Back Pain

Back Pain

Coping with a Common Ache

Years ago, you had dance moves that could have tied Patrick Swayze in knots. So when you went to your high school class reunion, you figured you were a cinch to win the limbo contest. But just as you were making your first pass under the bar, you felt a stabbing pain in your back. In an instant, "Twist and Shout" had a whole new meaning, and you felt like a golden oldie.

You recovered in a few days, but that episode was an all-too-painful reminder that your spine isn't made of rubber and that age is tiptoeing into your life through the back door.

"A 30-year-old woman who has an aching back and limited mobility can feel like a 90-year-old," says Joseph Sasso, D.C., president of the Federation of Straight Chiropractors and Organizations.

At least 70 percent of women will suffer from back pain at some point in their lives. Of those, 14 percent will have severe pain that lasts at least two weeks, and up to 7 percent will suffer chronic pain that can last for more than six months, according to Gunnar B. J. Andersson, M.D., Ph.D., professor and associate chairman of the Department of Orthopedic Surgery at Rush-Presbyterian­St. Luke's Medical Center in Chicago. Nearly 400,000 back injuries occur on the job each year, and that results in more lost productivity than any other medical condition. Back pain is the most frequent cause of restricted activity among people under age 45 and the second most common reason (after cold and flu) that we see doctors, according to the American Academy of Orthopaedic Surgeons. It is also the fifth leading cause of hospitalization and the third most common reason for surgery, Dr. Andersson says.

"Sleep, sex, sitting--I can't imagine any activity that isn't affected by the back. It's involved in almost everything we do. You can't get in and out of a car, run, jump or walk. Until you have back pain, you don't realize everything that a back does for you," says Alan Bensman, M.D., a physiatrist at Rehabilitative Health Services in Minneapolis.

The Age of Opportunity

Many women experience their first bouts of back pain during pregnancy, as the uterus expands to accommodate the growing baby, Dr. Bensman says. Back pain can also occur after menopause, when estrogen production falls and a woman becomes more susceptible to osteoporosis, a loss of bone mass that weakens the back and causes pain. But back pain is particularly common among women between the ages of 30 and 45, says Dan Futch, D.C., chief of the chiropractic staff at Group Health Cooperative HMO in Madison, Wisconsin.

"Those ages are the window of opportunity for back pain," he says. "About the same time you start getting gray hairs, you'll probably start noticing twinges of pain in your back."

The thirties and forties are the years when arthritis and other types of natural degeneration in the small joints of the back begin to catch up with us, says Robert Waldrip, M.D., an orthopedic spine surgeon in private practice in Phoenix. Spinal stenosis, for example, a narrowing of the canal in the vertebrae that surround the spinal cord, puts pressure on nerves in the low back and causes pain. In other cases, the problem is a herniated disk. Disks are small pads made of a tough, elastic outer covering (called the annulus) and a soft center. The disks act like shock absorbers between the vertebrae. Over time, a disk can herniate, meaning that the annulus has torn and the soft center has extended out to press against a nerve root, causing horrible pain. Poor posture also increases strain on the back and can aggravate arthritis and lead to disk problems.

But by far, the most common cause of back pain is muscle and strain. As we get older, many of us get less exercise. As a result, the muscles in the abdomen and back that support the spine weaken and get out of shape, Dr. Bensman says. So things that you used to do with ease, such as hauling a bag of groceries out of your car, lifting a baby out of a crib or raking the leaves, suddenly make you feel like you have a dozen knives sticking in your back.

Lifting something when your back is out of shape is like someone pulling you out of the crowd at the Boston Marathon and forcing you to run the 26-mile course. You're probably going to get hurt, because you're straining your back in ways that it's not prepared for.

Of course, even well-trained athletes can get back pain, but in general, the better conditioned you are, the less likely your spine will cause havoc.

See your doctor if the pain is so intense that you can't move, if it spreads to your legs or buttocks, if your legs or feet feel numb or tingly, if you lose control of your bladder or bowel movements or if you also have a fever or abdominal pain.

