Glossary of useful terms

  • DISC, nucleus pulposus, annulus, Disc prolapse, Disc bulge, Discectomy, Discogram
  • FLEXION, Forward flexion, Side flexion
  • INFLAMMATION, Acute inflammation, Chronic inflammation
  • JOINTS, lntervertebral cartilage
  • LIGAMENTS, Longitudinal ligaments
  • YOGA



An acute back is when there is a sudden onset of inflammation and pain which is of brief duration. This is a crisis, which may be caused by a fall, a wrench, a strain, an activity, or something very trivial such as turning on the bath tap. It also may be due to heat, cold or an invasion of bacteria. An acute back comes on suddenly; immediate treatment is necessary.

There will be the following signs:

  • Pain.
  • Limitation of movement.
  • Swelling.
  • Protective muscle spasm.

What to do

Stop what you are doing IMMEDIATELY and think what to do next. A minor injury or twinge can be turned into a more severe one if you continue with the activity that may be causing it. Telephone the doctor at once if you are worried and need medical advice. Lie down on a firm surface. Go to bed if it is supportive and if you can get there. If not, lie on the floor, supported where possible with pillows. A light mattress or a piece of foam will soften the hardness of the floor.

Rest for 24 hours in a lying position so the back no longer has to carry the weight of the body. The back cannot be rested by sitting down. Relax and try not to be apprehensive. You may need bed rest for two to three days.

Crawl on all fours to go to the bathroom and lavatory, getting in and out of bed carefully. When using the lavatory do not bend forwards. Avoid constipation, which will cause more pain, by eating plenty of fruit and roughage. Use a bedpan, bottle or bucket if the pain is so severe you cannot get out of bed.

Use heat or cold therapy, according to your tolerance and preference, for no longer than 1 5 minutes, three or four times a day. A hot water bottle, an electric heating pad or infra-red lamp should give gentle warmth only. Ice or cold towels will also assist the circulation and relieve pain.

NOTE: If there is no skin sensation on touching the back, avoid using heat or cold therapy.

  • Take painkillers such as aspirin or paracetamol which act as anti-inflammatory medication. Homeopathic remedies such as arnica or rhuta will also help relieve the inflammation.
  • Wear a support or corset if your muscles are weak. Keep a collar and corset handy in case of an emergency until you can get to bed and rest. A simple lumbar belt is ideal.
  • Start gentle movements gradually, once the peak of the pain has passed, to prevent stiffness and more pain. Exercises to correct pelvic tilt are extremely important and should be done first.
  • A good position to relieve pain is to elevate the legs on to a chair or stool so that the hips and knees are at a 90 degree angle.
  • Have showers, not a bath, allowing the water to stimulate the circulation in the back.
  • Give the back time to get better, and avoid starting manual work until the muscles have good tone. Don't carry or lift anything until you are better.
  • If it hurts - DON'T DO IT.


This is the name - the Norwegian word for 'balance' - given to the seating which was created in Norway in the late 1970s. Credit for the original concept goes to Hans Christian Mengschoel, although four designers have been involved in the development. The first was a Norwegian, Peter Opsvik, a furniture designer, who as a result of meeting Dr Aage Mandal designed a seat with a forward tilt. Since Mandal advocated a chair with a seat that tilts 15 degrees forward, Opsvik incorporated this feature in his designs. Hans Christian Mengschoel found himself eating dinner while kneeling at a low coffee table and had the idea of inventing a kneeling stool or chair; since kneeling is natural and children often play in this position. He met Opsvik in 1978 and, with the encouragement of Addvin Rykken, a kneeling stool was produced, and the Balans seating is the result.


A general deterioration in the bones and discs of the neck due to the excessive use of head movements results in the condition called cervical spondylosis. Movement in the neck becomes limited and this may also extend to the shoulders and arms. The most likely place for cervical spondylosis is in the fifth, sixth or seventh cervical vertebrae. It will show on an X-ray as a crumbling of the bone, and the joint spaces will be narrowed. It is most common in the 35-50 age groups.

What to do

  • Seek professional medical advice about treatment.
  • Stop all movements that cause pain and rest the neck.
  • Wear a neck collar to support the head.


