Back to the Basics – A Guide to Preventing Back Pain

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An everything-you-need-to-know guide to preventing back pain.

It’s easy to take your back for granted, until it hurts. That’s when it dawns on you, once again, just how essential your spine is for everything you do each day’s standing, walking, sitting, bending, carrying things and more. So, it’s no wonder back problems can be so debilitating. They’re the second leading cause of disability in the U.S., according to the Centers for Disease Control and Prevention (CDC), and they appear to be on the rise. In a survey of 4,437 households in 1992 and 5,357 in 2006, researchers at the University of North Carolina (UNC) at Chapel Hill found that chronic low back pain that impaired daily activities had nearly tripled.

Unfortunately, all too often, doctors and those with ongoing back trouble aren’t using the treatments that have the best evidence for effectiveness behind them, according to another study by UNC researchers. That trial concluded that narcotic medications are overused, while antidepressants and exercise aren’t tried often enough. The majority of lower back pain issues are more mild stretching or tendon-tearing, rather than deeper injuries to the disc or pinched nerve, says Neal Alpiner, M.D., a neurorehabilitation specialist at William Beaumont Hospital, in Royal Oak, Michigan. That doesn’t mean we shouldn’t treat the back pain; it means we shouldn’t over treat the back pain, which suggests, too, that you don’t need your doctor to give you an optimal back pain-management plan. In fact, you could follow the advice we’ve gathered here in our everything-you-need-to-know guide to preventing back pain almost none of it requiring even a doctor’s visit and probably see a big decrease in the frequency and severity of your pain. If a person were to take the following nine steps, they would greatly reduce their risk of back problems and shorten the recovery period should a back problem arise, Alpiner agrees. Read onto get started on a healthier, happier back today.

Stay at a healthy weight.
Simply put, extra pounds strain the body, especially the back. Excess weight seems to put a greater amount of pressure on the spine and accelerate some of the degeneration that normally occurs in the discs, explains Mehul J. Desai, M.D., M.P.H., director of pain medicine services at the George Washington Pain Center, in Washington, D.C. It also affects posture: The more weight you have in the front of your body, the more it pulls you forward, which puts your spine at a disadvantage. After having back surgery in 2005, Debra Vekstein made a concerted effort to lose weight and exercise more frequently to stay pain-free. I had back problems on and off for close to 20 years, and the combination of losing 50 pounds, stretching and exercising regularly has made a huge difference, says Vekstein, 50, a social worker in Washington, D.C. Now that I’m carrying less weight and I have a stronger core, I’m less prone to back pain. The way I look at it is, once you get rid of the pain, it’s about lifelong maintenance.

Move with care.
How you perform everyday tasks from loading or unloading the dishwasher to carrying shopping bags to taking out the trash can have a significant effect on how your back feels. Every motion has to have proper biomechanics, says Alpiner. Anything you can do to put your body in a better biomechanical alignment and reduce stress on your body will help your back. In other words, don’t twist your spine while standing or sitting for long periods (this strains the back), and be sure to always bend from the knees and hips, rather than the waist, when lifting something. If anyone knows the value of this advice, it’s Patti Oakland, 52, a mother of three grown children and a jewelry designer in Kalamazoo, Michigan, who has had recurring backaches since 2002, despite having two back surgeries. “I’ve continued to have back pain so I’ve had to make some lifestyle changes in order to move more comfortably”, she says. One thing that made a difference was reorganizing my cupboards and cabinets, placing the things I use most at a level where I don’t have to bend or reach. I also use the golfer’s pick-up: When I drop something on the floor, I put one leg out and bend from the hips, keeping my spine straight as I reach for the floor.

Get stronger.
It’s been ages since doctors recommended resting when your back hurts, because with inactivity those muscles just get weaker, which can make the pain worse. Instead, you need to keep moving and build up your core muscles, which include your abdominal, back, hip and thigh muscles, through physical therapy, strength-training exercises, Pilates or yoga. Core training helps support the back and strengthen and stabilize the muscles that keep us upright, explains Robert S. Gotlin, D.O., director of the orthopedic and sports rehabilitation program at Beth Israel Medical Center, in New York City. The abdominal muscles are really the Grand Central Terminal for the spine. (Alpiner believes that regular, appropriate exercise and maintaining proper body mechanics and posture are the two most important things anyone can do for their back.) Meanwhile, aerobic exercise whether it’s walking briskly, swimming, biking or anything else that keeps your body in motion and your heart rate up, helps with overall conditioning and weight control, enhances blood flow and triggers the release of feel-good endorphins, all of which can ease back pain.

John Holden, 48, has had recurring back problems since 1995. To avoid going under the knife, he stepped up his exercise regimen with water aerobics, swimming and eventually yoga. In 2005, my yoga instructor advised me to give yoga a year before deciding whether to have an artificial disc put in,” recalls Holden, a public relations manager in Chicago. I’m glad I listened because I now have less pain and stiffness and greater range of motion than I have had in 15 years. It does require a lot of time and commitment, but it’s worth it. In fact, a new study at West Virginia University found that yoga improves the ability to function, eases pain intensity and lifts depression in people with chronic low back pain.

