Getting the better of back pain
By Cynthia Godsey M.S.N., F.N.P./C. , Pure Matters
Back pain is the second most common nerve problem in the United States, after headaches. It is the most common cause of job-related disability, according to the National Institute of Neurological Disorders and Stroke (NINDS).
Back pain is rare in children and teens. It occurs more frequently in people as they age.
Although pain can occur anywhere in the back, it is the low back, or lumbar region, where most people experience pain. The lumbar region includes five vertebrae, along with muscles and ligaments, and supports most of the weight of the upper body. It also does most of the work of bending, stooping, sitting and lifting. Wear and tear and injury can cause discomfort ranging from a mild ache to sudden, sharp, debilitating pain.
Fortunately, most low back pain goes away on its own in a few days to a few weeks. This short-term, or acute, low back pain is usually caused by an injury to the structures of the low back or by arthritis. Pain that lasts three or more months is called chronic back pain. The cause of chronic pain is often difficult to determine.
Symptom, not disease
Low back pain is a symptom of a problem, rather than a disease itself. Conditions that cause it can be the normal aging process, or sprains, strains or spasms in muscles and ligaments, or a bulging (ruptured) disk.
The spine is a column of 30 round bones called vertebrae stacked on top of each other. Each vertebrae has an opening in the center. The vertebral openings are aligned so that they form a tube that runs the length of the spine. This tube contains the spinal cord, the nerves that carry signals and control movement of many parts of the body. Throughout the length of the spine, more than 50 nerves enter and leave the spinal cord through small openings in the sides of the vertebrae. The spaces between the vertebrae are filled with round spongy pads called intervertebral disks. These cushion the bones and absorb shocks to prevent injury to the vertebrae. Ligaments and tendons hold the vertebrae and disks in place and attach the back muscles to the spinal column.
In the aging process, bones of the spine to become thinner and more easily fractured; muscles, tendons and ligaments that support the back become weaker, less flexible and more easily strained; and the disks between the vertebrae become thinner, stiffer and less able to cushion the vertebrae.
Sprains and strains to muscles and ligaments can be caused by improper body mechanics that overstretches them, such as lifting something too heavy, or a sudden awkward movement. Lifting heavy items can also compress the vertebrae and cause a disk to bulge outward, or rupture.
When a portion of an intervertebral disk is moved out of place, or is ruptured, it can bulge into one of the spaces where a nerve enters or leaves the spinal cord. The bulging disk irritates or puts pressure on the nerve, causing a kind of pain called radiculopathy.
In many cases of back pain, the cause is unknown. These are some of the more common conditions or situations that put a person at risk for back pain:
- Improper body mechanics when lifting or bending.
- Poor physical conditioning, which causes weak muscles, and inflexible ligaments and tendons. When these areas are weak, they are more easily injured and fail to properly support the spine.
- Chronically poor posture when sitting, standing or sleeping.
- Standing or sitting for long periods of time, especially if you are jostled by movement while sitting, such as when driving a truck long distances.
- Osteoarthritis and other degenerative bone diseases, which can cause a breakdown of the intervertebral disks called spondylosis; bone spurs, and an overgrowth of bone in the vertebrae. This overgrowth narrows both the tube used by the spinal cord and the spaces through which nerves enter and leave the spinal cord. Osteoarthritis can also cause degenerative spondylolisthesis, a slippage of one vertebra over another. Degenerative conditions cause irritation of the nerves, resulting in low back pain, leg pain, muscle spasms and weakness.
- Osteoporosis, which is a thinning and weakening of bones throughout the body, not just the vertebrae. This disease makes it easier to fracture bones. Sometimes low back pain may be because of a fracture in the lower part of the pelvis caused by osteoporosis.
- Inflammatory forms of arthritis. These include Reiter's disease, ankylosing spondylitis, psoriatic arthritis and the arthritis of inflammatory bowel disease.
