Back pain - the curse of the nation it would seem and according to research set to be released to coincide with this year's Chiropractic Awareness Week, something that we really sit up and pay more attention to.

The British Chiropractic Association (BCA) undertook extensive research amongst the public across the UK at the beginning of the year to investigate the state of the nation's posture and back pain. As a result, the BCA are urging the nation to take proactive steps to improve its posture and will be joining us in a Web TV show to highlight exactly where we're going wrong and how to overcome our slouch potato lifestyle.

Poor posture can have health implications yet, by making just a few lifestyle changes, people can help to improve their posture, take care of their spine and help themselves look and feel their best. The even better part is that all this requires a minimum effort - just three minutes a day can make the world of difference.

So if you're a parent who's suffered the odd twinge when lifting your young ones; an office worker who, no matter how many times you adjust the height of your chair at work, can't seem to get it right; or if you're just generally fed up of back aches and pains - join our Web TV show as Tim Hutchful and Rishi Loatey of the BCA will be on hand to deliver their expert advice.

For practical advice on helping to avoid back problems and improving your posture click here: www.chiropractic-uk.co.uk

H: Lis Speight, host
T: Tim Hutchful, Chiropractor of BCA
R: Rishi Loatey, Chiropractor of BCA

H: Hello and welcome to the Healthcare Show I'm Lis Speight. Now, sit up straight and pay attention, quite literally, because today we're looking at posture and how the way in which you sit or stand can impact on your back. How many of us take special care of our backs during normal, everyday life? Poor posture can have health implications yet, by making just a few lifestyle changes, you can improve their posture, and take care of your spine, helping you to look and feel your best. Well joining me to talk about this I have chiropractors Tim Hutchful and Rishi Loatey from the British Chiropractic Association here with me in the studio. Guys welcome along, it's really great to see you today

T: Hi

R: Hi

H: But before we get started, for the benefit of those who aren't sure what a chiropractor actually does, let's take a look at this short video clip

Video Footage

Tim Hutchful, BCA: Chiropractic is a primary healthcare profession. We're the third largest profession after medicine and dentistry. There are about 10 million chiropractic visits to BCA members every year, we're governed by statute. Because we're governed by statute we have to keep up-to-date, so you can be assured of the best treatment for your problem. Chiropractors treat problems with joins, muscles and nerves. All the joints in the body, but mainly concentrating on the spine. Chiropractors use often gentle, but very specific manipulation, which sometimes chiropractors call adjustments, to improve the functions of joints which helps to reduce inflammation and restore normal function to the joints. Chiropractic is suitable for everybody, from babies to the elderly, so as a chiropractor, we look at the person as an individual, and we will tailor a package of care for them. Chiropractors do not use drugs or surgery, chiropractic works and it's actually backed up by growing medical evidence, and it's recommended in numerous government guidelines. If you go to the BCA website, and go under "find a chiropractor" you'll be able to find a chiropractor, you'd have quite a big choice

H: Now we are going to be taking some of your questions later about back problems, but we've had a lot of questions as to what's the difference between a chiropractor and an osteopath? Can be a little bit confusing. Tim can you help us out with this one?

T: Yes there's a lot of similarities between a chiropractic and an osteopathy – the main difference is chiropractic, as part of an undergraduate programme, are trained to take and read x-rays

H: Right

T: But both professions are statutory regulated, ok ,so they're both governed by statute. If you've got a recommendation then go to see either the chiropractor or the osteopath -

H: Is that from your GP?

T: From your GP or from other patients but whoever you go to, as long as they're regulated, and they can help you, that's fine

H: Ok. Now I hope that's clear! Now we have some research that's been done just recently telling us a little bit about backcare problems that we have in the UK – it's quite a growing problem isn't it Rishie?

R: It is, the British Chiropractic Association surveyed 5000 people across the country and what we found was that 56% of the population felt that they had, or had been told that they had poor posture. Now this is increased by nearly half from 37% in 2007. We also found that the average person sits for approximately 9 hours a day, but a third of us sit for up to 15 hours a day, and this is probably what's contributing to the incidence of back pain increasing

H: Ok. And what are the hot spots then? Are some areas worse than others Tim?

T: Yes. London is probably the worst place for back pain

H: Right. And why would that be do you think?

T: Well it might be through commuting, it might be through the style of work that we do. And Belfast seems to be the worst for poor posture. And again like you said, like Rishie said, there's 50-odd percent of people who actually think they have bad posture. So it is definitely contributory.

H: Ok.

