Many forms of back problems, including sciatica, while chronic, do tend to come and go, waxing and waning in intensity with there often being little obvious reason why suddenly there is a worsening or improvement in the condition. While the correct treatment, coupled with sensible lifestyle adjustments and the taking of proper precautions will usually bring great relief from any acute attack of back trouble, this does not necessarily mean that any underlying condition has been cured permanently. As most back pain sufferers will testify, once you have had the problem you’re always going to be particularly susceptible of it happening again.

Because people with back problems don’t always get all the help they would hope for from conventional medicine, it’s not surprising that many of them eventually turn to practitioners of alternative medicine. There are many reasons why this should happen, but these are the main ones, according to a recent survey: Patients often feel that their family doctors do not treat them with the seriousness that they feel their symptoms deserve. In fact, once the possibility of any dangerous underlying condition has been eliminated, doctors can be somewhat dismissive of what they consider to be ‘minor’ back problems, saying, more or less, that it’s up to the patient to take the recommended steps to avoid the symptoms. Many of these recommendations are, however, sometimes a whole lot easier to offer than to follow, and a patient may well feel that his doctor has ‘abandoned’ him after offering the minimum advice.

While specific attacks of sciatica or other symptoms of back trouble occur because of a direct cause at the time, there is nevertheless often little obvious reason why the problem should be so much worse during one period of time than another. As we’ve already discussed previously, this ‘waxing and waning’ can be at times directly attributed to greater or lesser stress. Conventional Western medicine is by no means always terribly successful in dealing with ongoing and changing personal problems that exacerbate physical problems, leaving sufferers to wonder whether they might fare better with other therapies. Busy family doctors, especially in today’s over-worked National Health Service, tend to look primarily at physical causes, and patients may feel that a better overall solution to their problems may be found by alternative practitioners because they usually focus their attention on what they call the ‘whole person’, and not just the particular complaint being presented. Another prevalent reason for seeking alternative help is because the patient may be desperate for improvement. When this doesn’t seem to be forthcoming from conventional medicine, despite his having tried all it had to offer, he will then quite reasonably also look elsewhere for help.

Some patients also turn to alternative medicine, especially to those disciplines that preach ‘mind over matter’, for help in complying with some of the health recommendations they have

received from their doctor. For example, a patient may find it easier to lose weight when supported in his attempt by some alternative therapies, especially those that concentrate on developing the power of self-suggestion.

Other reasons why alternative or complementary practitioners can help include:

The mere fact of consulting an alternative practitioner can in itself make a patient treat more seriously the recommendations he receives that way. It’s a fact that when you have to pay for advice, you tend to listen to it more carefully than when it comes free. The additional motivation this effect can produce may at times be enough to allow a patient to do all that’s needed to bring about an improvement, such as taking the right kind of exercises, losing weight, and so on.

One more important reason why alternative therapy may at times be more successful than conventional medicine is that many of the techniques commonly used by alternative practitioners are specifically devised to increase a patient’s confidence in himself and his own ability to take the necessary steps to bring his condition under control, or to, at least, be less affected by the symptoms when they occur.

While there’s a great deal to be said in favour of alternative medicine, it must be pointed out that patients would always be well-advised in being extremely cautious in deciding whether to follow this course and, if so, how to go about it. These tips will guide you:

Before seeking help from other sources you should always see your own doctor first to ensure a proper diagnosis is made initially. This is absolutely vital, if only so that other possibly more serious reasons for your symptoms can be safely excluded. It might also be useful to ask your doctor whether he believes that one or another form of alternative medicine could help you; not all doctors have closed minds about the possible benefits of alternative approaches to treatment.

Should you decide on a course of alternative therapy, you should immediately consult your doctor once again if any new symptoms were to develop or if your existing ones were to become more severe or frequent while you were being treated by someone else. What’s more, it’s also a good idea to check out with your doctor the safety aspects of any alternative treatments you’re offered. As far as choosing a specific therapist is concerned, do make sure

that it’s a properly-trained and reputable one. These suggestions will

help you do just that:

Make sure that the alternative practitioner of your choice is a fully accredited member of a professional body whose standing is generally recognised.

