Nature Creation ArticlesHealth, Pain, Therapy, Remedies

Back pain is a com­mon com­plaint. Four out of five peo­ple in the United States will expe­ri­ence low back pain at least once dur­ing their lives. It’s one of the most com­mon rea­sons peo­ple go to the doc­tor or miss work.

On the bright side, you can pre­vent most back pain. If pre­ven­tion fails, sim­ple home treat­ment and proper body mechan­ics will often heal your back within a few weeks and keep it func­tional for the long haul. Surgery is rarely needed to treat back pain.

Causes

Your back is an intri­cate struc­ture com­posed of bones, mus­cles, lig­a­ments, ten­dons and disks — the cartilage-like pads that act as cush­ions between the seg­ments of your spine. Back pain can arise from prob­lems with any of these com­po­nent parts. In some peo­ple, no spe­cific cause for their back pain can be found.

Strains

Back pain most often occurs from strained mus­cles and lig­a­ments, from improper or heavy lift­ing, or after a sud­den awk­ward move­ment. Some­times a mus­cle spasm can cause back pain.

Struc­tural problems

In some cases, back pain may be caused by struc­tural prob­lems, such as:

* Bulging or rup­tured disks. Disks act as cush­ions between the ver­te­brae in your spine. Some­times, the soft mate­r­ial inside a disk may bulge out of place or rup­ture and press on a nerve. But many peo­ple who have bulging or her­ni­ated disks expe­ri­ence no pain from the condition.

* Sci­at­ica. If a bulging or her­ni­ated disk presses on the main nerve that trav­els down your leg, it can cause sci­at­ica — sharp, shoot­ing pain through the but­tock and back of the leg.

* Arthri­tis. The joints most com­monly affected by osteoarthri­tis are the hips, hands, knees and lower back. In some cases arthri­tis in the spine can lead to a nar­row­ing of the space around the spinal cord, a con­di­tion called spinal stenosis.

* Skele­tal irreg­u­lar­i­ties. Back pain can occur if your spine curves in an abnor­mal way. If the nat­ural curves in your spine become exag­ger­ated, your upper back may look abnor­mally rounded or your lower back may arch exces­sively. Sco­l­io­sis, a con­di­tion in which your spine curves to the side, also may lead to back pain.

* Osteo­poro­sis. Com­pres­sion frac­tures of your spine’s ver­te­brae can occur if your bones become porous and brittle.

Rare but seri­ous conditions

In rare cases, back pain may be related to:

* Cauda equina syn­drome. This is a seri­ous neu­ro­log­i­cal prob­lem affect­ing a bun­dle of nerve roots that serve your lower back and legs. It can cause weak­ness in the legs, numb­ness in the “sad­dle” or groin area, and loss of bowel or blad­der control.

* Can­cer in the spine. A tumor on the spine can press on a nerve, caus­ing back pain.

* Infec­tion of the spine. If a fever and a ten­der, warm area accom­pany back pain, the cause could be an infection.

Fac­tors that increase your risk of devel­op­ing low back pain include:

* Smoking

* Obesity

* Older age

* Female gender

* Phys­i­cally stren­u­ous work

* Seden­tary work

* Stress­ful job

* Anxiety

* Depression

Most back pain grad­u­ally improves with home treat­ment and self-care. Although the pain may take sev­eral weeks to dis­ap­pear com­pletely, you should notice some improve­ment within the first 72 hours of self-care. If not, see your doctor.

In rare cases, back pain can sig­nal a seri­ous med­ical prob­lem. See a doc­tor imme­di­ately if your back pain:

* Is con­stant or intense, espe­cially at night or when you lie down

* Spreads down one or both legs, espe­cially if the pain extends below the knee

* Causes weak­ness, numb­ness or tin­gling in one or both legs

* Causes new bowel or blad­der problems

* Is asso­ci­ated with pain or pul­sa­tion (throb­bing) in the abdomen, or fever

* Fol­lows a fall, blow to your back or other injury

* Is accom­pa­nied by unex­plained weight loss

Also, see your doc­tor if you start hav­ing back pain for the first time after age 50, or if you have a his­tory of can­cer, osteo­poro­sis, steroid use, or drug or alco­hol abuse.

