Back care

What's behind back pain and what you can do to prevent it

Modified from an original, published as Medical Essay, a supplement to Mayo Clinic Health Letter, February 1994
Your back hurts. The pain comes whenever you stoop to tie your shoes or pump the brakes in your car. Maybe you've "thrown out" your back lifting something heavy. Or maybe you can't remember when or how it started, but now it seems like the pain won't go away. Your back reminds you it's there. And it hurts!

You're not alone. Back pain is ranked second only to headaches as the most frequent cause of pain. Four out of five adults will experience a bout of back pain at some time in their lives. In fact, back injuries were the nation's most common form of disabling work injury in 1992. And, even though back trouble is rarely life-threatening, it costs an estimated $40 billion a year in medical bills, lost wages and insurance claims in the United States. With numbers like these, it may surprise you that you can ward off back problems with simple steps such as exercise and adopting a new way to sit or stand.

Even if you've injured your back before, you can learn techniques to help you avoid recurrent injuries. Back pain is common, particularly as you get older. But it's not inevitable.

Back basics
If you're like most people, you don't think much about your back--at least not until it hurts. What does your back actually do for you? The answer is a matter of balance. Cars have four wheels; chairs have four legs. And fellow mammals from mice to monkeys walk on four feet. Four points make balance easy. But humans stand and move about on two legs--a remarkable piece of engineering. Muscles contract and relax to enable you to stand and move. Tendons fasten muscles to the bones in your back (vertebrae). Ligaments--tough, fibrous bands--hold your vertebrae together. Your backbone also protects the spinal cord, the main pathway for your central nervous system. It takes this delicately balanced interworking of bones, muscles, ligaments, tendons and nerves to balance and bear the weight of your body and the loads you carry.
Common kinds of backaches
Even minor damage to any one component of your back's structure can upset the delicate balance and make movement painful. Back pain can occur for no apparent reason and at any point on your spine. The most common site for pain, however, is your lower back because it bears the majority of your weight. Lack of muscle tone and excess weight, especially around your middle, commonly cause and aggravate back pain. Poor posture adds stress, too. When you slouch or stand with a swayback, you exaggerate your back's natural curves. Any imbalance can stress muscles and joints, causing fatigue and injury from overuse. Add the daily stresses and strains you put on your back, such as carrying out the trash, mowing the lawn, leaning over close handwork for long periods, or even applying the brakes in your car. And all too often the result is the familiar complaint, "Oh, my aching back."

From the simple backache to more serious back problems, here are common sources of back pain:

Muscle strains and spasms--Once commonly called "lumbago," aches and pains usually signal strained muscles, tendons or ligaments, or inflamed joints along your backbone. If you strain your back, you may feel the pain immediately or develop soreness or stiffness later.

Muscle spasm may occur after an injury. Spasm is your back's response to injury, designed to immobilize you and prevent further damage.

Osteoarthritis--Commonly referred to as arthritis, this disorder affects nearly everyone past age 60. Excessive use, injury or aging slowly deteriorates cartilage, the protective tissue that covers the surface of vertebral joints. Discs between vertebrae become worn and the spaces between the bones narrow. Bony outgrowths called spurs (osteophytes) also develop. Gradually, your spine stiffens and loses flexibility. As vertebral joints rub together with greater force than normal, the surfaces where they meet, called facets, compress and become irregular. Cartilage becomes inflamed, and the result is pain.

Sciatica--One to two people in 100 with back pain may experience "sciatica" (sy-AT-ic-a), named after the sciatic nerve that extends down each leg from your hip to your heel. Nerve inflammation or compression of a nerve root in your lower back can cause sciatica. You may feel the pain radiating from your back down through your buttock to your lower leg. Tingling, numbness or muscle weakness may also accompany nerve compression. Coughing, sneezing and other activities that exert pressure on your spine can worsen sciatica. Severe nerve compression can cause progressive muscle weakness.

Osteoporosis--The amount of calcium in your bones decreases as you age. Loss of calcium weakens your bone structure. In some cases, the vertebrae become compressed, resulting in back pain. One in three women older than 50 is affected by compression fractures caused by osteoporosis. Progressive compression of vertebrae often leads to a gradual loss of height in women, starting after menopause. Frequently, structural changes also occur in the spinal column that may cause many women to develop a crooked stance or a stooped-shoulder posture called "dowager's hump."

