Q Is it true that sitting on those large exercise balls or funny-looking chairs where you kneel help back pain?
A One of the commonest causes of back pain is sitting with poor posture for long periods of time. We often tend to slump, especially when using a computer. It is on these occasions that sitting on a ‘Swiss’ ball is beneficial. When sitting on a ball it is necessary to sit with good posture, or you’ll fall off! When starting we should sit with our feet wide apart to provide a stable base, as we become more proficient we can move our feet closer together, becoming more unstable and needing to work harder to remain upright. In this way, not only are we sitting with better posture but also we are exercising the key ‘core’ muscles essential for spinal health. Kneeling chairs are an alternative; they also encourage us to sit with improved posture.
Q My partner has a trapped nerve in his neck. He’s under a neurologist who has said there’s nothing that can be done. It causes him incredible pain. Do you have any advice?
A ‘Trapped nerves’ in the neck are becoming more common due to the use of computers. It is almost never true that nothing can be done. Most settle naturally in the first few weeks. Simple painkillers such as paracetamol or ibuprofen are useful. Stronger painkillers can be prescribed if needed. If the pain is severe or doesn’t settle in a few days, physiotherapy, chiropractic or osteopathy are all likely to be beneficial. It is also important to keep moving. If these measures do not succeed, invasive treatments such as spinal steroid injections will probably help, but these should be undertaken only after an MRI scan to identify the exact cause of the trapped nerve. Surgery is the last resort, used in fewer than 5 per cent of cases, it may be considered earlier if there is any evidence on examination or imaging of nerve damage.
Q Would you recommend a hard mattress or soft mattress? Does it really matter? What about foam mattress versus traditional spring mattresses? I’ve always heard that you should spend as much money as you can afford on a mattress, but wonder if that rumour was started by a mattress company.
A Mattresses are a very individual issue. The key issue is that the mattress supports the normal curves of the spine in all positions of sleep. Too soft and we sag, too hard and we lie on top of the mattress on a few points. A mattress that moulds to our shape is best. This can be achieved with a good quality spring mattress with a high spring count or with a memory foam mattress. It is certainly not always true that most expensive is best.
Q Can you explain what a laminectomy is and what it’s used for? My mother has been told she needs one but the family GP hasn’t been able to give us much information.
A A laminectomy is a relatively old-fashioned operation in which a piece of bone is removed from the back of the spine to relieve compression of the nerves produced by narrowing of the spinal canal (spinal stenosis). It is very effective in relieving pressure on the nerves in this situation. It is not very effective at relieving back pain and may indeed make this worse. As much bone is removed as necessary to release the nerves but as little as possible to avoid making the spine unstable. If it is necessary to remove a relatively large amount of bone making the spine potentially unstable, the operation will need to include a procedure to stabilise the spine artificially using screws and rods as internal scaffolding (a fusion). Depending on how large the operation is, the recovery takes six to 12 weeks although patients are mobile straight away.
Q I am pregnant and have been experiencing really bad back pain. I’ve never had this before. Why has it suddenly come on and is there anything I can do or take to make it better? I want to avoid painkillers for obvious reasons.
A Back pain in pregnancy at some level is normal. In most instances it is due to the action of the hormones produced during pregnancy which are preparing the mother for delivery. Part of this involves relaxing the ligaments of the lower back and pelvis, this leads to low-back pain. As weight increases during pregnancy the pain becomes more of an issue. It is vital to keep as fit as possible during pregnancy, it may mean changing a normal exercise routine so that there is less impact. Swimming, cycling, using a cross trainer and walking are all fine. It is normal to gain some weight during pregnancy but it is important to keep that weight gain to reasonable levels. Pilates for pregnancy is a good way of keeping the back strong during the pregnancy, helping back pain before, during and after delivery. Any pain that is severe or constant or any problems with nerve function should be discussed with your GP or midwife. It is also best to discuss exercise plans with your midwife or GP in advance.