R: It seems to be a national problem, there doesn't appear to be a particular north / south divide but what we have found is the problem seems to be worse in coastal cities

H: That's bizarre

T: But we don't know why

R: Belfast comes out top and then you've got Plymouth, Cardiff, Liverpool and Southampton. All in the top five

H: How odd. And what is generally causing this then? Is it just our lifestyle, that we're spending a lot of time at desks and a lot of time in front of the telly? Is that the general problem?

T: I mean like Richie said, so the average of people sitting is 9 hours a day, and then some people – a third of us I think you said was 15 hours a day?

R: That's right

T: Which is a huge amount. So that's all a compressive load on your spine.

H: Ok. And tell us a little bit about how the spine works? We've had a question in about slipped disc from Clara, she says "is it true that there's no such thing as a slipped disc?"

T: Not quite. Let me just get my little model here.

H: Can't believe that when you look at that, it's so complicated isn't it?

T: It's plastic, don't worry about it. Ok so a slipped disc is really a lamen's term ok? And it's often misused. So slipped discs do happen but they're not as common as people think, ok?

H: Right

T: So it's a little bit like people saying "I've had the flu" when actually they've had a cold.

H: Right. So just because you've got a bad back -

T: Doesn't mean you've got a slipped disc

H: You haven't necessarily got a slipped disc

T: So very few percentage of people who have got a bad back have actually got a slipped disc. But it's also called a herniated disc, a deranged disc

H: A deranged disc?

T: A deranged disc ok -

H: Goodness me

T: What I mean by a deranged disc – the best way to try and explain it is if you have a bicycle in a tube that's new, it keeps a nice shape

H: Right

T: What actually happens with a slipped disc or a bulging disc is that part of the disc wall becomes weaker so it actually starts to swell. So if you imagine a – an inner tube where there's a little bit of weakness in the wall, you can actually start to see it swell. Now the trouble with that is it can potentially press into the little canal that houses the nerves, that can actually cause pain into your legs. So sometimes people with slipped discs actually don't have back pain at all, they just have leg pain

H: Oh goodness

T: Yes. So slipped discs do occur, but like I said there's lots of different names for them

H: Right. So your problems with your back can actually impact on different areas of your body then ? If you have problems with your back, what other kind of problems can it cause Rishie?

R: Depending upon where it is in your back, you can get symptoms down your legs, so not only pain but pins and needles, numbness, loss of strength in the legs. It can also affect the arms, and again pins and needles, pain, loss of sensation, loss of strength in the arms. It can also give you other pains coming in to your groin, down your mid back. So it can affect all parts of your body because the nervous system comes out down through the spine, and out to the -

T: There's not only neurological problems but it can also cause just structural problems. I mean the bottom part of your spine's a bit like the foundation of a building

H: Right

T: What happens if you get a building with subsiding foundation?

H: You're in trouble

T: It effects the walls, the ceiling and the roof ok? So that's sort of a nice, easy way to sort of imagine sometimes people with neck pain, the problem can be coming from the bottom of their back.

H: Oh interesting – it's shooting up

T: Not always. It doesn't mean to say that your problem for the roof is caused by the foundation, but it could be

H: Right we've had a question in from Simone and she says "I'm a mum, and carrying my baby boy around a lot has meant that my hip really aches. What can I do about this?" Tim any advice?

T: Yes I'd say take lessons from people who have been doing it for a long time, so if you got Africa or Asia you'll see that local people carry their babies either on their front

H: Right

T: Or on their back, like in a papoose. So there are sort of modern versions of that. Obviously if the baby is quite small then the baby needs to be looking towards you to support its head. As they get older then you can turn them round. The idea is to try and keep the weight even on both sides of the spine -

H: Right

T: If possible

H: Right

T: Now the trouble is that's not always possible, if somebody's right handed then they'll probably just stick the baby on the left hip so they can do something with their right hand

H: Yes

T: To try and minimise that – the trouble with doing that is you tend to hike your hip

H: Right. So you're sort of twisting your back and it's not good

T: You twist it, so if you do have to carry the child on one side then there are lots of different devices. Something like a hippy check which is like a foam seat almost with a belt that goes round the mother, and the child actually sits on that. So the child is actually sitting so you're not having to hold them quite so much

H: Right

T: And it stops this hip hike ok? But if you can try not to carry the child too much. I mean children have got legs ok? So if you can, if it's somewhere safe to put them down, put them in like a play pen or something like that, but ideally try and carry them centrally if possible. If not some support on the side

H: Because they are heavy children. I mean by the time they sort of get to two or there they're two stone aren't they?

