A Good Back....

at home
Advice for sudden neck or
lower back pain

Good sleeping posture

Tips for lifting and

handling

Safer gardening

Ice or heat ?

A Good Back....at work

Regular breaks for office
workers

Basic computer
ergonomics

A Good Back....on the move

Correct driving posture

Using a laptop

ADVICE
FOR
SUDDEN
NECK
OR
LOWER
BACK
PAIN

Neck and low back pain are

common and will affect over 80%
of us at some point in our lives.
Back pain in particular is one of
the main causes of absenteeism
at work. Sudden or ʻacuteʼ onset
of neck and low back pain is
therefore a common occurrence.

Your return back to normal can be helped by following some of the simple guidelines below:
Stay active and if possible try to continue with normal daily activities
Try and avoid bed rest. Keeping the neck and back moving with gentle exercise is better than resting it
Avoid sustained positions such as sitting for too long. Try and alter your body position every 20 minutes.
Avoid heavy lifting and prolonged or awkward postures, e.g. twisting, long car journeys

Depending on the type of work you do it is normally best to remain at work or return as soon as possible. It
might mean discussing with your employer restricted duties or less hours but it is important that you
stay engaged with the working environment.

Gradually and progressively increase physical activities. As pain subsides be especially careful. Your back is
still recovering but it isn’t telling you about it as much. Avoid falling back into bad habits such as
poor posture / manual handling.

Seek further medical attention immediately if you experience or develop:

Severe pain in the back

Bladder or bowel problems (such as incontinence)

Altered sensations such as pins and needles in the legs, buttock or

pelvic region

Numbness around the inner thighs and genital area

Weakness of the lower extremities

GOOD We all have our own preferences

SLEEPING when it comes to our chosen
POSTURE sleeping position. This position
of course will often change as
we move around in bed during
sleep. Whatever posture we
choose it is important to maintain
the spine’s natural alignment. If
we do not, extra strain can be
placed on the spine often
causing pain in the neck or low
back. If you have recently
suffered an injury to these body
areas, poor sleeping posture can
provoke the problem. Here are
some guidance notes on good
sleeping posture:

Sleeping on your side

The most common sleeping position is on your side, with your legs and hips aligned and flexed. Because
this position leaves your upper leg unsupported, the top knee and thigh tend to slide forward and rest on the
mattress, rotating the lower spine. This slight rotation may contribute to back or hip pain. To prevent that
problem, place a pillow between your knees and thighs.

Sleeping on your back

If you sleep on your back, place some pillow under your knees to help maintain the normal curve of your
lower back. You might try a small, rolled towel under the small of your back for additional support. Support
your neck with a pillow. This position may be helpful if you have low back pain.

Sleeping on your front

Sleeping on your front can be hard on your back. If you can’t sleep any other way, reduce the strain on your
back by placing a pillow under your pelvis and lower abdomen. Use a pillow under your head if it doesn’t
place too much strain on your back. If it does cause strain, try sleeping without a pillow under your head.

TIPS Most of us are aware of correct lifting

FOR habits but often an impatience to get the
LIFTING job done will push this good knowledge to
AND one side. This article will reinforce some
HANDLING of the main topics regarding good manual
handling and hopefully provide a few
useful tips for future use:

Remember, that whilst we often consider

that injuries occur after one single event of
poor lifting it is more likely that these
occur due to an accumulation of minor,
repetitive traumas over a period of time.
Serial offenders of poor lifting and
handling are most likely to cause injury to
themselves.

