If you have had back trouble, learn to delegate some or all of the heavier jobs that were formerly your lot. Encourage family and colleagues to share the load.

Bed making is a job that often makes a painful back worse, and in some cases even induces back trouble, because it requires a good deal of bending and stretching. Ideally, the bed should be high enough for the mattress to be at hip height, narrow enough for you to reach across easily, and placed so that you can walk all round.

On the old-fashioned high bedstead, it requires less effort to make the bed than on a low divan bed. A low bed can be raised by putting blocks or bricks under the legs.

When making the bed, get close to it and bend at the hips and knees, keeping your back upright. If you have any difficulty in bending at hips and knees, kneel down when tucking in the bedclothes.

A fitted bottom sheet and a duvet do away with the need to bend to tuck in bedclothes. When changing a fitted sheet, do not stretch over the bed, but kneel close to each corner of the bed in turn.

A mattress should be turned by someone else. If you really have to do it yourself, have handles fitted to the sides (at the ends, too, if it is to be turned fore and aft). Grasp the handles and lift the side of the mattress so that you stand erect; back away a step and then step up on to the base and raise the mattress high enough to turn it over by letting it fall over to the other side. But better to leave it to other members of the household to do the turning.

Cleaning the bath puts considerable strain on the back. This job can be done much more easily by kneeling beside the bath and leaning across to rest one hand on the far edge of the bath to take your body weight, or by sitting on a chair alongside. Along-handled sponge or mop is useful. A bath is cleaned more easily when still warm immediately after use, so keep cleaning materials at hand – and insist that the others in the household clean the bath themselves.

You can avoid cleaning the bath altogether. Various preparations are available (especially for bathing children) which replace soap, and leave no ring round the bath. Or, if you prefer to wash with soap, putting a squirt of washing-up liquid in the bath water will ensure that there will be no ring.

Using a vacuum cleaner is often stressful to the back, so do it in short sessions. Make sure that the handle is long enough for you. Some cylinder cleaners have extension pieces; fitting one of these may help. Use your legs and your body weight to do the work. Always pull forwards and backwards in short lengths. Avoid twisting movements. Above all, do not just stand and make your arms do the work: that way is bound to stress your back.

Similarly, when using a mop, carpet sweeper or broom, move the whole body forwards and backwards with the sweeping action, not just bending from the waist to get the increased reach.

Dusting gives you opportunities for different kinds of muscle action. It is a good idea to slot short spells of it into spells of vacuuming, polishing, washing floors or any other task which requires vigorous movement in one direction only, for which you generally use your stronger arm. Try using the other arm or use both arms and stretch upwards to counteract the bending and pushing movements of vacuuming.

In the kitchen, have at hand all the things you use regularly – for instance, saucepans on the wall, plates and dishes at waist height. Only the things you use least often, or which are fairly light, should be stowed away below thigh height in low cupboards or out of easy reach above chest height. Ideally, heavy equipment such as a food mixer or cast iron casserole should be kept where it need not be lifted to be got out.

Whenever you have to do anything near floor level, get right down to it. Bend your knees to lift dishes in and out of the oven or dishwasher. When lifting a heavy casserole, hold it close to your body, with your elbows bent. To save your back, do it in stages: put a stool at the side of the oven, squat down, put the casserole on the stool, stand up and lift the casserole on to the top of the stove or working surface. Remember avoid twisting – rotate the whole body when moving objects from one table to the next.

Having a tall stool in the kitchen is a good idea so that you can alternate between sitting and standing. A stool should have a foot-rail and needs to be of a height to suit the height of the work surface.

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Acupuncture-Acupuncture is an ancient Chinese therapy used in the treatment of many diseases, as well as for the relief of pain. The principle of acupuncture is the belief that in the human tissues there exist numerous points connected with particular organs, and these points are linked by a network of channels, called meridians, through which streams of life energy flow. The functioning of an organ is said to be affected by tapping these channels at appropriate points. In acupuncture, fine needles are inserted; other ways of tapping the points include touch (acupressure), electric currents, ultrasound and laser.

Western medicine rests on totally different assumptions, and so finds it hard to account for the fact that acupuncture is frequently effective. The probable explanation is that acupuncture leads the brain to produce substances called endorphins, which are a natural pain-killers.