Chiropractic means 'practice with the hands', being derived from the Greek words cheir. Hand, and praktikos, done by. Chiropractic is manipulative treatment for misalignments of the back and its joints which can lead to other complaints. (See manipulation.) It was developed in the late 1800s by Daniel Palmer of Davenport, Iowa, a grocer turned 'magnetic healer'.

Modern chiropractic is the branch of complementary medicine which specializes in the mechanical disorders of the joints, particularly the spinal joints, and their effects on the nervous system. The difference between chiropractic and osteopathy is that an osteopath mostly treats the affected back joints, searching for a lack of mobility by levering and twisting manipulations, whereas a chiropractor is more exact, feeling for individual vertebral displacements with specific thrusting techniques at one level, applied directly to the misaligned bone after a diagnostic X-ray.


The back is not rigid but flexible, due to shock absorbing structures between each vertebra and the next called intervertebral discs. They can be seen when viewing the spine from the front. These discs are engineered to deal with compression, preventing the vertebrae crashing, grating, grinding and rubbing against each other.

The nucleus pulposus

The core of the disc is composed of a soft jellylike material called the nucleus pulposus. It has a shock absorber effect, working like hydraulic fluid to protect the vertebrae. Fluid is absorbed into the disc from the surrounding tissues whilst you are asleep and squeezed out during the day when the discs are constantly under pressure from the forces of gravity when standing up, sitting, bending and lifting. During movement, however, the disc can suck in more fluid and nutrients, so if the back is sedentary and static the disc will dry out problems will occur.

The annulus

The nucleus of the disc merges strongly with the hard tough outer part of the disc called the annulus, which encircles the central portion. The annulus has many layers in a laminated construction, formed of fibers crisscrossed at an angle, one layer lying in a slanting direction and the next layer lying in an opposite oblique direction. The annulus provides strong reinforcement to keep the vertebrae together. It minimizes compression on the disc and can stretch to a limited degree allowing flexibility in the back. If the annulus becomes twisted, the fibers are stretched and cannot cope with movement; they tear, first on the outside layers and then on the inside, which will cause muscle spasm and pain in the back.

Disc prolapse

Contrary to popular belief, a disc does NOT slip. It becomes prolapsed due to a violent twisting action, an injury or degeneration with age. The annulus becomes so badly cracked, damaged and distorted that some of the centre or nucleus of the intervertebral disc is squeezed through the outer wall. This rupture of the annulus allows the bulging protrusion of the nucleus into the spinal canal causing interference and pressure on the spinal cord or nerve roots. This herniation results in severe spasm in the back muscles nearby and pain due to the compression on the sensitive spinal nerves or ligaments; there are no nerve endings in the discs themselves to cause pain. A prolapsed disc is most likely to occur between 25 to 50 years of age.

Disc bulge

With ageing or after injury, the contents of the disc may bulge, herniate or protrude and press on the spinal nerves. This may not necessarily cause pain.


This technique is used to investigate a disc.-After the injection of an opaque dye, X-ray pictures are taken to show what is happening in a disc, in order to detect a suspected disc prolapse or degeneration.


Ergonomics is the science that has evolved to reduce the friction between man and work. It is the study of the physical relationship between the worker and the work environment; for example, when seated to work, the height of the work surface in relation to the height of the chair should be comfortable, with both feet resting on the floor. The environment can then be planned for the activities involved, to ensure the best results, in the office, the factory or the home. The application of ergonomic principles will produce greater efficiency for the same amount of effort, and as a spin off will prevent back problems. In an ideal situation, furniture, fitments throughout the house and surfaces at work will be ergonomically designed to fit the individual's body and lifestyle, thereby preventing stress and strain on the back.

  • Plan your worktops so that they are the correct height for you in the kitchen, the bathroom, the garage and the greenhouse.
  • Assess your workplace; for example, if you are a typist, is your chair at the right height and angle for you?
  • Learn to bend, lift and carry loads correctly.

NOTE: If you want to invest in ergonomic furniture, make sure you go to a specialist shop where trained staff will understand your needs and take time to guide you in finding the right solution. The Back Shop free assessment service is available to help you choose the correct furniture for your requirements.


