Dr. Abhay is a highly-valued spinal surgeon from Mumbai. After higher training in orthopedic surgery, he has been the recipient of various international awards throughout the course of his career.

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Abhay Nene

<h4>
 DR. ABHAY NENE is a spinal surgeon from
 Mumbai, India, who has been the recipient of
 various international awards throughout his career. He is interviewed here
 by
 DR. SNEHAL DESHPANDE
 of the Heartfulness Institute about back pain – why, how, and what to
 do?
</h4>

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<h4>
 What Causes Back Pain?
</h4>


 Q: Dr. Nene, tell us about back pain. What does it
 encompass?



 AN: The world
 is made up of three kinds of people: those who are having back
 pain, those who’ve had back pain, and the rest who
 will have back pain.



 Back pain is one of the top three reasons to consult a doctor worldwide.
 That’s quite telling.&nbsp; It shows us how common it is.



 There is often a misconception that back pain is for the rich, or for the
 urban, but we’ve done a study where tribal Indians also voted back pain as
 their biggest problem after infant mortality and malnutrition. Back pain is
 a huge problem across communities, and across profiles of people.



 As a back surgeon, I define two categories
 of pain: The first comes from the
 physical structure. The pain comes from bones, joints,
 muscles, and ligaments. It is physical and mechanical in nature. It is not
 always urgent, but it is a nuisance.



 The second category of pain comes from the neural system,
 the nervous system. It is more urgent, and so a person often needs to seek
 medical help.


<h4>
 Posture
</h4>


 Q: What are the implications of having bad
 posture?&nbsp;



 AN: Take
 sitting as an activity. Most people are either leaning toward a computer
 monitor, looking at their mobile, snoozing at the table, or slouching. You
 might feel that you’re chilling in your chair, but you’re actually loading
 your back. Most of us load our backs over days, months, and years on end,
 without really servicing them. We use our backs for up to eighteen hours a
 day, and mostly we abuse them.



 There’s almost nothing that you do functionally where your back remains
 straight. That’s where posture comes in. If you load your back in a way that
 it was not designed to take loads, it’s gonna wear out faster. Posture is a
 neutral state in which your body takes loads.


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 Most of us load our backs over days, months, and
 years on end,
 without really servicing them.
</h4>

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<h4>
 Sitting Versus Standing Desks
</h4>


 Q: Many people have been talking about standing tables
 while working from
 home. What are your views on that?



 AN: You have
 probably heard the statement, “Sitting is the new smoking.” The human body
 was designed to be upright, and the back consists of a central structure
 which is like the mast of a ship. The muscles around it are the dynamic
 supporters of the ship. Those two elements together give the back a
 shape memory. This shape memory loads the back at the disk
 level. These are the disks that lie between the bones of your back. They are
 like shape memory pillows. They’re supposed to absorb the load, but over
 time they degenerate.



 It is just like using a sofa for many months; eventually it loses its
 capacity to maintain shape. Similarly, the discs in the lower back begin to
 degenerate or dehydrate, so your back loses shape memory. When it’s put in
 an awkward shape, it doesn’t conform to it but adapts to that shape. If you
 sit on an old sofa, you sink in. A similar thing happens to your back when
 it’s loaded beyond its capacity.


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<img decoding="async" width="450" height="676" alt="" class="lazyload has-img-center"
 src="https://cdn-prod-static.heartfulness.org/backpain_posture2_cebdae52d5.jpg?updated_at=2023-04-11T18:15:16.929Z" />


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 Standing:
 Please stand
 up with your back against a wall, and your heels dug in. A neutral posture
 is when the central line of gravity is perfectly aligned to load your back
 the least. That’s the neutral position of the back.



 Sitting:
 When you sit, instantly the lower back curves forwards, because your pelvis
 tends to tilt forwards.&nbsp; As soon as that happens, the centerline of
 gravity moves forward and the load on your back doubles or triples,
 depending on how you’re sitting.



