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‘My bed is so cosy, nice and soft,.
When I sleep I sink into it, I am in adreamland and I
feel wonderful and so fresh in the morning. I love my
bed, it is so dear to me.’ ‘Disgusting!’
said the osteopath.
‘I have never played any game in my life. When I was
young I entertained myself with novels and movies, or
kept myself busy with my course books; I was a bookworm.
When I got married, I hardly had my chance to participate
in games. My house is well equipped with modern gadgets
and amenities so that I hardly exert myself
physically.’ ‘Frustrating!’ said the
osteopath.
‘I was tall with good features, but since I was tall
I could hardly hold myself erect. This was also due to
the natural instinct of a teenaged girl. I
graduallydeveloped a habit of walking and sitting with a
forward stoop. I gradually developed a habit of walking
and sitting with a forward stoop. I cannot change it
now.’ ‘So unmindful!’ said the osteopath.
‘If you go to Rajasthan, watch the ladies carrying a
number of water pitchers on their heads. They walk miles
and miles to bring water for the cooking and daily
washing. It is a pleausre to see them walking. They walk
so straight and their walk looks so very graceful.’
‘Wonderful, it is healthy!’ said the osteopath.
‘Do you see boys making pyramid formations in a
circus or on the streets of Bombay to bring down the
pitcher hanging high and tied to a rope on Janmashtami?
They make human pyramids, one boy over another, to reach
the top to break the pitcher. Only a team of healthy and
stout boys with straight backs can play this game and
succeed.’ ‘It must be very interesting and so
healthy!’ said the osteopath.
‘We live in a village and our work involves hard
labour in the fields and at home. When we are young we go
to the akhada to do dand-baithak and wrestling. We
perspire, we rub mud on our bodies, we take a swim, we
feel fresh and fine. We cannot afford thick mattresses,
so we just spread a little rug on the ground and full
into a dreamless sleep, only waking up in the morning. We
feel fine and energetic; we feel like pushing and
punching somebody. ‘You have the healthiest habits
in the world! Said the osteopath.
At the London college of osteopathy, we used to hear an
interesting story about a man called Frederick Matthias
Alexander. He used to cure his patients of their aches
and pain, only by teaching them how to stand and sit
correctly and how to do different activities using the
correct posture. He cured his patients just by correcting
their posture! This may appear very surprising, but it is
true. Osteopaths are very careful about the posture of
their patients. They tell their patients how to correct
their posture and do corrective exercises, so that men
today are conscious of the role that posture plays in the
etiology of different diseases.
It is very important to know how one should carry
one’s body. A humped back and vertebrae contracted
together cause back pain. The neck sunk down on the chest
causes stiffness in the neck, pain in the arm and
headaches. When we stand erect, how many of us put equal
pressure on both the legs? All the body weight is usually
put on leg, putting a constant strain on the pelvis and
lumbar spine. Bad posture keeps our muscles tense.
How many teachers or parents are watchful of their
child’s posture? The correction of posture in a
child is much easier than in grown-ups and elderly
people. Healthy habits developed by a child help him
right through his life. As parents or teachers, we should
be conscious of how a child sits and if the posture is
incorrect, we should point it out to him and take care to
keep on correcting it. It is very important to see how a
child sits, treads, writes, walks and plays.
Spinal curves are absent at birth and during the first
few weeks of life, there is one continous curve as the
child is curled up in the womb. This primary curve
undergoes changes as the child gorws and lifts up his
head, tries to sit, crawl, stand, walk and run. At the
age of three months when the child tries to lift his head
and look around, the upper secondary curve in the spine
– from the first cervical to the first dorsal
vertebrae – starts developing. By nine months when
the child is able to sit, this curve is convex forward.
The lower spinal curve (lumbar) from the first lumbar to
the fifth lumbar vertebrae appears between twelve to
eighteen months when the child tries to walk. It is more
prominent in females than in males. The thoracic curve
from the second to the twelfth thoracic vertebrae is
concave forward. The pelvic curve from the lumbo-sacral
joint to the coccyx faces downwards and forward.
The primary thoraic kyphosis (being forward at the
thorax) present at birth is maintained; the cervical and
lumbar lardosis (bending backwardat the lower spine) are
developed during the process of growth, so that man can
assume an erect posture. Biologically speaking the lumbar
and cervical (neck) curves emerged after man acquired an
erect posture during the evolution of human life.