Forward flexion

Sit on the edge of a firm chair. Bend forwards, sliding your hands down your legs to touch the floor - just flex forwards as far as is comfortable for your back. Hold for a count of five. Return to the starting position, uncurling slowly, and relax for a count for five. Repeat five times.

Side flexion

This movement is away from the mid-line and is limited in range by the vertebral bodies and discs. Stand with your feet apart, arms by your sides head erect and the chin tucked in. Bend first to the left and then to the right, keeping the head in line with the trunk. Stretch the left hand toward the left knee for the count of five and then repeat to the other side in a slow rhythmical fashion.


Man stands upright, so muscles have to overcome the forces of gravity. It is therefore extremely important that they are all strong enough to support the back in a balanced posture in order to avoid failing forwards or tipping sideways as a result of the pull of gravity.
Gravity can be used as a form of traction for the back.


A herniated disc is the protrusion of the nucleus of the disc which squeezes out through an opening in the annulus, pinching nerves in the back.


Inflammation is a reaction in the tissues that have been hurt due to:

  • A mechanical irritation of a joint.
  • A muscle injury or tear.
  • An infection.
  • A chemical reaction.

Extra fluid is formed at the site of inflammation, which may be acute or chronic.

Acute inflammation

Immediate swelling occurs as extra fluid accumulates in the injured tissues, the swelling varying from severe to microscopic, depending on the nature of the damage. The fluid is sticky and is composed of blood and clear lymph. Adhesions may occur due to the inflammation, which will restrict movement resulting in stiffness and pain.

Chronic inflammation

The fluid which has wept into the joints or tissues becomes slowly thickened and hardened with time, resulting in the formation of fibrous tissue, which further restricts movement. Adhesions may occur, and muscles can become wasted.


lntervertebral cartilage

With the vertebrae, a pad of cartilage lies between the bone surfaces of the vertebral bodies and there is a fibrous capsule to hold the bones and cartilage in place. The cartilages of such joints, the intervertebral discs, also act as shock absorbers between the bodies of the vertebrae. As you get older, and with the stresses an strains of everyday life, ageing in the joints occurs. Degeneration can start in your 20s but is more common in the 40~-50 age group.


Kyphosis describes the forward curve of the thoracic spine. If it becomes exaggerated the resulting round back is sometimes called a 'dowager's hump' or 'The Hunchback of Notre Dame'. It may be just a bad postural habit, but it can become fixed and permanent.
Some causes of permanent fixed kyphosis are:

  • Heredity.
  • Scheuermann's disease.
  • An abnormality from childhood.
  • A disease such as ankylosing spondylitis.
  • Osteoporosis.

What to do

Watch growing children for signs of kyphosis, poor posture and vague backache.

  • Have a mattress which supports the thoracic curve when sleeping.
  • Have gentle mobilising and strengthening exercises for extension of the back.
  • Learn postural re-education by attending a back class or having Alexander Technique sessions.
  • Go swimming. The breaststroke is a helpful movement.
  • Learn to lift correctly.

NOTE: Never have a manipulation if kyphosis is due to disease.


Ligaments act as guy ropes, along with the muscles, to support the central backbone. Ligaments are strong tough bands of white fibrous tissue which connect one bone to another. They stabilise the back, controlling and guiding movement. The ligaments tense or stiffen when you move forwards and relax as you bend backwards. thus preventing the bones from tipping sideways. Ligaments are slightly elastic and flexible, but when they are stretched beyond the limit of their elasticity they tear and are painful. If they are stretched for prolonged periods they become elongated, rather like overstretched knicker elastic, and can eventually ping or snap, resulting in disaster! Sprained and strained ligaments as a result of poor posture at work or a sudden forceful effort are a common cause of back pain. They heal slowly and not very well as they do not have a rich blood supply. The sacroiliac ligaments are especially vulnerable in pregnant women, since during childbirth an enzyme is released into the ligaments, increasing their elasticity.

NOTE: Standing in a shop all day, going round an art gallery, or queuing for long periods can strain the ligaments of the feet, causing you to stand badly which will result in backache.

