Wet clothes and bed linen are much heavier than dry ones: lifting wet sheets and towels in and out of a low washing machine is the sort of movement that might eventually cause back trouble. When taking clothes out of a front-loading washing machine, put a low chair or stool beside the machine. Put a basket or large bowl on the floor, and squatting down, pull the washing into it. Then carefully lift the basket on to the stool. Do this in stages; try to make sure that you lift only one piece of wet washing at a time. If transferring something heavy such as a large wet bath towel to the spin drier of a twin-tub machine, do it one end at a time.

Looking after babies and young children-A cot with a drop-side makes it easier to lift a child in and out; choose a cot high enough to save you having to stoop. Bringing the child’s weight as close to the adult’s body as possible reduces the amount of effort required.

When lifting a toddler from the ground, bend your knees and go down to him and lift him close to you. Swinging a child up at arms’ length can be a cause of acute back trouble.

With a rucksack type of baby carrier where the child is placed behind the parent, its weight is taken through the shoulders and across the back of the hips. If possible, get someone to lift the carrier on for you, or find a safe place to prop it and the baby, while you get it on to your shoulders.

When bathing a small baby in a baby bath, put the bath on a table where you can stand or sit without stooping. Do not try to empty the bath yourself if you have a vulnerable back, because water is heavy to carry, and baby baths are an awkward shape to lift. Get some able-bodied person to do it for you. If none is available, bale out the water gradually with a jug. This will mean several trips and is laborious, but better than injuring your back.

When dressing a child, put him on a chair or bed to avoid undue bending. For doing up shoe laces, the foot should be put up on to a box or chair. Do not stoop – squat or kneel. It helps to ask an older child to ‘hold on to you’ when lifting. This response reduces the ‘dead’ weight effect.

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No surgeon can ever guarantee beforehand that a spinal operation will be a complete success. Complications, some serious, can sometimes occur. However, most operations are

successful – otherwise surgeons would not continue doing them. The surgeon should discuss the position with you fully, and should give you some idea of what to expect after the operation. No operation is done without the patient’s consent. Surgeons are unlikely to suggest an operation unless they are sure of your full co-operation at all stages. To a large extent, success will call for your determination to regain strength and get back to normal.

Being successfully operated on does not mean that the spine is now as good as new, and that all previous activities can be resumed – including the ones that caused the original damage.

The spine is a complex structure, and it is seldom that damage such as a disc prolapse happens in isolation. Damage to other structures often occurs and will not be cured by the operation, and may go on causing problems afterwards. A complete recovery following a spinal operation is likeliest when the damage is isolated to a specific tissue, eg disc, and not the culmination of years of gradual deterioration.

If an operation is not a success consider carefully the reasons for a second one.

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There are some other radiological investigations for someone with severe symptoms or repeated attacks (these investigations are the exception rather than the rule for uncomplicated cases of back and sciatic pain). For example, the nerve root itself can be injected outside the spinal canal – extraspinal radiculography. The epidural space can be injected via the gap between the bones of the sacrum and coccyx to show the space in the spinal canal surrounding the dural tube – epidurography. Alternatively, the medium can be injected direct into the bone of the spinous process and then drains into the veins of the epidural space – epidural venography. More commonly, this is done by inserting a catheter in the femoral vein in the groin and then injecting the lumbar veins – ascending lumbar venography. In stereoradiography,

X-rays are taken to give a three-dimensional effect.

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It is in the earlier stages of degeneration that disc injuries and pain are more likely. The disc is much weaker than it was formerly, and much readier to bulge. It can therefore become the source of repeated back trouble. Mechanically, it can no longer restrain the shearing forces between the vertebral bodies as efficiently as it once did, and therefore the joints and ligaments may have to resist greater strains than they are designed for.

A sign of degenerative change is the appearance of small ruptures in the annulus fibrosus (the outer casing) and the pulpy nucleus tends to spread through these. It is at this stage that some people undergo a disc prolapse which can cause trouble.

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The bony basin of the pelvis holds and protects many vital soft structures in the abdomen, such as the intestines and the female reproductive organs. Being articulated with the hip joints, it transfers weight down the legs to the feet. The tilt of the pelvis is an important factor for the balance of the spine.

The individual shapes of the vertebrae govern the direction of their movements, permitting certain movements and not others. For example, the first cervical vertebra (called the atlas), allows the head to nod backwards and forwards, and to tilt sideways. The second (called the axis) has a knob which fits into a socket through the atlas into the base of the skull: it allows the head to rotate, that is to turn to the left and right.

The thoracic vertebrae also allow backward, forward and sideways movement, and most of them also permit rotation – but only to a limited extent, because they are anchored to the rib cage. The lumbar vertebrae permit backward, forward and sideways movement only.

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