Are you stooping when putting clusters on cows?

Is the lance on your power hose the correct length, allowing you to stand up straight rather than bend forward?

Are you carrying one heavy bucket of milk instead of two balanced, lighter ones?

Do your wellington boots have a good heel?

Is your mattress supportive? What about the couch you sit on at night?

Jonathan Flavin, a chartered physiotherapist with a practice in Youghal, says farmers need to put a lot more thought into the ergonomics of their work day and living environment in order to look after their backs – something that often comes under pressure at busy times on the farm.

Jonathan Flavin is pictured with a patient, dairy farmer Edmond Donavan from Aglish, Co Waterford, at Flavin Spinal & Sports Injury Clinic, Youghal, Co Cork. \ Donal O’Leary

“Farmers pour in (to the clinic) during the spring with all types of injuries, especially lower back injuries,” he says.

“Some of them are unavoidable, but a lot are very simple injuries. Overall, back pain is not the really frightening thing that people worry about.

"Most problems can be sorted quickly, but the environment you work in has to be looked at in order to avoid injuring yourself again.”

Jonathan stresses that he is not talking about back pain caused by medical conditions, eg psoriatic arthritis.

Instead, he is concentrating only on physical back injuries due to working for long periods in a bent position or from lifting a heavy object incorrectly.

With this mechanical type of lower back pain, bending forward or stretching backwards are usually the issues, he says.

He explains that the area most affected is the central part of the back, just above the coccyx (the tailend bone), in the L5-s1 area. L5 is one of the five lumbar vertebrae and the s1 is the first vertebra of the sacrum.

“That’s the most common location of pain and depending on how bad it is, it might be radiating to the buttocks, or down the back of the leg into the knee, or into the calf or foot.

"That’s still back pain, because it originates in the back.”

He gives examples of the causes of such pain, eg hand-milking cows in an awkward position, carrying milk buckets incorrectly, not wearing supportive wellingtons and using a lance on a power washer that is too short.

“With the hand-milking situation, the farmer is calving a cow maybe at 2am and doesn’t bring her into the milking parlour to milk her.

Instead, he milks her by hand into a bucket and does this in an uncomfortable, sustained flexion position, ie bent over forward to draw the milk. This can result in lower back pain.”

A lot of lower back pain is actually positional in nature, he adds.

Everyone makes the mistake of thinking it’s about lifting a huge, heavy calf that weights 40kg and your back goes bang, but a lot of the time it’s the sustained position that is a lot more likely to aggravate your back than the lifting of one heavy item.

Wrestling with a cow to get her up can cause back problems too, as well as feeding calves.

“Situations like these are occupational hazards,” he says. “With calf-feeding the key to avoiding back pain is balancing the load.

"Carry two 10l buckets rather than one 20l one. It’s an easy – and sensible – pain prevention tactic.”

Wear supportive boots

Unsupportive footwear is a huge cause of lower back pain too, he says.

“Understanding why you need a pair with a good, solid heel comes down to understanding what your sciatic nerve is and how it works.”

He talks of how the sciatic nerve is a string running from your brain straight down your spinal cord, coming out at different levels of your spine and running down your leg.

“It gives innervation (supplies nerves to many parts of your body), it tells your legs to move and it senses the pain in your body. It’s a two-way conductor from brain to big toe.

It is, therefore, carrying the same root as your calf muscle, so anything you do that will stretch the muscles on the back of your leg will also stretch your sciatic nerve.

Doing this continuously (eg by wearing wellies that don’t have a solid heel base) can cause lower back pain.”

He, therefore, advises buying a good pair of wellington boots.

“You should pay around the €60 mark for a good pair ( something like the Dunlop Purofort Plus). Without a solid base under the welly your neurological system and your back are just being abused.

It’s a very easy change to make. Also switching over to a laced work boot as often as you can is important. The difference that makes to the lower back is huge.”

Depth of milking parlor pit

If a farmer’s back starts hurting halfway through milking the cows something has changed within that milking environment, he believes.

“Make sure that you are not having to bend or stoop at all to apply the clusters. You shouldn’t have to stretch up too much either. Think of your spinal health.”

Power-hosing

Power-hosing is the number one cause of sustained flexion position back pain.

“A huge amount of people would present (at clinic) one day after doing a lot of power hosing.

"They would have been standing bent over three, four or five degrees forward – slightly stooped for long periods.

" A longer lance on your power-hose would make a huge difference, so that you are standing completely upright.”

Ploughing

Tillage farmers’ position in the tractor when ploughing can also cause lower back pain, he adds.

“The tillage man has to do a lot of hours at once, so he is sitting in a semi-rotated position, looking over his right shoulder for hours every day.

It is simple to avoid this kind of pain – you just have to break the cycle.

Don’t be looking to your right all the time. Make a point of turning and looking over your left shoulder regularly to balance it.”

Lifting not a major culprit

Lifting is one of the least likely causes of lower back pain that Jonathan treats.

“This is because most people would have braced themselves before lifting,” he says.

“You’ll have tensed up your muscles to naturally protect yourself. It’s repetitive tasks being done in an incorrect position for a long time that cause more problems.”

Mattress could be to blame

If a person has stiffness first thing in the morning, the mattress they are sleeping on could be the issue and a better mattress can fix that.

“Try sleeping in another bed with a different mattress before you go buying a new one, though, to see if it does help.”

He is not a big fan of memory foam mattresses, however.

“They are too soft, in my opinion. A mattress with a really high spring count (1,100-1,600) would give better support.

"Many of the Irish manufacturers make very good mattresses (like the higher end of the King Koil range).”

Treatment

Mechanical lower back pain should be easily treatable, he says.

“Left alone, most mechanical back pain problems would subside by themselves within a week to a year.

"By taking a corrective treatment course from a qualified health professional, the ‘out of action’ time can be minimised during a busy time.

“Farmers want to be well enough to get out again tomorrow and there are very few occasions where they’re not well enough to do that.”

With treatment, the aim is to find the cause and eliminate it.

It shouldn’t turn into a massive ordeal and involve repeat visits to someone like me. If it’s recurring you have to look at your environment too.

“The vast majority of people, if you ask them to lean backwards, if they block or have pain, or it’s difficult to do, that’s an extension problem.

"We treat in the direction of the pain – all disciplines do.

"You find the directional preference of that person and you work towards that. If there is a pattern in the back pain we treat that pattern.

“Usually if you restore that movement, unless they aggravate it again, it should settle down.”

Diagnosis

Initial diagnosis involves answering a lot of questions, he says.

“We drill down into the detail, eg what part of the day do things go right or wrong.

"I don’t tell people to rest for days. Movement is the key to back pain treatment.

“Treatment will involve treating the issue then finding the ergonomic elements of the working day that are causing the problem.

If the pit is deep enough, you could be looking at the footwear worn. Some people put cubicle mats in the pits now so that they have a less punishing surface under their feet.

“We’ll spend a while discussing what’s wrong at home too. The car or jeep seat could need adjusting, or the recliner you sit in to watch the news. It’s a two-pronged approach – eliminate the cause and address the pain.”

Tips for lower back pain

  • Find a comfortable position in bed. Lie on your back and put a pillow under your knees. This will shorten the sciatic nerve, giving ease.
  • If lying on your side in the foetal position keep a pillow between your knees. Again this will give ease.
  • Also make sure your pillow is supportive – remember the sciatic nerve runs from brain to big toe.
  • To give your back a chance during a period of lower back pain try skipping TV time on the couch and go straight to bed.
  • A kitchen chair might be better when watching telly also.
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