Think before you lift Bend your knees and use your leg muscles

Before lifting any object consider
its shape, weight and whether it
is within your capability to lift it.
Test the load first if you are
uncertain of its weight. If you are
in any doubt ... don’t lift it !
Consider whether the load can
be shared (get some help),
whether it can be reduced (half
the load and make two trips),
whether there is any lifting /
moving equipment available
(e.g. use a trolley) and whether
you can lessen the journey (e.g.
if you are loading up the car,
reverse the car back as close to
the load as possible). Make sure
there are no obstacles in the
way or anything to trip or slip
over as you move the load.
Whilst we consider that our trunk is broad and robust, the actual back
muscles responsible for straightening us up from a bent position are
long, strap like and not particularly strong. By contrast the buttock and
thigh muscles (quadriceps and hamstrings) are the largest muscle
groups in the body and they are strong.
Keep your back straight
The vertebral discs in the spine act as our shock absorbers and
spacers in the back. They are placed under more pressure in a
slumped or stooped position. When further stress is added to them
(such as lifting a heavy load with an incorrect lifting technique) then
the risks of causing injury are raised significantly. Keep your back
straight throughout the lift, avoid twisting and let the leg muscles take
the strain.
Move closer...move your body real close
It is important to hold the load really close to your body. The further
away from the body the weight is held, the greater the stress on the
spine.
The must do’s:

Ensure a wide stable base.

Ensure you have a good grip of the object you are moving.
Take regular breaks often and stretch if you are doing repetitive
handling.

A Working out in the garden can be very

GUIDE relaxing and great exercise. However care
FOR must be taken to avoid injury. Here are
SAFE some simple tips:
GARDENING

Be prepared Little and often Lifting and handling

Warm up before starting any
activity by gently stretching your
muscles. Analyse each task and
ask yourself... how can I make
this easier ?
Have your greenhouse work
benches built to the correct
height to avoid bending.
Use a cushioned pad or kneeler
to avoid pain and swelling in the
knee joints.
Vary jobs every 30-60 minutes or
so to give the different muscle
groups a rest. For example if you
have been kneeling for a while
planting or weeding... change to
a different posture and different
task such as 30 minutes of
mowing the lawn.
Take regular breaks and drink
plenty of liquid.
Digging
If a heavy object needs to be
moved consider if you need
assistance or whether you could
use equipment such as a wheel
barrow to help. Plan the move,
get an indication of the weight
and shape of the object and
make sure that there are no
hazards to trip or slip on. Don’t
attempt to lift an object that is
too heavy. If you must lift
something,

Tools Digging is one of the chief KEEP YOUR BACK

Choose tools that are the correct
size for you. Use tools with long
handles, this will provide you
with greater leverage and
require less effort.
Ensure that blades are sharp to
avoid extra strain.
Put secateurs in a holster
attached to your belt. This saves
having to constantly bend down
to pick them up.
Don’t use a heavy, full watering
can– fill it halfway and do more
trips
causes of back ache. Use your
body weight and thigh muscles
to avoid straining the low back.
Dig large areas in stages.
Choose a spade with a narrow
blade to avoid the temptation of
digging large spadefuls .
Pace yourself, and develop a
rhythm.
Rest frequently, and stop if your
back aches.
STRAIGHT AT ALL TIMES
and let your thigh muscles do
the work. See our Tips for
lifting and handling on page 5.
When using a wheelbarrow,
place the weight to the front,
over the wheel, and then lift the
handles using the technique
described above. Always push a
wheelbarrow, don’t pull it. Resist
the temptation to overload it – do
two trips with a lighter load than
one trip with a heavy load.

It is important that you avoid ice burn by

ICE
ensuring there is a barrier between the ice
bag and the skin – the usual
recommendation is to wrap the ice bag in
a wet tea towel. Whilst some debate

OR exists over how long the ice bag should

be placed on the injured part and how
many times a day, the common advice is

HEAT? often that it should be applied no longer

than 15 minutes (less debateable) for 4
times a day (far more debateable!).

Should you use ice or heat for your injury? Compression: Apply compression at the
earliest opportunity following injury to limit
This is a question that often arises. In certain
and reduce swelling. This is most often
circumstances there is a definite answer but in other
the case for a joint sprain or muscle strain.
cases it is more down to personal choice. The
Compression bandages, elasticated
application of ice (cryotherapy) or heat is often linked
tubular bandages or orthopaedic supports
to how old the injury is and the stage of healing.
are common means of achieving this.
Ensure that the compression is even
Protect: Use aids and across the injured part, and regularly
Ice for new, acute check the extremities (fingers and toes)
appliances to minimise the
injuries (up to 72 for diminished circulation; cold, blue,
hours) stresses on the injured
area. For example with an altered sensation or swollen - these are
These injuries are usually ankle sprain a pair of common signs of too much compression.
characterised by a body crutches would be useful or It is recommended that you remove
part that feels hot (usually a with a shoulder injury a sling compression whilst asleep.
joint or muscle) when will support the injured part. Elevation: Try and elevate the injured
compared to the uninjured
Rest: Try and avoid part at the earliest opportunity. This is to
side. It can be swollen,
provoking the injured area help reduce swelling and is therefore most
painful and reddened.
and causing further trauma effective for oedema (swelling) that occurs
These are the symptoms of
and inflammation. at the extremities of the body such as an
inflammation and ICE is
ankle sprain.
always indicated. The Ice: This can be applied in a
application of ice minimises number of ways from
the extent of damage and commercial ice bags or
inflammation to assist a more commonly using
faster recovery. It is often something like bag of frozen
advised that an acute injury peas.
follows the PRICE regimen:

