A Pain in The Rear
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A subscriber wrote the following comment following the issue,
"My Lucky Day." http://www.mountainwings.com/past/2254.htm

"I noticed that in reading 'My Lucky Day,' that you also carry
your wallet in your front pocket. I had a sharp pain in my back
a few years ago, and my chiropractor told me to always carry my
wallet in my front pocket. I have had a better back since."
Bud


That is also the reason that I carry my wallet in my front
pocket. I didn't have back pain but I didn't want it either,
so I modified habits to help prevent it. It also makes your
wallet more pickpocket proof.

Perhaps many of you have back pain, a pain in the rear.
Perhaps you or someone you know also carries a back-pocket
wallet. Below is an article that explains the back-pocket
wallet and a few other things that I didn't know.

Hopefully, it will help remove some pains in the rear.

"Beloved, I wish above all things that thou mayest prosper
and be in health, even as thy soul prospereth." (3 John 1:2 KJV)
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Sooner or later, lower back pain hits almost everyone.

Consider the statistics:

* Fifteen million American adults currently suffer from lower
back pain.

* More than 85 percent of adults have periods of intermittent or
chronic back pain.

* In excess of 370,000 work-related back injuries occur annually.

* Each year, Americans lose 93 million days of work at a cost
of $11 billion, due to lower back injuries. They spend another
$5 to $24 billion in direct medical expenses.

Furthermore, these statistics represent only the tip of the
proverbial iceberg because most people who suffer chronic back
pain don't complain - they suffer in silence.

Despite this sobering picture, John S. Gillick, MD, who treats
and researches muscle/nerve and fibromyalgia type disorders in
San Diego, explains that back pain can be reduced or eliminated
and back health maintained by modifying several common daily
behaviors.

According to Dr. Gillick, the way a person manages his back
health can be likened to the way he manages his bank account.
Picture a hypothetical guy named Sam. His bank account has a
$5,000 balance. He normally receives deposits of $300 each day
from a generous relative. Sam can also earn as much as an extra
$150 per day through his consulting business. He makes regular
daily withdrawals to cover credit card bills and living
expenses.

However, whatever amounts are deposited or withdrawn, Sam's bank
has a rule that his account can never carry over more than a
$5,000 balance into the next day.

Similarly, Sam also has a "back account," but its currency is
activity, what will be referred to as "back dollars."

Sam's account receives deposits for adequate daily rest. He can
also earn some additional back dollars through regular, moderate
exercise.

Regular withdrawals result from common activities such as
running, sitting, lifting and carrying. If Sam withdraws more
"back dollars" than he deposits, he dips into the account's
reserve.

When Sam spends back dollars faster than they are deposited, his
back health deteriorates and he becomes vulnerable to back
injury and pain. If the account balance drops below zero, Sam's
back health is "in the red" and he experiences pain.

Back health, like financial health, is much easier to maintain
than to rebuild. While back pain can be serious if it is
related to spine or nerve injury, 95 percent of all back
problems involve simple sprains or common habits that can easily
be fixed.

Dr. Gillick notes that the habits, activities and traits that
are the most frequent contributors to low back pain/sciatica
include:

1) Carrying items in a back pants pocket;
2) Uncorrected foot problems;
3) Poor sleeping position; and
4) Driving a stick-shift vehicle.

Carrying Items in a Back Pants Pocket
Symptoms:
1: Pain in the mid-low back and/or buttock that may extend down
the back of the thigh with prolonged sitting (i.e., during
meetings, long car drives, air flights).
2: Hip or back pain that interferes with sleep.
3: An undefined, gnawing lower backache that occurs while
sitting or standing.

Test: Does deep knuckle pressure in the middle of one buttock
cause unexpected pain? Do you have difficulty sitting still?
Do you find yourself taking your wallet out of your pocket
during long drives?

What happens: A back pocket wallet or other bulky item acts like
a rock, bruising the sciatic nerve where it crosses muscles deep
in the buttock. Sometimes large back pocket objects cause the
wearer to sit in a twisted position that results in concentrated
body pressure on the sciatic nerve on the opposite side.

Either way, direct pressure can bruise the sciatic nerve and its
surrounding muscles. These bruised structures can result in
dull pain that is felt mostly in the back or leg.

