Bending over a basin to wash your hair puts undue stress on both the neck and the back. It may help to sit on a stool and rest your elbows on the side of the basin or sink. Abetter way is to wash the hair under the shower. If necessary, you can buy an inexpensive shower attachment to fit on to the bath taps, and wash your hair while bathing.

Things to make life easier-There are specialist shops and some chemists throughout the country which supply goods specifically for people with back problems. When possible, try something out in the shop before buying it; otherwise, see if you can buy it on approval, so you can return it if you find it is not suitable for you.

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Sufferers can administer this treatment by themselves, by means of a portable battery-operated unit, connected to electrodes which are attached to the skin with surgical tape. The wearer can switch the current on at any time, and control the amount, duration and strength of each dose of stimulation, which is felt as a gentle tingling. TENS is sometimes applied to a patient on complete bed rest. Some back pain sufferers swearby TENS, but it does not work for everybody. However, it is essential not to use a TENS machine unless you have first seen a physiotherapist or other health professional because its use may mask pain, the cause of which should be investigated.

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While standing upright, you will be asked to bend, as well as you can, backwards, forwards and sideways, so that the doctor can see which of these movements causes you most discomfort. This gives a clue as to which of the joints or muscles of the back may be involved.

Muscle spasm is an important sign. The doctor will ask you to walk for short distances, if the intensity of the pain is reasonably well tolerated. You will first be examined face up. then as you lie prone (face downwards) on the couch, the doctor will palpate, that is, explore by finger pressure, the tender area of your back, as well as other areas where you may not have felt pain before, but which are now found to hurt when prodded. If the source of the pain is a nerve root, the pain may be felt all along the nerve.

As you lie supine (on your back) on the couch, you or your doctor will raise each of your legs in turn, with the knee straight. This stretches the sciatic nerve, and the doctor wants to see how far he can do this without producing or aggravating the pain.

The doctor may try other movements, to find out whether certain nerves are working properly, for example whether there is any loss of sensation in any part of your body, and whether your reflexes are normal. Muscles will be examined for weakness.

In most cases, back pain is due to a dysfunction of the spine. However, there may be other causes, which the doctor is bound to consider: for instance, kidney disease, or a peptic ulcer. So the doctor will probably examine your abdomen as well. In women, backache may be caused by gynaecological trouble, such as fibroids or a prolapse of the womb (but such a cause is not at all common); however, lower backache from any cause may be worse before a menstrual period.

If the doctor suspects that a cause of your pain is a prolapsed disc, you will probably be told to return to bed, because rest is essential to permit any inflammation to subside, or to allow the disc bulge to shrink somewhat, thus releasing the pressure on the nerve that is causing the pain.

The doctor may give you pain-killers, if necessary by injection, and also tablets to take at home. You may also be prescribed a tranquilliser because of the beneficial effect of a relaxed mood on muscles in spasm. Tell the doctor if you happen to know that any of these remedies upsets you.

The doctor may propose treatment which can be given by a physical therapist, for example a physiotherapist. You may choose to see an osteopath. Treatment outside Medicare can be expensive. The GP may refer you to a specialist for further examination and treatment.

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Both types of injury, subluxation and dislocation, are more likely to occur when the body is bent over and the joints are already undergoing tension.

In either case, there is some tearing of the ligaments which bind the facets together, and which are part of the synovial capsule enclosing the joint. There may be some internal bleeding; the irritated capsule becomes inflamed and swollen, and there is pain.

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No one can ignore back pain when it does strike – usually in the lower back, but it can be anywhere along the length of the spine. It can manifest itself as a ‘crick’ in the neck, a sharp pain between the shoulder blades, a cramp in the back of the waist, a deep ache across the hips or the arms and legs. Often it can make it difficult, even impossible, to maintain some or all of the commonest human postures – sitting, standing, lying down. It can vary from a feeling of discomfort to one of the most intense kinds of pain known; it can mean a few days off work-or even, very occasionally, prolonged disablement.

Back pain, it goes without saying, is not an illness, but a symptom. It indicates a malfunction of the spine or its supporting musculature, but says nothing about causes; muscle strain, a trapped nerve, spondylitis are just three of the many possible ones. Not all back pain derives from the spine: the symptoms may have quite a different cause, such as gynaecological problems or some type of kidney disease.

Even though most backache is a passing problem, early episodes of back pain should not be ignored. The first two or three episodes may last a few hours, days or weeks, and while they last, the sufferer can usually think of nothing else. But once they are over, they are readily forgotten. Most people, in fact, recover quite quickly, even without treatment. However, these attacks tend to recur; there may be a pattern, perhaps with each successive one lasting longer; eventually the pain may come to stay. It may therefore be wise to establish the cause of even moderate attacks of back pain, in the hope of preventing recurrences.

There are some types of damage stemming from an inherited weakness that cannot be prevented. Some attacks of back pain strike out of the blue, seemingly without any unusual stress or strain, but may nevertheless be the culmination of years of unwitting misuse or of minor incidents in which small aches and pains are disregarded. Some aerobics enthusiasts exercise through sensations of soreness, perhaps ‘going for the burn’ (that is, deliberately exercising till it hurts). It is not easy to know why some people who do these things are afflicted, and others spared. There may well be a hereditary factor, endowing some people with a tendency to weakness in some of their structures. Very tall people seem to be more at risk than others; also those who are too stout. However, just as some people worry compulsively, yet do not suffer from stomach ulcers, or smoke heavily without getting lung cancer, so there are people who court disaster by lifting heavy weights awkwardly, stooping over their work, sitting slumped in badly designed seating, being overweight – yet are never bothered by back or neck pain.

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