The pain was horrible. It felt as if someone had taken a match and set my back on fire! All I remember was bending down to snip off a rose, and suddenly my whole back ignited, as it were. I remained in that position for days, unable to straighten up. I never experienced pain like that before! BACK pain ranks second to headache in the number of people it affects. It is the leading cause of long-term disability in people younger than 45 and the third leading cause among those older than 45.
Is back pain inevitable? What can you do to alleviate it or to prevent it? When should you seek medical help for your back? Although back pain that is persistent can signal many internal diseases, this discussion will focus on two sources of back pain .. herniated disks and muscle spasms.
Herniated disks are a major cause of back disease among young and middle-aged adults. Such disks are often referred to as "slipped disks," a misnomer, since they cannot be slipped in or out of place.
By the time a person reaches his 20's, the spongy interior of the disks begins to lose its elasticity and moisture, causing the disk to shrink. But this does not usually result in pain. For some people, however, intense pain occurs when part of the spongy interior herniates, or bulges, through the outer ring of fibrous tissue.
Fortune magazine comments regarding the disks: "Once they've degenerated past a certain point, the slightest stress .. something as trivial as a sneeze or bending over to move a stereo .. can be the straw that breaks them."
Disks act as shock absorbers between the first 24 vertebrae, or bones of the spine. These bones are stacked atop one another and form a vertical tunnel, the spinal canal, through which the spinal cord runs. Between each pair of vertebrae, there is a small opening through which a bundle of nerves, called a nerve root, leaves the canal, one bundle on either side. A disk may herniate and press against a particular nerve. This pressure can interrupt nerve signals that convey sensations to and from other
parts of the body.
A very painful condition known as sciatica, for example, can occur if there is pressure exerted on the roots of the sciatic nerve. Several that emerge from the lower part of the spine form the sciatic nerve. There is one on each side, running down the back of each thigh as far as the knee and then branching into other nerves. Sciatic pain usually begins in the low back and shoots out into the hip and buttock and on down the back of the thigh, sometimes as far as the calf and foot. As a result, a person may
experience "foot drop," a condition in which the foot drags because the leg muscles cannot raise the toes. A sufferer may also experience sensations of pins and needles, numbness, and muscular weakness in the affected leg.
If the disk presses on nerve roots in the cauda equina, a group of nerves just below the waist that service the bladder and the bowels, a person may have problems urinating or defecating. Persons with any of these symptoms should consult a doctor immediately, as they may be signs of serious neurological problems.
When contracted and relaxed, the muscles in the back join the ligaments in supporting roles, keeping the spine from collapsing and enabling it to bend and twist. Under strain, however, an out-of-shape muscle can go into a spasm, tensing up so much that it becomes a hard lump.
Occurring without warning and temporarily immobilizing a person, episodes of back spasms can be agonizing. I can only describe this pain as a "series of earthquakes erupting in my back."
Doctors agree that muscle spasms occur to guard a person from incurring further damage to weakened muscles. A Time-Life book, The Fit Back, observes: "By immobilizing the back, the spasm forces you to take the best course of action and lie down. This position not only places the least amount of stress on your back, but it allows inflamed tissue to repair itself."
In order to prevent back strain that often triggers spasms, the muscles of the back, abdomen, and thighs need to stay toned and firm. Lax abdominal muscles, for example, may create back strain because they do not give proper support and are less able to resist the pull of the body’s weight on the spine. If abdominal muscles are well-conditioned, they create a “muscular girdle” that prevents the lower back from arching into a swaybacked position. Swayback, an excessive curvature of the lower back, pulls the vertebrae of the lower back out of alignment.
What You Can Do to Ease Pain
Poor posture, obesity, weak muscles, and stress are four factors that contribute to the likelihood of pain in the lower back. Common activities that are done improperly, such as sitting, standing, or lifting, are other predisposing factors.
A mutual relationship exists between good posture and strong abdominal and back muscles. Correct posture allows the muscles to work properly, while good muscle tone is vital for proper posture. An alignment that follows the spine’s natural S curve is required for good posture. It does not mean a rigidly straight spine.
If improper posture is corrected, pain of postural origin can be eliminated, indicates Robin McKenzie in the book Treat Your Own Back, adding: "As time passes, however, if uncorrected, the habitual poor posture causes changes to the structure of the joints, excessive wear occurs, and premature ageing of the joints is a consequence."
Excess weight, especially in the abdomen, can also strain the back because it creates a gravitational pull on the muscles that support the back. A regular exercise program is a key to a fit and healthy back.
