SPECIAL OFFER: - Limited Time Only!
(The ad below will not display on your printed page)
You're lifting groceries -- or bending to tie a shoelace -- when all of a sudden your back goes out. Or maybe you're just sitting at your desk when your lower back starts aching. Backaches can come on suddenly or gradually and their cause can be maddeningly hard to pinpoint. "Most people try to blame their pain on one thing they did or didn't do, when it's usually the buildup of a number of factors that is responsible," says Sheila A. Dugan, MD, associate professor of physical medicine and rehabilitation at Rush University Medical Center, in Chicago.
"For a vast number of people, back pain comes from multiple sources, and we're just not sure why it hurts so much," says orthopedic surgeon Howard S. An, MD, director of spine surgery at Rush. What's more, what works for one person may have no effect on another, making the search for relief a byzantine journey from orthopedist to chiropractor, rheumatologist to physiatrist (a physician specializing in rehabilitation medicine).
In the process Americans spend $85.9 billion a year on coping with back pain, according to a recent article in the Journal of the American Medical Association. Approximately 80 percent of us have at least one episode, making it the second most-frequent health complaint after the common cold.
"The irony is, most back problems can be prevented," says Stephen H. Hochschuler, MD, chairman of the Texas Back Institute, in Plano. "If you stay in shape, watch your weight, and are careful about how you move and use your body, you have a good chance of avoiding or lessening the severity of back problems." Use the following pages to see whether your habits could be setting you up for a backache -- and to find out what you should do if pain strikes.
Problem: You strained a muscle or tendon, or sprained a ligament. Bands of ligaments and tendons hold the vertebrae in place and attach muscles to the spinal column. A strain or sprain is the most common cause of back pain. Torn muscles and tendons are known as strains; the same kind of injury to a ligament is a sprain.
Why it hurts: Think of your abs and back muscles as support wires for your spine. If you have bad posture and you rely on the wrong muscles to hold up your spine, they can become fatigued. Playing sports incorrectly or when you're not warmed up can also cause this. Something as minor as bending over to pick up a toothpaste cap can also stress weakened tissues, pulling the back out of alignment and causing a painful back spasm. When you tense up or hunch over to protect the injury, you can make the spasm worse. The trigger can also be psychological rather than physical. If you are stressed, that tension can make muscles tighten, pinching nerves and setting off a spasm.
Problem: A disk is getting worn, compressing a nerve. Disks (rounds of fibrous tissue between vertebrae) function as shock absorbers for your back. More than 50 nerves branch off from the spinal cord, and when they are squeezed or irritated, pain results.
Why it hurts: When disks wear as a result of aging, osteoarthritis, degenerative disk disease, or injury, the jelly-like center herniates (or bulges), which can press on nerves (a condition colloquially known as a "slipped disk"). One possible result is sciatica (pain involving the long sciatic nerve, which runs down from the lower back through the buttocks and legs and into the feet).
Problem: One or more vertebrae are cracked or out of alignment. The spinal column has 24 vertebrae, stacked one on top of another. The five lumbar (lower-back) vertebrae carry the weight of the entire torso, making that part of the spine the most frequently injured.
Why it hurts: The usual suspects: excess weight, pregnancy or congenital conditions such as scoliosis (sideways curvature) or lordosis (exaggerated arch to lower back) stress weak muscles and joints, especially the sacroiliac joint (where the lower spine connects to the pelvis). Other culprits: bone spurs (bony growths caused by arthritis) that press on the nerves or cause spinal stenosis (narrowing of the spinal canal, which also pressures nerves) or spondylolisthesis (weak and slipped joints). And hard or sudden falls can fracture vertebrae made weak and porous by osteoporosis.
Problem: Your back hurts because something's wrong elsewhere in your body. Doctors call this "referred pain" because it's not caused by the back itself.
Why it hurts: Endometriosis, kidney stones, or pregnancy weight can trigger back pain that may become chronic. So can fibromyalgia, a disorder of widespread muscle/ligament/joint pain, fatigue, and tenderness at trigger points through the body, most often the lower back.