T: My 18 month old is very, very heavy and you don't want to be carrying him around for too long

H: Several stone isn't it as time gets on?

T: That's right

H: What are the worst mistakes that people make then? When I was coming here today I was having my handbag over my shoulder like this, and I could feel my back in a completely bizarre position. But we all do these things don't we? Rishie what are the worst mistakes that we make?

R: I think probably the greatest mistake is how people sit and how long we sit for

H: Right. Ooh I'll sit up straight!

R: Ok, given that we're spending so much time sitting. Our driving position, how we lift. Simple things like lifting shopping in and out of the car. You're talking about children, putting children in and out of the baby seat, especially as they get older

H: Yes and you're at a really odd angle then aren't you?

R: That's right you know you're leaning in so you've got to be careful with that. Reaching out, cleaning, bending down – you hear people – "I've got low back pain. I just bent over to tie my shoelace and my back went"

H: Your back went

R: So we find with back pain very often it's a cumulative affect, it's doing lots of things, small things incorrectly than very rarely doing one big thing

T: What's really interesting, going back to Richie's point about sitting, what we don't want – what people don't realise is that sitting incorrectly can put twice as much load on your spine as standing can

H: Goodness me

T: So looking back at research, looking at research, looking at office workers and factory workers, there's a higher instance of back pain in office workers than factory workers. So sitting for too long, loads the lumbar disc – especially if you don't get up and move around

H: Yes

T: So joints and muscles are made for movement and we just, we become too sedentary. We need to get up and move

H: We've become too lazy which moves very nicely onto our question from Darren actually, and he says "I spend 9 hours a day at my desk, and find myself slumping as the day goes on." Oh I know that feeling! "How do I combat this? Any tips?"

R: Well Darren's not alone because like I said the average person spends 9 hours a day sitting down. I think the thing to do is first of all get up regularly every 15/ 20 minutes if you can just get up, it doesn't have to be a long break, just walk around your desk. Or if the phone rings, stand up and answer the phone – you're just breaking up -

H: That's a good idea

R: Yes so you're not sitting too long which locks up the joints and like Tim says puts more pressure on the disc and the low back

T: One of the things I often say to my patients is drink plenty of water, because again if you get dehydrated it causes a problem, but if you drink plenty of water you've got to go to the loo

H: And go to get the water in the first place

T: Correct

H: So that's two trips isn't it?

T: So it makes you get up and move. Because sometimes you actually get so concentrated on what you're doing, you don't realise you've been there for two or three hours.

H: And sitting in front of a computer as well, you get very tense don't you and -

T: So this is why kind of ergonomically chairs that are actually adjustable so you're in a nice neutral position. Trying to sit back into the chair is always helpful. As soon as you start to perch you're going to slouch, so let the furniture take your weight, ok so get back into the chair is a good one

H: Good tip. Which leads very nicely onto our question from Liz. She says "I suffer from back pain and I know it is my desk chair that is the problem. What can I do? I use a cushion to try and prop myself up more but it doesn't seem to be helpful."

R: Well -

T: Sorry can I?

R: Yes

T: Well the chair is only half of the story, so in other words you've got to have a decent desk as well as a chair, so you can't just look at the chair in isolation.

H: Right

T: You can have the world's best chair, but if everything on the desk is too far away or the desk is too low or too high, it's still going to cause a problem

H: Right

T: So you need to look at both, both parts of that. Ideally the cushion, even though it lifts you up, ideally what you want to try and do – so I'm going to use my little model again

H: Get your back out again. I'll hold this because it is -

T: if you look at a spine, in the neutral position the pelvis is actually tilted slightly lower

H: Right

T: And that keeps a nice curve here. That curve is what you need, that helps to take some pressure off your lower back

H: So even though you think you've got a straight back, you actually haven't really -

T: You've got a little hollow in your back

H: Right

T: This is where sort of lumbar – lordosis or curve supports help

H: Right

T: But if we sit and we sit on anything that's too low, basically what happens is our pelvis does this, and it causes us to slouch. So ideally having a chair that allows your knees to be slightly lower than your pelvis helps. So a lot of chairs, a lot of office chairs actually have a tiltable mechanism, so your knees are slightly lower, or you might have seen these kneeling chairs?

