat, is the position in which the lumbar lordosis becomes kyphosis. If one is driving for several hours in this position (eg on a trip), it is certain that pain will arise. Especially in those who have a problem with their waist (eg some sciatica), causing pain to be more intense. 
Tips:
  • Bring the seat forward so that your knees are higher than your hips and you can easily reach the pedals without stretching.
  • Sit with your waist straight. Do not bend forward or lie down in the seat.
  • Place a soft pillow (non-protoclinical) in the middle if the seat especially if you are going to travel on a long trip.
  • On a long trip it is recommended to take frequent stops in order to unwind by getting out of the car. Also, make sure that the headrest is in the correct position.

On the couch or armchair:

Unfortunately, many people have combined the comfortable seat with some form of “sliding” of the body, either on the side or down. However, all the normal curves of the body are canceled and the problems arise. Furthermore, sitting on the sofa incorrectly can be the main factor in developing spinal diseases. For example, by using the armchair arm as a pillow will lead to the deformation of the spine. As a result; the neck in particular as well as the waist – are ‘violated’ in a very dangerous way.

Tips:
  • Sit with your torso upright and with your back leaning backwards.
  • If you already have a problem with the lower back, support the back with a pillow, which will increase lordosis and will bring the lumbar spine to a more normal position by disappearing minor annoyances that may exist.
  • Do not let your body “slip” on the couch.
  • Do not sit in the same position for a long time.

When we lie down, the mistakes that are made during sleep are probably one of the most serious, as our body can remain in an inappropriate position for about 7-8 hours – without realizing that it bothers us, thus not changing it.


Furthermore, one common mistake that many people do is the use of an old mattress. Mattresses that are 10 years old can loose their elasticity. As a result, the body will be kept in a deformed position during resting hours without realizing it.

Using multiple pillows or sleeping without a pillow.

In both cases where kyphosis is created in the cervical spine and the increased lordosis which is created are caused due to having troubles when sleeping.

Tips: 
  • Sleep or rest on a straight, hard orthopaedic mattress that has an average lifespan of 5-6 years.
  • Sleep on the side, with both hands in front and knees slightly bent.
  • Avoid sleeping facing down
  • When lying on your back, you can put a pillow under your knees. This will lift your legs and straighten your waist

Watching TV:

The majority of the population watch TV by lying on the bed with lots of pillows or lying on the couch by using couch arm as a pillow. In both cases, neck injuries (cervical syndrome) will arise especially if this is done on a regular basis.

Tips
  • Watch TV while sitting normally (so that the normal curves of the body are not violated).
  • Keep the TV screen at eye level in order to maintain the normal curvature of the cervical spine.

In the office:

When working in an office, you will need to make sure that the working space is adapted based on the ergonomic dimensions of your body. Consider how many hours a day (or, worse, time) we may spend being bent over because our desk is too low for our height or because our chair is too high for the desk. As a result, the body gets stressed most of the time without realizing i.t.

Tips: To achieve the right position, you need to:
  • Adjust the height of the seat in relation to the desk so the body is in a position that you do not have to bend over to work.
  • Sit with the torso upright with the waist slightly curved forward, but never backward.
  • Sit with the knees higher than the feet as they need to be tilted at an inclined level.
  • The seat should be orthopedic, with a hard back.
  • Do not stay in one place permanently. Make sure you change your posture regularly or, have small breaks in between.

Proper use of the computer 

The way your body is positioned in front of the screen is very important not only for your health but also for your productivity. For this reason, sitting on the chair for many hours should be avoided. Frequent breaks are mandatory, and you should definitely take care of the following:

  • Choose a chair that provides support around your waist to avoid back pain.
  • Adjust the height of the chair so that your eyes are in line with the screen and your hands can easily reach the mouse, keyboard and other objects on the desk surface.
  • Remove all items under the desk so that your feet can move comfortably. A footrest can also be used.
  • Place the keyboard and mouse at the level of your elbows so your hands are straight along the desk and do not get tired while typing.
  • When writing text, make sure the keyboard is right in front of you and the mouse is next to it, so it is easy to access.
  • Keep your wrists straight, making sure that they do not bend in any direction. If necessary, use the special brackets under the keyboard to place it in a sloping position in front of you.
  • When typing, make sure your hands are above the keys. Hands should be able to move as freely as possible. Move the whole hand and do not stretch the fingers
  • Place the screen right in front of you in order to avoid the long inclination of the head to the right or to the left. The screen should be placed at a distance that exceeds the length of your arm when it is fully extended. If you are using documents, make sure you place them slightly to the side.
  • Use an analog, so that your documents are right in front of your eyes and you don’t have to bend down to read them.
  • The top of the screen should be at eye level.
  • Avoid reflecting various light sources on the screen (lamps, sunlight). Control access of the light in the work area by placing curtains on the windows, if necessary. If you have a light bulb on the desk, keep it behind the screen and away from your eyes so that it shines without disturbing you.
  • Don’t forget to clean the glass surface of the screen as well as your glasses if you wear Finally, adjust the contrast, brightness, and font size of the words that appear on screen, so as to make you feel as comfortable as possible when using the computer.
  • Type gently by keeping your hands and fingers relaxed. Apply the same gentle pressure to the mouse buttons.
  • When typing, do not rest your hands on the desk. It is advisable to have a keyboard with an extended base or purchase a special silicone surface, this will help you to avoid carpal tunnel syndrome.
  • Adjust your chair properly. This will decrease pressure from being applied at the back of the knees as well as avoiding body weight bear by feet.