Herniated disc--A "slipped disc" is how you might describe this problem. While they don't actually "slip," normal wear and tear or strain may cause a disc to bulge or to rupture (herniate). Discs have a strong, fibrous outer structure that contains a gel on the inside. When a disc herniates, its soft, jelly-like interior protrudes from its normal position between your vertebrae. Pain can result when a fragment of the herniated disc places pressure on an adjacent nerve.

Injuries and accidents--A decrease in muscle tone as you age makes you prone to back pain, especially that caused by muscle injuries. A shifting in your center of gravity due to increased fat around your abdomen also may offset your balance and increase your risk of an injury or accident.

Fibromyalgia (fye-bro-my-AL-gee-ah)--This syndrome is characterized by achy pain, tenderness and stiffness in muscles and areas where tendons insert into bones. Pain often worsens after you're inactive and tends to improve with movement. It's uncertain how many people have fibromyalgia. Doctors have only recently identified the syndrome and the cause is not well understood. At Mayo Clinic, physicians diagnose about 5,000 people a year with fibromyalgia.

Less common causes of back pain

Spinal or lumbar stenosis. Stenosis means a narrowing of the spinal canal. Narrowing compresses nerves in your lower back and can cause numbness, pain and weakness in your back and legs. Symptoms often worsen when you walk and subside when you sit or bend forward.

Ankylosing spondylitis (AN-ki-LO-sing SPON-dill-I-tis), a serious form of arthritis, is an uncommon type of back pain that typically affects young men. At first, it causes pain and stiffness in the joints of your spine. With time, the disease causes your vertebrae to fuse together, limiting movement in your back.

Rarely, infections can develop in your vertebrae. Tumors may spread from other parts of your body, such as your breasts or esophagus, to cause pain. But it's not common. Also, tumors typically don't originate in your spine and, if they do, are usually benign.

Sometimes your brain mistakes pain signals from other organs as pain originating in your back. Problems with your kidneys, uterus or prostate, or cancers in other parts of your body are common sources of "referred pain."

Lifestyle factors such as stress and smoking also may play a role in back pain, although the mechanisms aren't proven. Try simple measures first. If you have strained ligaments or severe muscle strain, your recovery could take as long as 12 weeks. But with time and proper care, even a herniated disc can be repaired.

Here are guidelines for treating back pain at home:
Use cold treatment first.
Immediately after an injury, apply ice several times a day--but for no longer than 20 minutes at a time. Put ice in a plastic bag, then wrap the bag in a cloth or towel to keep a thin barrier between it and your skin.

After acute pain subsides, usually within the first one to two days, apply heat from a heating pad or heat lamp. Limit each heat application to 20 minutes. To avoid burns, keep the heating pad on a low setting and away from areas of reduced sensation.

Use over-the-counter medications ONLY IF NEEDED! Pain relievers like acetaminophen may help control pain, but can cause liver and kidney problems. Nonsteroidal anti-inflammatory drugs like aspirin and ibuprofen can also reduce inflammation that affects muscles and joints. Be sure to check with your doctor if you're taking medications for other health problems.

For persistent pain, get professional care
In rare cases, back pain can signal serious medical problems. Don't hesitate to contact your doctor immediately if your back pain is the result of a fall or blow to your back. Also, be on the lookout for weakness or numbness in one or both legs, and new bladder or bowel control problems.

If you've tried home remedies for several weeks but still have pain, your chiropractor may be able to pinpoint the source of your pain and recommend additional therapy. During a typical visit, your doctor will ask how the pain began, how long it has lasted and what aggravates or relieves it. He or she will probably watch your muscles and joints as you stand, walk and move your back.

Heat, cold and massage--When performed by a licensed professional, applications of heat, cold and gentle massage may relieve back pain due to muscle spasms.

Electrical stimulation--A procedure called transcutaneous electrical nerve stimulation (TENS) may help stop pain by blocking nerve signals from reaching your brain.TENS is a reasonable approach, but it may have minimal benefit for chronic back pain.

Exercise can play a vital role in your recovery. Two days of rest in bed on a firm surface or mattress help ease pain caused by strains or most disc problems. But because you need to move regularly to maintain muscle tone, doctors warn against longer periods of strict bed rest.

Once acute pain improves, your chiropractor can design a rehabilitation program to help prevent recurrent injuries. Rehabilitation typically includes exercises to help correct your posture, improve your flexibility and strengthen the muscles supporting your back.

