Who's singing the Back Pain Blues?

Almost everyone at some point has low back pain that interferes with work, routine daily activities or recreation. It is the most common cause of job-related disability in the U.S.

What is low back pain?

Low back pain is pain, muscle tension or stiffness in the lower back, with or without leg pain. The lower back is the connection between your upper and lower body, and it bears most of your body's weight. Because of these roles, it is often injured when you lift, reach or twist.

Types of back pain include:

* Acute (short term) back pain lasts less than three months. Most people feel much better after 4-6 weeks of home treatment.

* Recurrent back pain is a repeat episode of acute symptoms. Most people who have had back pain have at least one episode of recurrent low back pain.

* Chronic (long term) back pain lasts longer than three months. Few people who have had acute back pain develop chronic back pain.

The good news is that most low back pain will go away in a few weeks with some basic self-care. Fortunately, 90 percent of people with low back pain recover within six weeks, and 95 percent recover within 12 weeks, over 98 percent recover within one year.

What can cause low back pain?

Acute low back pain is often caused by overuse, strain or injury. For example, you may hurt your back by playing sports, by working in your yard, having a sudden jolt such as a car accident, or by lifting something too heavy for you.

Less often, low back pain is the result of arthritis, compression fractures caused by bone loss (osteoporosis), illness or a spine problem that you may have had since you were born.

Obesity, smoking, weight gain following pregnancy, stress, poor physical condition, incorrect posture for the activity being performed, and poor sleeping position also may contribute to low back pain. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury.

Occasionally, low back pain may be due to a more serious medical problem. Pain with fever or loss of bowel or bladder control, pain when coughing, and progressive weakness in the legs may mean there is a pinched nerve or other serious condition. People with diabetes may have severe back pain or pain radiating down the leg due to problems with their nerves. People with these symptoms should contact a doctor immediately to help prevent permanent damage.

Who is most likely to develop low back pain?

Nearly everyone has low back pain at some time. Men and women are equally affected. Low back pain usually begins to affect people in their 30's to 50's. This is due in part to the aging process but also due to sedentary lifestyles with too little (sometimes punctuated by too much) exercise.

Low back pain unrelated to injury or other known cause is uncommon in pre-teen children. However, a backpack overloaded with schoolbooks and supplies can quickly strain the back and cause muscle fatigue. The U.S. Consumer Product Safety Commission estimates that more than 13,260 injuries related to backpacks were treated at doctors' offices, clinics, and emergency rooms in the year 2000. To avoid back strain, children carrying backpacks should bend both knees when lifting heavy packs and use both straps of the pack on their shoulders, instead of just slinging it over one shoulder. They should also visit their locker or desk between classes to lighten loads or replace books, or purchase a backpack or airline tote on wheels.

What are the symptoms?

Low back pain symptoms can range from muscle ache to shooting or stabbing pain, pain down one or both legs or an inability to stand straight. Some acute pain syndromes can become more serious if left untreated.

How is back pain treated?

Most low back pain can be treated without surgery. Treatment involves using pain medicines, reducing inflammation, restoring proper function and strength to the back, and preventing the injury from happening again. Most patients with back pain fully recover. Patients should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care.

The use of cold and hot compresses may help reduce pain and inflammation for some people. As soon as possible after trauma, you should apply a cold pack or a cold compress (such as a bag of ice or bag of frozen vegetables wrapped in a towel) to the tender spot several times a day for up to 20 minutes. After two to three days of cold treatment, switch to about 20 minutes of heat to the tender spot (such as a heating lamp or hot pad.) Heat relaxes muscles and increases blood flow. Warm baths may also help relax muscles. Patients should avoid sleeping on a heating pad, which can cause burns and additional tissue damage.

Take pain medicine, such as ibuprofen (Advil or Motrin, for example) aspirin or acetaminophen (Tylenol, for example). These medicines usually work best if you take them on a regular schedule instead of waiting until the pain is severe.

As soon as possible, get back to your normal activities. Movement helps your muscles stay strong. Staying in bed for more than one or two days can actually make your problem worse.

Walking is the simplest and perhaps the best exercise for the lower back. Your doctor or a physical therapist can recommend more specific exercises to help your back muscles get stronger. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild or lasts more than 15 minutes after finishing exercise, patients should stop and see their doctor.

Patients should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. You may need stronger pain medicines, or you might benefit from physical therapy. Only a few people with low back pain need surgery.

How to prevent back pain

- Exercise most days of the week (for example, walking, biking or swimming.) Exercisers get back pain less, and if they do get it, the pain is less intense and interferes less with their daily routine. Stretch before you exercise. Ask your doctor or physical therapist for a list of low impact exercises appropriate for your age that will help to make your lower back and abdominal muscles stronger.

- Practice being taller for good posture when you sit, stand, and walk. Pull your belly in for better posture.

- Wear low-heeled shoes with good support

- Sleep on your side with a pillow between your legs to keep your back in a good position. A medium-firm mattress may be easiest on your back.

- Don't try to lift things that are too heavy for you. Avoid lifting and twisting at the same time. When you must lift, bend your knees and keep your back straight with your abdominal and pelvic muscles contracted. Exhale on the hard part (actual lifting) and keep the object you are lifting close to your belly button.

- Watch your weight. Being too heavy, especially around your waist, puts extra stress on your back.

- Make sure your diet has a sufficient daily intake of calcium, phosphorus, and vitamin D that will help to promote new bone growth.

- If you smoke, quit. Smoking decreases blood flow and prevents healing.

If you sit or stand for long periods at work:

- Pay attention to your posture. Sit or stand up straight, with your shoulders back and belly button pulled in.

- Make sure your chair has good back support. You might benefit from a lumbar roll (a rolled towel between your back and the chair.)

- If you stand for more than 20 minutes, relieve back stress by putting one foot on a step stool. At regular intervals, switch the foot on the stool.

- Take regular breaks to walk around

If your work involves a lot of bending, reaching, or lifting:

- Talk to your human resources department to see if there are other ways you can do your work

- Don't depend on a back belt to protect your back. Studies have not shown these belts to be effective in reducing back injuries.

- Assess the object you are lifting. If it is too heavy or bulky, ask for help. When 2 people are lifting something, always count out loud ("lift on 3") so both people lift at the same time.

The TCRHCC Wellness Committee would like to thank Denyse Hermann, TCRHCC Physical Therapist, for her review of this article.


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