OH MY ACHING BACK!
By: Linda Hepler, BSN, RN, May 2015
One minute you’re perfectly fine, and the next minute, you’re lying on the floor, writhing with back pain. None of us are immune to an aching back. In fact, according to the National Institutes of Health, this condition affects 8 out of 10 people at some point during their lives. It can be either acute, developing suddenly and dissipating after a few weeks, or chronic, meaning that it has lasted for longer than three months.
Most lower back pain is caused by mechanical injury resulting from injured muscles or tendons due to a strain or sprain, said Kaixuan Liu, MD, PhD, an endoscopic spinal surgeon practicing in the New York area. But for those older than 50, the normal aging process can lead to degenerative changes that affect the spine. “As we get older, our muscles become weaker and can’t hold the bones tight and in alignment,” he explained. The resulting spinal instability may cause abnormal curvatures of the spine.
Wear and tear of the structures that support the spine can also cause a gradual narrowing of the disc spaces between the vertebrae as well as narrowing of the space within the spine that the nerves travel through, a condition known as spinal stenosis. And older persons are more prone to inflammatory disorders of the spine caused by arthritis and osteoporosis, added Dr. Liu. All of these conditions can cause lower back pain.
While we can’t stop ourselves from getting older – or our spine from aging right along with us – we can alter lifestyle habits that trigger the pain or make it worse, according to Dr. Liu. “Many every day activities we do without thinking can make a huge difference to our lower spine health,” he said.
Back Pain Triggers
Here are some common factors that contribute to lower back pain:
Lack of exercise, especially those that strengthen your core. Developing strong core muscles in the hips, back, abdomen and pelvis help to support the spine, keep it straight and prevent strains and sprains. Exercises such as lunges, planks and squats and regimens such as yoga and Pilates help to strengthen core muscle groups.
Exercising too much. While most people know that too little exercise is detrimental to spine health, many people don’t realize that too many repetitions while exercising, especially while lifting weights or doing squats, can cause back pain. “Exercising is definitely a good thing,” said Dr. Liu, “but be aware when your body is crying out for a break.”
Being Overweight. The lumbar and sacral areas of the spine that are in the lower back bear the largest share of the body’s load, and even as few as 10 extra pounds of weight in your abdominal area can add to that load, pulling the spine out of alignment.
Sitting too much. Sitting is worse on your spine than standing or walking, said Dr. Liu, as it places pressure on spinal discs and vertebrae. And if you’re sitting in an uncomfortable, unsupportive chair, it can force the spine out of alignment. Try taking a break every half hour or so and walking around for a minute or two.
Being stressed. Stress causes muscular tension in the lower back, which can trigger pain. And stress also lowers your tolerance threshold to pain, making it seem much worse. Managing your stress through stress management techniques, from walking to therapy, will help to control your back pain.
What To Do?
What to do if you have back pain? Most often it resolves within a few weeks using at-home remedies such as over-the-counter pain medications and rest, noted Dr. Liu. “But if it doesn’t go away, if it keeps you up at night or if you have weakness, numbness or pins and needles in your extremities, it’s best to see a medical professional.”
Techniques to diagnose the cause of your back pain, such as x-rays, MRIs or CAT scans, can help guide the doctor toward an individual treatment plan. The good news? Most back pain – more than 80 percent – can be alleviated without surgery, said Dr. Liu. “Even if you do need surgery for a structural problem of your back,” he added, “it can often be done with advanced technology through a scope, which causes less trauma and pain.”
Is Surgery the Answer?
You’ve done everything your doc recommended: the tests, physical therapy, exercises and pain medications – and still, after six months, you’re experiencing back pain. Should you consider back surgery?
Not necessarily, according to David Hanscom, MD, a Seattle-based orthopedic spine surgeon. “Spine surgery should only be considered for specific structural problems, and most back pain is not related to a structural problem,” he said. Instead, explained Dr. Hanscom, author of “Back in Control, A spine surgeon’s roadmap out of chronic pain,” the pain is often either a result of injured soft tissue (muscles or ligaments) supporting the spine, or, in the case of many chronic back pain sufferers, a permanent neurological problem – Mind Body Syndrome – that has evolved from the pain itself.