Mechanically these curves are so constructed due to the
structure of the vertebrae, that they are maintained even
when we lie on the floor or an extremely hard bed. If
these curves are excessive, they are a causative factor
for different aches and pains. For example, the spinal
joints most vulnerable to internal derangement are
between the fifth and sixth cervical, and fourth and
fifth lumbar vertebrae – the area of the spine where
the cervical and lumbar is most marked.
From early childhood every effort should be made to
prevent future backache. Back pain is a universal
symptom. So the aesthetic consideration of a child’s
posture and mechanism of disc protrusion should be a
consideration before selecting exercises for children. In
adulthood when disc degeneration has already started and
the spine is comparatively stiff, exercises suddenly
forcing a person to bend forward should not be included;
if included at all, enforcement should be gradual, so
that the spinal ligaments are able to reattain their
elasticity and undue damage is not caused by sudden
force. A patient with back pain should not be advised to
do forward bending exercises. Sometimes even when a
sufferer from back pain finds that flexion exercises
increase his discomfort, he is asked to do these
exercises. Any exercise which aggravates pain. During or
after it has been done, is harmful. It is a symptom of
injuring a sore spot and healing of the pain is delayed
by such exercises.Selecting the Right Bed
While selecting a
bed due importance should be given to posture and spinal
anatomy. Most people are not aware of these
considerations. In fact, with affluence and luxurious
living, things are changing for the worse rather than the
better. Cotton mattresses are being replaced by foam
mattresses. The thickness and number of pillows used by
an individual are increasing. Springs are often added
beneath these foam mattresses. A comfortable bed is
considered to be one into which you sink in. Is that
correct? Very definitely not!
It is important to keep the spine as straight as possible
while sitting, standing or doing any job. Equally
important is to help the spine to remain as straight as
possible while lying in bed, and even more so when you
are suffering from back pain or neck pain. Let us
consider what a soft bed does to your spine. When you lie
on a soft bed the heavier part of the body sinks deeper
into the bed, and the lighter part of your body stays up
in bed, thus increasing the curvatures of the spine and
putting a lot of undesired strain on it. Thick pillows
worsen this situation. The thicker the pillows, the more
you flex your cervical spine, which is again an unnatural
strain,.
The body has a great capacity to compensate. It
compensates wrong posture for a long time. It does not
complain till prolonged excesses are committed. However
continuous prolonged excesses are committed. However
continuous prolonged strain gradually weakens the
ligaments, leads to minor displacements in the
intervertebral joints, and it is at this stage that the
mechanism of the body, to compensate for undue strain,
breaks down and we start feeling the pain.
The brahmachari or the pupil who went to his
teacher and stayed with him in an ashram till he
acquired sufficient knowledge and made himself fit for
family life, was advised to sleep on the floor with a kush
or rug made of grass. In gurukuls and even in the
Banaras Hindu University founded by Madan Mohan Malaviya,
students were provided with a wooden plank to sleep on.
A relaxation posture in yoga called Shava asana or
Corpse pose is done by lying flat with the back on the
floor with only a mat intervening. This asana is
done to attain maximum relaxation of all parts of the
body. Similarly hardness of the bed helps to maintain a
straighter posture of the spine which is the normal
posture – a posture of maximum relaxation and
greater relief. This should be given due consideration
while recommending a hard bed to a patient with back
pain. Resting in bed with a soft mattress does not help
such patients.
The lumbar curvature is best maintained when a patient
lies on a hard bed – that is, a wooden plank with a
mat or blanket and a sheet. Lordosis is maintained due to
the structural peculiarity of the lumbar spine. Sleeping
on a soft mattress disturbs this lordosis and so deprives
the patient of maximum relief. Exercises are prescribed
for patients with low back pain when their lumbar
lordosis is obliterated. The lumbar curve can be compared
to the arch of the foot, which is maintained by the
peculiarity of the construction of the bones of the foot
joint. This arch gives resilience of the foot and, due to
the construction of the foot bones and the arches,
provides it with strength and a springing action. The
weight of the body is well distributed on the foot in
order to bear the weight of the whole body and maintain
its mobility.
