Smart Guide to Healing Back Pain

Introduction

Back pain is a life-changer. It changes the way we move, the things we do, and the manner in which we do them. But it doesn’t have to be a life-stopper by any means. Whether you suffer from a dull ache that seems to have had no beginning and is never going to end or periodically grapple with ferocious attacks of sudden anguish, you can take steps to relieve the torment and lessen its negative impact on your life. We hope this book will help.

We start with a look at who’s most susceptible to becoming a back-pain sufferer and what can put a person at risk, and move on to a simplified anatomy lesson about the incredibly complex network of bone and tissue summed up in the four-letter word back. In chapters 2 and 3 we let you in on when you have the greatest likelihood of running into trouble and how to better your odds, as well as when you should see a doctor. The most commonly used tests for diagnosing the cause of pain, and some of the problems that might be detected are discussed next. Chapter 4 explores how the ways in which you move—or stay still—can play a significant role in back health, and suggests an array of preventive, back-strengthening exercises as well as exercises to help relieve pain that has already begun.

In the second half of this book we move on to treatment methods and options, from over-the-counter pills and unguents to high-tech surgical procedures. Chapter 5 reviews the many modes of relief that are available, including prescription and nonprescription drugs, electrical stimulation therapies, and pain-numbing injections. Chapter 6 provides an overview of the numerous surgical approaches to which you might turn when other methods fall short, and is followed by a chapter on popular alternative approaches to healing— such as chiropractic, acupuncture, and mind-body techniques—being used by millions today.

We conclude with a window-shopper’s guide to the many products now on the market to help prevent and ease back pain, from body-contoured pillows to gadgets and gizmos that suspend you upside down, with a few words of caution on how to be a good consumer.

We wish we could promise you a cure to back pain, but if we did we wouldn’t be telling the truth. In many cases, back pain will occur no matter how careful you are to prevent it, and it does have a likelihood of recurring once it’s first appeared. The good news is that the great majority of it is preventable. By learning how to strengthen your back bones and muscles and increase your flexibility, by becoming aware of how to move and how not to and knowing what to do to help yourself when back pain does strike, you can lessen the frequency and severity of the pain.

CHAPTER 1

Back

Basics

THE KEYS

• Back pain is among the most common physical maladies of modern life.

• Lifestyle and other factors affect our suspectibility to back injury and pain.

• A complex network of bones, muscles, ligaments, and nerves, the spinal system functions in more ways than we might expect.

• Back trouble isn’t always where we think we’d find it.

Back pain can interfere with every movement, every moment of our waking and less-often-sleeping lives, restricting our activities and monopolizing our attention. It doesn’t have to. In many cases the pain can be eradicated; in others the volume can be turned down. In the best case scenario, back pain can be prevented using simple, precautionary measures within everyone’s reach.

Everybody’s Enemy

In North America, more people see doctors for back pain than for any other medical ailment, with the exception of colds and upper respiratory complaints, and it’s a leading cause of hospitalization and surgery. Low back pain is one of the most frequent problems treated by orthopedic surgeons, according to the American Academy of Orthopaedic Surgeons (AAOS), based in Rosemont, Illinois; and, according to Women: Work and Health, a Department of Health and Human Services report on the health and well-being of America’s working women, for both women and men, job-related injuries most frequently affect the back.

An equal opportunity affliction, back pain does not confine itself to men doing hard physical labor in blue-collar jobs. Nurses rank second only to heavy-industry workers in the number of people suffering back pain, reports AAOS. Mothers of newborns, men and women taking care of elderly parents, and other caregivers are common victims.

The good news: as many as one-third of patients with back pain are symptom free within a week, and 90 percent of the time the problem resolves in less than two months. More good news: most cases are acute; only 1 percent of back pain sufferers become chronically disabled. The best news: through relatively modest changes in lifestyle, sufferers can recover faster and better and reduce the likelihood of harming their backs again, and everyone can learn to avoid hurting their backs in the first place.

Do You Fit the Profile of the Back Pain Sufferer?