 A short break from work in front of a computer is very important and its frequency depends mainly on the nature of the work performed.


Other aggravating factors that are considered to be responsible for the development of problems in the spine:

a. Smoking:

Smoking is an aggravating factor for chronic lower back pain. The burden is proportional to the severity of smoking, ie the more cigarettes a person smokes, the more frequent and intense the lower back pain becomes. Epidemiological studies have confirmed that smoking over the past 12 months is associated with increased incidences of disc herniation. Smoking can cause  the blood vessels to constrict. Vascular contractions cause a decrease in blood flow to the vertebrae and can also cause the onset of eating disorders. Smoking also causes a cough which sharply increases the pressure on the abdomen, which affects the intervertebral discs. Additionally, a cough can cause pain in the waist and increases the risk of recurrence of a surgical hernia.

b. Obesity

Obesity is considered an aggravating factor for simple back pain and can lead to long-term health complications. Also, those who are obese are usually not fit and exhibit bad posture, which can cause the spine to be burdened even more. In general, the extra weight does not favor good health and therefore the loss is significant. If you are overweight, you need to reach or at least approach the right weight for your height, age and gender. Dietary advice and follow-ups can help.

d. Chronic cough.

Respiratory diseases accompanied by chronic cough are a significant aggravating factor. Coughing sharply increases the pressure on the intervertebral discs and can cause or exacerbate an existing problem

e. Vibration exposure.

Vibrations can affect the nutrition of the intervertebral disc and can accelerate its degeneration. The frequency of lumbar concussion in vibrations is about 4 to 6 vibrations per second. Exposure to vibrations of 5 per second causes the greatest stress


What can help:

  1. Exercise is one of the best ways to prevent such problems. This is because exercise will strength the muscular system, which in turn holds and protects all joints and especially the spine
  2. Swimming is the most suitable exercise for these conditions because water repels 80% of body weight and joints are only burdened by 20%. The movements that are made in the water do not burden the spine and also have a higher efficiency due to the resistance of the water. Such exercises in water are recommended for every case. However, cold water should be avoided.
  3. Walking is a good type of exercise, which benefits significantly. It mobilizes the lower extremities, improves blood circulation, strengthens the entire muscular system. The muscles of the abdomen and the lower back work when the spine does not stay in a static position.

Gymnasts are 10 times more likely to have lower back pain than those who do not train 

Basically, you have the following options:
  1. Exercise regularly in order to have a good and correct posture and feel better.
  2. Finding reasons to avoid exercise, staying weak and having bad posture will result in pain.

Techniques for lifting objects: Our back has three natural curves: inwards in the neck, outwards on the shoulders and again inwards in the middle. No matter what you do, proper aligning of these curves is vital while lifting an object or while working to prevent back injuries.

  • Study the work you need to do. Leave space around you and make sure there are no obstacles in front of you. If possible, use a stroller for transport.
  • Open and bend your legs. Grab the load by placing all the weight on the legs.
  • Embrace the load. By placing the load close to the body you put less force in the middle (figure 1).
  • Instead of turning your back, which will cause pain, rotate your legs.

Correct Postures to be used on everyday activities:

Follow these steps:

1.     Support your legs well, with your toes slightly outward and one foot slightly in front of the other.

2.    Bend your knees and use your strong leg muscles to lift the weight. Keep your spine as straight as possible. As you lift weights, tighten the abdominal muscles which support the spine.

3.     Keep the weight close to the body. Do not lift weights above waist height.

 

Figure 2.

The strain on the lumbar spine (when the object is not lifted properly) which exerts a weight on various slopes of the spine (according to Muenchinger, in Rieckert 1981, 107).

Tips on how to avoid harmful postures: During the day (at work or at home) we make movements and take positions that are harmful to the waist. Here are some instructions on how to avoid some harmful postures.

If you need to lift weights, do not stretch the lower extremities. Approach the weight close to the body and bend the knees, place one foot in front of the other to achieve better balance. 

Also, do not lift weights abruptly. If you think you can’t do it on the first try, ask another person for help.