While medical doctors usually aren’t keen to recommend alternative practitioners, it’s quite possible that your family doctor may be willing to do exactly that, but you may perhaps have to read somewhat between the lines of what you’re told. The positive contribution that alternative practitioners can make in some instances has received wider acceptance from mainstream medicine in recent years.

Personal recommendations from people whose judgement you trust are another excellent guide.

Which particular alternative therapy might be worth a try is largely a matter of individual choice, each and every one of them having their ardent supporters. Here to help you make your choice are brief details of the main ones most likely to be able to help with sciatica or other back problems.

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Sciatica and back pain are. of course, part of a much wider range of, at times, work-related ailments of all kinds that fall under the broad label of ‘musculoskeletal disorders’, a term that encompasses those conditions that affect the bones and muscles of the body and the tissues that hold them together.

Musculoskeletal problems often arise from tasks performed while employed, and each year more than half a million cases are reported as being caused by work. Says the Health and Safety Executive (HSE): “The potential to cause these conditions exists in most workplaces – although certain types of work are more often associated with musculoskeletal disorders than others, such as poultry processing, clothing manufacture, keyboard operation, nursing and assembly line work.”

According to the HSE, the causes fall into three main categories:

Manual handling and lifting – poorly designed tasks and incorrect lifting techniques and posture all increase the risk to workers. More than 55,000 injuries due to handling, lifting or carrying accidents are reported yearly.

Repetitive work – where work is done too quickly, such as in piecework, or where the work rate is controlled by a machine. This can be a particular problem when combined with the need for force; where the operator is positioned badly; or where the job is not varied enough.

Unsuitable posture – often caused by poor seating arrangements or by reaching and stretching awkwardly.

While a specific injury to the affected part can be detected in many instances of work-related disorders, in others, pain and discomfort may be the only evidence of problems, as in the case of chronic back pain or sciatica.

The HSE firmly believes that most of these problems can be avoided, often through relatively simple corrective action, such as perhaps modifying how a job is performed, or through re-siting parts of machinery or adapting seating positions.

The responsibility for preventing health problems caused by working conditions is one that is shared to a large extent by both the employee and the employer, and these can be summed up as follows:

The employer has a legal duty to safeguard the employee’s health and safety, and should identify tasks which could cause problems and take steps to improve the situation.

The employee must, however, exercise care and follow good work practices, particularly where lifting and carrying are involved. It is also up to the employee to ensure that any workstation is correctly adjusted when adequate adjustment is possible. Spelling this out more fully, current relevant legislation includes:

- Section 2 of the Health and Safety at Work etc Act 1974 (HSW Act) which places a duty on employers to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all their employees.

Section 6 of this Act also places a duty on manufacturers, designers, suppliers and importers of articles for use at work to ensure, so far as is reasonably practicable, that the article is so designed and constructed as to be safe and without risks to health.

Under section 7 of the Act, employees have to take reasonable care for their own health and safety and that of others who may be affected by what they do (or fail to do); they also have to cooperate with their employer, so far as is necessary, to enable

the employer to comply with legal duties.

It must be noted that the HSW Act deals with general duties and does not provide specific requirements on the prevention of particular ailments. However, various Regulations are more to the point as far as reducing the risk of back pain or injury are concerned, as shown below.

The Management of Health and Safety at Work Regulations 1992 (the Management Regulations) include requirements for employers to:

Assess risks to health or safety.

Arrange for the effective planning, organisation, control, monitoring and review of preventive and protective measures.

Appoint competent people to assist the employer in complying with health and safety law.

Cooperate and coordinate health and safety actions where the activities of different employers interact.

Provide appropriate health surveillance, information and training.

The Provision and Use of Work Equipment Regulations 1992 place duties on employers concerning the safe and proper use of work equipment. The risk assessment carried out under the Management Regulations, as mentioned above, is intended to help employers select work equipment and assess its suitability.

The Health and Safety (Display Screen Equipment) Regulations 1992 are directed mainly to protect employees who habitually use display screen equipment as a significant part of their normal work. Employers have duties to:

Assess and reduce risks.

Make sure new workstations meet minimum requirements covering equipment, furniture, the working environment, task design and software. There was a transition period until 31 December 1996 for existing workstations

Provide breaks or changes of activity, information and training.

While the health risks most commonly associated with operating computers and other VDUs are upper limb disorders (including repetitive strain injury) and sight problems, back troubles can easily arise from inadequate seating and a lack of breaks in the day’s work.