 The right way to sit is in an imitation of standing, where you’re still
 arching. Your lower back is upright, which is done by engaging your muscles,
 not sitting passively, but most of us don’t sit like that. So that’s where
 standing desks, bar stools or high chairs come into play.



 When you stand, you get tired, or your legs hurt, but eventually it’s good
 because it helps you to stand for longer periods. People spend so much money
 on fancy chairs, but the best chair is your muscles.


<h4>
 Can Shoes Prevent Back Pain?
</h4>


 Q: There are specific kinds of shoes designed for walking,
 running, and
 everyday use. Can wearing a particular type of shoe help us
 avoid backache?



 AN: For 95% of
 the population, there’s no shoe that can remove back pain. I’m gonna to tell
 you a little story. A company that is a famous sole manufacturer asked
 someone to jump from ten feet with a very well-padded shoe, and then asked
 the person to jump without any shoes at all. The load on the knee and spine
 was less when he was barefoot.



 Your foot is not one block. It’s designed with very small hinges. So, when
 you land barefoot, your feet nicely absorb the shock so almost nothing lands
 on the torso. Heavy padded shoes actually take away that movement. Even
 though they give you a lot of shock absorption, they take away the micro
 movement in your feet, and that can actually be counterproductive.


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<img decoding="async" width="450" height="673" alt="" class="lazyload has-img-center"
 src="https://cdn-prod-static.heartfulness.org/backpain_posture3_1d3223fdbe.jpg?updated_at=2023-04-11T18:16:22.484Z" />


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 So, there’s no magic shoe. There are, however, a few things that you may
 want to remember about shoes. People with flat feet and feet that hurt may
 do better with shoes that have inner padding which will align their axis
 together. People who wear tall heels for long hours push their center of
 gravity forward. They would be well advised to wear them for shorter
 periods.


<h4>
 Job-related Posture Problems
</h4>


 Q: There are some professions with repeated
 posture-related problems.
 What are these professions?



 AN: It’s very
 telling that an athlete who’s running every day, jumping, and doing
 heavy-duty loaded activities, rarely comes with back pain. But a
 white-collar professional, who’s sitting on a laptop all day is the most
 common candidate for back pain. During the pandemic, we all started sitting
 longer hours. Anyone whose work involves sitting for long hours is likely to
 suffer from back pain. Of course, athletes and people who engage in heavy
 lifting can get back pain, especially if they overshoot their capacity.



 Also, neck pain is a common postural problem because most people’s jobs
 involve looking down. That includes surgeons, diamond sorters, secretaries,
 and dentists; basically, anyone who tilts their neck for long hours will
 have neck problems.



 The most common professions are the most sedentary professions. The more
 active professions don’t come with back pain. Now, that’s counterintuitive!
 Something to think about!


<h4>
 Gym Injuries
</h4>


 Q: There is another group I also look at – gym
 enthusiasts. Some come to
 me with pulled muscles and other related injuries. What would you share
 with this group?



 AN: You have to
 be aware of your capacity, which means knowing your strain versus pain
 equation: if you do something that gives you strain, the next day you’re
 okay for another session. The minute you’ve got pain, you’ve overshot it.



 The other big problem in gyms is compound exercises. The machines are
 designed for ergonomic workouts, so the load on your back is not multiplied
 when you’re exercising your arms or legs.&nbsp; Compound exercise, in other
 words a free workout, for example, a weighted squat, will load your back,
 your legs, and your glutes. It’s a multi-muscle workout. If you’re not
 strong enough, which most of us are not, one of these will give way.



 When you’re doing a deadlift, for example, your hamstrings, quads, glutes,
 back, shoulders, arms, everything is loaded, and if they don’t all work in
 unison, the back gives way. The back gets the brunt of it.