If you have to move objects, avoid twisting only the trunk, turn the whole body

If you have to place an object high, avoid stretching the waist too much. Use a stool or ladder. 

If you have to move furniture or large boxes, never bend your back forward or backward.

When carrying weights, avoid carrying too much weight with one hand. It is best to divide it into two equal parts and hold it with both hands.

If you have to work crouched, avoid bending the waist, but bend the knees 

If you have to work standing for a long time, don’t bend your waist. Lift the work surface in order to form a right angle for the elbows, or alternately rest one foot on a stool. 

When you iron, avoid placing the ironing board too low. Adjust it so that your back is upright. Alternately rest one foot on a stool. You can also sit.

In all cases, remember to change your posture regularly.. 

If you have to sit for a long time, avoid sitting with your back bent and hunched over. Avoid using a table that does not have enough space for your feet. In this case, your back will remain curved.

Do not use a seat without a back support.

When you work at a desk, avoid having your head tilted too far forward or sideways.

When you sit in an armchair, do not “sink” in a very soft armchair. Try to keep your waist firmly on the armchair. Use a pillow behind the neck and waist.

If you knit or sew, avoid sitting in a bent position. Lean on the back and rest arms on the seat. In any case, avoid sitting in this position for a long time. Every half hour, at most, get up and take a few steps

At work, choose a chair with a seat and back that is adjustable so that: your elbows rest on the table and the knees are at a right angle, the feet are constantly resting on the ground or on the special support and the waist rests well on the back of the chair.

In any case, do not sit for more than 30-40 minutes, but change your posture often and get up and take a few steps.

Do not work for a long time with your hands raised. Always try to create a support for your hands.

When you drive a car, do not place the back of the seat on a steep slope. Make sure your waist and neck are well rested on the seat.

If you have to drive for many hours, stop driving every forty-five minutes and take a few steps to unwind.

Sports and back-to-back problems

The table below can help you choose the right activity to deal with back problems

Sports activity

Recommended – not recommended

Swimming

Highly recommended. Swimming is the most suitable activity for everyone and especially for those who have back and waist problems.

Walking

Recommended. Walking is an activity for all people. It is easily integrated into our daily schedule and does not require special equipment. When walking, distance should be raised every week

Walking in the pool or the sea

Highly recommended. Water supports the spine and weavers the pressure on the discs.

Bike

The bike is a good opportunity to exercise without straining the joints of the spine. The saddle must be lower than the steering wheel so that we are not in a squat position.

Run

It is not recommended. 

Tennis and similar activities

It is not recommended.

Golf

It is not recommended.

Aerobics

Not recommended. The aerobic program includes many jumps, with the result that the intervertebral discs receive a lot of vibration. However, it is recommended in the water (pool or sea), because the joints do not receive pressure.

Old habits: ways to change and how?

It takes time to behave friendly in our body. Here are some tips to help you change year bad habits:

  • Don’t expect miracles from day one. Our behavior cannot change suddenly.
  • Set small daily, achievable goals and focus on achieving those one only not all.
  • Use reminder notes. It is vital for changing our lives. A small red note in the office could help us remember to take a break after a continuous two-hour session.
  • Don’t give up easily. Do not regret it if you did not follow the instructions given properly for the correct use of the body. Accept it and make a fresh start.

Well-known symptoms such as Headaches, Autorhythmic diseases, Neck brace Syndrome, Periarteritis of the Shoulder, rachialgic disease, Back pain, Sciatica, Hip – Knee – Foot Pain etc are related, for the most part, to musculoskeletal diseases of mechanical etiology, which is the subject of the McKenzie method.

What is the Mckenzie Method?

Mackenzie method is the method that provides the ability to self-medicate the problems of the waist, neck and other joints for a lifetime.

Also, the Mckenzie method will be known from the very first visits by the patients that have problems with their waist and neck.

The McKenzie method distinguishes and increases the patient’s potential for self-medication without medication, hot or cold pads, ultrasound, needles, surgery. It is possible for the patients to intervene effectively in their symptoms, by reducing their dependence on medical intervention.

The goals achieved by following the McKenzie Mechanical Diagnosis and Treatment method are:
  • Elimination of symptoms
  • Restore functionality
  • Preventing re-injury
The Mckenzie® Mechanical Diagnosis & Treatment Method

The McKenzie method is not just about stretching exercises. The McKenzie method is a comprehensive approach to the spine as well as to the peripheral joints based on specific, basic and fundamental principles. When those principle are properly understood and followed effective results can be achieved. The McKenzie evaluation process is very remarkable and “special” as it is something that should be appreciated in our country, as in the rest of the world, and is depended on.