We have mentioned that heat

Heat for chronic Injuries (2
weeks +)
There is much debate about the
definition of chronic. Some
describe it in terms of time
frames, others more in terms of
the stage of healing. For the
purpose of this information page
it doesn’t really matter. A chronic
injury is usually characterised by
stagnation in terms of healing.
The injured part will usually feel
the same temperature as the
non injured side, sometimes it
may be accompanied by slight
swelling if it is a joint of the lower
limb. There is a strong
sense that the body has finished
its healing process but left some
residual deficits that continue to
cause a problem. This plateau in
recovery is most often treated
with HEAT.
Heat over the injured part will
increase the blood flow to it and
therefore stimulate activity
around this area. If it is a swollen
joint this may help reduce any
swelling and help flush out any
inflammatory agents around the
injured site.
The provision of a increased
blood supply with greater oxygen
and nutrients can help speed up
the healing process and
decrease pain. If it is an injured
muscle then heat can reduce
muscle spasm (or tone) -
compare and contrast the
difference in muscle tone when
we are faced with the cold
(shivering) against how our
muscles relax in the heat
(picture melting away on your
sun lounger !). A decrease in
muscle spasm will decrease pain
and help you to move more
normally.
Application of heat
Heat modalities come in many
forms. Commonly a clinician
may recommend a heat bag that
can be placed in a microwave, a
hot water bottle, commercial
heat packs/pads or hot baths. A
comfortable warmth is desirable
and usually the application of
heat is for a period of 20-30
minutes.
Exceptions, debates and
personal choice to Ice or
Heat
Ice treatments might also be
used for chronic conditions, such
as overuse injuries in athletes –
common conditions where this is
the case is when a tendon
repeatedly becomes inflammed
over a long period of time. This
can be described as ‘an
acute on chronic injury’. In this
case your clinician may advise
you to apply ice immediately
after the activity to minimise the
degree of swelling. For an
overuse injury the clinician may
also recommend heat before the
activity to relax and loosen
tissues.
If there is chronic swelling of a
joint such as a long standing
ankle problem there would be a
reasonable argument for a
clinician to recommend BOTH
heat and ice.
increases blood flow
(vasodilator) and ice decreases
blood flow (vasoconstrictor).
With chronic swelling there is a
theory that a pumping action can
be achieved by placing the heat
on the injured area for 5-
10minutes and then applying the
ice for the same period of time.
This cycle is often repeated for
up to 30 minutes. When hot and
cold water is used to achieve
this effect it is known as a
contrast bath.
Where pain is the primary
problem with a chronic injury
(such as low back pain), the
choice of using ice or heat can
be a personal preference. On
one hand ice has the effect of
distracting away from the pain
whilst heat can help relax the
muscles around the painful area.
Conclusion
Ice is the treatment of choice for
hot, inflamed, acute injuries. It
helps reduce blood flow and
lessen the extent of damage.
Heat should never be used on
acute injuries.
Heat is the treatment of choice
for most chronic injuries. It helps
increase blood flow and can
reinvigorate the healing process
of a stagnant condition.
There can be further complexity
of when to use ice or heat and,
as ever, this decision is best
determined by a qualified
practitioner.

