‘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.