Longitudinal ligaments

There is an anterior (front) and posterior (rear) longitudinal ligament running the length of the back, lining the vertebral bodies. These wide long ligaments also constitute the outer layer of the annulus of each disc. The posterior ligament has a rich nerve supply and can be easily damaged if the abdominal muscles and back muscles are weak.


Manipulation has been used for centuries as a treatment for the relief of back pain. When an individual vertebra is manipulated, the mobility of movement in the back improves due to the controlled force that removes the restrictions in the joints. An accurate diagnosis should always be established by a qualified medical practitioner before you have a manipulation.

Having chosen the vertebra and the direction of movement after an exact examination and diagnosis, the manipulator will use the hands quickly and deftly to 'crack', 'pop', 'unlock', or 'thrust' - all expressions used to describe the movements which remove the restrictions in the joints. As a result, the associated problems of limited movement, muscle spasm and stiffness will be relieved in the back.


This word comes from two Greek words, neuron (nerve) and algos (pain). Neuralgia is thus an intense intermittent nerve pain, often felt in the arms and face.


This is one of the names that is given to the process of degenerative arthritis. Degenerative arthritis is correctly called osteoarthrosis and it has nothing to do with rheumatoid arthritis. Everyone after the age of 21 experiences some degree of osteoarthrosis according to their lifestyle and activities - degeneration occurs in the discs and facet joints, where a certain degree of wear and tear is inevitable. When you are young, the repair processes of the body keep up with any wear and tear, but as you get older the body gets slower in healing, muscles become weaker, cartilage is lost and the lubricated joint surfaces become rougher and grate together.
Pain may result in the back as a result of:

  • A lack of shock absorption.
  • Protective muscle spasm.
  • The formation of new bone which appears at the edges of ageing joints as spurs' of bone.

Osteoarthrosis is often detected early in younger people who do regular excessive exercise programmes for activities such as gymnastics and athletics. It is therefore important to have growing children checked regularly.

What to do

  • Keep moving as 'man is made to move'.
  • Have heat therapy to improve local circulation.
  • Wear supports to help painful joints. (See collar, corset)
  • Maintain good posture constantly. Perform gentle light exercise on a regular basis.
  • Buy the correct furniture.


The position of the pelvis controls the balance of the back and the body. The pelvic tilt is therefore the most important thing to learn for strong stable good posture and to avoid mechanical strain for activities such as lifting. NOTE: Practice the pelvic tilt every day, like cleaning your teeth. Lie on your back on the floor or a firm bed with your knees bent and slightly apart, your feet on the floor. The head and neck should be supported with a pillow and your arms should be by your sides. The hips and knees should be at a comfortable angle, about 45 degrees. Place the back of one hand between the floor and the hollow of your back. Press down, flatten your waist and lower the back firmly and gently on to your hand by tightening your abdominal muscles and squeezing your buttocks. Don't arch the back or hold your breath. Hold for five counts and relax for five. Feel the pelvis tilting up and back - think about it - and then feel it roll out of position as you relax. NOTE: It is important to think about what you are doing, what it feels like and how to control it, so it becomes a good habit.


Physiotherapy can play a vital part in pain relief, healing and rehabilitation of the back. Physiotherapy incorporates a wide range of skills including massage, manipulation, mobilization, and exercises, often aided by sophisticated electronic and electrical apparatus or acupuncture. Preventative medicine is a very important aspect of physiotherapy. During treatment, time is spent looking at the causes of the pain, teaching the patient how to avoid a recurrence of the back problem by postural correction, reeducation and relaxation techniques for stress related problems.


Rheumatoid arthritis is a painful and disabling disease, the diagnosis of which is confirmed by X-rays and other laboratory tests. It should not be confused with osteoarthritis. Rheumatoid arthritis often starts in middle life by changes taking place in the joints, causing general stiffness, deformity and restriction of movement. The joints in the limbs become inflamed and red, but those in the back may often not be affected until later. Rheumatoid arthritis can attack the top two vertebrae, the atlas and the axis, damaging and weakening the ligaments that tie them together and bind the vertebrae to the skull. This, together with the swelling in the joints, compresses the spinal cord and the lower part of the skull. If you think you have rheumatoid arthritis, seek medical advice and help immediately from a doctor and a rheumatologist.