The Manual Handling Operations Regulations 1992 require the avoidance or reduction of risk where the manual handling of loads involves a risk of injury.

The Workplace (Health, Safety and Welfare) Regulations 1992 include requirements for lighting, workspace, workstation arrangements, seating and facilities for rest.

The Supply of Machinery (Safety) Regulations 1992 apply to the supply of new machinery which will need to meet relevant essential health and safety requirements.

Taken together, the HSW Act and the various Regulations put a strong onus upon any employer to ensure that everything reasonable be done to prevent employees from contracting work-related ailments. Despite that, it remains a fact that many sufferers from back problems certainly attribute their difficulties to conditions at work. Should you think that your health problems are due to unsatisfactory work practices, this is what the HSE says you should do:

In the first instance, consult your doctor, giving as much information as is possible to enable him to decide whether or not your condition is likely to be due to your work. In some cases individuals suffering from specified conditions can get state compensation under the Industrial Injuries Prescribed Diseases Regulations. Ask your doctor about this or get leaflet N12 from your nearest Social Security office.

If you suffer from symptoms which may be attributable to work, particularly if they recur, then it is important to tell your doctor and employer. If you have a works nurse or doctor, then you should also tell them about your problem. You may also want your union representative to know that -you think your job is affecting you. If you are off sick for more than seven days your doctor will inform your employer of the cause via a sick note.

You can also contact a doctor or nurse from your local Employment Medical Advisory Service. You’ll find them at your local office of the Health and Safety Executive.

If you need more information, contact the HSE’s Information Centre on 0541 545500.

Additionally, should you develop a musculoskeletal disorder that makes it difficult for you to continue with your current job or you are out of work, you can get advice from your local Job Centre on assessment and rehabilitation schemes, registration as a disabled person, job retention, work aids for people with disabilities and help with job applications.

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There are many different types of these techniques, all of them sharing the same broad aim, but seeking to reach their goal in varying ways. Three techniques used frequently – and generally most successfully – to reduce stress that may be exacerbating muscular tension in general and back pain in particular are active relaxation, passive relaxation, and breath control, all of which can be used either individually or in any permutation with the other two.

Relaxation techniques produce tangible benefits in two quite distinct but interconnected ways:

1) They can prevent stress and/or tension from reaching such a point where they cause symptoms to appear.

2) When symptoms, such as sciatica, are already present, relaxation can help reduce them.

While it is not within the scope of this book to go into the various relaxation techniques in depth, there are many other books available that give simple step-by-step instructions. To help you make a start, there follows details of three simple methods for promoting relaxation that many people with back difficulties have found especially useful. First, however, a note of caution is in order: while all of these techniques are normally safe for anyone in reasonably good health, it is just possible that they could lead to an adverse effect under some circumstances. Therefore, should you try any of these methods, stop the exercise immediately if you feel at all uneasy at any time. And, to be absolutely safe, ask your doctor for his advice before you try these.

METHOD ONE – ACTIVE RELAXATION

This is probably the single most useful technique for bringing rapid relief from stress and also has the benefit that it is the most easy to learn and apply. Essentially, it consists of promoting mental relaxation through physical relaxation, the latter being attained through first deliberately tensing muscles and then consciously relaxing them.

Here’s a very basic active relaxation programme which you can adapt as you wish to meet your own needs and circumstances:

Select a time of day when you don’t expect to be interrupted. Lie down flat on your back on the floor, placing a light support – a small cushion or a rolled up towel – under your head.

Extend your legs fully, but spread slightly apart. Your arms should be at your sides, but also spread out slightly.

Clear your mind of all other thoughts and concentrate solely on registering the sensations that will be fed back from various parts of your body as you alternatively contract – that is tense up – and then deliberately relax various muscle groups in your body.

Incidentally, never try to relax a muscle without contracting it first – by contracting the muscle first, you’ll learn to recognise the contrast between a muscle that is tense and one that is fully relaxed. To make sure that a muscle is fully contracted, clench or tighten it hard for at least ten seconds before letting it go fully limp and resting loosely wherever/ it is, supported only by gravity.