- Obesity, because extra weight has to be supported by the lower back. Weight carried in front on the spine (a “beer belly,” for example) causes the muscles in the low back to contract into order to hold the belly up. This can lead to muscle spasms, disk degeneration and arthritis in the spine.
- Smoking, which reduces blood flow to the lower back. Smoking prevents the disks and muscles of the back from getting enough nutrients; they become weaker and are slower to heal if injured. Smoker’s cough may also cause back pain.
Uncommon causes of back pain include cancer, infection in the vertebrae or spinal column, aortic aneurysm, kidney stones, fibromyalgia, pregnancy, endometriosis and some inherited conditions.
Back pain from a sprain or muscle strain usually has these symptoms and usually can be treated with medication and exercise:
- Pain that ranges from an ache to a stabbing pain
- Pain in a broad area of the back or on only one side
- Pain that is worse with activity and is severe enough that you can’t bend, stand or sit without discomfort
- Pain that interferes with sleep
Back pain from a sprain or muscle strain does NOT cause pain or weakness in your legs.
Pain from a ruptured disk depends on the where in the spine the disk is located and the size of the rupture. If the ruptured disk does not press on a nerve, there may be no symptoms and you will not know you have it. If it does irritate a nerve, the symptoms are usually pain, burning, tingling, numbness or weakness in the area the nerve serves.
One common cause of low back pain linked to a ruptured disk is sciatica. Sciatica is caused by irritation of one of the nerves that make up the sciatic nerve. The pain from sciatica is usually described as a sharp, shooting pain that runs from the buttock down the back of the leg, sometimes as far as the foot. It is on one side and may be worse when standing, walking or sitting.
If you have symptoms of a ruptured disk, see your health care provider for an evaluation.
See your health care provider if you have back pain with these symptoms:
- A sudden loss of bladder or bowel control, or weakness in a leg; this symptom means you need emergency care, because a ruptured disk may be causing a serious problem with nerves
- Pain runs down your leg to your knee or ankle; this may mean a possible ruptured disk
- Pain on one side of your back with blood in your urine and burning during urination; this may be a possible kidney stone
- Pain after a fall or injury
- Numbness, tingling or weakness in the legs or back
- Difficulty urinating
- Abdominal pain
- Pain that does not improve in two to three days of self-care
- Pain that lasts more than three weeks
- Back pain that wakes you up at night or gets worse when you rest
- You are older than 50 and the pain is new
- You have had cancer or osteoporosis; you use steroids; or you abuse drugs or alcohol
- You have unexplained weight loss
Most acute low back pain can be treated with a pain reliever, gentle exercises, cold and hot compresses, and one to two days of bed rest (for severe pain). Most patients with back pain recover without a loss of function. In some cases, surgery may be needed. If you try self-care of your back pain and it is not better after 72 hours, call your health care provider.
Several prescription drugs and over-the-counter (OTC) drugs are available for pain relief. Be sure to check with your health care provider before taking OTC drugs for pain relief because some are unsafe during pregnancy, may interact with other medications you take, and may cause side effects, including drowsiness, or may lead to liver damage. These are common OTC pain relievers:
- Non-steroidal anti-inflammatory drugs, such as aspirin, naproxen and ibuprofen. These reduce stiffness, swelling and inflammation, and ease mild to moderate low back pain.
- Creams, ointments or sprays, which are applied to the skin over the painful areas. These products can stimulate the nerve endings in the skin to provide feelings of warmth or cold to dull the sense of pain.
- Other creams or sprays, which can reduce inflammation and stimulate blood flow. Many of these compounds contain salicylates, the same ingredient found in oral pain medications that include aspirin.
Prescription drugs that offer pain relief include anti-seizure drugs; certain antidepressants, such as amitriptyline and desipramine, which relieve pain and help with sleep; and opioids, such as codeine, oxycodone, hydrocodone and morphine, which are for short-term use to treat severe acute and chronic back pain.
Exercises prescribed by your health care provider or a physical therapist may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles.