Keeping Your Spine Sublime

Often back pain is easily relieved without surgery or drugs, Dr. Waldrip says. In fact, 60 percent of people with acute back pain return to work within one week, and 90 percent are back on the job within six weeks. Here are some tips for preventing and treating back pain.

Do an early morning stretch. "I tell my patients to always start off their days by stretching while they're still in bed," Dr. Bensman says. "Remember that you've been lying prone for eight hours, and if you jump right up, you may be looking at a sore back." So before you get up, slowly stretch your arms over your head, then gently pull your knees up to your chest one at a time. When you're ready to sit up, roll to the side of the bed and use your arm to help prop yourself up. Put your hands on your buttocks and slowly lean back to extend your spine.

Walk away from it. Walking and other aerobic exercises such as swimming, biking and running keep your back healthy by conditioning your whole body. They strengthen the postural muscles of the buttocks, legs, back and abdomen. Aerobic exercise may help your body release endorphins, hormones that subdue pain. Try doing an aerobic workout for 20 minutes a day, three times a week, says Dr. Futch.

You deserve a break. Sitting puts more strain on your back than standing. If you must sit at your desk for an extended time or you're traveling by plane, train or car, change position often and give your back a break by standing up and walking around every hour or so, says Augustus A. White III, M.D., professor of orthopedic surgery at Harvard Medical School in Boston and author of Your Aching Back.

Leave your luggage lie. Instead of leaping out of the car or airplane and grabbing your bags, take a couple of minutes to stretch, Dr. Bensman suggests. Slowly bring your knees toward your chest and gently swing your arms around to loosen up stiff muscles. Avoid lifting with overstretched arms and try to keep the bags close to your body. Consider getting a collapsible luggage carrier with wheels.

Kneel, don't bend. Avoid bending over at the waist to pick up something. That creates tension in the back and increases your risk of injury, Dr. Futch says. Instead, use long-handled tools and kneel on a cushion or knee pad to garden, vacuum or do other "low-level" activities.

Let your legs do the work. If you're lifting something--no matter if it weighs 5 pounds or 50--bend your knees, keep your back straight, and lift with your legs. "The legs are much stronger than the back and can lift a lot more weight without strain," Dr. Futch says.

Test the load. "How many of us have strained back muscles when we tried to pick up boxes that we thought were empty but were actually filled with encyclopedias?" asks Dr. Sasso. Always nudge a box with your foot or cautiously lift it an inch or so before really trying to heft it. If it's too heavy for you, ask for help.

Turn your back on heavy lifting. If you can't find someone to help you move a heavy object, try this maneuver as a last resort: If the object is sitting at table height, turn your back to it to drag or lift it. You can also use this technique for raising windows. This position reduces the pressure that would be exerted on your spine by forcing you to use your legs for leverage.

Straighten up. Maintaining good posture is one of the best ways to prevent back pain, Dr. Futch says. To improve your posture, try this. Stand against a wall or sit in a dining room chair, making sure that your shoulders and buttocks touch the wall or your chair. Slip your arm into the space between your lower back and the wall or chair. If there is a point where your hand isn't touching both your back and the wall or chair, tilt your hips so that the extra space is eliminated. Hold that position for a count of 20 while looking in a mirror to see what your posture looks like. Try to sense what it feels like, so you can maintain that posture for the rest of the day. Do that exercise once a day for three weeks to ensure that good posture will become a habit.

Don't be a heel. High heels change your gait, put additional stress on your lower back and adversely affect your posture, Dr. Bensman says. "High heels shouldn't be part of a woman's daily life. They should be worn only for special occasions. In normal daily life, heels should never exceed ½ inches," he says. If you occasionally wear heels higher than that, wear them for no more than two hours at a time. Always have a pair of tennis shoes or flats available.

Check your mattress. Your mattress should provide proper support, be level and not sag. So if you feel like you're sleeping in the middle of a pita bread, it's probably time to get a new mattress, Dr. Sasso says.