The same is true about the construction of the lumbar and
cervical vertebrae. When one lies flat on the floor
without a mattress, the cervical and lumbar lordosis is
in a posture of maximum relief and should be maintained
in patients suffering from back pain and neck pain.
Compare the quick fatigue you feel when you walk barefoot
on the sand and the sand hampers the effective action of
the foot arches. The same is true when you sleep on a
thick mattress; it does not allow the lumbar lordosis to
be maintained in a position of maximum comfort.
The best remedy for your tired back after a whole
day’s work is to lie down just for a few minutes
with your back flat on the ground and you will feel
relaxed. Buddhists in ancient India lived in a monastery
which consisted of a large hall with small rooms all
around in the monastery. These rooms were often made by
digging into big rocks, and stand to this date. Beds were
also made by cutting into the rocks; these were for
meditation and for the monks to sleep on.
There is an interesting shloka in Bhav Prakash
by Rajeshwar Dutt Sashtri. This is one of the most
authentic books on ancient Ayurveda.
To sleep on a proper
bed stimulates the heart; a person gets good sleep,
develops better patience, and his health improves.
Sleeping on a bad bed has the opposite effect. Sleeping
on a khat (a bed on four legs with tightened string top)
helps rheumatism and a cough. He who sleeps on the bare
earth will be more virile and strong. A wooden bed
produces vatal, one of the dosas. He who sleeps on a
wooden plank will be cured of all his aches and pains.
Ayurveda considers that
all pains and aches are caused by vata, the energy which
can get stuck in any part of the body and cause pain.
Charaka, a famous teacher of Ayurveda, mentioned thast
‘the person who feels lazy due to discomforts in the
body, and wants to sleep, should sleep on a somewhat hard
bed’ (asukha shaiyya).
When a person changes from a soft to a hard bed, he feels
a little discomfort and slight stiffness in the
beginning, but this phase passes off quickly and he later
feels comfortable and relaxed. A person who is healthy
and does not have any back problem should have a bed with
a solid base and a comfortable mattress, two to three
inches thick. It can even be a foam mattress which is one
inch thick. If there is a spring in the mattress, a
wooden board should be placed on top of it and then a
thin mattress. A patient with a spinal disc problem
should be provided with a harder bed.
If pain and stiffness are felt after a night’s
sleep, it is an indication that the bed is faulty.
Dyuring sleep, the muscles are relaxed and all the
strainb is tolerated by the ligaments. When these
ligaments are stretched for a long time they start
aching. This indicates that the bed is wrongly
constructed and in spite of relaxing the spinal
ligaments, it makes them taut, and pain is felt due to
stretching of these ligaments.
Correcting
Your Sitting Posture
Pain over the
dorsal spine is very rarely due to a slipped disc. It is
mostly due to the searing strain on the posterior
ligaments of the spine, following a wrong posture. Due to
the chronic habit of standing or sitting with a forward
stoop, the patient develops a round back. This
long-standing strain on the back weakens the spinal
muscles. As the muscles are not able to take the strain,
the strain passes on to the ligaments; and as the
ligaments are continuously stretched for s long period,
the body’s compensation breaks and you start having
back pain. When a patient has dorsal kyphosis, the site
of the vertebrae placed at the summit of the dorsal curve
feels most painful after fatigue. This pain may also
radiate to the chest, shoulder and back. The cartilage of
the disc is insensitive since it has no nerve supply and,
therefore, the first sign of disc damage is due to the
stretching of the supporting ligaments.
The prolapsed disc may bulge and stretch the posterior
ligament. A thin disc leads to narrowing of the space
between the adjacent vertebrae of facets, with
aconsequent strain on the ligament which causes pain.
Have you observed the statues and paintings of Buddha at
Ajanta and Ellora? Buddha is always shown sitting in yoga
mudra with is spine straight. Yoga mudra is the sitting
posture for meditation. This posutre frees the body from
any strain on the spine so that it does not hurt and
divert the attention of the person who is meditating.
This posture has to be maintained for hours and
therefore, it shoyuld be comfortable , and free of any
pain or strain.
Yoga asanas called posture exercises were developed in
India in ancient times, and were practised for
generations. Asanas are taught by Yoga teachers to
patients suffering from back pain; they take the form of
back extension exercises. A simple set of exercises of
dand baithak practised in the villages of India has a
beneficial effect on the spine. It takes off the strain
from the spine and makes it fit to fight the other
strains on the spine caused by the adoption of an erect
posture.