Diag­nos­tic tests aren’t usu­ally nec­es­sary to con­firm the cause of your back pain. How­ever, if you do see your doc­tor for back pain, he or she will exam­ine your back and assess your abil­ity to sit, stand, walk and lift your legs. He or she may also test your reflexes with a rub­ber reflex ham­mer. These assess­ments help deter­mine where the pain comes from, how much you can move before pain forces you to stop and whether you have mus­cle spasms. They will also help rule out more seri­ous causes of back pain.

If there is rea­son to sus­pect that you have a tumor, frac­ture, infec­tion or other spe­cific con­di­tion that may be caus­ing your back pain, your doc­tor may order one or more tests:

* X-ray. These images show the align­ment of your bones and whether you have arthri­tis or bro­ken bones. X-ray images won’t directly show prob­lems with your spinal cord, mus­cles, nerves or disks.

* Mag­netic res­o­nance imag­ing (MRI) or com­put­er­ized tomog­ra­phy (CT) scans. These scans can gen­er­ate images that may reveal her­ni­ated disks or prob­lems with bones, mus­cles, tis­sue, ten­dons, nerves, lig­a­ments and blood vessels.

* Bone scan. In rare cases, your doc­tor may use a bone scan to look for bone tumors or com­pres­sion frac­tures caused by osteo­poro­sis. In this pro­ce­dure, you’ll receive an injec­tion of a small amount of a radioac­tive sub­stance (tracer) into one of your veins. The sub­stance col­lects in your bones and allows your doc­tor to detect bone prob­lems using a spe­cial camera.

* Nerve stud­ies (elec­tromyo­g­ra­phy, or EMG). This test mea­sures the elec­tri­cal impulses pro­duced by the nerves and the responses of your mus­cles. Stud­ies of your nerve-conduction path­ways can con­firm nerve com­pres­sion caused by her­ni­ated disks or nar­row­ing of your spinal canal (spinal stenosis).

Most back pain gets bet­ter with a few weeks of home treat­ment and care­ful atten­tion. A reg­u­lar sched­ule of over-the-counter pain reliev­ers may be all that you need to improve your pain. A short period of bed rest is okay, but more than a cou­ple of days actu­ally does more harm than good. If home treat­ments aren’t work­ing, your doc­tor may sug­gest stronger med­ica­tions or other therapy.

Med­ica­tions

Your doc­tor may pre­scribe non­s­teroidal anti-inflammatory drugs or in some cases, a mus­cle relax­ant, to relieve mild to mod­er­ate back pain that doesn’t get bet­ter with over-the-counter pain reliev­ers. Nar­cotics, such as codeine or hydrocodone, may be used for a short period of time with close super­vi­sion by your doctor.

Low doses of cer­tain types of anti­de­pres­sants — par­tic­u­larly tri­cyclic anti­de­pres­sants, such as amitripty­line — have been shown to relieve chronic back pain, inde­pen­dent of their effect on depression.

Phys­i­cal ther­apy and exercise

A phys­i­cal ther­a­pist can apply a vari­ety of treat­ments, such as heat, ice, ultra­sound, elec­tri­cal stim­u­la­tion and muscle-release tech­niques, to your back mus­cles and soft tis­sues to reduce pain. As pain improves, the ther­a­pist can teach you spe­cific exer­cises to increase your flex­i­bil­ity, strengthen your back and abdom­i­nal mus­cles, and improve your pos­ture. Reg­u­lar use of these tech­niques will help pre­vent pain from com­ing back.

Injec­tions

If other mea­sures don’t relieve your pain and if your pain radi­ates down your leg, your doc­tor may inject cor­ti­sone — an anti-inflammatory med­ica­tion — into the space around your spinal cord (epidural space). A cor­ti­sone injec­tion helps decrease inflam­ma­tion around the nerve roots, but the pain relief usu­ally lasts less than six weeks.

In some cases, your doc­tor may inject numb­ing med­ica­tion into or near the struc­tures believed to be caus­ing your back pain. Early stud­ies indi­cate that bot­u­lism toxin (Botox) also may help relieve back pain, per­haps by par­a­lyz­ing strained mus­cles in spasm. Botox injec­tions typ­i­cally wear off within three to four months.

