Doctorweblog. About Health & Medicine

Lawnmowers are heavy, yet have to be heaved backwards, humped over lawn edges and in and out of sheds. Pushed mowers are the lightest and comparatively easy to manoeuvre. When using a push mower, wear boots or shoes with good grip and use your body weight to help the movements. Avoid jerky manoeuvres

Of the powered mowers, the lightest are those with electric motors which run off the mains, followed by those with petrol engines. Cylinder mowers are on the whole heavier than rotary mowers, but, being more compact, are easier to manoeuvreand are usually self-propelled. The additional cost is often justified! Rotary mowers are handy for rough grass but there the effort of manoeuvring is far greater, particularly if the mower has small wheels.

Many people empty the grass box into a wheelbarrow but unless you have an ergonomically satisfactory barrow or cart, it may be easier to empty the grass box on to a sheet with handles at the corners which is easy to pull across the lawn to the compost tip.

With mowing, as with all gardening and other heavy work, the rule is not to do too much at a time. Plan all the work so that you can divide it into many short sessions, rather than a few long ones, and allow plenty of time to do the work. If working alongside somebody else, do not feel that you have to keep up; work at your own pace. If your back starts hurting, do not struggle on to finish because the weather is right or you are going away tomorrow – stop.

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Patients may be referred to occupational therapy (often referred to as OT) after recovering from surgery as part of rehabilitation, or after being inactive because of a prolonged spell of pain (where there was no surgery).

Patients are referred to occupational therapy in the same way as they are referred to physiotherapy. The two types of treatment are likely to overlap; the physiotherapist may start treating the patient when the patient is in bed, while occupational therapy does not start until the patient is up and out of bed.

Occupational therapists have completed a four year full time course. Occupational therapy is usually requested by the doctor, but the actual treatment is left to the discretion of the therapist. It may take the form of any activity, work or recreation which will most effectively help the patient to achieve full recovery and return to work; or which will minimise the effects of permanent disability and help the patient to live with such a disability.

Occupational therapy services are available in the public health system, especially in public hospitals, rehabilitation centres, psychiatric centres, centres for the intellectually disables, geriatric nursing homes and community services. OT is covered by Medicare and most major health funds. There is also a growing number of occupational therapists working in private practises. Depending on the type of service being offered and the size of the practice fees range from $95 to $112 per hour.

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Over the centuries, victims of back pain have submitted to a vast variety of treatments. The bizarre nature of some of these testifies to the sufferers’ desperation: they were willing to try anything – even, it is said, having a tame bear tread on their back. In spite of great advances in medical science generally, these unorthodox treatments – except, perhaps, the bear – are still in with a chance.

Back pain therapy presents special problems. It is often difficult to diagnose accurately the cause of an attack of back pain. Damage to the structures of the back does not, as a rule, show on the surface, many do not show up on X-ray and even in-depth specialist investigations may not reveal anything obviously amiss.

Moreover, very often back pain is out of proportion to the problem causing it; although the pain is severe and disabling, the structural damage may be minor, and one accepted view is that it will heal, given time, provided movement is restricted to the pain free range. Another school of thought considers this to be short-sighted and holds that correct treatment by a qualified therapist will expedite recovery and may help to reduce scar tissue, the presence of which can produce long-term problems.

If any treatment is given, it is sure to get the credit for the recovery. But the next time it is tried on someone, it may not work, either because it is valueless, or because the problem is not the same.

The information gleaned from each case may be of only limited use in the next one, and the treatment of back pain has had to be largely empirical. The fact that diagnoses are often less than accurate makes the choice of therapy problematic and specific therapies which exist for one condition are sometimes applied erroneously to another. There is no scientific body of knowledge which allows a doctor or any other practitioner to state with certainty that a particular treatment will cure the trouble.

The rationale of advising rest, and particularly bed rest, is based on the clinical observation that lying down may relieve pain. This applies to a diagnosis of disc prolapse: intra discal pressure is lowest in the lying position. However, disc prolapse constitutes only a small percentage of all lower back pain and treatment for disc prolapse cannot necessarily be extrapolated to all lower back pain. However, rest is the first line of treatment for acute attacks of back pain.

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The kinds of back trouble that have been described so far derive from some dysfunction of the spine or from a congenital deformity, or from a violent injury, or from gradual deterioration with use and age.

There are other kinds of back trouble. Some of them affect the spine mainly or solely; others affect various parts of the body, the spine being just one of them. A third category includes disease which produces back pain without necessarily involving the spine.

Ankylosing spondylitis-This is a chronic inflammatory condition or arthritis, predominantly affecting spinal joints. It tends to run in families (but not always so that every member is afflicted). It affects men more than women, and symptoms often start young, in the teens. It is a systemic disease; the person feels ill when the disease is active, and other parts of the body (for example the eyes) may be affected.

In ankylosing spondylitis, the same process of laying down calcium deposits which creates osteophytes may continue to the point of fusing together some vertebrae, so that the spine in that region becomes completely stiff.

It starts usually in the lining of the sacroiliac joints and spreads gradually upwards to the other joints of the spine; it sometimes also spreads downwards into the hip joints and, more rarely, other leg joints. Over a period of time the inflammation may cause the ligaments of the joints to calcify, so that the joints become ankylosed (rigid) producing, in the worst cases, a spine locked permanently in a bowed posture. The ligaments joining the ribs to the spine may also harden, flattening the rib cage and making breathing difficult. This is one of the early symptoms. Others are pain and stiffness in the hip joints, which feel worst in the morning, because they are made worse by lying still and are relieved by movement. Pain-killers and anti-inflammatory drugs as prescribed by the doctor will help considerably. Controlled exercise is invaluable: it should be taught by a physiotherapist. Done regularly, it may help to keep the joints flexible and avoid severe deformity. Many patients take up squash, tennis, swimming and other sports and prefer this to the repetitive use of formal exercises over many years.

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Muscles are the fleshy part of the body and consist of long, thin fibres, bound together in bundles by connective tissue, and supplied with blood and nerves. What is remarkable about these fibres is that they can become shorter in response to a stimulus. The shortening is caused by protein filaments inside the cells which pull against each other; on relaxation, the muscles are pulled back into their original position, by gravity or by the action of other muscles. Sometimes the cells are unable to relax their hold – this involuntary contraction of a muscle is called a spasm and may be caused by pain.

There are, roughly speaking, two types of muscle: the involuntary and the voluntary. The heart and the hollow organs (digestive system, uterus, blood vessels, etc.) are of the first sort. They work without conscious control while life lasts – you do not need to instruct your heart to beat. The voluntary muscles are mostly under conscious control, so that it is for you to decide to move your limbs, for example; but you do not, of course, have to plan the movements of each muscle. When you decide to bend your knees, for instance, reflex actions determine the different movements of the several different muscles which this entails, and you neither know, nor need to know which ones they are.

The voluntary muscles also respond to various stimuli through reflex actions – when you touch a hot stove, messages racing along the nerves will jerk away your hand faster than thought.

Because they can be controlled, the voluntary muscles can be trained to work more efficiently. With suitable training, the nervous system learns how to recruit muscle fibres more rapidly and more precisely, and the muscles themselves become stronger and bigger and more capable of clearing away the waste products of their activity, so that they can continue working for longer. If they are not exercised, they waste away quickly.

The action of a muscle is to develop tension between two points on the skeleton, so as to draw them together or prevent their being pulled apart or control the rate at which they are being pulled apart. Without muscular control, the spine is much less stable – as in an unconscious person.

The muscles which control the spine are those of the back and neck and the abdominal muscles.

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