H: Yes. They look really weird but they must work, otherwise people -

T: They work to a certain degree but the trouble is again sometimes you sit in one position for too long

H: Right

T: Or they put too much pressure on your knees. So a lot of chairs actually have a tilt or floating mechanism, so you can actually be in that position but it allows you to move. So like I said, good position but also keep moving

H: Yes

R: I would just add to that – if we're looking at sitting down the first thing we should make sure is starting from the bottom, your feet are touching the floor

H: Right

R: So if your feet don't touch the floor, get a foot rest ok? Make sure that the seat, the front of the seat isn't touching the back of your legs, ok? As Tim said ideally your hips should be level with your knees, or really your hips should be slightly higher, or raised because it puts less pressure on the back. Sit well supported, sit

T: Sit into the back of the chair

R: In the back of the chair, and if you bring your arms down by yours sides, 90 degrees with your elbows, that's the level of your desk

H: So -

T: And ideally -

H: Sorry

T: Ideally you've got a support here ok?

H: Right

T: So it just takes the pressure off this part of -

H: So you should spend some time then at work, trying to get your position right, but a lot of people are hot desking these days aren't they -

T: That's a problem

H: How do you kind of make sure that you're not sitting badly?

T: The way around it is to try and make sure you've got an adjustable chair

H: Right

T: Ok so one size doesn't fit all ok?

H: No, if you've got a little lady and a 6'2" man then – completely different

T: So a lot of chairs, even a simple thing like actually adjusting the squab, the bit you sit on, the length of the squab, if you've got somebody whose got very, very long legs, if the chair's not long enough it doesn't give them enough support. If they're short and the squab is too long then they'll feel hunched up ok?

H: Yes

T: So adjustability is key. So if you are hot desking, ideally the office should have adjustable furniture

H: Yes. And they are quite hot on that, talking about hot desking, they are quite hot on that at offices these days, it's because of health and safety so there should be someone in the office that should be able to help you with it

T: Yes. And find out how the chair works. It's amazing, I do ergonomic audit round the country and it's amazing how people don't know what their chair does

H: Right, yes

T: I say ok adjust it – oh I don't know – well do that, and they go down, and it's about trying to know, ok well this does this, this does this, so actually look at how the chair works

H: Yes.

R: Well with hot desking there's also a new phenomenon really of people using their laptops as their main computers

H:Right

R: And really the top of the screen should be at eye level, so you find with laptops your head is -

H: Yes because you're sort of hunched over -

R: That the keyboard is smaller so you almost adopt this type of posture, which gives rise to more back pain. So ideally if you're using your laptop as your main computer if they can use a docking station with it, maybe with a detachable keyboard which then helps you to maintain your correct posture

H: So your screen should be higher up really?

R: Yes top of the screen should be approximately at eye level

T: What's interesting the longer you adopt a posture for the more your body thinks that posture's normal

H: Right

T: Which is always a problem

H: It starts compensating

T: It starts compensating, then when you do try and put it right it actually feels quite uncomfortable, so talking about this bent forward position, I had a big chap who works on a computer, and I said you need to do an exercise called open like a flower, and he looked at me slightly strange, and basically it's what we call a counter stretch, so rather than being bent in all the time it's actually sort of extending and doing this, ok, so you're actually getting used to using the muscles to pull you back ok, so you're not in this position all the time

H: Ok which – exercise is very important actually, we've had a question in on that, Harry Thomas says are there any straightforward exercises you can do at work that don't take loads of time, and you don't look very stupid doing?

T: Does it matter if you look stupid doing it? If it helps -

H: Well it doesn't actually does it, Harry didn't actually say that – I just added that on because I would feel a bit stupid doing your flower thing in the middle of the office! But if it keeps – if it helps your back, it's worth it

T: I've seen guys doing it on a building site

H: Oh well there we are. So anyone can do it!

T: It's a bit of fun and it makes people talk about it, it makes people think about it

H: Yes exactly. So Rishie any tips?

R: Yes for Harry and everybody else out there, the British Chiropractic Association has designed a simple three minute exercise program suitable for all ages, it can be downloaded for free, it's quite simple as you can get this leaflet. It's from straightenupuk.org. The principle behind it is it's a bit like brushing your teeth – if you brush your teeth every day, hopefully you won't get back pain – tooth pain!

H: Tooth decay! You're not a dentist, it's alright, we know what your specialist is!

