Back Pain

(Backache, back strain, piriformis syndrome, sciatica)

At least 80 percent of all Americans suffer an occasional backache, and for 15 percent, the problem is chronic. The majority of backaches originate in the lumbar spine, between the waist and tailbone, the cervical spine (neck) is the second most common source of pain. Depending upon the cause, the pain may be constant, dull, and centered in one area; or it may be acute or stabbing, and spread from the lower back to the buttocks and legs or from the neck to the jaw and arms.

Most back pain is due to muscle strains and spasms, often the result of improper lifting or abrupt twisting. Poor posture, obesity, and pregnancy are common contributing factors, as is a sedentary lifestyle. A slipped or ruptured disk, the spongy cushion that lies between each pair of vertebrae can also cause back pain, especially if the disk pinches a nerve in the neck or lower back. So can a structural abnormality, such as a
curved spine (scoliosis).

You should see a doctor if back pain persists for more than two weeks despite rest, or if it recurs. Don't delay if the pain is accompanied by other symptoms, such as numbness in the arms or legs, or loss of bowel or bladder control.

Diagnostic Studies and Procedures

After examining your back and testing nerve reflexes, the doctor will probably order X-rays of the back. If a ruptured disk is suspected, imaging studies such as computed tomography (CT scans or magnetic resonance imaging (MRI) can pinpoint the problem. Other tests may include bone density studies and nerve and muscle evaluations.

Medical Treatments

Most simple backaches can be managed with aspirin (or stronger non-steroidal anti-inflammatory drugs) and rest (see Self-Treatment). If this conservative course proves inadequate, a muscle relaxant and perhaps a cortisone injection may be tried.

Sometimes immobilizing the back with a brace, neck collar, or traction is needed, especially if the problem stems from a back injury. Persistent back pain caused by a ruptured disk may require surgery to remove the disk. Back pain due to a structural abnormality or disease requires treatment of the underlying condition.

Alternative Therapies

Back pain is one area in which alternative therapies are widely used and often highly effective. Included are:

Acupuncture or Acupressure. These techniques, the cornerstones of traditional Chinese medicine, are widely used to overcome chronic back pain. Treatments involve inserting needles into or pressing on the meridians (body points) related to back pain. Some patients report relief after the first treatment; more commonly, however, a series of six or more sessions is needed to produce results.

Alexander Technique. Many chronic back problems are due to poor posture, which often can be remedied by training in the Alexander technique. After carefully analyzing a person's posture and body movement, the practitioner will teach exercises and movements designed to bring the back bones into proper alignment and to strengthen the supporting muscles.

Chiropractic. This alternative therapy, which involves manipulating the spine to correct faulty alignment, is one of the most widely used treatments for back pain. Even physicians who are critical of other aspects of chiropractic often recommend it for back patients, but to be sure that there is no underlying medical problem, a physician should be consulted first.

Massage. Because so many backaches are caused by muscle spasms, massage designed to relax the tensed muscles is a natural remedy. Techniques may range from the relatively gentle Swedish (classic) massage to rolling, a deep massage that calls for considerable pummeling (A word of caution: Rolling can be dangerous for people with osteporosis, spinal arthritis, and other degenerative bone disorders.)

Osteopathy and Physical Therapy. These approaches include such methods as massage, electrical stimulation, ultrasound, and manipulation to relax tensed muscles and alleviate pain.

Yoga and T'ai Chi. These and other movement therapies can strengthen supporting muscles, improve posture, and reduce stress -- all important elements in controlling back pain.

Self-Treatment
Appropriate self-care is the key to overcoming and preventing back pain. Although most simple backaches are easily self-treated, you should consult a doctor to rule out a serious underlying problem before embarking on a self-treatment regimen for back pain.

During an acute flare-up, back pain due to muscle strain or an injury requires rest in order to heal. Lie on a firm surface, such as a hard mattress or floor mat. Don't lie on your stomach (even though this may be the most comfortable position); instead, position yourself on your back with your knees slightly bent and supported by a pillow, or on your side with the knees bent. For extra relief, try using a healing pad, an ice pack, or alternating applications of heat and ice.

As soon as the pain eases, start exercises designed to strengthen your back. A word of warning, however: If an exercise produces pain, STOP it immediately. Pain is a warning that something is wrong. Other preventive measures include:

• Use the correct techniques for lifting and carrying.
• If you work at a desk or computer display terminal, make sure that your chair provides proper back support, and that the desk and chair are comfortable heights for you.
• Avoid prolonged periods of silting; they put undue stress on the back muscles. Whether at work or in a car, theater, or airplane, take a break to stretch and walk around at feast once every hour or so.
• If your job requires long periods of standing, rest one foot on a low stool to ease back strain. Try to move about every few minutes.
• Work to improve posture through such exercises as yoga, dance, and the Alexander technique.
• Sleep on a firm mattress, or put a bed board under it.

Other Causes of Back Pain

Severe osteoporosis, or thinning of the bones, often results in compression of the spinal column, spontaneous fractures of the vertebrae, and chronic back pain. Arthritis can also cause chronic back pain. A less common cause is cancer that has spread to the I bones.