As the statistics amply demonstrate, back pain can strike any of us: male or female, young or old. The problem can stem from physical injury, disease, emotional duress, poor posture, an inherited congenital flaw, an unhealthy lifestyle, or any combination thereof. With all these possible causes and perhaps others that research has not yet discovered, none of us is exempt. For some, however, the odds of joining the statistics are greater than for others.

Age

It’s a disease of working-age people, says Jerold Lancourt, M.D., an orthopedic surgeon specializing in spine rehabilitation in private practice in Dallas, and that’s why it’s so disabling. Back pain can start as early as the twenties, though many patients report their troubles began between the ages of thirty-five and forty-five. The cause, however, tends to vary with age: Herniated disks, for instance, where the cushions between the bones of the spine shift position, are more common during the working years, with the age of onset spread relatively evenly from the twenties to the early forties, and gradually declining after that.

SMART SOURCES

American Academy of Orthopaedic Surgeons

6300 North River Road

Rosemorrt, IL 60018

800-346-AA0S or 847-823-7186

www.aaos.org

This not for-profit organization is the word’s largest of medical assosciation of musclousskeletol specialists, with twenty thousand board certified members. Free educational brochures are available at Its Web site, or by calling or writing, Although the academy doesn’t offer a referral service, Its Web site lists members in each state.

You can get a free pamphlet, Lift it Safe, by callling:

800-824-BONES.

SMART DEFINITION

Orthopedics

Medical specialty devoted to the diagnosis, treatment, rehabilitation, and prevention of Injuries and diseases of the musculoskeletal system, including the bones, joints, ligaments, tendons, muscles, and nerves. The word originates from the Greek words ortho (meaning straight) and paes or pais (child), and early orthopedists were dedicatad to the task of straightening children with spine and limb deformities. The modern orthopedist treats patients of all ages. (The modern spelling, orthopedics, erroneously refers to straightening the foot—from the Latin word pedis.)

As people enter the fifties and sixties, stiffening of the spine due to the normal process of aging limits the motion that leads to much back pain, but degenerative problems such as spinal stenosis—a narrowing of the lower spinal column—become more common. Back pain in the later years is more often of the chronic type, and is less likely to be experienced as an acute attack. (More on acute and chronic pain in chapter 2.)

Occupation

Occupations at both ends of the scale—either very physically demanding or very sedentary—tend to increase the risk of back pain. Those working in jobs involving heavy manual labor take significantly more time off work because of back pain. Those whose professions involve exposure to vibrations, such as jackhammer operators, are also at increased risk for back pain. Caretakers, whether salaried or tending to elderly parents or young children at home, also run an increased risk.

According to the Department of Health and Human Services, of the 9 million working women with back pain, about one-third attributed the pain to work-related activities or injuries, with the figure rising to more than one-half among women employed in service or blue-collar occupations.

Sedentary occupations, too, add to the likelihood of back pain and herniated disks. Not only will the lack of physical activity take its toll on muscle condition, or, more accurately, the lack of it, but the very act of remaining seated for hours at a time exerts significant pressure on the back.

Posture

Different postures exert different amounts of pressure on intervertebral disks, which cushion the bones of the spine. When we are lying down, for example, disk pres-sures have been approximated at 165 pounds per square inch, compared with 220 pounds per inch while we are standing or walking, and 300 to 400 pounds while we are sitting. Not only do those who sit during a large portion of the day weaken their back muscles and the support the muscles provide, but they exert great pressure on the disk areas near the spinal cord and nerve roots, which are poorly supported areas to begin with.

Pregnancy

At least 50 percent of pregnancies involve back pain. The good news: the patient is usually freed from the pain following the delivery of her child.

Gender

Excluding the back pain related to pregnancy, there is little difference in the incidence of back pain in men and women. For all those predominately male construction workers at increased risk, there are predominately female caretakers matching them ache for ache.