R: If you do these exercises, hopefully you won't get back problems

T: And the whole idea, like Rishie says is don't wait for you to get pain before you do them

H: Right

T: So you don't wait until you get toothache before you see the dentist. So don't wait until you get pain before you do the exercises, or if you're in doubt, go and see your chiropractor

H: And prevention is better than cure isn't it, let's face it. So let's have a look at another video clip – this time showing how to avoid injury

Video Footage

Tim: Chiropractors don't only treat pain, they try and improve function and they try and prevent injury. So getting into good habits, getting education about what your spine can do and what your spine should do is quite important. And example is proactive treatment – it's a bit like going to the dentist – you go to the dentist regularly, you have your check-ups, you brush your teeth. Chiropractors can offer you a similar service. Go for spinal check-ups or MOTs, do something like the Straighten up UK program. The Straighten up UK program is a three minute exercise program that's designed to help to straighten, to strengthen and to improve mobility of your spine. This will help to reduce the chances of developing a bad back. People sometimes have a misconception of back pain – they always look at the last thing that causes the back pain and blame that, so for instance lifting a heavy object – they think lifting is the cause of their back pain. What people don't realise is something as simple as sitting badly over a period of time can give you a bad back. The reason being, sitting incorrectly can put twice as much load on your spine as standing can. So having the information of how to reduce the stresses on your spine, can make a lot of difference. Education is one of the best forms of prevention. Accurate diagnosis is very important. What might appear to be a simple hamstring strain might be a problem with your lower back, even though you treat the hamstring, the symptoms might get better, but the actual underlying cause is there. One of the problems is people think lack of symptom means lack of problem. It's not just about treating symptoms. It's about treating cause and managing that cause

H: Some good advice there. Well moving on to some of your questions, and we've had one in from Mr Seymour and he says "I've suffered intermittent low level back pain for years. Occasionally it flairs up and I'm bedridden for a couple of days" – that sounds pretty miserable doesn't it? "Is it worth me seeing someone? My GP just says that I should rest." Should he see a chiropractor?

T: I would say definitely – sorry I was going to jump in there, after you

R: I was going to say – well for Mr Seymour obviously his problems are not going away

H: No

R: And this is what the research shows us with back pain, that unless you go ahead and correct the problem, the pain keeps on coming back. So I would suggest that he does get his back examined, he can find a chiropractor from the BCA website – chiropractic-uk.co.uk, they'll undertake a full medical history, give him a thorough orthopaedic and neurological examination, and from there they should hopefully be able to tell him a) what his problem is and b) what can be done about it, and offer a package of care involving treatment, exercises, rehabilitation, stretches, lifestyle, postural advice to try and stop this problem from coming back

H: Ok

R: Because that's the key because we find that most people get back pain and they keep on getting back pain

T: One of the problems is people use pain as the indicator whether they've got a problem or not, but that's not how it works ok?

H: Right, yes

T: So a lot of people come to me and say I should have come last week, I was really bad last week and I go well actually we can still examine you, you don't need to have toothache for a dentist to find a tooth – a problem with your tooth, ok? So you don't have to wait until you're really, really acute – and even when the pain's gone away, that doesn't mean to say the problem's gone away

H: No

T: So there's lots of conditions like people with high blood pressure, people with diabetes that don't have any pain, but there are tests that you can do to find out if they've got that problem. The same thing is true for mechanical back pain?

H: Ok which moves on nicely onto Desmond's question actually. He says "is it worth seeing a chiropractor to decrease your risk of developing back issues in the first place?"

T: Yes ok so postural advice, ergonomic advice, actually seeing how the team works ok? Again I liken the spine to a football team or a rugby team ok?

H:Yes

T: The team might win, but the manager might change the players around ok? So what you're looking at is not just the team winning is no pain. The manager moving the players around is actually making it better

H: Right

T: So the answer to that is go and see somebody

H: Ok

R: Well with treatment and preventative exercise, again we can try and prevent these problems from occurring a) to stop you from getting pain and b) requiring more treatment to get you out of pain

H: Ok so if you want to find a good chiropractor then how do you go about it? I've had a question in from Suzy, she says "how can I find a good chiropractor near me?"

T: So like Rishie said, so chiropractic-uk.co.uk is the BCA website ok, so that's a good place to start. There's actually a postcode search so you can put your postcode in and they'll actually tell you, they'll give you the chiropractors in that area. All chiropractors in the UK are registered by law, they're statutory regulated, and most chiropractic is actually covered by most insurance companies as well

H: Ok well it's worth having a go isn't it? Well thanks very much Tim and Rishie fro coming in

T: Thank you

H: It's been really interesting talking to you. And if you've got back pain don't just moan on about it, go and see your chiropractor and you can find one near you by going to the website which is www.chiropractic-uk.co.uk and you can put your back pain behind you! Thanks very much for watching the Healthcare Show and we'll see you next time. Bye bye

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