How to Keep Your Spine Healthy While Riding in a Humanitarian Aid Truck in Nepal

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It’s 22 days since the first earthquake in Nepal. On May 12th the second earthquake happened. There have been many after-shocks between and after.

There is a joke here now, that there is no more danger anymore because all the buildings are just a hill of bricks.

Laughter, I think is what is keeping the volunteers from going mad. After the second earthquake more people left Nepal, and others are planning to. Westerners can decide for themselves, but the Nepalese have no choice.

A lot of volunteers, both local Nepalese and Westerners are are taking humanitarian aid trips in old trucks. These trips are very dangerous not only because of slippery narrow mountain roads prone to avalanches, nor because of hungry people who can block and mob the trucks on the road. These trips are very dangerous to the volunteers’ spines because they are riding in the back of a rigorously bumpy truck for 17 – 20 hours. Sitting on bags of rice, with nothing to hold on to, can damage one’s back very quickly. This article intends to bring awareness of this real issue and explain how people can avoid or reduce injury to their spine while making humanitarian aid trips.

Spinal Health Overview

Our health depends on the functioning of the central nervous system (CNS). The CNS consists of the brain and spinal cord. CNS is like a wire connecting all internal organs’ information to the brain. There are 31 pairs of nerve roots extending from the spinal cord. The nerve roots exits from the spinal canal through the intervertebral holes and connect the CNS and pass to the internal organs, as shown in the picture below:


Our brain is a “processor” – it receives and sends the signals to the wires of CNS. In this way, the brain coordinates the whole functioning of the internal organs essential for life. For instance, if external microorganisms attack the throat, a command is submitted to the brain in order to raise the temperature of the body up for the fight. Interestingly, scientists cannot find the central, or main cell within our brain. Instead, all brain cells are interconnected and have a more or less equal importance. The phenomenon of this process of exchanging accurate information between brain cells and internal organs is the basis of a healthy life.

This process in the body is also similar to social organizing. One of the main principles of Hatha Yoga is called “satya,” which is the recommendation to not lie. The signals transferring between the brain and internal organs, must be accurate to keep the body healthy. If any signal is corrupted or a “lie” the information between the organs and brain are inhibited, and the body becomes vulnerable to disease. Likewise, our societies are also hindered by misinformation and corruption. Accurate information, or truth, is essential for both the well-being of our bodies, and societies.

To ensure that the information transmitted between internal organs and brain running over wires (nerves) are not distorted, it is necessary that these nerves were not cut or pinched anywhere. The spine itself is meant to protect the central nervous system and keep the nerves from getting pinched.

For normal functioning of the central nervous system the vertebrae must never be displaced (vertebral subluxation). There is a natural space between each vertebrae that keeps the spine cord safe. Between each vertebrae are intervertebral discs, which are essentially shock absorbers. The intervertebral discs also have a hydrophilic function, and can restore themselves by absorbing the spinal fluids around it. This process of restoring occurs typically at night while one is asleep or after special yoga exercises.

Why is it dangerous to be jolted repeatedly in a moving vehicle?

Let's imagine what happens to the spine when a person is constantly thrown about a truck, landing repeatedly on a hard surface for hours on end. The space between the vertebrae is reduced, which has an adverse effect on the intervertebral discs. Since the back is not "straight" ( vertebrae aligned properly one over the other) the muscles along the spine are relaxed and not activated, therefore the muscles cannot hold the vertebrae in alignment. This misalignment of the spine during a bumpy situation makes the situation dangerous. And if a person bends the back, leans over the truck or lies down to relax, it increases the cervical dislocation of the vertebrae (subluxation of the vertebrae) possibly leading to micro cracks, and aggravating pre-existing back issues.

It is not difficult to imagine, that if displacement of the vertebrae occur the nerve roots can be pinched. This is when back pain appears. However the actual pinching of the nerves, although painful is not the most dangerous effect- the hinderance of accurate signal and connection to the internal organs is the true danger. A blocked signal from the organ to the brain will result in a slow atrophy of the organs. The aid volunteers must avoid situation if possible.

What can volunteers do while riding out to remote Himalayan villages in the back of an aid truck?

When in a bumpy ride, never bend, twist or arch your back. It is also not helpful to try to sit straight because with the each of toss and kick is likely back arch and compression of the spine. The safest position is to sit hunched, with a slightly rounded back or/and lean the elbows on the feet.

