Has your back got you down? A patient, conservative approach is the best course. Surgery is rarely needed.
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Keeping Ahead of Low Back Pain
Are you all bent over with back pain? Or are you waiting in dread, with vivid memories of your last back attack?
If you can honestly answer no to both of the above questions, you are in a fortunate minority. At some time in their lives, about 80 percent of Americans suffer from back pain serious enough to see a doctor, according to the National Institutes of Health.
Although back pain can be a direct result of trauma–an auto accident or a sports injury–the most common scenario is mock heroic. A professional athlete–or a young bus driver–bends down to pick up his crying three-year-old child, wrenches his back and goes on the disabled list.
It’s understandable that the back could be a source of trouble. The spinal cord is nerve central for the entire body, and the muscles of the back are used in some way for nearly everything we do–bending, stooping, reaching, lifting and even sitting. After years of repetitive movements, poor posture or weak muscles from a sedentary lifestyle, the back is clearly vulnerable to breakdown.
Back pain is a symptom rather than an illness, and some types of pain can be red flags for serious problems. If the pain is the result of a fall or injury; is associated with a fever, irregular menstrual symptoms; numbness, tingling or weakness in the legs; bowel or bladder problems, or pain radiating through the buttocks and into the legs, it’s important to see a doctor right away.
In the majority of cases, the reason for back pain is hard to determine, and the pain is likely to resolve on its own within a few days or a few weeks with or without treatment.
The course is never predictable, however, and about half the time, the pain returns–leading to the mistaken inference that the condition is only in remission and may be getting worse. Because of the misery it causes and the worry about a recurrence, many individuals allow back pain to severely limit their lives.
Don’t Go To Bed
The first and most understandable reaction is to get into bed and avoid moving the painful back. This was once the standard prescription for treatment, but doctors now know it’s the worst thing you can do. Bed rest and immobilization leads to rapid deterioration of muscle strength, not to mention stiffness and swelling– making the pain even worse.
Another common reaction is to pop a handful of over-the-counter pain medications such as aspirin, acetaminophen or ibuprofen. At recommended dosages, these are helpful, but those who exceed guidelines put themselves at risk of dangerous interactions with prescription medications, cold remedies and alcohol. Long-term use of aspirin and nonsteroidal antiinflammatory medications such as ibuprofen and naproxen can cause unwanted gastrointestinal bleeding and kidney damage. Combining acetaminophen with alcohol–even in moderation–creates a risk of liver failure.
The final desperation measure–contemplated all too soon by many patients–is surgery. It’s estimated that only about five percent of back patients ultimately need surgery, and many patients who choose this route do not find the relief they seek.
A spine center brings together at one location a comprehensive array of non-surgical treatment options.
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Even when the problem seems severe, it’s nearly always best to try conservative measures first. Many communities now offer a spine therapy center to provide a comprehensive array of non-surgical treatments–usually with all services gathered at one site.
Physical therapy is an important component of most treatment programs. Goals are not just to reduce pain but to improve function and learn how to keep the back healthy.
Passive physical therapy includes heat and/or ice packs, used to decrease muscle spasms and inflammation. Some individuals respond better to either heat or ice; sometimes the two are alternated.
Studies have shown that exercise decreases present and future pain and reduces lost time from work.
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Ultrasound uses sound waves to penetrate into soft tissues and apply deep heating, relieving inflammation and promoting tissue healing.
A transcutaneous electrical nerve stimulator (TENS) unit uses electrical stimulation to provide pain relief. Iontophoresis is a process involving topical steroids plus electrical current to produce an anti-inflammatory effect.
Active physical therapy, aimed at rehabilitating the back, includes stretching, strength training and cardiovascular workouts monitored by a trained therapist.
Patients are also educated about back pain and ways to protect the back while lifting and performing daily activities.
Most persons suffering acute back pain are afraid to exercise for fear of making the condition worse, but studies have shown that exercise decreases present and future pain and reduces lost time from work. In one study, chronic back pain patients taking a three-month program of calisthenics had fewer “painful months” than other subjects over the next 12 months.