RARELY surgery is the answer
Most "good" surgeons will NOT perform surgery just because of back PAIN (regardless of how severe). Odds are you won't need surgery for back pain. The pain and disability caused by a herniated disc or spinal stenosis frequently diminish with conservative treatment. However, if you develop neurological deficits, or muscle weakness caused by nerve compression, you may need a surgical consultation. Your chiropractor will advise you if this is appropriate.

Before you agree to back surgery, consider getting a second opinion. Surgery to repair a herniated disc is among the most frequently performed procedures in the United States. Yet the outcome is often the same whether you have surgery or choose a less-invasive treatment.

Exercise is the cornerstone of pain prevention

Regular exercise is your most potent weapon against back problems. Activity can increase your aerobic capacity, improve your overall fitness and help you shed excess pounds that stress your back.

Stretching and toning your back and other supporting muscles can help reduce wear and tear on your back. Stretching reduces your risk of injury by warming up your muscles. It also increases your long-term flexibility.

Strength training can make your arms, legs and lower body stronger. In turn, your risk for falls and other injuries decreases. Strong arms, legs and especially abdominal muscles also help relieve back strain. If you have osteoporosis, back strengthening exercises may help prevent additional compression fractures.

Ask your chiropractor for advice before beginning an exercise program, especially if you've hurt your back before, or if you have other health problems such as significant osteoporosis.

Then follow these general suggestions:

Start slowly--If you're out of condition from lack of activity, your back muscles may be weak and susceptible to injury. Pace yourself and don't overdo. As you become stronger, work up to 15 minutes of exercise daily.

Make smart moves--Generally, swimming and other water exercises are safest for your back. Because they're nonweight-bearing, these activities place minimal strain on your lower back.

Workouts on a stationary bike, treadmill or cross-country ski machine are less jarring to your back than running on hard surfaces. Bicycling is a good option, too. However, be sure to adjust the heights of the seat and handlebars so that you assume proper posture while pedaling. If you golf, protect your back by shortening your backswing.

Avoid high-risk moves--You may need to avoid or modify activities, especially if you've had back problems. Avoid movements that cause you to exaggerate the stretch of your muscles. For example, don't try to touch your toes with your legs straight.

Activities that involve a lot of twisting, quick stops and starts, and impact on hard surfaces, such as tennis, racquetball, basketball and contact sports, pose the greatest risks to your back.

Back-saving body mechanics

To practice sound body mechanics, pay attention to how you move. By maintaining your spine's normal curves throughout daily activity, you save energy and reduce strain on your back.

Use these tips to help prevent injuries and use your back wisely:

Plan ahead--Think through and reorganize your work or leisure activities to eliminate high-risk movements.

Listen to your body--If your back hurts, stop what you're doing and rest. If you must sit or stand for a prolonged period, change your position often. Avoid unnecessary bending, twisting and reaching.

Prevent falls--Falls can seriously injure your back, especially if you have osteoporosis.

Stand tall--Poor posture is exhausting work for your back. Good posture is more relaxing. It takes minimal effort to balance your body and maintain the three natural curves in your back.

Sit comfortably--Sitting is stressful for your back. To minimize stress, choose a seat that supports your lower back. Or place a pillow or a rolled towel in the small of your back to maintain the normal curve. When you drive, adjust your seat to keep your knees and hips level. Move your seat forward to avoid over-reaching for the pedals.

Sleep smart--Because you spend about one-third of your life in bed, lie in a good position on a firm mattress. Use pillows for support, but don't use one that forces your neck up at a severe angle.

Lift with your legs--Before you lift a load, decide where you'll place it and how you'll get there. Pushing is safer than pulling. Always bend your knees so your arms are level with the object. Avoid lifting overhead. Use a footstool to reach high objects. Place heavy objects on casters.

Keep your back strong and healthy

Take stock of your back and how you use it. Then "invest" in prevention--regular exercise, healthy weight, good posture and, perhaps most important, back-saving lifting techniques. Keep your mind on your back each time you take out the trash, pick up a suitcase, swing a golf club or just lean over to brush your teeth.

If you have periodic bouts of back pain, remember to rest and see your chiropractor regularly, not just when you experience severe discomfort. This type of simple self-care together with sensible daily living can help keep you and your back strong, healthy partners.

Back to Lewes Chiropractic Center's Homepage