We analysts often talk — too lightly perhaps — about the psychological stress involved in our work. But rarely do we focus on the profession of analysis as having physical health risks. So I am going to travel where, I think, no one has gone before, and describe a major health problem that can develop from doing analytic work — “analysts back.” I can also tell you exactly what to do about it, a special treat in our profession, where we generally must inhibit ourselves from telling people what to do.
If you follow the advice below, you may be able to prevent back trouble during your career and even reverse back pain that already occurs. Whence do I derive my authority? Well, my own experience of course, information gleaned from a brilliant physical therapist, and fifteen years of talking to people about it and absorbing what I could.
If your lower back doesn't hurt now, it will soon. This is because the typical analyst sits in a chair eight to ten hours a day, usually leaning back comfortably, or leaning forward eagerly, with his spine in a C formation. This stance is relieved by a fifty-foot walk every hour or so to get the next patient, and perhaps a ten-minute walk at lunchtime, or to the train or car.
If your chair is a wonderful, soft, down-filled armchair, you are in worse trouble, since your back receives no support and your back muscles must work harder to support your spine. If your chair is one of those classy leather 1970s office chairs that recline, you are in terrible trouble, since the shape of the chair as it meets your lower back is also a C, making it impossible to sit any other way.
Things have gotten even worse for the analyst's back in recent years. Many of us go home after those eight hours curved into a C to sit for a couple of hours at the computer, shoulders hunched up, lower back still strained. I'm not going to go into the strains on our upper backs in this article, because I regrettably am not as opinionated on the subject. But the continued immobilization further hurts the back muscles already traumatized by the day's sitting.
The lucky analyst who is in excellent physical shape from running, tennis, walking, or whatever is unfortunately not protected from these problems. General physical (and mental) condition helps, but it is not enough.
That C curve is the culprit, along with the unchanging position and the lack of relief. In routine situations, the pain comes from the muscles, not the spinal cord or spinal nerves. The muscles go into spasm, leading to local inflammation and release of lactic acid and other pain-generating chemicals in the tissue. The spastic muscles can also crunch down on nerves, compressing them and causing nerve pain that can be relieved if the muscle spasm is reduced.
Drawings by Jing Cui
The wishes of your back are simple. It wants to be straight. It doesn't want to sit around all day and night. It wants to be in various positions and do various things. It doesn't want soft things against it, unless it is lying flat on them. If you are sitting, it wants firm support in the lumbar region (from the middle of your back down to the top of your hips).
Treat your back with respect. Don't get mad at it for hurting, or consider yourself a sissy, or try to “push through” the pain.
During an acute episode of pain, take anti-inflammatory medicine, put ice alternating with heat (about ten minutes each) on your back where it hurts, and rest when it hurts too much to move about.
When resting or lying in bed, lie flat on your back with your knees bent, or even better, with your knees bent and your feet propped high on pillows so they are level with your knees. Be sure your back is absolutely flat, with the lumbar area pressed into the bed (you can accomplish this by tilting your pelvis upward and sucking in your abdominal muscles). This is the position of most relief for a strained back.
Try to learn to sleep on your side with your knees bent. Add a pillow between your knees, at least when back pain is flaring up.
If you take all of the following steps, you will drastically reduce your risk of low back pain and episodes of acute flare-up. If you ignore some of them and only do a couple, it will not work. You have to take on the whole package.
Throw out your office chair, especially if it is more than five years old. Your new chair must meet the following requirements: It must be high or very high-tech; it must cost at least $300 (any cheaper chair isn't good enough); it must look like an office chair of at least the 1990s, not a living room chair; it must swivel; and it must bill itself as being ergonomically designed and having great lumbar support. If it has padded arm supports, that's a great bonus, but these are hard to find. We tend to lean on our arms and elbows a lot while listening to patients. Expect to pay $300 to $1000 for a back-friendly chair.
Set the lumbar support in your car to the maximum forward position. If your car doesn't have this option, buy a back support pillow and put it between your back and the car seat.
Do a simple set of floor exercises to strengthen the muscular girdle around your lower back. Most important is strengthening your abdominal muscles. The stronger your abdominal muscles, the less back trouble you will have. If I get the slightest bit of encouragement, I will describe a set of easy and quick floor exercises in a future issue of TAP.
Reform the way you lift. You've heard this many times before — always bend your knees when you lift. The worst position for your back is for you to lean forward, say deep into your car, and pick up something weighty and haul it out.
Sit properly. Ideally, you want to sit up straight, with your lumbar spine arched very slightly, your abdominal muscles pulled in, your thighs at right angles to your back, your lower legs at right angles to your thighs, and your feet on the floor (Figure 1). Your new chair will help you do this. Your old one made it impossible. You have to make some effort though, to strive toward this ideal. It seems unlikely, but you will get used to it and even find it comfortable. Sit this way at home as well. This means you don't sit on 90 percent of the sofas out there. You should instead find a firmer chair like a dining room chair and sit straight.
Relieve your back. Between patients, get up and stretch your back. Arch it to counteract the C curve; twist and generally move around more. If it's sore, it's a good idea to rest it during the work day for a few minutes at a time. Lie on the floor, and scoot up as close to the edge of your couch as you can. Lift your legs and rest them from the knees down on the couch. Scoot up more (Figure 2).
To summarize, the key life changes to reduce stress on your back are what you sit on, how you sit, and strengthening abdominal muscles.