How to deal with the problem

  1. Mechanical evaluation
    Mechanical Diagnosis and Treatment with the McKenzie® method is a unique step-by-step mechanical assessment of the patient’s musculoskeletal problems (Spine and Regional Joints). This mechanical assessment is based on the patient’s history and picture. It classifies patient’s condition by assessing the level of pain or the restriction of specific movements or positions. Evaluation based on the principles of McKenzie Mechanical Diagnosis and Treatment reduces the need for accurate and / or invasive procedures. Research has shown that using McKenzie method can be a process as reliable as, with, the use of very expensive diagnostic imaging tests in order to determine the source of the problem.

McKenzie’s classification of spinal or pain (or regional joint pain) ranks patients with similarly replicated clinical trials in three specific subgroups (syndromes) to determine the appropriate treatment.

These three mechanical syndromes of the McKenzie method are:

  1. Stasis Syndrome
  2. Dysfunction Syndrome and
  3. Disorder Syndrome

 All three mechanical syndromes occur in the cervical, thoracic and lumbar region of the spine as well as in the joints.

Each distinct syndrome is classified according to its unique reaction to the mechanical processes using movements and positions. Disorder syndrome which is the most common, where the “focus” phenomenon occurs .

The well-trained and specialized McKenzie therapists are able to identify the most difficult cases that require advanced McKenzie techniques in order to help the patients. They can also identify patients whose problem is diagnosed as non-mechanical. This will reduce the risk of a patient being referred to the wrong specialty, saving time and money.

  1. Mechanical therapy
    McKenzie’s Diagnostic and Diagnostic Mechanism Treatment determines a number of individualized exercises for each patient. No machine or medicine is used. Emphasis is placed on the active involvement of the patient by providing them with the necessary knowledge in order to deal with their own problem. It also minimizes the number of hospital visits, because patients can cope on their own when given the right knowledge and when the proper training is given. For patients with more difficult mechanical problems, the specialist and graduate of the McKenzie Method will apply specific specialist techniques with their hands, until the patient becomes able to self-manage their condition.
  2. Prevention
    When patients are trained to deal with their problem on their own, the risk of relapse is minimized. Furthermore, the risk of developing persisted problems is decreased when patients follow the prevention rules that they learnt through McKenzie method.

Leading Scientific Medical Magazines, report on the Mckenzie method:

People who were treated with the Mckenzie method, five years later proved to have significantly fewer relapses and fewer absences from work when compared to those who were treated with other methods.

  1. Stankovic, O. Johnell. “Conservative treatment of back pain: A 5-year follow-up study of two methods of treatment.” Spine 20 (4), 1995

“… The Mckenzie program is effective in acute or chronic cases. It is superior to Back School and Lumbar Traction.”

Dimaggio A., Mooney V. “Mckenzie Program: Effective Exercises Against Back Back.” Journ. Musculoskel Med. 4:12; 63-74, 1987


Bibliography for research on the clinical efficacy of the method in the fields of Pathology, Epidemiology and Physical History of Pain, Mechanism of Pain, Intervertebral Discs, Development of posterior disc herniation, Mechanical communications, diagnosis, diagnosis, and studies of vertebral diseases or general diseases with the Hellenic Institute or visit the website of the International Mckenzie Institute

Bibliography / Article writing

  1. Becker-Haarer R, Schoer D., PHYSICAL THERAPY IN ORTHOPEDIC AND TRAUMATOLOGY, Siokis Medical Publications,
  2. Campbell Anthony, SQUARE & MIDDLE, Key Number Editions,
  3. Davies Kim, SQUARE, MIDDLE AND ARTICLES, Keyword Publications,
  4. Smoth-Liebmann Joan, Egan Nardi Jacgueline, BODY NOTE, Fitrakis Publications,
  5. Dorziotou - Kouklogiannou Esthi, Dorziotou Ioanna, OSFYALGIA: PREVENTION, MODERN TREATMENT AND AUTOFRONTINA, Athens 1994,
  6. Kavvidias Elias - Siotis Giannis, THE COMPIUTERS, OUR HEALTH, NEW TECHNOLOGIES, NEW DISEASES, Patakis Publications,
  7. Kotzailias A. Diomidis, PHYSICAL THERAPY IN RESPONSIBILITIES OF THE MYOSKELETIC SYSTEM, University Studio Press Publications,
  8. Leftheroudis V. Theodoros, PREVENTION: IN THE MIDDLE, Christodoulidis Publications,
  9. Roumeliotis A. Dimitrios, MEDICAL RESTORATION, Zita Publications,
  10. Four D. Giannis, OSFYIKI DISKIKI NOSOS, NEWER VIEWS - MODERN CONFRONTATION, Medical publications BC Paschalidis,
  11. Tsaklis Panagiotis, GENERAL PRINCIPLES OF EMPLOYMENT AND PREVENTIVE PHYSICAL THERAPY, University Studio Press Publications.

     

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