01 February 2011

Where it is located

I’ve realized, again, that the lower back is the genesis of much movement in African dance. It’s the center, the core in a different sense than is described in Western forms of dance (the Western “core”, at least from what I’ve heard/been taught, focuses more on the anterior, the abdomen). It’s the center of gravity if you’re bending back, held up to the sun with an invisible force, giving homage with joy to everything above and around.

It’s different.

If you’ve been to Africa, backs – particularly women’s backs – look different. And this is why. Somehow (and I haven’t identified this, anatomically) these are muscles that aren’t used as much in other parts of the world.

It’s more than standing tall, proud, unadorned.
It’s carrying a bucket of water on your head, touching lightly with fingertips on one side.
Not swaying. Not spilling any.
It’s doing the same with laundry, régimes of plantains, furniture.
It’s walking back from the fields with the woven basket on your back, tied around your arms with the two lengths of fabric. Machete hanging out behind, probably, with the plantains and manioc and arachides.
It’s carrying children there. The crook not of an elbow, but of a back. Shifting on the hip sways you to one side – it’s uneven, it’s not ergonomic. It’s not long-term. You – they – can walk forever with the child cradled there, just so, tied in a pagne.
It’s the classical pose of the drummer reaching for the sky, pausing between tam-tam beats.
It’s the wooden statue of a women with a water jug on her head.
It’s the machete raised high overhead to reap plantains and papayas and coconuts and palm fronds and avocadoes and…

And it’s the junction of the lumbar and sacral (L-S) spines.

L4, L5, S1.

The bulging, the herniating, the compressing discs. The seat of the sciatic nerve – where it starts, from whence it courses all the way down the back of the leg. If your back hurts – chances are – this is where it hurts. It’s the most common musculoskeletal injury in America. Second cause of clinic visits. Chronic pain. Pain killers. Sick days. Most common cause of job-related disability.

Different cultures use different signifiers for the body. In France, pain in the back is “kidney pain.” It’s the same in Spanish – and now I explain to patients that “your kidneys are actually much higher up.” The left is protected by the rib cage. The right is…partly protected (pushed lower down by the liver. The things we live with that are not symmetrical).
This doesn’t particularly matter. In France, there’s also “spleen pain” (la rate). How many Americans could point to a spleen? “Gall” we use for arrogance. “Bile” for anger (interesting relationship).

Acute back pain can be a harbinger of serious things – prostate cancer. Cauda equina syndrome (medical emergency). Mostly, though, it's chronic.

And the ones who tend to hurt the most are the ones in professions that stand and bend all day. But there aren’t as many studies on farm workers, minimum wage jobs, drivers. The ‘known’ epidemic is the one of cubicles, of delineated squares and desks and noise-unchanging partitions. The sedentary society. This two, becomes a symbol, of being hunched over a computer desk. We make special chairs for that. We make special keyboards. We don’t…move.

Doctors stand. Doctors in the hospital walk, a lot. Rounds mean…walking around, around, around. Pediatrics for the past few weeks has been much less exercise than usual, because our patients are only on two floors. In general, they’re on about ten floors. And we’re always walking quickly. And we’re bending over patients. A lot. And there’s really not an ergonomic way to do an eight-hour surgery. And you can’t move much when you’re scrubbed in. And…
and the special-researched shoes for people who spend all day standing are expensive and made for doctors (and other healthcare professionals. I use “doctor” as proxy). Our health “matters”, we invest in it, and there are stores with stylish options. Often located near major medical centers.  

Sciatica is perhaps one of the most latinate and difficult-to-pronounce medical words that is spoken colloquially. That it derives from the sciatic nerve is possibly less well-known. That it describes a common type of radicular pain and that there are specific physical exam findings to test for it… it becomes just another word for back pain. At a certain age. At the age of the aging population.

Looking up sciatica and Africa, I find 18 papers. I get HIV and schistosomiasis. And again, the health care providers. A quick pubmed search elicits studies of mostly dentists and nurses with low back pain in Africa.

Of course there are biases: research done in Africa? little. Research done in US? lots. 156 papers.
One review paper, looking at research mostly in South Africa and Nigeria, states that rates of low back pain are similar in prevalence in Africa to those in ‘developed’ countries. Fine. I know this very unlikely takes into account anyone in villages, farmers, etc – it’s city people. So maybe I’m wrong, and maybe there’s actually no physical difference, and maybe it’s not developed any differently. Watching the loads of water and laundry that children carry, my wooden furniture friends carried to my house in Mvangan on their heads, and my own improvement in carrying water home without spilling it and with barely touching the bucket…this is difficult to believe.
Carrying water, or carrying anything on your head, you discover the sweet spot. It’s much farther back that you would imagine, or than I did. It’s not midline. It balances the kyphosis of the lumbar spine. Carrying that many kilos on your head actually helps you stand up straighter, because otherwise, it’s painful and it’s almost impossible. It takes confidence and a leap of faith in your axial skeleton to put something that heavy that far back on your head. It’s not going to fall. Your neck is not going to snap. Once you learn, it’s the most sensible way to carry everything. (Imagine: city street in residential-ish area, you’re walking or driving, and you see someone who has picked up  a free wooden nightstand and is carrying it the six blocks home on her head).

Maybe it really is different in Africa. And maybe it’s not. Maybe, with constant development from childhood, the lower back doesn’t herniate and break and ache. Maybe – just like they’ve shown that smiling more actually makes you happier – standing stretched from the center makes you stronger, more confident, and less prone to injury later. And maybe this is an area of strength that is fading.

Point being, it’s the same locus.

The locus of joyful, free-flowing, natural and difficult-to-accomplish movement is the part of the body with the greatest tendency to injury. In adults. In the US.

Whatever it is has been lost. Or is losing.


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