You should resume your activities as soon as possible. Only people with severe back pain should rest in bed -- and then only for one or two days. Studies have shown that people who continue their activities without bed rest after an episode of low back pain recover more quickly and suffer fewer complications, such as depression, decreased muscle tone and blood clots in the legs.
Alternating ice and heat treatments may help reduce pain and inflammation. The NINDS says that you should apply a cold pack or cold compress as soon as possible after an injury. A cold compress can be a bag of ice or a bag of frozen vegetables wrapped in a towel. Apply the cold to the tender spot several times a day for up to 20 minutes at a time. After two to three days of cold treatment, apply a heating lamp or hot pad for brief periods to relax muscles and increase blood flow. A warm bath may also help relax muscles. Don't sleep on a heating pad, which can cause burns and lead to additional tissue damage.
Sleep on your side with a pillow between your knees.
If these measures don’t relieve pain, your health care provider may suggest other treatments. Medications that block the transmission of pain impulses from nerves to the brain can be injected into the painful area. Ultrasound therapy can help muscles relax. Transcutaneous electrical nerve stimulation (TENS) blocks pain signals to the brain by sending a mild electric pulse sent along nerve fibers.
If your back pain is caused by poor physical conditioning or improper body mechanics, you can help prevent injuries by regularly doing a combination of exercises that don't jolt or strain the back, maintaining correct posture, and learning how to lift objects properly. Activities that include stretching exercises, swimming, walking and movement therapy can improve coordination and develop proper posture and muscle balance, the NINDS says. Yoga helps stretch and strengthen muscles and improve posture. Always talk to your health care provider before beginning an exercise program to make sure it is the right thing to do.
Although some people use a wide elastic belt to support back and abdominal muscles when lifting heavy objects, studies have not proved that such belts are beneficial. Don’t use these belts as a substitute for physical conditioning and proper lifting techniques.
Here are some general tips on how to maintain a healthy back and avoid causes of low back pain:
Get regular exercise
You should do some type of exercise on most days of the week. Low-impact aerobic exercises, such as speed walking, swimming or stationary bike riding for 30 to 60 minutes a day can increase muscle strength and flexibility and help maintain a healthy weight. A weightlifting program designed by a physical therapist or professional trainer can build strength and improve posture. Stretching and flexibility exercises maintain posture and prevent injury and falls.
Maintain good posture
- When standing, keep your weight balanced on your feet, with your ears, shoulders and hips in a straight line, and your stomach pulled in. If you stand for long periods, try to elevate one foot or shift your weight often. Women should avoid wearing high heels; instead, they should wear low-heeled shoes with good cushioning and arch support.
- Sit in a chair with a straight back and good lumbar support. Keep your shoulders back and your knees slightly higher than your hips. To do this, you may need to adjust your chair height or use a footstool.
- Don't slouch over your desk or lean your head forward. Slouching requires greater muscular effort and creates more tension in your back.
- To do close work, move your chair in. Get up every hour or so and stretch. Also, to keep moving, fidget when you are sitting.
- Move the car seat forward enough so your knees and hips are at the same level and you don't have to stretch your legs to reach the pedals. Sit in an upright position; don't recline the back of your seat. On long drives, take frequent rest stops so you can get out and stretch.
Eat a nutritious diet
A nutritious diet can help you lose extra pounds, especially weight around the waist. Your body mass index should be between 18.5 and 24.9. Make sure you get enough calcium, phosphorus and vitamin D each day to promote new bone growth. For more information on a healthy diet, go to http://mypyramid.gov/.
Learn how to lift
Learn and practice proper lifting techniques. Do not lift things that are too heavy for you. Don’t lift by bending over; instead, bend your knees and squat to pick up the object. Before you lift, tighten your stomach muscles by pulling them in; keep your back straight so the weight is pushed onto your knees, keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting. To move heavy objects, push rather than pull.
Sleep on a firm mattress
Sleep on your side with a pillow between your knees, if needed to relieve back aches.
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