Remedy: Always keep your back pockets empty.

Uncorrected Foot Problems
Symptoms:
1: Backache that occurs with prolonged standing or walking.
2: Pain that radiates down the outside of the hip to the knee or
further.
3: Hip "clicking" that occurs with squatting or climbing.

Test: Is the height of the foot's arch as high when it bears
full body weight in a relaxed standing position as it is when
the foot just lightly touches the floor?

Push the back part of a pen gently under the relaxed arch before
standing. Does the arch fall and press down hard on the pen
when you stand?

When in a standing position, is the Achilles' tendon
perpendicular to the floor or does it angle outward?

What happens: Flat feet, fatigued arches or arches that sag or
flatten with relaxed standing produce imbalance. When the
relaxed standing body does not balance over the center of the
feet, the hip and the back muscles compensate. The extra
balancing work by the hip (gluteal) and lower back muscles
causes low back fatigue/pain and can produce pain that extends
from the hip down the side of the leg (false sciatica).

Remedy: Use proper, flexible foot orthotics (arch supports, not
footpads) on a full-time basis to keep the body in neutral
balance over comfortable feet.

Remarks: Uncorrected weakened arches can also cause hip pain,
kneecap pain, shin splints, ankle sprains, and/or foot pain in
the heels or toes.

Poor Sleeping Position
Symptoms: Awakening in the middle of the night or in the morning
with a stiff, aching back.

Test: Does your back hurt more after sleep than before?
Does your back wake you at night?
Do you go to sleep or wake up on your stomach?

What happens: When a person sleeps on his stomach, the lower
back arches or twists in a manner that shortens the back muscles
and encourages them to cramp. This position doesn't allow the
muscles to relax, rest or stretch at night.

Nighttime lower back strain may also result from twisted side
sleeping or back sleeping on a hard bed without elevating the
knees and lower legs.

Remedy: Keep the spine in balanced alignment by sleeping on the
side with pillows between the knees or on the back with pillows
under the knees. Place three or more large pillows between the
hips and the feet when going to bed. This ensures pillows will
remain under or between the knees throughout the night and make
it more difficult to unintentionally turn onto your stomach.

Remarks: Stomach sleeping is also a common, yet rarely
suspected, cause of neck strain, shoulder injury, shoulder
bursitis and arm pain. Pulling a pillow under the shoulder
during side sleeping may twist back muscles, pinch neck nerves
and is a another common cause of back, neck, shoulder, arm and
hand pain.

Driving a Stick-shift Vehicle
Symptoms:
1: Chronic mid-back pain that worsens with driving, particularly
in stop-and-go traffic.
2: Pain in the left hip, thigh, knee and ankle.

Test: Sit in a chair and reach for an imaginary gearshift with
the right arm while imitating the clutching action with the left
foot eight to 10 times, keeping the heel off the ground.

Does this action cause or increase back pain?

What happens: The clutching action balances the weight of the
left leg against the right upper back. Repeated clutching twists
and tires the back and hip muscles, torquing the back muscles
between the hips and the lower rib cage.

Remedy: Drive a vehicle with an automatic transmission whenever
possible.

Remarks: Clutching can cause other chronic problems including
left hip spasms with pain radiating down the side of the leg
and left knee (patello-femoral pain). Manual shifting can also
strain the right neck, shoulder, arm and wrist causing soreness
and spasm.

In Summary
Simple modifications of daily habits and activities can very
positively affect back health. With these simple, behavioral
modifications, most chronic back pain can be eliminated,
recovery from acute back strains can be accelerated, and
vulnerability to future injury can be decreased. The key to back
health is prevention, identification and elimination of back
health enemies moves your back health account solidly into the
black, leaving you in the pink!

by John S. Gillick
www.simple-ergonomics.com

John S. Gillick, MD, MPH, FACP, FACA is a medical doctor in San
Diego. He is American Board Certified in Internal Medicine,
Anesthesiology, and Preventive Medicine with subspecialty
Certification in Occupational Medicine. He is an associate
professor of anesthesia and internal medicine, non-salaried, at
the University of California, San Diego (UCSD). He works both
at the UCSD Center for Occupational and Environmental Medicine
where he practices occupational medicine and at the Veterans
Administration where he conducts comprehensive disability
evaluations. [email protected]