Quit Smoking
Research has found a link between smoking and low back pain in adults and teenagers alike. Smoking decreases blood flow and depletes the delivery of oxygen to the muscles, nerves and tissues, Gotlin explains. So the muscles are in constant damage-repair mode, which, in turn, makes the back vulnerable to injury. Plus, smoking creates free radicals, unstable molecules that damage cells and cause inflammation. All of these changes can accelerate the degeneration of the discs, making it harder for your back to maintain good shock absorption. Another eye-opener: There are a growing number of surgeons who are holding off on doing surgery until people are smoke-free, Alpiner says, because smoking slows healing, too. So kick those butts now, for your back’s sake, as well as your overall health. All sorts of aid from smoking-cessation support groups and antidepressants to nicotine patches, gums, inhalers and nasal sprays can make breaking the habit a little easier.

Don’t see drugs or surgery as cure-alls.
Sure, they both have their roles, but they’re limited. Medications, which often have unwanted side effects, don’t address the underlying cause of back pain, and surgery can’t always fix a complicated problem. Surgery can only adjust the architecture: Central pain mechanisms, located in the spinal cord and brain, are not directly affected by spinal surgery explains Jeffrey Gross, M.D., a clinical associate professor of rehabilitation medicine at the New York University School of Medicine. And a lot of people look to drugs to deal with back pain. It’s part of our quick-fix culture. But sometimes the cause and solution to lower back pain are not always so clear.

Mary Westheimer found this out firsthand. After having surgery to repair a herniated disc in 2001, muscle spasms in her back caused the pain to return. Rather than relying on medication, she decided to go for acupuncture and chiropractic work. For me, these therapies aren’t a once-and-you’re-done solution, says Westheimer, 54, a sculptor’s assistant in Phoenix, Arizona. I continue to go for treatments, and they really do help. The chiropractic work helps convince my right hip, which tends to go out of place and contributes to my back problems, that it really should stay in place, and the acupuncture relieves the pain and muscle tension. Other effective noninvasive options with little risk and few side effects are physical therapy (PT)¸massage and other types of bodywork.

Brush up on back facts.
If only we knew as much about our backs as we do about who’s on American Idol. In Europe, there are back schools that address the prevention and rehabilitation of long-term back pain by providing information about how the back works, what causes pain and how to protect your back. In the U.S., this kind of education is often part of physical therapy, but if you’re not getting PT, you may not learn the basics of spinal health. We don’t take a very preventive look in this country: we’re more treatment-oriented, Desai says. So the onus is on you to learn how your back functions and how to protect it.

Make your job easier on your back.
Not surprisingly, manual labor jobs can easily lead to back pain because of the heavy lifting involved, but even desk jockeys are at risk. Most people don’t realize that the incidence of lower back pain is higher in people who have sedentary desk jobs, notes Peggy W. Brill, a physical therapist and certified orthopedic specialist in New York City. In fact, new research from the Paris Descartes University in France found that maintaining the same posture for hours at work often causes low back pain.

That’s why it’s important to make your workspace back-friendly. For starters, sit with your upper back against a firm, supportive chair; maintain a hollow in your low back (a rolled-up towel placed against your lower spine supports the natural lumbar curve); keep your thighs parallel to the floor; and adjust your computer screen to eye level so you don’t have to crane your neck. Keep your keyboard and monitor directly in front of you so that you’re not in a twisted position, adds Brill. Even if you’re working against a deadline, get up and move around every 30 minutes throughout the day, Gross recommends. Sitting in one position without a change causes fatigue of the postural muscles in the entire spine and may lead to pain and loss of normal postural muscle control,” which can make it even harder to maintain good posture while you’re sitting.

Ease stress regularly.
Stress has an enormous role in the management of neck and back pain, Desai says. With increased stress, (both types of pain) tend to get worse because there’s an increase in the clenching of muscles and an increased sense of more aggravating pain. That’s why it’s so important to find your own personal release valves and to use them often by regularly meditating, doing deep breathing, using self-hypnosis or spending time doing activities or hobbies you enjoy. This way, you can help prevent stress from taking a toll on your back, and you’ll be able to use the pleasure principle to remind yourself that there’s more to your life than back pain when it does flare up.

Pay attention to how and where you sleep.
First, make an effort to get enough snooze time because a sleep deficit leads to muscle fatigue and weakness and increases stress on the body, which can cause back pain, Alpiner notes. Second, consider your position: Back-sleeping is bad for some, but fine for others. If you find a position that’s more comfortable tell your doctor, as it may be a clue as to what’s wrong with your back. Third, think about sleeping habits in a new way: What kind of shape is your bed in? How does your pillow look? If you see your mattress sagging or it’s not giving you enough support, it may be time for a new one, Mehul Desai says. Mattresses should probably be replaced more often than they are every 10 years or so is reasonable, though it may depend on how much time you spend in bed. Generally, a firm mattress is better for your back, and try to avoid overstuffed pillows: Your head shouldn’t be elevated at an angle greater than 10, says Gotlin.

These upgrades are worth it: When researchers at Oklahoma State University had people with minor musculoskeletal pain compare sleeping in their own beds for 28 days to sleeping in new, medium-firm beds, most reported better sleep quality and less back discomfort with the new beds.

Written by: Stacey Colino, a Maryland based health writer
Originally published in Pain Solutions Magazine, Spring 2010

Photo Credit: by Yanc, courtesy of Stock Free Images

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