A significant part of the pain usually comes from stiffness of the muscles, ligaments and tendons of the back. With patience and the right stretching exercises, these soft tissues can become mobile again, bringing meaningful relief. This is a process that may require weeks or months.
Typically, a person with a bad back has tight hamstrings in the thighs. This tightness limits motion in the pelvis, and that in turn produces excessive stress on the lower back. The hamstrings should be stretched once or twice every day with a gentle non-bouncing motion. One of the most common stretches simply involves bending forward at the waist with legs fairly straight reaching as far as possible toward the toes.
Cardiovascular workouts frequently start with warm water walking, sometimes combined with calisthenics, leg curls and other exercises. Eventually, the patient may progress to low-impact activities out of the water, such as walking or stationary biking.
Lower back pain is frequently caused by dysfunction of the lumbar spine joints. Chiropractic or osteopathic manipulations of these joints can be particularly effective at relieving pain and increasing mobility.
Massage, biofeedback, yoga, stress management and acupuncture have also been found to be effective components of a comprehensive treatment program.
If pain persists, powerful antiinflammatory medications can be injected directly into the area.
For some individuals, surgery may well be the solution, but there is no reason to rush to that judgment. As many spine center patients have discovered, it is possible to stay ahead of the pain and get back to normal activities–working, gardening, golfing and playing with the children.
REFERENCES:
“BMJ Article Highlights Controversies about Chronic Back Pain,” The Back Letter, August, 2003.
Daniel C. Cherkin, “A Review of the Evidence for the Effectiveness, Safety and Cost of Acupuncture, Massage Therapy and Spinal Manipulation for Back Pain,” Medical Benefits, July 15, 2003.
E. Ernst, “Chiropractic Spinal Manipulation for Back Pain: The Effectiveness of Chiropractic Spinal Manipulation for Back Pain Is Uncertain,” British Journal of Sports Medicine, June, 2003.
E. Ernst, “Massage Treatment for Back Pain: Evidence for Symptomatic Relief Is Encouraging but Not Compelling,” British Medical Journal, March 15, 2003.
“Grandma May Have Been Right: Heat Works Best: Topical Heat May Be Effective for Back Pain,” Occupational Health Management, January, 2003.
J. Guzman, R. Esmail and K. Karjalainen, “Review: Intensive Multidisciplinary Biopsychosocial Rehabilitation Reduces Pain and Improves Function in Chronic Low Back Pain,” Evidence-Based Nursing, October, 2002.
“Is Physical Inactivity a Risk Factor for Back Pain?” The Back Letter, August, 2003.
Bill Krasean, “Pain, Pain, Go Away: Spine-Center Therapies Can Help Patients Avoid Surgery,” Kalamazoo, MI Gazette, November 11, 2003.
Dliana Mahoney, “Nonsurgical Care Relieves Back Pain: Behavioral Intervention,” Internal Medicine News, September 15, 2003.
“100 Million Americans Live with Aching Backs; Most Don’t Seek Help,” Health & Medicine Week, October 7, 2002.
Meghann Peterson, “Unknot Your Back: Find Sweet Relief from Back Pain with These Four Simple Stretches,” Natural Health, May-June, 2003.
“Popular Treatments for Back Pain May Be Riskier than Imagined,” The Back Letter, May, 2003.
Jo Samanta, Julia Kendall and Ash Samanta, “10 Minute Consultation: Low Back Pain,” Student BMJ, April, 2003.
“Should Health Care Providers Advise Patients with Back Pain To Lose Weight?” The Back Letter, April, 2003.
Michele G. Sullivan, “Address Psychosocial Aspects of Back Pain: Preventing Disability,” Internal Medicine News, September 15, 2003.
“What Chiropractors Can–And Can’t–Do for You,” Tufts University Health & Nutrition Letter, February, 2003.
