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Back to basics

Is your dodgy back giving you grief? Joel Key, a former physiotherapist for Premier League side West Bromwich Albion FC, reveals the secrets of a strong and supple spine

NO DOUBT ALL of us at some point or another have felt aches and pains in our backs, and write them off as a temporary nuisance or put up with them as a fact of life, something to be accepted when getting older. Indeed my patients often say that they’ve suffered from back pain for years and they just get on with it. 

Back pain, or any pain for that matter, might be considered a warning system, our body’s internal alarm telling us that something is wrong. It might be an indication that you’ve been sitting for too long in a meeting, that you’ve slept awkwardly, or that you haven’t warmed up properly before running.

At first these aches and pains may appear minor and relatively short lasting, but what happens when the back pain alarm is ignored? The answer, for the large majority of people, is that the alarm starts going off more frequently and much louder.

Lets take a common scenario: A middle-aged man (Mr. X) starts a new job, which is predominantly desk based and involves a lot of meetings and travelling. Mr. X has previously suffered from minor back pain, but it has always resolved by itself without the need for medical attention.

With little free time between the office and seeing the family, he stops exercising. At work, Mr. X finds himself sitting for long periods, which gradually leads to stiffness and pain in his lower back. Thinking the pain will go away as it did before, Mr. X continues his normal routine until one day, when picking up a box his back “goes” and he is unable to stand up.

Why does back pain occur?

As we have seen from the previous scenario, lifestyle can be a major predictor of back pain. Generally speaking, the more sedentary a person is, the more likely he or she is to develop problems. This is especially relevant when considering postures such as sitting for long periods in slouched positions or unergonomic workspaces.

In such cases the core muscles that are not being used become weak and stop supporting the spine. Consequently more pressure is placed on important structures (discs/joints/nerves) in the back, which over time start to complain and give rise to pain.

Other factors that often contribute to back pain include being overweight, lifting incorrectly, overstretching or repetitive movements, which lead to overuse injuries.

What structures may be at fault?

Perhaps the question I am most often asked by my patients is whether they have suffered a “slipped disc”, known medically as a disc herniation. This is when there is problem with the rubbery material that sits between each bone of the spine, and which act as small shock absorbers. If too much stress is placed through the discs, over time they can develop small cracks, which can eventually lead to some of the watery material inside escaping. This material may start to place pressure on adjacent nerves, which produce pain.

Another common problem arises from the joints that run down either side of the spine and connect one bone to another. If these joints are kept in one position for too long, over time they can become stiff and sore. Often as people get older these joints are affected by osteoarthritis, which causes too much friction in the spine as the rubbery cartilage between the bones wears down.

If there is a problem with the discs, joints or nerves within the back, the muscles overlying these structures can become tight and go into spasm, causing more pain.

If I already have back pain, what can I do about it?

Well the first thing to do is do something about it. The problem is only likely to get worse when it is ignored. Back pain which has persisted for over twelve weeks is classed as chronic and is often much harder to treat effectively. If you already have pain, think about what things may be aggravating the symptoms. Is the pain worse when you are lying in a certain position in bed, when you are lifting, or after you have been sitting at work for an hour? If you can identify a pattern between your daily activities and the symptoms, try changing these factors as a first line treatment.

Recent studies show that keeping active is key to treating back pain. Gradually building up your activity levels is often the first key step towards self-help. Enrolling in a gym, or attending an exercise class such as Pilates, which focuses on strengthening the core muscles that support the back, can help enormously.

Begin by taking small measures such as walking over to talk to a colleague rather than sending them an e-mail, taking a short walk at lunch instead of eating at your desk, or climbing the two flights of stairs to your apartment instead of catching the lift.

Performing exercises two or three times a day can prove extremely beneficial in breaking up the static positions that we adopt at work and home. Every hour try standing up at the desk and performing some basic stretching exercises to replenish the muscles and reduce stiffness. At home, perform exercises after getting up, when you get home from work, and before you go to bed.

What if I my back is just too painful to do anything?

If this is the case, trying to stay as active as possible within your pain limits is the best approach. Gone are the days when doctors advise bed rest for their patients. This has been proven beyond doubt to make matters worse. Even if you are unable to walk long distances, changing position regularly and trying to stand and move a little will speed up the recovery process. Often lying on your side/back with a pillow between/under your legs will be a comfortable position initially. Medication will often be prescribed for an acute episode of back pain, potentially in the form of an analgesic or anti-inflammatory. This will help to control pain so that you can continue to move a little. Heat is a very useful adjunct to medication to reduce pain and prevent muscles from going into spasm, which may delay healing.

If you have experienced an acute episode of back pain, you should seek medical attention as soon as possible. In this stage you may benefit from an assessment by a doctor or physiotherapist. They will be able to confirm what is wrong, and apply pain-relieving treatments, which will help you to safely increase your activity levels. These treatments may include electrotherapy, acupuncture, massage, joint mobilisation or a gentle exercise programme.

Final Word

Back pain does not have to rule your life. Be proactive and begin your journey toward a healthy back today.

Joel Key is a qualified physiotherapist, acupuncturist and Pilates instructor from the UK. He works for International SOS in Beijing, China. 

Mayurasana is made of two Sanskrit words, mayur + asana (mayur is peacock and asana means posture). In this yoga posture, one is raised like a horizontal stick holding the floor with both the palms with the support of elbows. The final posture resembles a peacock.


1.    Sit down in thunderbolt pose, by placing both your palms on your thighs and hips on your heels.

2.    Take a deep breath in and as you exhale move your body forward and place both palms on the floor just below your shoulders in cat pose. 

3.    Now slowly point your fingers toward your stomach.

4.    Inhale deeply and keep your elbows on both sides of the navel; then raise thigh and buttock such that head and knees are parallel to each other.

5.    Place knees at a distance of one foot from each other.

6.    Then place wrists and palms near the knees.

7.    Balance complete weight of your body on palms, hands and elbows.

8.    Exhale slowly and get back to normal and initial posture. 

  • It is suggested that one should hold their breath for 2-4 seconds and repeat the same process 3-4 times.

>Advantages of Mayurasana

This asana provides increased supply of blood to the digestive system and hence helps cure digestive disorders.

  • This pose is usually recommended for athletes and sportsmen since it strengthens hands and shoulders. 

Precautions for Mayurasana:

People suffering from cervical spondylitis and high blood pressure should not practise this asana. If you have an ulcer or hernia, avoid doing this.

Sumit Manav, Lifestyle Yoga(

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