This ‘tense it up first, then relax it totally’ procedure is carried out in sequence to extend to every major set of muscles in the body, starting with those that are furthest from your head. This is the sequence recommended by experts to attain the maximum amount of overall relaxation in the shortest time:

Begin with your toes, tensing and relaxing each of them in turn. Then on to the feet, one at a time, then the calves, knees, thighs, and buttocks, alternating between your left and right sides until both your legs are totally relaxed.

Next comes the trunk. Start with the lower abdomen, then the upper abdomen, followed by the lower back, the upper back, the chest and finally the shoulders.

Now do the arms, starting once again with the muscles furthest away from your head. First the fingers, each individually of course, followed by the hands, wrists, forearms, and upper arms.

Finally, it’s the turn of the neck and head. Start with the neck, then the throat and lower jaw, finishing with the face. Contract each section of the face separately – that is chin, lips, cheeks, nose, forehead and eyes in turn.

Once all the muscles in your body are fully relaxed, just lie still for ten minutes or so, enjoying the sensation of physical relaxation while keeping your mind clear of worries or problems.

At the end of your allotted time, get up slowly and deliberately, not abruptly as this could cause the unnecessary contraction of muscles you’ve just relaxed.

Although this routine should ideally be performed daily, this may not always be possible. If so, do the exercise as often as you can, preferably at least three times a week. Incidentally, although it may take you twenty minutes or longer to work your way through the various sets of muscles at first, you will soon find that this speeds up immensely after you’ve done it a few times.

METHOD TWO – PASSIVE RELAXATION

This form of relaxation – also called meditative relaxation -addresses itself directly to your mind as you clear it of extraneous thoughts to concentrate on a single relaxing idea or image.

Passive relaxation will usually be most effective when it immediately follows a session of active relaxation, for example, such as the exercise described directly above. There is no specific position you should adopt for passive relaxation, but it’s obviously important that you be at ease and comfortable, and you could either be sitting or lying down, whatever seems most suitable for you.

Start by spending a moment or two relaxing your body and clearing your mind before going on to the meditative process itself with one of the following methods:

Close your eyes, then evoke a mental image of a place where you’d really like to be. The image you imagine can either be that of a real or totally imaginary place. For example, it could be a warm beach, a sunlit meadow, a mountain top, or whatever strikes your personal fancy. Use your mind’s eyes and explore in depth all the pleasing aspects of this peaceful and wonderful place, absorbing and rejoicing in its sights, sounds and smells as you luxuriate and delight in being there. Eventually, bring yourself gradually back to reality, but hold on to the deep sense of inner peace and calm you experienced as you visited your mental paradise.

While in a relaxed state, look at a previously chosen object you find really pleasing, such as a vase full of flowers, a statuette, or a painting. Bring all your senses to bear fully on this object: your eyes noting its every intricate detail; your hands gently exploring its shape, contours and textures; and your mind responding to the beauty of every pleasing pattern it recognises. Spend a few minutes on this mental inventory, then close your eyes and re-create the object in your mind while you think about all its beautiful aspects.

METHOD THREE – BREATH CONTROL

Both of the two relaxation promoting methods described above can be used most successfully with additional exercises in which you exercise conscious control over your breathing. Breath control can not only help you relax even more deeply, but it also revitalises your whole body by providing it with an extra intake of oxygen that ‘recharges’ your whole organism.

Of the many different kinds of breathing exercises, the single most useful one is the Complete Breath, a technique that comes from ancient Hatha Yoga, that part of Yoga discipline concerned with the control of the physical body. An excellent time to use the Complete Breath is while you’re still lying down after completing a relaxation exercise. Here’s what you do:

Bring your legs and feet together so that they nearly touch, leaving your arms lying loosely at your sides.

Very slowly and deliberately, take in a deep breath and while doing so gradually raise your hands upwards to initially make them meet above your head, then move them back further so that they end up lying straight out behind your head with their palms up.

Now exhale slowly and deliberately, fully emptying your lungs, and as you do so bring your arms back to where they were originally along your sides.

Repeat this procedure up to ten times, making certain that each successive cycle proceeds smoothly into the next one. It’s most important not to hurry this exercise, but to concentrate on making each movement as smooth as possible, letting it flow naturally into the one that follows.

The above are, of course, just a few of the many proven relaxation techniques available. Many more are an essential part of the therapies offered by alternative practitioners, details of which can be found in

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