Headlines
As reported by The Hartford Courant, May 30, 2010.
What Causes Back Pain, and How to Prevent It
By Matthew Sturdevant
It can happen while you're hauling boxes to the attic, gardening in the yard or even sitting in front of a computer too long.
Back pain: It's one of the most common medical problems in the United States, according to the National Institutes of Health.
The pain can range from a sharp stabbing that locks you in your tracks to a dull, chronic ache that slowly gets worse over time. Most people will have back pain at some point in their life, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, which is a division of the National Institutes of Health.
People who have had back strains and pains know how debilitating it can be. Sometimes every move is uncomfortable. But a basic understanding of how the spine works with back muscles, along with a regular routine of stretching and common-sense, can help prevent or relieve the pain.
Risk Factors
Some people are more prone to getting back pain than others. The risk factors include:
Age: Back pain might start, or begin a recurring pattern, for people in their 30s.
Being out of shape: Lack of exercise can lead to tight or weak muscles, which don't support the spine well. Weak or tight muscles are also more likely to spasm, according to the national musculoskeletal institute.
Obesity: Too much weight can strain back muscles and disks in between the vertebrae of the spine.
Smoking: Disks between the vertebrae have a soft center — a nucleus pulposus — and a tougher exterior, annulus fibrosus. The disks absorb shock and vibration when you run or walk. To stay healthy, the disks need nutrients and water, and smoking restricts the circulatory system from providing both.
Work: Heavy lifting or pulling, particularly while twisting the torso, can pull muscles or force a disk out of place. Sitting also puts pressure on the lower back. Working at a desk can push disks out from between vertebrae, sometimes squeezing nerves that run down the spine and branch out to the left and right.
"Sitting is a huge factor in chronic pain," said Laurie Devaney, clinical instructor at Nayden Rehabilitation at the University of Connecticut in Storrs. "You're getting more compression in your spine in sitting than in standing."
Family History: Some back problems are passed down in genes — such as a type of spinal arthritis called ankylosing spondylitis, according to the national musculoskeletal institute.
What Causes the Pain?
Back pain is generally either spasms in one or more muscles, or the gradual degeneration or collapsing of disks between vertebrae in the spine, or both.
Acute pain typically last less than six weeks and is a sharp pain that can be treated with rest and over-the-counter pain relievers. Chronic pain lasts more than three months and typically requires a combination of prescription medication, physical therapy and, in some cases, surgery.
Disks, which are sized to vertebrae, can sometimes bulge, which causes them to flatten out like a burger being squeezed beyond the edges of a bun. In some cases, the tough exterior of the disk can rupture and the soft center will squeeze out.
The center, which is the consistency of uncooked shrimp, can poke out and press against a nerve in the spine. In some cases, a disk can pinch the sciatic nerve. A pinched sciatic nerve can cause pain along the nerve, into the buttocks on one side, down the hamstring, on the outer side of the lower leg all the way to the foot. That pain, called sciatica, is also associated with numbness and tingling in one leg. Go see a doctor if you feel tingling or numbness.
One in three adults older than 20 show signs of herniated disks, but only about 3 percent of those disks cause pain symptoms, according to the University of Maryland Medical Center.
Other conditions can factor into back pain: scoliosis, spondylolisthesis, arthritis, spinal stenosis, pregnancy, kidney stones, infections, endometriosis and fibromyalgia.
Prevention
Stretch and exercise. Keep limber by stretching and strengthen cores muscles from the hips to the arms. A stretching and exercise regimen works best when it is tailored to a patient by a physical therapist, sometimes with advice from an orthopedic surgeon. Yoga and pilates can help maintain core fitness, provided your doctor doesn't disapprove of some squatting positions or other moves taught in yoga classes.
Don't smoke. Medical research shows a strong correlation between smoking and back pain, said Dr. Alexander Mohr, an assistant professor with a joint appointment in the Department of Orthopedic Surgery and the Division of Neurosurgery at the University of Connecticut Health Center.
Don't twist while lifting, and lift with your knees while keeping your back straight.
Maintain a healthy weight. Keep your body mass index between 18.5 and 24.9, according to the U.S. Department of Health and Human Services. The index is a calculation of height related to weight, and the Health and Human Service online calculator is available at http://www.nhlbisupport.com/bmi/.
Don't sit for too long. Get up from your desk every hour and walk around for a few minutes.
To keep a strong spine, get enough calcium and vitamin D every day.
"If everyone did yoga and pilates and had a normal body weight and didn't smoke, you'd really put a damper on the back pain epidemic," Mohr said.
Treatment
Acute back pain can get better with over-the-counter pain relievers, such as ibuprofen, and going about usual activities, according to the national musculoskeletal institute.
Some people benefit by cooling and heating the sensitive area, alternating between a hot-water bottle and a cold pack.
"It's like a hot pepper that you're putting on your skin, which masks the pain," said Mohr, the UConn professor and orthopedic surgeon. "In terms of changing the outcome... it doesn't do anything."
Treatment for chronic pain usually starts after someone has had recurring bouts of pain with greater frequency. It might be a sharp pain every six months or every year, and then every couple of months. Usually, a primary care physician will recommend prescription medication and physical therapy.
Your doctor may order imaging, such as an X-ray or magnetic resonance imaging, or MRI, to get a better look at the problem. If some cases, a doctor will refer you to an orthopedic surgeon.
The medical community debates the long-term effectiveness of back surgery, one of the most common procedures being the removal of all or part of a disk and fusing two vertebrae together. Surgery tends to provide immediate relief, but can require months of minimal activity afterward. Mohr, a professor and orthopedic surgeon, says patients should always try physical therapy first. Only when the pain is unbearable should a patient have the surgery.
"I personally love spine surgery," Mohr said. "But most people don't need spine surgery."