One reason we get -- or can't get rid of -- back pain is that we're unaware of the things we do (many of them seemingly harmless) that can wreak havoc. The majority of adults unknowingly develop habits that lead them to tighten their neck, shoulders, and back or use the wrong muscles in the wrong way," says Dr. Hochschuler. "Muscles that were not designed to support your back end up doing just that." Check out the simple changes below.Standing and Moving
If back pain doesn't go away, don't put off doing something about it. Options range from massage and acupuncture to medication, pain-zapping injections, outpatient procedures, and surgery. "Sixty to 75 percent of back-pain patients can be helped by a combination of these techniques, treatments, and drugs," says Jeffrey Y. Ngeow, MD, a pain specialist at Integrative Care Center at New York's Hospital for Special Surgery.1. Body Therapies
Massage. Research supports using massage for simple lower-back pain. Particularly effective: myofascial release, a deep-tissue technique that targets the fascia, a weblike layer of connective tissue between the skin and muscles that literally holds the muscles in place.
Acupuncture. "Studies suggest it stimulates blood circulation as well as pain-relieving endorphins in the brain and spine," says Dr. Ngeow. You get the best results from twice-weekly treatments for two to three weeks. "If you don't feel better after six to eight sessions, stop," says Dr. Ngeow. "You're wasting your money."
Spinal manipulation. Osteopathic physicians, physical therapists (PTs), and chiropractors apply controlled pressure to mobilize joints, increase range of motion, improve circulation, and stimulate nerve centers. While manipulation has been widely studied and is considered safe for most people, if you don't feel better after one month of treatments, stop.
Yoga. The best classes for back pain: Vini (one-on-one therapeutic yoga); Iyengar and basic Hatha (which emphasize position and alignment); or restorative yoga (for breathing and relaxation). Avoid: Bikram (yoga done in a very hot room) or Ashtanga ("power" yoga). Consider starting with a private session to gain confidence and learn correct postures, and always tell your teacher you have back problems.
Other movement and exercise programs, such as tai chi, Feldenkrais, or the Alexander Technique, also build muscle strength and help you change unconscious physical mistakes that can trigger tension and pain. Pilates, an intense program of core-strengthening exercises, is great for maintaining a strong back -- but don't try it if you're in acute pain.2. Medications
Doctors treat persistent back pain with several types of prescription drugs.
Anti-seizure medications such as Neurontin and Lyrica (recently approved by the FDA for fibromyalgia) as well as low doses of older antidepressants (Elavil, Norpramin) and newer siblings (Cymbalta) work by altering the brain's perception of pain as well as by promoting a good night's sleep, which is essential for muscle repair and stress reduction.
Prescription muscle relaxants (Soma, Flexeril, Skelaxin) work on either the central nervous system or the muscle itself to reduce spasms and pain.
Anti-inflammatory patch was approved by the FDA last year. Sold by prescription (brand name: Flector), it lessens the gastrointestinal upsets associated with oral anti-inflammatories, such as aspirin, because the medication goes directly into the bloodstream, bypassing the stomach.3. Pain Injections
Shots, optimally administered by an anesthesiologist knowledgeable about backs, provide short-term relief for acute pain and perhaps prevent it from becoming chronic.
Anesthetics such as Bupivacaine or lidocaine coupled with a steroid (usually cortisone) can be injected directly into knotted muscle fibers to break up a spasm; around facet joints (small joints at the back of each vertebra that allow the spine to bend); in the epidural space surrounding the spinal column; or around nerve roots to reduce inflammation (nerve blocks).
Prolotherapy involves injecting ligaments or tendons with compounds such as dextrose (sugar) and lidocaine over a period of several months to kick-start the body's natural healing process. Though its effectiveness remains fodder for debate, proponents contend that prolotherapy strengthens these tissues, helping them better support the back.
Pulsed radio-frequency ablation. Using a local anesthetic, a doctor inserts a needle into the inflamed area and stuns the nerve with a radiogenerated electric current, shutting off pain signals. Relief can last months, even years.
Electrical stimulation. This technique sends electric signals deep into muscles via thin electrode patches worn on the skin, creating an electrical field that blocks chronic pain. A portable transcutaneous electrical nerve stimulation machine costs about $45 a month to rent, $395 to own.
Spinal stimulators. Doctors use minimally invasive surgery to implant tiny electrodes along the spine. These can emit a low-level electric current that you turn on and off via remote control to block pain. Most patients say it feels like a pleasant tingling.5. Inpatient Procedures
"Americans have back surgery twice as often as people in other countries," says Dr. An. "We also have the highest rate of failed back surgeries."
Surgery shouldn't happen without asking why, how much pain is involved, and what recovery is really like. The most important query: What if I wait? "Very often symptoms improve with no intervention at all," says James N. Weinstein, DO, chairman of orthopedics at Dartmouth-Hitchcock Medical Center.