Height and Weight

Tall people have been found to have a greater incidence of back pain than their shorter counterparts, in part due to a tendency to stoop, either to appear shorter or simply to function in a world geared to smaller-sized human beings. Also, the greater the height, the greater the weight and force the lower spine must support.

smart MOVE

Even healthy, fit people can experience back pain, says William Lauerman, M.D., associate professor of orthopedic surgery and chief of the Division of Spinal Surgery at Georgetown University Medical Center in Washington, D.C., but the individual who weighs the appropriate amount and is in good physical condition is significantly iess likely [to experience back pain] than an overweight individual who’s sedentary except for going to his stressful, physically demanding job.

Obesity is one of the most common contributing factors to back pain. Every pound added to the gut, one leading rehabilitation center warns its patients, adds ten pounds of pressure to the spine. The sedentary lifestyle associated with obesity and an unbalanced diet that doesn’t supply adequate nutrients contribute as well.

Are You a Candidate for Back Pain?

How much at risk might you be for suffering with back ailments? The more of these questions to which you can answer yes, the more careful You should be when you bend to pick that piece of paper up off the floor, grab the baby, or reach, for the phone across your desk.

1. Does your job involve heavy physical labor?

2. Are you between the age of thirty-five and forty-five?

3. Are you overweight?

4. Do you lead a sedentary lifestyle, without regular exercise or physical activity?

5. Do yon sit for great periods of time?

6. Do you smoke?

7. Are you pregnant?

8. Are you sigmffieandy taller than average?

9. Are you under stress?

10. Are you depressed?

Smoking

Odd as it might sound, back pain is yet another one of the numerous reasons to kick this habit. Significant evidence shows an increased prevalence of low-back pain associated with smoking. This might be blamed not only on related unhealthy lifestyle patterns often found among smokers but on physical reasons as well.

Smokers cough more, and coughing increases intra-abdominal pressure, which increases pressure on the disks, says William C. Lauerman, M.D., associate professor of orthopedic surgery and chief of the Division of Spinal Surgery at Georgetown University Medical Center in Washington, D.C. Smoking also interferes with the microcirculation to the disk, and it’s well accepted that disks degenerate faster in smokers.

Add to that the fact that the worsened circulation of smokers slows healing in general. Plus, when you’re experiencing back pain, coughing can make it feel all the worse.

State of Mind

Those who are under stress, depressed, or fatigued are also in the increased risk category. In such states, our coping skills are hampered, and we’re less apt to guard against injury or properly care for ourselves.

[People experiencing emotional stress] make mistakes, says orthopedist Lancourt. It’s very rare that you get in trouble when you’re bright-eyed, fresh, and prepared.

In addition, the perception of physical pain can be magnified by a poor emotional state. In a vicious circle, the back pain can cause depression and withdrawal, which can overly prolong inactivity, which can decondition muscles and add extra weight, which can add back strain, and on and on.

SMART MOVE

Having at least a rough idea of the anatomy of the back cars not only help you to better understand how to care for It, but can reduce your stress if something goes wrong. Knowledge helps you cope, says Jerold Lancourt, M.D. PeopIe with back pain are scared if they? can be given an anatomical explanation and understand what’s going on, they can cope better.

Anatomy of the Back

Although we do not need to memorize the names and parts of the bewilderingly innumerable body components that at times seem to exist for the sole purpose of making us feel pain, understanding some basic back anatomy can provide useful insight into the way the back functions, how to keep it from malfunctioning, and how to better cope with those malfunctions if they do occur.

The Spine

The spine, or backbone, more accurately called the spinal column or vertebral column, consists of twenty-four vertebrae (vertebra in the singular form, from the Latin vertere, to turn). These moveable, more or less cylindrical bones are stacked one on top of another, cushioned by intervertebral disks, and connected by joints and ligaments, something we’ll discuss later in this chapter.

In nearly all vertebrates—and that includes mammals, birds, reptiles, amphibians, and fishes— the spine not only provides major support to the body but protects the spinal cord, which, along with the brain, is a major component of the central nervous system (more about the spinal cord ahead). The spinal column reaches from the base of the skull to the coccyx, or tailbone.