To sit slumping in a low chair puts considerable strain
on the lower back. If the posture of sitting is not
correct any measure to relieve the low back pain will not
be effective. The patient should sit right at the back of
the seat and then rest against the back of the chair. An
ordinary office chair is much better than a sofa. If the
cushion is not of a proper design, a small pillow may be
placed behind the small of the back.
While designing furniture - be it a bed, kitchen shelves,
or cupboards – keeping in mind the right posture is
important. As an osteopath, I remember being paid a big
fee for designing the chairs for the British Airways
aircraft.
Strengthening
Muscular Control
Exercise are
needed to tone up the muscles and to maintain a good
posture. Slack muscles lead to poor posture and undue
strain is passed on to the ligaments. Eventually
ligaments stretch and further abnormal mechanical strain
produces still more symptoms. Poor muscle tone is
inevitable if the number and kind of exercises done are
insufficient. A person with poor muscle tone is much more
vulnerable to mechanical strain than one with a normal or
muscular build.
An office worker, for example, whose spinal muscles are
slack and weak due to his unstrenuous job, is much more
vulnerable to strain or sprains if he tries to lift
something heavy or do gardening. On the other hand, a
person who does his exercises daily or participates in
games has muscles which are in good shape. The following
example will give a complete picture. When a person is
ill and completely inactive in bed, he loses the strength
of the muscles at the rate of 7 per cent a day. To
increase the power of the muscles, exercises should be
chosen wherein two-thirds of the maximum muscle strength
is used. To maintain the strength at the same level,
one-third of the maximum strength should be used. The
power of the muscles decreases if only one-fifth or less
of the maximum muscle power is used.
Increase in firmness and tone of the muscles is the
indication of increase in muscle power. To acquire
hypertrophy of their muscles, weightlifters and body
builders exercise their muscles to a point of
considerable fatigue. Hypertrophy of muscles is not
necessary for healthy living. The muscles should not be
forced beyond a certain limit. If they are exercised
beyond the tolerable muscle limit, they cease to contract
in spite of maximum mental effort, and become inflamed,
swollen and tender to touch. The subsequent contraction
of muscles is painful for two to three days.
Mobility
of the Spine
The intervertebral
joints of the spine can be hypomobile (less mobile) or
hypermobile (more mobile). A hypermobile joint with
elongated weak ligaments is more vulnerable to disc
lesion. Hypermobility leads to impaired nutrition, and
then degeneration and softening of the disc. In this
case, as the supporting ligaments of the annulus fibrosus
are weak, herniation of the disc is inevitable.
Hypermobility also leads to injury and tearing of the
ligaments, and when there is a prolapsed disc, it takes
much longer to heal, as giving support and rest to these
joints is difficult.
A hypomobile spine has advantages over hypermobile
joints. People with hypomobile spines are stocky and
muscular. To have big muscles is not a disadvantage, but
when such persons stop exercising, they suddenly become
flabby. When exercise is not done, the muscles become
poor in tone, and there is a likelihood of getting a
mechanical strain.
The regulation of posture is governed largely through
sensations emitted through the head. This is facilitated
by the vestibule of the internal ear as well as by the
nerve endings (called pacinian corpuscles) present in the
ligaments of the cervical vertebrae.
An incorrect lifting posture is the reason why we
sometimes get vertigo or giddiness due to disturbances in
the upper cervical spine. A faulty posture and gravity
impede the return of blood to the heart. If a faulty
posture is maintained for a long time, blood congestion
takes place and difficulty in breathing may be
experienced. The central nervous system depends upon the
integrity of the spinal column. All the impulses coming
and going between the brain, spinal chord and peripheral
nerves have to pass through the intervertebral foramen
which can be very easily disturbed by a faulty posture,
and can, in return, affect part of the nervous system.
Certain precautions must be taken to avoid a strain on
the spine.
- When you want to lift
something heavy from the ground or bathe a child,
or make the bed, do not stoop; sit and lift the
baby for a bath.
- Do not twist the body
while turning, but rather change the position of
your feet and turn. Just bending down and turning
to one side is the worst movement you can make.
- Do regular
back-extension exercises and abdominal exercises
to keep up the tone of the muscles.
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