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<img decoding="async" width="450" height="453" alt="" class="lazyload has-img-center"
 src="https://cdn-prod-static.heartfulness.org/backpain_posture4_51b341ba91.jpg?updated_at=2023-04-11T18:17:16.633Z" />


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<h4 class="text-center">
 You have to be aware of your capacity, which means
 knowing your
 strain versus pain equation: if you do something that gives you
 strain, the next day you’re okay for another session. The
 minute you’ve got pain, you’ve overshot it.
</h4>

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<h4>
 Lumbar Belts and Cervical Collars
</h4>


 Q: I have seen many people with either a belt around their
 abdomen or a
 collar around their neck, while doing everyday activities like going for a
 walk. What is your viewpoint on the use of collars and belts for neck pain
 and backache?



 AN: A lumbar
 belt is like a corset, a fake abdominal muscle, which keeps your tummy in.
 In a way, it gives you the right posture, it keeps your mind on your back,
 so you’re upright. That’s okay in the early days, but if you keep using it
 for longer, two or three things happen: your muscles start to forget that it
 was their job to hold you up, the belt begins to loosen so it’s no longer
 protecting you, and eventually, you’re not able to survive without it.



 Long term, it’s good to create your own belt. That means having really good
 strong abs so they become your belt. It is a permanent free belt that stays
 with you. Learn to walk upright, walk tall, and tuck your tummy in.



 The same is true for a cervical collar. The neck has a fixed load of ten
 pounds, but that load can multiply significantly the minute you start
 tilting your head forward.



 A collar allows this distance to remain constant so your head doesn’t drop
 down. In a way it’s doing you a service, but things can go wrong, so we
 don’t recommend a collar. First, you get used to it, and without it you’ll
 stoop. Second, you get a universal-sized collar. Your neck isn’t a
 one-size-fits-all; you could have a collar that’s too small or too big. It
 gives you a false sense of security. So, I would also deter you from wearing
 a collar.



 Instead, walk with your chin and vision parallel to the floor, the back of
 your head in line with your shoulder blades. When you’re upright, your
 muscles will tire, but they will then learn to adapt to that posture.



 So, collars and belts are okay for a short time, but dump them in the long
 run. Unless you use your muscles, you lose your muscles. Also, if you depend
 continuously on the belt, you tend to become psychologically dependent.


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<img decoding="async" width="450" height="453" alt="" class="lazyload has-img-center"
 src="https://cdn-prod-static.heartfulness.org/backpain_posture5_85899afd33.jpg?updated_at=2023-04-11T18:18:19.645Z" />


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 Q: When is the right time to go for back surgery?



 AN: My
 professional opinion is that many people who have back pain are generally
 great candidates for rehabilitation, not surgery. Back pain comes from
 multiple sources, so you can tackle one or two at best. The surgery we do
 for back pain ends up stiffening the spine. It is going against nature’s
 principle of mobility. It makes your back stronger but less mobile. It does
 not necessarily fix your life. Surgery for back pain has a 50% success rate
 worldwide.



 In contrast, people who develop nerve pain are great candidates for surgery,
 and I would encourage them to have it, because often the pain goes down
 through the buttock into the leg, and that causes the leg to go numb or
 weak. It increases leg fatigue, weakness on walking, and so on.


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<h4 class="text-center">
 My professional opinion is that many people who have
 back pain are
 generally great candidates for rehabilitation, not surgery.
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 Q: Which allied professionals can help with back
 pain?



 AN: First,
 there are physical therapists, because they know which muscles are weak, and
 which to strengthen to support the back. A physical therapist knows the
 physics of back pain, and they start enhancing the muscles without actually
 damaging the background.



 Next are nutritionists. A good nutritionist will help you cut down weight if
 necessary.



 Third, ergonomic experts can see how you place your computers, your
 workstations, and how you’re driving. They are often the lifestyle experts.
 Overall, I think these professionals help.


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<h4 class="text-center">Interview by DR. SNEHAL DESHPANDE</h4>

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