Many people who take up sports or games do not follow a regular routine, and risk injuring their health rather than improving it. To be effective and safe, exercise must be regular, and a time of each day should be set aside for it. You should strictly follow a graduated program of exercises, and as far as possible make sure that you are building up muscular strength on both sides of the vertebral column equally.

Sports and athletics-Each sporting and athletic activity has its own techniques, which must be learned and practised, for preventing damage to joints, ligaments and muscles. Even professional sportsmen, athletes and gymnasts, who train constantly, quite often suffer from strains and sprains, and anybody who goes in for such activities without adequate training and preparation is very likely to suffer for it.

If you go in for sport as relaxation from work, you should be restrained in your ambition, and bring not too competitive a spirit with you which would make you disregard your health and safety.

One golden rule for sport which should always be followed is: warm up before you start. Gymnasts and ballet dancers always start with some gentle exercises designed to warm up joints and muscles which have not been used for a while. They know that to start to work cold is to invite injury. Warm-up exercises should activate the postural muscles; loosen and stretch all the leg joints and foot joints; stretch the arm and hand joints. If you intend to be involved in sport, it is important to train and play regularly. It is irregular training or playing which is a frequent cause of injury. Do not train or play when you are injured. In attempting to protect one injury you may precipitate another – for example, a knee injury may produce limping and aggravate a back problem. If pain persists see your doctor.

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The task of the Alexander teacher is to help make pupils more aware of their physical self while enabling them to positively direct their bodies and minds in such a way that their bodies are ‘freer and more expansive’. In this process it is claimed faulty habit patterns begin to release as more balance and ease are achieved.

In practice, the Alexander Technique teacher makes small physical adjustments to the pupil’s body to decrease muscular contraction accompanied by specific verbal instructions while the pupil is sitting, standing, lying down and in movement.

The Alexander Technique is taught on an individual basis, as people’s individual habits need to be dealt with. Group introductory classes giving a general idea of the technique are often run by colleges. Individual sessions cost anywhere between $30 and $50 depending on the experience of the teacher. Generally a lesson has a duration of 30 to 45 minutes and an initial course of ten lessons is recommended in order to achieve some lasting benefit.

Alexander teachers have undergone a three-year training course under the auspices of the Australian Society of Teachers of the Alexander Technique (AUSTAT) Inc. or an internationally affiliated society (STAT in UK or NASTAT in USA etc). When choosing a teacher ascertain that the teacher has been accredited by AUSTAT or one of the affiliated bodies.

You can write to AUSTAT, PO Box 716, Darlinghurst NSW 2010 or phone Melbourne 853 1356 or 008 339 571 for a list of teachers or more information.

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‘Lysis’ means dissolution. In chemonucleolysis, an enzyme called chymopapain is injected into the centre of the damaged disc nucleus. This enzyme is derived from the papaya (pawpaw) fruit (and is used also as a meat tenderiser). It has the effect of dissolving the more complex proteins in the nucleus and in the prolapsed part of the disc. Afterwards, the disc shrinks, becoming perceptibly narrower and stiff er. Because of this reduction in volume, the compression of the nerve is relaxed.

Chemonucleolysis is most successful in young people, and where the disc prolapse is fairly recent and has not had time to cause nerve damage or to produce adhesions. It is least successful in the case of extruded disc material having broken away completely – because the chymopapain cannot reach it.

How it is done-Chemonucleolysis is done under sedation or local anaesthesia; X-rays are used to place the needle accurately through the skin of the back. The orthopaedic surgeon, neurosurgeon or radiologist first injects some contrast medium into the disc to assess the damage; then, with the needle still in place, injects chymopapain. If the treatment is successful, the sciatic pain in the leg goes, sometimes with dramatic rapidity; however, most patients have some backache for a week or two.

There is a considerable risk if the chymopapain is injected in the wrong place, it is a technique only for experts. Even then, there is a small risk of an allergic reaction to chymopapain in patients who have become sensitised to it through eating tenderised meat, or who are allergic to papaya. Drugs are usually administered before the treatment, to minimise the risk of this complication.

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There are other kinds of back trouble. Some of them affect the spine mainly or solely; others affect various parts of the body, the spine being just one of them. A third category includes disease which produces back pain without necessarily involving the spine.

Paget’s disease (osteitis deformans)-This is a bone disease of unknown origin, and may occur in any bone. It usually starts in middle age and is rarely found before the age of 60. The bones thicken and become denser, but also softer, tending to deform. If the disease is mild, as is often the case, and causes no symptoms, no treatment is given. In the spine, Paget’s disease may cause pain through pressure on the nerve roots; pain-killers may suffice.

Treatment, notably with calcitonin, a hormone which inhibits the excessive laying down of bone material, is very expensive and considered justifiable in only very few cases.

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Tendons and fascia-The muscles in the arms and legs are attached to the bones by means of tendons (sinews) which are tough, fibrous elongations of the muscle fibres. The muscles attached to the vertebrae are not always connected by tendons; in some places very tough, thin sheets of connective tissue, called fascia, connect the muscles to the vertebrae. A big band of fascia runs down the neck, becoming rectangular across the nape. There is another big, rectangular sheet of fascia at waist level. When the muscles are working strongly, the fascia and tendons take the strain at the point where they are attached to the bone.

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