Roll it up. A lumbar roll, a round foam-rubber pad that can be purchased at most medical supply stores, can help you maintain the natural curve in the small of your spine and prevent lower back pain, says Hamilton Hall, M.D., director of the Canadian Back Institute in Toronto. Whenever you sit, stick the roll between your lower back and the chair.

Dress for success. Fitting into a pair of skintight jeans may do wonders for your ego, but it can prevent you from using proper biomechanics such as bending your knees, especially in lifting, Dr. White says. Try wearing looser-fitting clothing for a month and see if that makes a difference.

Smoking makes backs fume. Smoking decreases blood flow to the back and can weaken disks, Dr. Bensman says. So if you smoke, quit.

Drink your milk. Women in their thirties and forties who exercise regularly and have calcium-rich diets are less likely to suffer from back pain caused by osteoporosis later in life, Dr. Bensman says. The Recommended Dietary Allowance of calcium for women over 25 years old is 800 milligrams a day. That's about the equivalent of one eight-ounce glass of skim milk, 1 cup of nonfat yogurt and ½ cup of cooked broccoli a day. Other good sources of calcium include salmon, sardines, cheese, buttermilk, kale, broccoli, pinto beans and almonds. If you don't eat plenty of calcium-rich foods--and many women don't--talk to your doctor about supplements.

Do the big chill. Apply ice to your aching back as soon as possible to reduce pain and swelling, Dr. Bensman says. Wrap an ice pack in a pillowcase or towel (never place the ice directly on your skin) and put it on the sore spot for ten minutes each hour until the ache subsides.

Then warm it up. Once ice relieves the swelling--usually within 48 hours--you can begin using heat. Heat increases blood flow to the wound, relaxes tissues and can improve your mobility, Dr. Bensman says. Apply a warm washcloth--it should be about skin temperature--to your back for 5 to 10 minutes every hour, or take a warm 15-minute shower or dip in a whirlpool.

Reach for over-the-counter relief. Taking one or two aspirin or ibuprofen tablets every four to six hours can relieve pain and reduce swelling, Dr. Bensman says. Be sure you don't exceed the manufacturer's recommended dosage.

Put up your feet. When minor back pain strikes, lie down on the floor and put your legs up on a chair so that your thighs stay at a 90-degree angle to your hips and your calves rest at a 90-degree angle to your thighs. This position relaxes key back muscles and is one of the least stressful for your spine, Dr. White says.

Keep moving. Although lengthy bed rest was once recommended for back pain, doctors now believe that the more active you are, the sooner you'll recover. In fact, two weeks of bed rest weakens muscles and the spine, and that can actually slow your recovery and make you more likely to have a relapse, Dr. Hall says. So don't stay in bed for more than two days, and make sure you get up at least once an hour to walk or stretch.

Get manipulated. Chiropractors are gaining respectability in the medical community, Dr. Bensman says. An analysis of 25 studies of spinal manipulation--the heart and soul of chiropractic treatment--found that manipulation does provide at least some short-term relief for uncomplicated, acute back pain.

"Sure, chiropractors work," Dr. Bensman says. "They're becoming quite knowledgeable and offering some real benefits." In a typical case, a chiropractor may do a series of thrusts with the heels of her hands along the troubled area of your spine. Ask your doctor for a referral to a chiropractor in your area.

Belt it out. If you have back pain during pregnancy, it could be caused by stress in the sacroiliac joint, which joins the pelvis to the spine, Dr. Hall says. To relieve that pain, which tends to be lower in the buttocks and is aggravated by standing or walking, wear a belt around your hips, below your pregnancy, to stabilize the pelvis. "When my wife was pregnant, she had this kind of pain," Dr. Hall says. "I gave her a big, wide cowboy belt from a pair of my jeans. She just cinched that on, and it was quite remarkable in relieving her pain."

Get a second opinion. More than 400,000 surgeries, such as spinal fusion and disk removal or destruction, are done each year to relieve back pain, according to the American Academy of Orthopaedic Surgeons. Yet a Blue Cross and Blue Shield study found that almost 13 percent of spine operations are performed for inappropriate reasons. Get at least one other opinion if your doctor has suggested surgery, Dr. White says.