This term is incorrect. The disc does not slip, it Protrudes or bulges.


Traction can be a great relief for a painful back, especially where disc symptoms are present. It pulls the joints of the back apart to release pressure. Hang from a door or bar and allow the weight of the legs to exert a traction force on the back. Relax all the muscles of the back and legs and allow the dead weight to pull the vertebrae apart. The hands gripping the top of the door will tire quite quickly, but it is a method you can do at home. Traction can be given in bed or on an electrically operated table under supervision in hospital or by a registered qualified practitioner in a treatment room. A corset is applied around the pelvis and another band around the trunk. A system of pulleys and weights provide the traction, and it may be sustained, intermittent or rhythmic, according to the back symptoms.

  • For cervical or neck traction only, a halter is applied to the head and neck with cords and a spreader. Such traction can be given manually or mechanically, while seated or lying down, and it is thought to be safer than manipulation, providing it is applied correctly.
  • Traction can be given manually using the body weight of the patient and the pull and body weight of the medical practitioner.
  • Another form of traction which can be used at home is inversion therapy.

NOTE: Traction should never be given without an X-ray first, to confirm the diagnosis.


An electrotherapy treatment which helps in the alleviation of back pain especially in the acute phase. The high-frequency sound waves vibrate deep in the tissues, agitate the cells and, by increasing the circulation, produce heat. The head of the machine is moved constantly to prevent damage to the tissues. It should always be applied by a qualified registered practitioner.


The backbone is composed of 24 individual vertebrae stacked on top of one another, with discs in between, and nine fused vertebrae. Each vertebra can move a little in relation to the ones above and below, making the back a flexible column. Vertebrae are strong resilient bones which are made to last a lifetime. A typical vertebra has a body, a neural arch and seven processes or projections. The front of each vertebra is solid bone, the body of the vertebra. To the sides and rear of each vertebra are a number of bony projections, called the spinous and transverse processes. These support the muscles which, with the vertebrae, allow for flexibility and movement of the back. Other processes act as hinges in the form of joints which interlock the vertebral column. Behind the bodies of each vertebra the bone forms an arch, a central canal that runs in a tube-like fashion down the entire length of the back, from the head to the tail, forming a protective channel. It contains the nerves of the spinal cord and is known as the spinal canal.


This injury frequently results from a common kind of car accident, the rear-end concertina crash. The sudden jerking, twisting or whiplash movement of the head on the neck in the collision causes stretching and tearing of some of the tissues in the flexible neck, resulting in pain and spasm on one side. Muscle fibers, tendons, ligaments and nerves may all be damaged, and you may also have a severe headache. The sudden scraping which occurs on roughened joint surfaces is also extremely painful and provokes muscle spasm immediately as a protective measure. There may even be locking of the joints. Small areas of bleeding may occur in the muscle fibers and these may produce permanent scar tissue. The medical term for this acute neck condition is torticollis.

What to do

  • Always wear a seat belt in the car, and make sure you have properly adjusted head restraints.
  • Report the accident at the police station and inform your insurance company, as it may be necessary to make a claim if the injury persists over a period of weeks.


Yoga may have a value in helping backache or in the maintenance of a healthy back. It is a good activity, in that it involves peace of mind through gentle stretching and meditation, using a series of postures and techniques to help achieve complete physical and mental relaxation. The postures involve the contraction of certain muscles and the relaxation of others. In changing from one position to another, previously contracted muscles are relaxed and previously relaxed muscles are contracted, thereby creating muscle strength and endurance, as well as improving muscle relaxation. This all helps avoid back pain. However, you do need a really good teacher and you must be prepared to learn slowly and carefully, starting with the basic movements. If anything aggravates your back or you lose interest and become ambitious or impatient to learn new postures, you may find yoga is not for you.


Zone therapy has been practiced by the Chinese, Africans and American Indian tribes for thousands of years. The earliest picture is of Egyptian slaves giving it to their masters. It is based on the fact that massage using pressure application on certain parts of the body can relieve discomfort from conditions far removed from where the pressure is applied.