No matter how much our mothers might want us to sit up straight, our back is far more curvy than sticklike. In fact, there are three main curves to the spinal column: The two lordotic curves curve toward the front of the body and occur at the top of the spine (at the neck) and toward its base (beginning around the midsection, or stomach area). The curve at the neck is referred to as the cervical lordosis; the one that causes the hollow in the small of the back is called the lumbar lordosis. Between the two lordotic curves, around chest level, the kyphotic curve curves backward, allowing for a chest cavity and the room we need for our heart and lungs. This curve is also known as the thoracic or dorsal kyphosis.

We’re not born with these curves; they develop soon afterward, and provide far greater elasticity than a straight line would allow. If their angle of curvature is too extreme or too shallow, there is more of a strain on the back and the abdominal muscles, ligaments, and tendons involved in keeping us upright.

The top seven vertebrae, located in the neck, make up the upper or cervical lordotic curve and are called the cervical vertebrae—in medical shorthand, C1 to C7, with C1 at the top and C7 at the bottom. Within the cervical vertebrae—which are the smallest of the vertebrae—three are of particular note: The atlas (C1) and the axis (C2) are shaped differently than the others and aren’t separated by a disk. The ringlike atlas, with flat surfaces on each side, is named after the mythical Greek giant who bore the world’s weight on his shoulders. It is the atlas that supports the head and allows us to nod yes as the skull pivots forward and back on it. Fitting into an opening in the atlas, a post protruding upward from the axis allows us to shake the head no. The seventh cervical vertebra, the vertebra prominens, is characterized by a prominent ridge that can be felt at the base of the neck.

F.Y.I

Whether human, hamster, or giraffe, all mammals, no matter how long their necks, have seven cervical vertebrae.

The next twelve vertebrae, forming the thoracic kyphosis, are referred to as thoracic vertebrae (Tl to T12) or dorsal vertebrae. Each is attached to a pair of the ribs. The bottom five vertebrae, forming the bottom (or lumbar) lordotic curve, are lumbar vertebrae (L1 to L5), the largest vertebrae of all.

Each vertebrae has two sections: a cylinder-shaped anterior section called the body or centrum, facing forward; and the more irregularly shaped posterior section, or arch, toward the back. Endplates at the top and bottom of the anterior sections attach to the disks that separate and cushion the vertebrae. The anterior sections are the weight-lifters; the largest ones, down in the lumbar region, can support up to three hundred pounds per square inch. The posterior sections have somewhat spiky-looking pieces of bone interlocking with similar parts of other vertebrae to form the hollow spinal or vertebral canal for the protection of the spinal cord. The canal is largest in the areas where the spine is most flexible, such as the neck and loins, where it is wide and triangular; it is narrow and rounded toward the center of the back.

Pedicles are two short, thick pieces of bone that project backward, one on each side, from the upper part of the body of the vertebra. Laminae are two broad plates of bone that form the space that protects the spinal cord and are connected to the body via the pedicles.

Below the twenty-four moveable vertebrae are vertebrae that begin as individuals but end up comprising two larger anatomical bodies: the sacrum, at birth, is made up of five (rarely, four or six) sacral vertebrae that eventually fuse into one large, downward-pointing triangular bone, curved and tilted in such a way as to allow room for the pelvic cavity. Early in life, the sacral vertebrae are separated from each other by disks, but by about the age of eighteen the two lowest segments become joined by ossification (the process of bone formation) extending through the disk. The process gradually continues upward until all the segments are united and the bone is completely formed by the age of twenty-five to thirty. Because the sections remain visible, they can be identified as S1 to S5. Ligaments on each side of the sacrum attach it to the ilia, the two large bones of the pelvis, via the sacroiliac (SI) joints.

Below the sacrum is the coccyx (from the Greek kokkyx, or cuckoo, for its supposed resemblance to a cuckoo’s beak), which consists of four or, less often, three or five small coccygeal vertebrae—the topmost being the largest—that, like those of the sacrum, fuse together completely by the age of twenty-five or thirty, from the bottom vertebra up. Late in life, especially in women, the