REGULAR
BREAKS
FOR
OFFICE
WORKER

It is important to prevent this by Of course this isn’t always

Why is it important to take
regular breaks?
Having suitably designed office
equipment is very important. A
well thought out working
environment will reduce the
discomfort of sitting for sustained
periods but will not eliminate it.
The reasons it is important to
take periodic breaks are to:
Avoid postural fatigue
Static postures where certain
muscles are continually
contracted in one position (such
as the back muscles keeping
you upright whilst typing at the
keyboard) can cause muscle
dysfunction and pain. This can
be avoided by getting up and
moving around for just a few
minutes during the course of
your work.
Avoid Visual Fatigue
Eyes can begin to fatigue if they
are used in a prolonged and
sustained manner such as
looking at a computer screen for
too long.
changing your visual focus practical but at least it gives
regularly... in other words focus some idea of what we should be
on anything else but the screen trying to achieve.
for a short while.
A break can also be a change in
Take a break posture during the course of the
working period. Alternating
Taking a break for a few minutes
between using the computer with
can help improve concentration
more manual tasks such as filing
allowing you to return back to
or relaxing back in your chair to
your working tasks with new
make a series of phone calls
vigour. Take the opportunity to
allows your postural muscles to
stay well hydrated – this can
take a well earned rest. During
also improve concentration
the work period, design in some
levels.
forced breaks such as
Improved Productivity positioning the printer away from
Taking regular breaks, for a your desk so that you have to
‘reasonable period of time’, can get up to retrieve your work.
improve productivity levels. Visual breaks are easier to
achieve. Follow the rule of 20’s :
What constitutes a break every 20 minutes, look 20 foot
and what is a ‘reasonable away for about 20 seconds.
period of time’?
Jogging your memory to take a
Getting the balance right isn’t
break can be helped by visual
easy, but remember that a little is
reminders such as notes on your
better than nothing. Try and get
PC or use a diary application to
up and stretch muscles before
pop up and routinely remind you
they begin to ache, perhaps take
to take a quick break.
a quick stroll around the office
when you can. As a rule of
thumb most research shows that
taking a 2-3 minute break every
20 minutes is best.

BASIC Investing in a new work station can be an

COMPUTER expensive outlay. First of all assess what
WORK you have already and then what your
STATION needs are. There is little point in investing
ERGONOMICS in the most high specification equipment if
your job role requires you to be off site
most of the time.

The Desk
List all the functions that are conducted at your desk. Do you only use a computer or do
you also do handwriting? Do you need space for referring to documents? Ensure that the
space under the desk is not obstructed.

The Chair
Your chair should support you in a comfortable position that maintains the natural

curvature of the spine. Adjust the backrest height so that the back rest bulge fits in to your
lumbar arch. Sit well back into the chair. Pull your chair right into the desk. Avoid placing
pressure on important structures at the back of the knee by ensuring the seat pan is a
few centimetres short of your thigh length.

Where possible adjust your seat to tilt Slightly forwards.

This helps to maintain good Don’t rest your wrists on the

posture. Adjust the chair height
or arm rests so that your
forearms are horizontal and your
upper arms are vertical when
you place your hands on the
keyboard. If your feet are not
well supported use a footrest to
ensure that your hips and knees
are placed at right angles.
The Screen
The screen should be directly in
front of you with the top of the
screen at about eye level. It
should be placed about an arm’s
length away. Make sure that the
characters on the screen are
easy to read and flicker free.
Place the screen where there
are no reflections in to it.
The Keyboard
Make sure that the keyboard is
placed close to you so you do
not need to reach out for it.
desk in a fixed or ‘anchored’
manner while typing. Instead,
hover or move them while
keying. Use all your fingers and
type lightly keeping your fingers
curved. Avoid the habit of
keeping any of the fingers
Where possible set up your work
extended upwards (usually the
station so the wrists can be
little finger).
supported on the desk when you
There are a variety of different are not using the mouse. A
keyboards available. ‘Split standard mouse can place the
keyboards’ for example can wrist and hand in to awkward
place the wrists and hands in to positions. Choosing an
a more neutral position, taking ergonomically designed mouse,
uneven strain off of certain taking regular breaks and using
structures such as nerves, keyboard shortcuts can counter
tendons, joints and tendons. this.
The Mouse In all cases, if in doubt....seek
the advice of a suitably qualified
Make sure that the mouse is
health professional to assess
placed close to you so you do
your requirements.
not need to reach out for it, hold
it loosely and keep all fingers on
the mouse. Avoid leaving any
fingers in extended positions.

