Maintaining a healthy back

Back pains or pain near the waist are the usual complaints of patients who come to me for consultation.
My first question is whether an accident has happened: was there a fall, a bump, a slip? But in real day-to-day situations, the most common cause of back pain is due mainly to wrong body posture rather than to accidents or extreme exercise.
First of all, most of us sit the wrong way. The chair is probably one of the worst inventions of humankind when it comes to maintaining a healthy back. The best position for sitting is to sit on the floor or to sit on a low stool. This is exactly how our indigenous Filipinos sat or even how most Asians sat before the introduction of the chair from Europe.
But the chair is here to stay. So how shall we best sit on a chair, if nowadays to sit on the floor or a low stool is no longer the convention?
The rule of thumb when sitting on a chair is to sit always with the knees higher than the waist. So how do you actualize this? You can sit with crossed legs, an ankle resting on the thigh or a leg resting on the knee. Or you can place your feet on a footstool. To feel the relief and relaxation of this recommended sitting posture, place your hands on your lower back and sit normally on a chair. Then change your sitting position by crossing your legs. You will be able to feel that your lower back muscles have relaxed.
My advice for those who are required to sit during working hours, or for those using the computer and have to sit for several hours, to use the telephone directory or any stack of books as a footstool. Better yet, make the footstool a common feature in offices and factories. A corollary advice is to stand up every 20 to 30 minutes and pace around for a minute or two before returning to your chair.
For drivers of vehicles, it is healthy for the back if you are seated nearer the steering wheel. Drivers can either put a back pillow or a backrest to implement this. You will notice that this position for driving puts the knees higher than the waist.
When lying down in bed, the worst posture is to lie on your stomach. Your back muscles are severely stretched in this position. And if you are lying on your back, the proper position if to fold your knees so that your back muscles are relaxed. The best posture for sleeping is on your side with your knees folded or with a pillow in between your knees. It is important that your bed or mattress is firm and does not sag when you lie down on it.
When in a standing position, especially for a long period of time, find a spot where you can place one foot three to six inches higher than your other foot. This will make your back muscles relax.
When brushing our teeth or washing our face, we usually bend forward to get the water to our mouth or face. This bending puts an unnecessary strain on your back. My advice is to bend your knees a little bit when performing these daily habits.
When picking up things from the floor, whether these are heavy or light, always bend your knees. For men, forget the macho posture of bending from the waist to pick up things. The women have shown the best way of picking up things with full knees bent. And when carrying heavy objects, always carry them near your body. When shopping, we usually carry our shopping bags with our hands straight and parallel to our body. This posture again puts a strain on our back. The best way is to carry them in front with our arms or hands locked.
Some additional advice. If you are overweight, lose weight and achieve your normal weight. Especially if your abdomen is bulging or even with just love handles on your waist, these conditions put a strain on your lower back. Achieve a hip to waist ratio of less than one.
For exercise, my advice is to do the floor abdominal exercises. Lie on your back with your knees folded, press your back on the floor while tightening your abdominal muscles. Stay in this position for 5 to ten seconds and then relax your back and abdomen. Do this routine a dozen times in the morning and in the evening. The best sports exercises for the back are swimming and cycling.
Our back also mirrors our feelings, frustrations and tensions. The back will manifest pain if there is a lack of emotional support, a sense of guilt or if one has financial problems. Examine also your personal goals and relationships and find out whether there are problem areas causing emotional turmoil that manifests itself in back pain.
Is maintaining a healthy back difficult? It may seem so at the start since we have gotten used to our bad postures that have caused lower back pain. If we truly want to maintain a healthy back, the key is to start now until all these correct body postures become a part of our life. Cheers to a healthy back!

By Jaime Z. Galvez Tan, MD MPH

The author is chairman and founder of Health Futures Foundation Inc., a civil society organization working to create communities of wellness in marginalized communities nationwide.