Ask The Doctor – Back Pain

Please tell me more about back pain. Back pain is one of the most common conditions for which people visit the medical provider.

docLet’s look at the structure first. There are muscles which are attached to bones by tendons and there are ligaments which attach bones to each other. Discs are soft tissue between the many back bones (vertebras). The discs have a gel sack in the center which acts like a silicone cushion. Muscles, ligaments, discs and tendons are the soft tissues. Bones are the hard tissues. Any of these can cause pain.
Back pain has many causes. The soft tissues are the main parts that get injured. You have to have a major impact to hurt a back bone, like a car crash or falling down from a height.

The most common cause is a pulled muscle causing spasm. This comes from bending or lifting incorrectly. Either the back wasn’t aligned properly and/or the load was too much. Sometimes the other soft tissues also become damaged from such an injury. You can injure yourself bending over the wrong way to pick up a sheet of paper. I have to be careful to sneeze facing forward and untwisting myself to avoid injuring my back.
One should always lift with the buttocks down and the head straight up, facing the load. Pull the load close to the body and lift with the legs. It looks strange but it saves you days or years of pain. If the load is too heavy or awkward, like a large box, wait for help, don’t take a chance.

Herniated or Ruptured Disc: If you lift something too heavy and you feel a pop in your back, you may have ruptured one of your discs. This means that the disc was smashed so much that the gel broke a hole in the disc and has squirted out a little. Usually the gel touches a nerve nearby and that causes irritation down the nerve. These nerves pass down the buttocks to the legs and feet. So you may feel a stripe of pain down one side of your leg and foot. This pain is worse if you sneeze or cough. The physician knows certain tests to perform to see if it is a disc problem.

Older people who don’t get enough sun or exercise can have thin, weak bones—osteoporosis. So when they lift a moderately heavy object, the vertebra (back bone segment) gets crushed like the bottom box of a high stack.
Rarely, cancer is a cause of back pain.

Prevention: Keep your weight down, have less than an inch of fat near the navel (belly button). A large belly pulls on the lower back and is a good setup for a back injury. Do aerobic exercises like biking, rowing, or swimming. The more you use your trunk the stronger the back muscles will be. There are exercises for your back on the web. Crunches are important, since the abdominal muscles oppose-balance the back muscles to maintain good balance and posture. Speaking of posture, don’t slouch; sit and stand up straight. Put a small pillow or rolled up towel behind the lower back to prevent the slouching some seats make you do. Some car seats are poorly designed. Take out the thick wallet if sitting on it for more than a few minutes. Soft mattresses can cause back pain. You might consider putting a 1/4inch plywood sheet between your mattress and the box springs. Lumbar support belts look cool to some people but are not highly recommended; they may cause you to not exercise and have weak back and abdominal muscles. Stretching before exercising doesn’t have a lot of evidence. When you exercise, start out slow to warm up, then increase the exercise intensity. The internet has back exercises and stretches.

Treatment: Our natural inclination is to lay in bed to avoid pain. More than a day or so of this and the healing will be prolonged. Do get out of bed or the chair and walk around. Increase activity to feel only moderate pain or less. Avoid severe pain. If you lay down, put a thick pillow under your knees to take the pressure off your back. If you lay on your side, put a thick pillow between your knees to keep your upper leg from twisting your back over.

Manipulation by an osteopath (D.O. such as myself) or a chiropractor can be very helpful for some people. If you don’t feel enough relief by the second treatment, probably manipulation isn’t going to do much for you.
Stretches and exercises for those who have back pain are a good idea and available on the web from trustworthy sources.

Tylenol and ibuprofen are good medicines to try. Don’t take more than the label says without seeing a physician since you don’t want to lose your kidneys or liver.

If you have a herniated disc, it is easy to think that surgery is the way to put the gel back. I too was surprised when studies showed that rest for a day or so and then exercise as I explained, helps most discs recover enough without surgery.

Keep those questions coming. Are you sitting up straight right now?

By Dr Pearce