CORRECT
DRIVING
POSTURE

Our bodies love to move. Muscles act like sponges

; squeezing out blood when they contract and
absorbing blood when they relax. This pumping
action helps the circulation in and around the
muscles. Static postures such as driving
compromise this action. Muscles are often placed in
a tensioned position but neither shorten or lengthen
(known as isometric contraction). This leads to
postural fatigue of the muscles and causes
symptoms of achiness and stiffness particularly of
the back and trunk muscles.

There are strategies that can be employed
to avoid or reduce postural fatigue: Take
regular breaks, perhaps 5 minutes for
every 30 minutes that you drive. Get out
of the car and gently move your trunk from
side to side and extend backwards.
Whilst driving, try to fidget every few
minutes. Moving a little is much better
than not moving at all and will at least give
your muscles a brief respite. Try and
maintain a generally symmetrical position
whilst you drive.
A common bad habit is to have the
accelerator leg rolled outward which
places pressure on the hip and lower
spine.
The car seat should be firm and well-
contoured to suit your body shape.
Cloth/fabric seats give better support to
your back than leather or vinyl covers and
enables the driver to maintain the correct
posture while driving.
Step-by-step driving position guide
Adjust the seat and steering wheel as follows:
Raise the seat so that your head is a hands width from
the roof of the car.
Move the seat forwards so that you can fully depress
the brake and clutch pedals but still have a slight bend
in the knee at their most lengthened position.
Adjust the tilt angle of the seat base so it supports your
thighs along the length of the cushion.
Adjust the seat back in to a slightly reclined position as
this provides more support to the whole of the back.
Adjust the lumbar support to fill the natural curve of the
lower back.
Adjust the steering wheel so that your elbows are
slightly bent when the hands are placed at the ’10 to 2’
position. Ensure you can see the dash dials when
you’re in the correct seating position.
Adjust the height of the head rest so that the top of it is
aligned with the top of your head.
Make sure that your side and rear view mirrors are
reset with this new seated posture.

Where possible try and share the driving

with a colleague. Make sure you adjust
the seating to ensure a good driving
position using our Step by Step driving
position guide :

USING Laptops are convenient That said it is often an

A for people on the move invaluable piece of
LAPTOP but research shows equipment and there
that prolonged periods are some ways that
of laptop use are can make its use more
associated with upper ergonomically sound.
limb and/ or spinal For regular users on
problems. This is due the move or those that
to the combined use the laptop like a
keyboard and screen desktop PC - invest in
design which a laptop kit, including
compromises the spine an adjustable laptop
or upper limb posture stand, external mouse
of the user. and keyboard. Take the
time to connect and
use them.

Where possible, aim to apply the same

principles as you would to the set up of a
desktop computer – such as having your
chair at the correct height, pushed right in
under the desk, forearms well supported,
correct screen height (the top of the active
screen at eye level, or a bit lower) and
position (centrally positioned at a
comfortable distance from your eyes).
When a desk is not available try and
avoid using in cramped areas such as
economy class airline seats. These will
cause you to hunch over your laptop.
Improvise where possible such as using
some books to raise your laptop screen to
the correct height. Take regular breaks
away from your laptop.
Carrying your laptop
There are many types of laptop bags and as ever it is useful
to spend time assessing your personal needs.
The back pack: Generally speaking our bodies tolerate
symmetrical loads much better than asymmetrical ones. If
your laptop is quite heavy and you also have to carry paper
documents then consider a back pack.
Wheeled / roller case: If your laptop and equipment is too
heavy or too bulky then a wheeled/roller case might be more
suitable. This is especially helpful if you spend much time
walking or standing. Consider your mode of travel as it is
often the case that having to negotiate lots of steps will
require repetitive lifting which can cause adverse stresses on
your spine and upper limb.
A combination bag: that allows your equipment to be
carried as a back pack yet also be wheeled is often the best
compromise.

A briefcase: may be desirable if your laptop is lightweight

and you do not spend too much time carrying it.

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