Surgery

Few peo­ple ever need surgery for back pain. There are no effec­tive sur­gi­cal tech­niques for mus­cle– and soft-tissue-related back pain. Surgery is usu­ally reserved for pain caused by a her­ni­ated disk. If you have unre­lent­ing pain or pro­gres­sive mus­cle weak­ness caused by nerve com­pres­sion, you may ben­e­fit from surgery. Types of back surgery include:

* Fusion. This surgery involves join­ing two ver­te­brae to elim­i­nate painful move­ment. A bone graft is inserted between the two ver­te­brae, which may then be splinted together with metal plates, screws or cages. A draw­back to the pro­ce­dure is that it increases the chances of arthri­tis devel­op­ing in adjoin­ing vertebrae.

* Disk replace­ment. An alter­na­tive to fusion, this surgery inserts an arti­fi­cial disk as a replace­ment cush­ion between two vertebrae.

* Par­tial removal of disk. If disk mate­r­ial is press­ing or squeez­ing a nerve, your doc­tor may be able to remove just the por­tion of the disk that’s caus­ing the problem.

* Par­tial removal of a ver­te­bra. If your spine has devel­oped bony growths that are pinch­ing your spinal cord or nerves, sur­geons can remove a small sec­tion of the offend­ing ver­te­bra, to open up the passage.

You may be able to avoid back pain by improv­ing your phys­i­cal con­di­tion and learn­ing and prac­tic­ing proper body mechanics.

To keep your back healthy and strong:

* Exer­cise. Reg­u­lar low-impact aer­o­bic activ­i­ties — those that don’t strain or jolt your back — can increase strength and endurance in your back and allow your mus­cles to func­tion bet­ter. Walk­ing and swim­ming are good choices. Talk with your doc­tor about which activ­i­ties are best for you.

* Build mus­cle strength and flex­i­bil­ity. Abdom­i­nal and back mus­cle exer­cises (core-strengthening exer­cises) help con­di­tion these mus­cles so that they work together like a nat­ural corset for your back. Flex­i­bil­ity in your hips and upper legs aligns your pelvic bones to improve how your back feels.

* Quit smok­ing. Smok­ers have dimin­ished oxy­gen lev­els in their spinal tis­sues, which can hin­der the heal­ing process.

* Main­tain a healthy weight. Being over­weight puts strain on your back mus­cles. If you’re over­weight, trim­ming down can pre­vent back pain.

Use proper body mechanics:

* Stand smart. Main­tain a neu­tral pelvic posi­tion. If you must stand for long peri­ods of time, alter­nate plac­ing your feet on a low foot­stool to take some of the load off your lower back.

* Sit smart. Choose a seat with good lower back sup­port, arm rests and a swivel base. Con­sider plac­ing a pil­low or rolled towel in the small of your back to main­tain its nor­mal curve. Keep your knees and hips level.

* Lift smart. Let your legs do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lift­ing and twist­ing simul­ta­ne­ously. Find a lift­ing part­ner if the object is heavy or awkward.

Many peo­ple choose hands-on ther­a­pies to ease their back pain:

* Chi­ro­prac­tic care. Back pain is one of the most com­mon rea­sons that peo­ple see a chi­ro­prac­tor. If you’re con­sid­er­ing chi­ro­prac­tic care, talk to your doc­tor about the most appro­pri­ate spe­cial­ist for your type of prob­lem. In addi­tion to chi­ro­prac­tors, many osteo­pathic doc­tors and some phys­i­cal ther­a­pists have train­ing in spinal manipulation.

* Acupunc­ture. Some peo­ple with low back pain report that acupunc­ture helps relieve their symp­toms. The National Insti­tutes of Health has found that acupunc­ture can be an effec­tive treat­ment for some types of chronic pain. In acupunc­ture, the prac­ti­tioner inserts ster­il­ized stain­less steel nee­dles into the skin at spe­cific points on the body.

* Mas­sage. If your back pain is caused by tense or over­worked mus­cles, mas­sage ther­apy may help loosen knot­ted mus­cles and pro­mote relaxation.

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