The initial diagnosis is very thorough. A considerable amount of time will be spent asking patients details about their general condition. Questions may relate to physical, emotional and energetic signs and symptoms. In addition, examination of the tongue is a fundamental part of acupuncture diagnosis, as is the taking of the ‘pulses’ – at both wrists and in three positions, by the index, middle and ring fingers. The tongue and pulses give the practitioner information about the condition of the body, and indicate where the life energy needs to be changed.

If you’re seeing an acupuncturist the cost of a session will probably be between $40-$60. Acupuncture is not covered by Medicare, but is covered under some private health funds. There are also some general practitioners who are trained in and use acupuncture.

There is no mandatory registration of acupuncturists in Australia. When choosing an acupuncturist ensure they have formal qualifications and that they are a member of the Acupuncture Association of Australia.

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If you are a woman of childbearing age, you should first be asked about the date of your last menstrual period. There is a ‘ten-day rule’ allowing X-rays to be taken only during the ten days after the start of a menstrual period, before the probable time of ovulation. Later than this, there exists a possibility of conception, and an embryo could be damaged by irradiation.

Generally, three or four views of the spine are taken. Sometimes, one sideways view is taken with the spine bent fully forwards and another with it arched backwards. This can be uncomfortable, but do your best to relax and keep still so that the picture is not blurred. It is done like this in order to assess movement between these two postures at each vertebral

level – whether it is absent or excessive, or abnormal in some other way. One film may be taken in the standing position because the alignment of the bones and disc spaces may be significantly different when they are weight-bearing from when you are lying down.

On the film, the shadows of the bones show up in excellent detail, particularly if you are slim. It is possible to assess the size and shape of the spinal canal and its exits, which may be relevant. The discs themselves do not show, only the spaces they occupy. (Remember this in case you get a chance to look at your own X-rays.)

The X-rays are seen by the consultant, and may also be seen by the radiologist – a doctor specialising in X-ray diagnosis.

X-rays can reveal a fractured or cracked vertebra, or show the presence of degenerative changes in the vertebrae, such as the formation of osteophytes, or of bone thickening, as well as signs of abnormalities such as misalignment of vertebrae, of deformities, potential mechanical weaknesses, and possibly instability

X-rays can, however, be deceptive and show up an abnormality which causes the person no pain or, where a person is obviously in great pain, the X-rays may reveal nothing. The doctor may well not find anything abnormal, even though the patient may be suffering from acute disc prolapse, or serious muscular injury, because discs, muscles, ligaments and other ’soft’ tissues are not radio-opaque: they do not show up on X-rays, or only very faintly. If the space occupied by a disc is seen to be reduced, it suggests that the disc has been flattened, but this does not necessarily indicate a prolapse.

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The bad design of some equipment and furniture used in work, both domestic and outside the house, readily causes muscular stress in the user. It is also true that many people let themselves in for unnecessary muscular ache, in the back and neck muscles and elsewhere, by adopting a bad posture: such as sitting slumped in a chair, or humped over a desk.

Pain in the back muscles caused by postural stress can generally be relieved by rest and/or change of position and postural retraining. In extreme cases, it may become chronic and require treatment. Also, when a neighbouring part of the spine is painful and inflamed, the back muscles may be held taut to guard against a painful movement, and this in turn may fatigue them and make them ache. The additional pain resulting from this tightening of the muscles can be a considerable component of the pain experienced. Consciously trying to relax can help; if not, treatment of the inflamed condition will be needed to relieve the soreness in the muscles.

Not all muscular pain is caused by postural stress. Anxiety and frustration can give rise to muscular tension. If the frustration has no outlet or the anxiety is not relieved, muscular pain can occur. Tension in the shoulders and neck can also produce headaches.

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These processes have oval, smooth cartilage-covered areas, called facets, which meet the corresponding surfaces above and below to form joints, called apophyseal joints or facet joints. Each vertebra is joined to the one above and the one below: each inferior articular process forms a joint with the superior process of the vertebra below it, and so on down the line. Like many other joints in the body, these vertebral joints are enclosed in capsules lined with a moist membrane called the synovium, which is lubricated with synovial fluid.

At the back of the neural arch is a protrusion called the spinous process. The bony layers between it and the rest of the arch, one on each side, are called laminae. The spinous processes are the knobs you can feel when you run your fingers down someone’s spine.

The whole series of arches, stacked on top of each other, form a bony channel, down which passes the spinal cord, continuing from the base of the brain to the level of the first lumbar vertebra.

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