The best option is to sit on bag of rice, as if one was sitting in a chair. During strong tosses and bumps one can simply transfer the weight of your body to your legs, holding the hands over the side, or simply put the hands close to the body on the bag to support the spine. Unfortunately, in most cases it is not possible to sit on the bags like on the chair, because the truck is filled to the brim with aid, and empty upon return. In this case, sit with legs crossed so that your feet act like shock absorbers, with both hands holding the board of the truck to have the opportunity for support your body with your arms during strong bumps.

If you are seated in the middle of a truck with nothing to hold onto then choose a position with your legs crossed with your hands at your sides for support, bearing the weight of your body with arms bent at the elbows.

Keep the muscles of the lower abdomen activated and breathe with the upper part of the abdomen. With the weight of the body either partially supported by the arms or legs during bumps, the intervertebral discs will not be compressed as hard, thus limiting injury.

The picture below shows how to best sit in normal conditions. The first 3 pictures are not meant for a long bumpy truck ride and i wouldn't recomend to sit like that. Other pictures do illustrate a slight bend forward which activates the muscles of the lower abdomen, which will help prevent unconscious back arches during a bump.


What not to do when riding in the back of a humanitarian aid truck

– Do not rotate your body in a way, when the pelvis remains at the same place, but shoulders rotates to a side (like if you want to take something or say something to somebody).
– Do not lean against the side of the truck.
– Do not lay down on the bags of rice, arching your back.
– Do not fall asleep at the bottom of the truck.

Let’s look at these points in detail.

1. If we look at the spine in anatomical detail, we see that vertebrae are fixed successively at several points. Therefore, the amplitude of the rotation of the body is limited. Of course, our bones are not made of iron, there is some flexibility- but the limits are different for everybody. A slight rotation of the body from the shoulders is acceptable on stable ground, a twist however using the hands as a lever to twist the spine more will often lead to serious injuries by displacing the vertebrae (because the vestibules are connected with each other and is not meant for such twists).

As a result in unnatural twisting, pinches of nerve roots may occur. After such injury, it is difficult to improve the situation. In the context of riding in a truck, it is best to wait when the truck is stopped, or the road smooth (which may not be possible). If necessary to twist the body in a bouncing truck, the safest method is to turn all body all at once (shoulders and pelvis simultaneously while activating the lower abdomen muscles) and never use hands as a lever to twist further than what is natural. Such twisting is dangerous on solid ground, and more so in a jumping truck that can easily lead to the displacement of the vertebrae.


2. If leaning on the side of the truck, the vertebrae are not placed exactly one over another and therefore increases the likelihood of injuring your back. Local relaxation of spinal and abdominal muscles deprive support to the vertebrae. As a result, the displacement of the vertebrae can occur, and the stress on the intervertebral discs increases.

On return trips from villages, volunteers are tired and want to lie down in the truck to sleep. This is also extremely dangerous for the same reason; pressure on the vertebrae easily occurs when the muscles are relaxed and there is no protection offered to the spine. This is especially dangerous for the people who already have vertebral subluxation or scoliosis.

3. If we explore the basics of spine biomechanics, we will see that the structure of the spine involves bending forward but has limits in how far it can arch backwards. Some back arching is acceptable, but the limits are unique to each person and is determined by the space between spinous processes (illustrated below). To arch your back over limit of the space between spinous processes is a very dangerous and unfortunately is common practice in some sports and yoga schools.
During the uncontrolled jerking within a truck there is a high probability that the back can be flexed to a degree where the small space between spinous processes will be reduced to a critical level and injury will result.


In sum, aid trips to remote villages in Nepal require serious physical training and awareness about the potential damage which can be caused to the spine and how to avoid it. Moreover, these trips should not be carried out by the same people every day. Restoration of the spine (intervertebral discs to be precise) after such a journey will take time. Therefore aid volunteers should take at least a full day rest between each trip in order to reduce spinal injury and ensure a healthy body. We should all be aware of what happens to the spine during any activity in daily life, but especially during situations of continued violent shaking which is what puts a healthy spine at risk. As much as volunteers want to support the victims of the earthquake, they too need support from a healthy spine, the foundation for a long and comfortable life in a physical body.

for more information about Correct Approach to the Spine, please, check the book

Larisa Matteyssen, Kathmandu.
The English edition by Julie Pearne
for more information, please, feel free to call: +(977) 980 321 89 67 (Larisa Matteyssen)

this article in russian is here:

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