Health and medical information

Injuries can be caused by the unexpected: the box which was full when you thought it was empty, mistiming when lifting something jointly with another person, the load which you did not know was stuck.

The secret of safe lifting is to avoid static heaving and to use your body weight.

When you lift or shift an object, get as close to it as possible, with feet around it rather than to one side or behind it. That you are firmly balanced, one foot ahead of the other slightly apart, ready to move off in the right direction.

To get a good grip on the load, bend the hips and knees until it can be reached, then grasp it firmly. If there is nothing on the load by which to hold it, use a sling, or ropes.

Lifting, heaving or carrying with arms outstretched throws needless strain on the chest, upper back and shoulders – so keep the load close to your body. A weight held out at arms’ length causes as much stress on the spine as ten times that weight held close to the side, hence the risk when lifting a box out of a car boot. The shorter the lever, the smaller the effort required, so the closer one can get to the object, the better.

When dealing with something large and heavy, lift it first at one end only, and get it on to a higher level before you take the full load. This halves the stress.

When putting things down, if you cannot safely drop the object (which is the best way), put the lifting drill into reverse. Keep the object close to your body, watch your fingers and put one end or corner down first.

Rather than carrying a heavy load, pull it on a trolley or, if that is not possible, divide it into two smaller loads – one for each hand – or make a second journey.

Whatever you are lifting or carrying, keep its centre of gravity as near as you can over or under your own centre of gravity. This means that you have to keep your knees apart enough to keep the load close to you, and must use your leg muscles to help lift. Before you actually lift, it is a good idea to check quickly that your back is in the correct posture, then look up and tuck your chin in. Do not tackle a lifting job with your back rotated, twisted or bent sideways. Turn the whole body – avoid rotation.

Using your body weight can help to move things and saves the stress of direct muscular effort. If you move the body to give it momentum, it has what is called kinetic energy, and you can transfer that energy to something else. Just as you can give a cricket ball movement and thus kinetic energy enough to break a window, you can use your body in such a way that energy is transferred to the load you wish to shift. In this way, stress on the spine is reduced.

Do not ever attempt to shift a heavy cupboard or chest by yourself. If furniture has to be moved, try to get help. Unload every single item from the cupboard on to a convenient table before moving the cupboard – laborious but safer.

When pushing or pulling, make use of your legs and body weight. If the object to be moved is high and stable enough, you may be able to move it by leaning your back against it and pushing with your legs (wear shoes that grip the floor). If low and stable, it may be possible to move the object by lying on your back on the floor and pushing with your feet.

Ideally, all heavy pieces of furniture should have castors fitted on them to make them easy to move.

When lifting another person is required, encourage that person to hang on to you – allowing your body to more efficiently redistribute the weight.

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There are three main reasons for operating: to relieve compression on the lumbar and sacral nerve roots; to stabilise one or more adjacent intervertebral joints when there is a mechanical weakness locally; and for intractable pain.

A disc prolapse if massive can compress the spinal cord, or nerve roots; the effects, in addition to pain, can include weakness, loss of feeling in the legs, and partial or total incontinence of urine. Then an operation to relieve the compression must be done with great urgency to control the nerve damage.

Discectomy-This operation is performed in order to free a nerve root. It is done under general anaesthesia. The removal of the prolapsed disc material may be all that is necessary, although the surgeon may decide to remove the whole of the disc nucleus, in order to prevent another prolapse.

Discectomy is not a serious operation, and often produces immediate relief from sciatic pain. The patient is usually allowed up almost at once and is encouraged to move; sometimes it is necessary to wear a corset for a few weeks. Most people are able to return to work, if it is sedentary, within a month or so; but if they do heavy work, they will not be able to return to it for at least two to three months.

In a few centres, orthopaedic surgeons and microsurgeons are speeding up recovery by doing the operation through a small cut and the use of modern optic equipment. This is called microdiscectomy.

Sometimes the surgeon finds it necessary to remove bony thickening and osteophytes from the vertebral arch or body near the joints, if they are causing stretching, angulation, adhesion or compression of the nerve roots. The removal of bone from the articular processes near the vertebral arch is called facetectomy.

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This stands for computerised-axial tomography. It can be used on any part of the body, but is particularly useful for examining delicate and not easily accessible tissues, such as the brain and the spinal canal.

It takes rather longer than ordinary X-rays, but is not unpleasant. You have to lie still on a sort of couch for 15 to 20 minutes while X-rays are taken all round the spine, and a computer combines the information they give to produce a series of pictures of a cross-section of the spine at any given point, and also of the adjacent tissues. CAT-scanning uses lower dosages of radiation than other X-ray techniques. The technique is sensitive enough to show up disc bulges and degeneration even without a contrast medium, though it can also be combined with myelography.

Ultrasound scanning-This painless technique works rather like radar: by means of a microphone-like probe, which is passed over the back, inaudible ultrasound waves are directed at the spine, and the echoes which are bounced back are picked up by the probe. They are used to build up a picture of the spine on a monitor screen; one use of ultrasound is to measure the width of the spinal canal.

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Ligaments also undergo degenerative changes. The interspinous ligaments often begin to degenerate in people whose spine has become so stiff that they can no longer bend forwards. The ligaments become somewhat narrower, and their structure can become disorganised by ruptures and cavities. They then become a likely source of pain and local tenderness. These changes can occur at one ligament or a series of ligaments involving various levels of the spine.

Degeneration also affects the ligamentum flavum (the more elastic ligament which lines the back of the spinal canal), particularly when the spine has become stiff, and the ligament is no longer stretched normally. It becomes more fibrous, loses its elasticity, and can become a source of pain.

Joint degeneration-When the spinal joints are subjected to abnormal wear and tear, such as repeated sprains, the cartilage which lines the joint facets becomes thinner and more fibrous, and the articular processes tend to become thicker where they are attached to the capsule of the joint. This thickening reduces the space in the spinal canal and the intervertebral gaps. Degenerated facet joints can become the site of back pain, and of pain felt over the buttock and down the thigh.

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The spine has three main functions:

• it is the main support of the whole skeleton

• it protects the vital and vulnerable spinal cord

• it provides attachment points for muscles.

Ligaments-Wherever two bones form a joint, the two ends are bound together by fibrous bands or fibrous sheets. These are called ligaments, and are very strong, mostly inelastic but with some ‘give’. The fibres of each ligament are aligned along the lines of force occurring at that joint, and control movement by allowing it only in a certain direction.

The ligaments of the vertebral column are of various types. The main ones are the longitudinal ligaments, long bands which run down the length of the spinal column, before and behind and to the sides of it. Other ones connect the processes of adjacent vertebrae, or connect the spine to other structures, such as the pelvis and the rib cage. The ligamentum flavum (yellow ligament) lines the back of the spinal canal, connecting the laminae of the arches; it is more elastic than other ligaments in the spine.

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