The back rest of a word-processing officer’s chair should be adjustable so that the height above the seat can be varied to provide support at the lumbar part of the spine. Where there is a full-length back rest, it should be contoured to give support at the lumbar level.

Office work often requires both writing and word processing, and each requires a different posture. Since the height of office desks can seldom be varied, it should be possible to raise and lower the chair.

Word processing imposes a fair amount of strain on the back, particularly the neck and upper back, and also on the shoulders, because the word-processing officer often has to sit for longish periods with the arms unsupported. Therefore, for typing you should sit higher than for writing; the keyboard should be at a height that allows the upper arms to hang relaxed, with only the weight of the forearms having to be lifted. You should sit as close to the keyboard as you can without cramping your movements. If you sit too far from it, you have to lift the whole arm forward to reach it, increasing the strain on the upper back.

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You do not need to go through your GP to see an acupuncturist, osteopath, chiropractor, naturopath or Shiatsu practitioner, but can consult one direct on your own responsibility. It maybe wise to consult your GP beforehand, to ensure that there is no medical contraindication in your case, though the therapist should tell you if your condition is not suitable for the treatment and ought to be seen by a doctor.

Practitioners in private practice can charge whatever fees they choose. It is wise, therefore, to ask beforehand what the charge is likely to be for your course of treatment.

Manipulative therapies-Some practitioners who are outside the system of state-registration carry out manipulative procedures similar to those of the orthodox repertoire. In some circumstances, manipulation is inadvisable or even dangerous, for example in the case of rheumatoid arthritis in the neck or an undiagnosed tumour.

Osteopathy and chiropractic are manipulative therapies used in treating the joints of the spine. In both, the first consultation may last an hour (and X-rays may be taken). The patient is thoroughly examined, asked to undertake a whole range of movements and the practitioner generally asks for details of the patient’s medical – and life – history. Although manipulation forms the major treatment method of both osteopaths and chiropractors, these professions also make use of other approaches such as muscle re-education and the correction of postural faults.

Osteopathy-Osteopathy is a system of diagnosis and treatment for the mechanical problems which can affect all areas of the spine. Osteopaths use a variety of different manual techniques which are designed to improve the mobility and restore function to restricted spinal joints and the surrounding muscles and ligaments.

Treatment is generally painless and usually consists of soft tissue massage with gentle, passive stretching movements of the back. In some cases it is necessary to mobilise a very restricted joint using thrust techniques.

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If by the time you see the specialist your back is better, say so. Specialists are used to this, and they will not think that their time has been wasted. Their job is to get you completely well, and to prevent further trouble.

You should tell the specialist what makes the pain better, and what makes it worse – things like bending, sitting, walking and so forth – and the effect the pain has on your usual activities. Tell the specialist about your state of mind, too – if you are under any strain in your work, home, relationships or other personal factors, say so, in case it has any bearing on your back pain. The severity and unpredictable nature of the pain, and the disruption it is bound to have caused to your daily life, may be affecting you emotionally.

It may be difficult to describe symptoms other than pain, such as heaviness, dullness, tightness, numbness and weakness. Numbness, for example, means different things to different people. Some use it in a general way to describe a sensation that a leg, for instance, has ‘gone to sleep’. But it may also mean, more precisely, that the skin itself has lost all sensation and that you could scald it without feeling pain. Weakness, for instance, could describe feeling limp because of pain, or else being forced to drag your toes along because you cannot bend up your ankle. Analyse the feeling or pain carefully, explain it as descriptively as you can and try to make sure that the doctor understands what you are trying to describe. It is important for you to tell the doctor what you feel, not what you think you ought to feel. Spontaneity is the patient’s great asset. Analysis is the doctor’s job.

It is useful to be able to give information about any previous back trouble before the current attack. But when it is a long and complex story, it may be difficult to know how much to tell your doctor. On the whole, unless asked directly, it is better to avoid recounting in detail what has been said to you by various doctors, surgeons, chiropractors and physiotherapists you may have seen in the past. Doctors like to make their own diagnosis and it does not really help to give them other people’s. The important thing is where the pain was and whether you had to go to bed or could continue at work; how many times you have had the pain since and whether the pain then, and subsequently, was like it is now; what investigations were made (if you know); whether you have had any treatment and, if so, what helped and what made it worse.

Going to a specialist can bean intimidating occasion. You may feel more confident if you jot down some notes beforehand, with dates, of your case history so that you do not return home wishing you had mentioned all sorts of things you forgot at the time.

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An example is bending with a sudden jerking movement without allowing the back muscles to arrange themselves for co-ordinated effort. This can cause excessive strain to the muscles which have the job of controlling bending movements of the spine.

Any unaccustomed effort can injure a muscle; keep-fit and other exercises which do not begin with a warm-up period can result in aching muscles or even injury. People who rashly dig the whole garden after a winter’s inactivity are likely to suffer for it.

Another way to do damage is to lift heavy or awkwardly placed loads, particularly if this involves bending or off-centre one-armed efforts, or sideways twisting.

Muscular spasm: the pain/spasm cycle-In most parts of the body, following injury or pain, the involuntary response of the surrounding muscles is to contract in a spasm, clasping the hurting part as in a vice. This prevents it from being used any further, and so protects it, but it also impedes the blood circulation. If the pain was caused by pressure on a nerve, the spasm reinforces the pressure, setting up a kind of vicious cycle. For the damage to be repaired, and the function in the damaged part to be restored, the muscular spasm must first relax, usually by resting the injury.

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Improvements in the prevention and treatment of back trouble can only come after an increase in knowledge. We all know that machines must be oiled, maintained and used sensibly, to keep them working as long as possible. Yet replacements can be obtained for worn-out machine parts – but our bones have to last us as long as 80 years or more, and most of them are irreplaceable. As a first step to finding out how not to misuse them, it is worth getting to know how the back is constructed, and some of the ways in which it can be damaged.

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