Even if pain is no longer experienced, exercise is essential because back pain that has gone away tends to resurface unexpectedly. A complete medical evaluation is recommended before beginning a program. A doctor may suggest the proper exercises for an individual's back problem, or he may refer a patient to a physical therapist.
Many researchers believe that stress can also make a person vulnerable to back trouble. Stress may trigger spasms in some people because unrelieved tension tightens muscles, resulting in back pain. Managing or eliminating sources of stress can help reduce the risk of back pain.
People who spend a great deal of time sitting at work or when traveling for long distances may experience back strain. Much more weight is exerted on the lower back when sitting, according to a Swedish study. Unfortunately, this risk is increased by the use of office chairs with insufficient back support. It may be helpful to interrupt sitting at regular intervals by standing and walking around for a few minutes.
When lifting heavy or even light objects, people should guard against using their back muscles. Bending the knees is suggested when lifting so that back muscles do not bear all of the pressure.
A person who works in awkward positions is also likely to be subject to back problems. Assembly-line workers, nurses, electricians, housekeepers, and farmers are all required to bend forward for long periods in carrying out their work. To minimize the risk of back injury, physical therapists recommend resting regularly or changing positions. People who stand for a prolonged period of time are advised to use a small stool or other footrest and to slightly elevate one foot so as to straighten the lower back.
Some Helps in Preventing Back Pain
- Avoid picking up something in a quick, jerky motion. Instead of bending from the waist, bend at the knees.
- Ask for help when lifting heavy items.
- When carrying several packages, balance the load on each side. If carrying one heavy item, carry with both arms in front, next to the body. If carrying to the side, alternate sides.
- For travel, use a collapsible luggage carrier and/or lightweight luggage with shoulder straps.
- When lifting packages out of a car trunk, position the packages close to the body before lifting them.
- When vacuuming, use a long-handled vacuum cleaner. Instead of bending from the waist to vacuum underneath items, kneel on one knee, using knee pads. If you must bend from the waist, then, when possible, use one hand to support yourself on something.
- When doing office work, alternate sitting at a desk with standing at a waist-high work surface.
- Kneel down when gardening, and break up the work into shorter segments. When standing do not bend from the waist.
- Do back exercises on a regular basis even if only for 10 to 15 minutes a day. Use moderate exercises if you are older.
- When making beds, kneel on the bed with one knee, and brace yourself with one arm when reaching across the bed. When straightening or tucking in sheets, kneel on the floor at each side of the bed.
- When driving long distances, take rest stops. If the back of the car seat is not comfortable, use a pillow to fill in the space where the seat does not fit the small of the back properly.
- Don’t jog on hard surfaces. Wear proper exercise shoes.
- Use a pillow or other back support when sitting in an easy chair or sofa. Get up slowly, using your legs to push up.
- If you spend hours sitting at work, get a chair that has a properly shaped back support. Get up at times, and move around.
- Don’t bend over file-cabinet drawers for any extended period, but sit on a chair when you can.
- If you have to wear high-heeled shoes during the day, bring a more comfortable pair to alternate with them when possible.
The Search for Treatment
For the majority of those us who experience back pain of muscular origin, doctors recommend conservative treatment - bed rest, use of heat, massage, exercise, and, initially, anti-inflammatory pain-relieving drugs. As regards the latter, Dr. Mark Brown of the University of Miami School of Medicine offers a word of caution. He notes that in the United States, the prolonged use of drugs is a major cause of back pain suffering, that is, from the side effects of medications. People need to guard against developing a tolerance for a drug, which could result in increased dosage, possibly causing addiction. Physical therapy and chiropractic visits may also offer help and relief to some sufferers. Chiropractic care accounts for about two thirds of all patient visits for back pain in the United States, notes the journal HealthFacts.
Surgery may be necessary to correct problems or relieve pain associated with herniated disks. More often, however, doctors will first recommend conservative treatment for the majority of back-pain sufferers. People who are told they need surgery would do well to obtain second or third opinions.For millions of sufferers, constant but bearable back pain is a part of life. Many resign themselves to the pain but endeavor not to let it interfere with day-to-day activities.
I am aware of factors that induce my back pain and take measures to prevent or counteract it. I exercise regularly, maintain proper weight, improved my posture, and try to reduce stress in my life. Despite bouts of recurring pain from a herniated disk and from muscle spasms, I maintain a busy schedule, spending much time in the garden.
Many sufferers maintain a positive attitude while working toward controlling their back pain.