To explain how pain can actually cause more pain, Dr. Hanscom likens it to learning to ride a bike or learning a new athletic skill. “When the brain is hammered with the same pain impulses day after day, week after week, it becomes more and more efficient in processing them,” he said.
In other words, continuous pain impulses from your back eventually causes pain circuits to become imbedded in the nervous system, to the point that even if the pain itself has abated over time, you experience it as the same – or even greater – because your nervous system has memorized the pain circuit. An example of this, said Dr. Hanscom, is “phantom limb” pain, a condition in which a person whose limb that has been amputated continues to feel the pain even after the damaged or diseased limb that was causing discomfort has been removed. It’s a reminder, he explained, that the brain is an extremely complex and sophisticated computer which is programmable.
And it’s not only the pain that your brain programs, said Dr. Hanscom. It also programs negative thoughts related to pain, which intensifies pain. Finally the situation is made worse by the side effects of pain and negative thoughts: anxiety, sleep issues and anger.
The answer, according to Dr. Hanscom, is a “defined organized comprehensive care” program that revolves around education about the problem, management of sleep and stress, short-term medications, physical conditioning and actively working on a healthier life outlook. Through tackling all of these things at once, you can calm down a turbocharged nervous system, “reprogram” your brain – and make a full recovery.
Hanscom’s program is a result of both having experienced debilitating back pain himself, along with years of working with patients having pain. “It continues to evolve over time,” said Dr. Hanscom, who has presented numerous seminars and workshops on the defined organized comprehensive care program. To learn more, log on to Back-in-Control.com.
How Functional Movement Screening Can Help With Back Pain
Chris Tomshack, DC, founder and CEO of Health Source Chiropractic and Progressive Rehabilitation, doesn’t use an old school technique – spinal manipulation alone – to treat his patients with back pain these days. Instead, he said, “I use a progressive rehabilitation program that starts with functional movement screening.”
Functional movement screening, or FMS, said Dr. Tomshack, is a diagnostic tool to identify muscle asymmetries, tightness and weakness that may lead to (or already has led to) injury by examining the mobility and stability of the hips, core, shoulders, knees, spine and ankles. The FMS, administered by a trained health professional, such as a chiropractor or physical therapist, seeks out poor movement patterns during seven different exercises, such as deep squats and in-line lunges. “It’s an objective way to evaluate problems, and also when repeated after treatment, provides a measure of progress,” said Dr.Tomshack.
After the FMS test, a treatment plan is developed, he added, which involves functional stretching and exercises to retrain faulty movement patterns, in addition to deep tissue massage and chiropractic manipulation. “When you combine these treatments, they work synergistically to reduce pain and prevent re-injury,” said Dr. Tomshack.
The final step in back rehabilitation is to help people with lifestyle changes, such as better nutrition and exercises to do at home to maintain spinal health, he added.
To find a certified FMS provider in your area, check out FunctionalMovement.com.
How Long Should I Be on Bed Rest For Back Pain?
When your back hurts, it’s normal to want to lie down. But according to the National Institutes of Health, too much rest can make back pain worse. Instead of taking to your bed for days, it’s recommended that you limit your rest to a day or two to help calm the symptoms and reduce inflammation. After that, moving around by gentle stretching and walking can help you get better. As for your workout – wait for two or three weeks to resume vigorous activities.
Hot or Cold?
It’s a continuous debate – should you use heat or cold to relieve symptoms of back pain? Most experts say that it depends upon the type of pain. If your back pain is related to an injury like a strain or sprain, cold works best for a day or two to reduce inflammation. After that, heat will help to relax and soothe muscle tissue. For those experiencing chronic pain, heat will work best. MS&F
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