Unless your back pain is an emergency, you can usually ease or eliminate it with these do-it-yourself strategies, says Dr. Dugan.What to Do Immediately
Rx 1: Lie on your back with a pillow under your knees, or on your side with a pillow tucked between your knees and ice your back to calm inflammation (20 minutes on, 20 minutes off). If ice doesn't help, try the opposite -- a heating pad or warm bath. Heat dilates the blood vessels, bringing more healing oxygen and relaxing muscle spasms, and it also reduces pain. Take acetaminophen or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, naproxen, or aspirin. As soon as possible, try to walk, even if it hurts -- staying in bed too long makes muscles and joints stiffen, increasing pain. But don't lift anything heavy or bend from the waist.
Rx 2: As pain eases, begin gentle stretching and strengthening exercises. Continue, even when your back feels better, to strengthen the muscles that support the spine.Still Hurt After Two Days?
Rx 3: See your primary-care physician for a back exam. He or she may prescribe stronger painkillers, muscle relaxants, or an x-ray to see if there's a disk problem or fracture. If pain lasts more than six weeks, you may need a CT scan or an MRI to check for disk issues, spinal stenosis, or other conditions. If pain persists, get referred to a back-pain specialist or integrative medical center, which combines physicians and related services.
Who: Julie Tyson, 52; stay-at-home mother of three grown daughters; Euless, Texas
What happened: A car accident in June 2000, when she was 44, led to back pain that left her in almost-constant agony. "I was living in a fog with my life on hold," Tyson recalls. "I couldn't plan anything because I never knew if I'd feel okay or be in excruciating pain." Relying on painkillers, muscle relaxants, and antidepressants, she bounced from one doctor to another.
What finally worked: Last February, at the Texas Back Institute, Tyson had a spinal cord stimulator inserted along her spine, with nonvisible wires snaking under the skin to an "oreo-sized" battery pack near her hip. She carries a cellphone-size remote control with her at all times to turn on an electric current that blocks pain sensations. Every few days she recharges the device with a portable battery pack. "When it's on I feel like I'm wearing a pair of capris that tingle all over," she says. Though she's sometimes still sore, "I haven't felt this good in years," she says. As we went to press, Tyson had just had surgery to relieve disk pain in her neck. "My goal is to sing pain-free with my acapella group, the Rich-Tone Chorus," she says.
Who: Stacey Lender, 39, a New York City marketing entrepreneur and mother of two daughters
What happened: When she was three months pregnant with her second child, Lender fell hard on a marble floor. About 18 months later, her lower back still didn't feel right. After declaring "nothing was broken," one orthopedist said she'd just have to live with the pain. "That wasn't acceptable. I couldn't sit or ride in a car for long periods of time, and I wanted to be able to play with my kids."
What finally worked: She then went to Dr. Jeffrey Ngeow, who'd treated her husband for a herniated cervical disk. The doctor explained that she had injured a tendon in her sacroiliac joint. Though the initial injury had healed, scar tissue had developed, pressuring her nerves. Stretched ligaments from pregnancy made the condition worse. Dr. Ngeow suggested prolotherapy, 15 to 30 monthly injections of lidocaine and dextrose designed to rebuild collagen in the tendon. "My husband's best friend, a spine surgeon, insisted it wouldn't work," says Lender. "But after the first injection I began to feel better. It's a miracle."
Who: Shawn Frankel, 34, fulltime mother of three boys, 5, 7, and 8, in New York City
What happened: Hitting a backhand shot during a game of tennis, Frankel, a runner, felt "utterly excruciating" pain. She spent the next week flat on her back on the floor. Her leg became numb and she couldn't move her foot. An MRI revealed two herniated disks in her lower back, and an orthopedist advised that cortisone injections were her best option. She then tried a neurologist and a chiropractor. Nothing seemed to work. She was told she had a small window for physical therapy or else she'd have to have surgery.
What finally worked: Frankel was referred to physical therapist Patricia Ladis, who designed a program based on biomechanics infused with principles of Pilates and yoga. Thrice- then twice-weekly sessions for six months decreased pain, strengthened the muscles that held up her spine, and helped her relearn everyday movements that were exacerbating her pain. (Approximately 80 percent of the costs were covered by insurance.) She's back to running, takes twice-weekly yoga, and does stretches and strengthening exercises at home. "Being in tune with my body and focusing on moving the right way has become part of my life," she says.
Originally published in Ladies' Home Journal, November 2008.