If a straight posture is maintained while working in the office or at home, the pain may not occur. For example, a clerk may raise the height of his table so that he may sit more erect than usual. This can even be done by cutting the legs of the chair to lower its height. A typist may put his or her papers just above the typewriter on an inclined board, or keep them vertically tagged on the wall on a drawing board. Housewives may raise the kitchen platform if it is too low. They may use a chapati maker which involves pushing down rather than rolling.
Using a hard bed with no pillow or a very low pillow while sleeping is helpful. Sitting in an ordinary office chair instead of a low sofa is better. One must keep reminding oneself to sit straight as the habit of sitting in a wrong way may be difficult to change. Three exercises are of advantage:
Dand. This is a well-known Indian exercise. The patient rests on his arms and legs. The body is drawn backwards initially, till his hips reach the highest point. This is the starting position. Then the head travels slowly down in the direction of the arms, and after the nose has reached the floor level, the chin and the chest are gradually brought to the same level. Now the upward journey of the head and trunk starts in an arch till the final position of the exercise is reached where the spine is in full extension. This exercise is somewhat difficult. To make it easy, hands should be placed on a higher level than the feet – perhaps on the side of a table or bed. Six repetitions done morning and evening will be very useful.
Shoulder Raise. The patient stands erect with his hands on the side. Both shoulders are raised up and without bringing them down, taken behind as far as possible and then dropped down. This exercise can be done twelve times in the morning and evening. This also helps to alleviate upper back pain.
Swimming. Swimming helps patients with a postural backache problem. Keeping the head out of water keeps the body in a posture of extension. When the body floats, all the compression strain on the body ceases.
Manipulation
Manipulation is attempted in all cases unless contraindicated. In quite a few cases, a tender point can be located 2 cm from the middle of the spine at the level of the fifth or sixth dorsal spine. Pressure over this reproduces the exact pain which the patient is complaining of. Some years ago Kellagren injected 1 ml of hypertonic saline solution at the above-mentioned tender point. For a few minutes this injection produced the habitual dorsal pain which the patient had been complaining. Of. He proved that there was an involvement of the dorsal spine in such pain and, therefore, manipulative manoeuvres were justified for its treatment.
The lower cervical spine involvement as a causative factor for upper back pain has already been discussed in earlier chapters. Manipulation of the lower cervical and dorsal spine should be done in these cases. Manipulation can be done without general anaesthesia. It should be repeated once a week till final recovery takes place.
Case Histories
A 41-year-old woman with a two-year-old child had occasional pain in the upper back and both shoulders for a year. Then for three months it became continuous and severe. She would get severe back pain after ironing clothes or rolling chapatis. Along with pain in the upper back, she felt heaviness in the chest. After resting for 1-2 hours, she felt somewhat better. She underwent treatment from her doctors for a few months but this provided no relief.
She then came to me and after a clinical examination and investigations, manipulative treatment was started. Her pain subsided gradually and she was able to do all her household work without any discomfort. She was asked to do the upper back and shoulder-raise exercises.
A shop-keeper aged thirty-six, had pain in the chest now and then and a persisting heaviness in the same region. After a year, neck pain also started. Though he had suffered no injury, the pain increased and became persistent. He would also get occasional stiffness in the neck and pain in the arms while lifting heavy objects. However at nights he slept well. Treatment by general physicians and medical consultants did not help him. He consulted an orthopaedic surgeon but to no avail.
His chest X-rays and electrocardiogram were normal. The X-rays of the cervical spine and dorsal spine were normal. Laboratory tests were also normal. The manipulative treatment of the dorsal and cervical spine was started. He felt better after the first manipulative manoeuvre. His chest pain became less frequent and much less intense, and the pain in the neck did not occur after the second treatment. The chest pain and heaviness completely subsided after eight weeks. He was told to sleep on a hard bed and without a pillow. He was also told to do exercises.
An engineer, aged thirty-three, employed with a large company, used to get pain in the lower ribs and chest off and on. This became more prominent when he had to do any job bending for a long time. This pain persisted for two to three days. When he lay flat in bed, the pain subsided slowly. The pain was incapacitating and allowed him no exertion. He would also get pain in the upper back and lower back occasionally. The chest pain followed the low back pain and with this pain he became bed-ridden for fifteen days. X-rays of the chest and electrocardiograms were taken on several occasions but they were all normal. Laboratory tests too did not reveal any significant abnormality.
Manipulation was done on his dorsal spine. The pain subsided in six weeks’ time. He could bend and work for hours without any pain at all. He was also told to do exercises for his back for five minutes every day, and use a hard bed and a low pillow.
An engineer, aged twenty-nine, met with a car accident while in the US. He started getting pain in the upper back following this accident. The X-ray showed that he had a compression fracture of the fifth dorsal vertebra. He was hospitalised for eight days and later flown to India for treatment. Though he became better and improved, a mild pain continued for about a year. His hectic lifestyle also aggravated the pain.
He came to me with the above complaint. His X-ray showed an old fracture of the dorsal spine. Manipulative treatment was given to him for the cervical and dorsal spine. He improved and there was no pain at all within six weeks. He improved and there was no pain at all within six weeks. He was taught exercises and advised to be careful about his posture as he was in the habit of sitting and walking with a forward stoop.