Backache

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Backache

Considering all the grief and bother it causes people, back pain ranks right up there with the common cold. And like the common cold, which responds just as well to chicken soup as to antibiotics, "treating chronic low back pain effectively requires the consistent use of seemingly simple remedies, not rocket science methods," says Brent V. Lovejoy, D.O., an occupational medicine specialist in Denver and a medical consultant to the construction industry.

Only about 20 percent of acute back pain can be traced to some obvious cause, such as a herniated disk. So most back pain is considered a "mechanical" problem. And it's not all that easy to diagnose.

"Talk with ten different doctors and you will get ten different opinions as to exactly where in the back this pain originates," says Scott Haldeman, M.D., D.C., Ph.D., associate clinical professor in the Department of Neurology at the University of California, Irvine, and adjunct professor at the Los Angeles Chiropractic College. Muscle spasms, jammed back joints and stretched ligaments have all been implicated.

What is known for sure is that in addition to having a medical evaluation, there are lots of things you can do for yourself, both to ease flare-ups and to ward off future backaches. In fact, a few of these things are so important that doctors who treat back pain successfully consider them essential, not optional!

Raise your fitness level. "If you have a back injury that does not require surgery, studies indicate your aerobic capacity level is the single most important predictor of getting better," Dr. Lovejoy says. In other words, if you're physically fit, you're much more likely to recover.

That's why daily aerobic exercise is the "treatment of choice" in the view of Dr. Lovejoy and many other doctors. "For the construction workers I treat, I recommend brisk walking with hand weights and strength training with free weights," Dr. Lovejoy says. Adds Dr. Haldeman: "Do anything and everything that you can do comfortably and continuously."

Cushion your dogs. The pounding stress that running, and even just walking, normally produces is transmitted right up your back. And for a weak back, that can mean pain.

"Shoes designed specifically to absorb shock, such as running shoes, or special shock-absorbing inserts available at sporting goods stores may reduce back pain," says researcher Arkady Voloshin, Ph.D., professor of engineering in the Department of Mechanical Engineering and Mechanics at Lehigh University in Bethlehem, Pennsylvania. In one study, Dr. Voloshin found that 80 percent of back pain sufferers reported rapid and significant relief when they switched from basic street shoes to lightweight, flexible-soled shoes with simple shock-absorbing cushions.

Get horizontal--then get going. Rest, not exercise, is what most doctors recommend initially for acute back pain. "But we tell people that in order to get their circulation going, they need to be up and walking around for 45 minutes of every three hours," Dr. Lovejoy says. "Otherwise, they stiffen up like a board, and everything they do hurts."

Don't overdo a rest stop. More than two days' bed rest may not be, helpful, according to Richard A. Deyo, M.D., D.P.H., professor in the Departments of Medicine and Health Services at the University of Washington in Seattle.

He found that back pain sufferers who were advised to stay in bed just two days missed 45 percent fewer days of work during the following three months than patients advised to rest for a full week. Muscles may weaken quickly with bed rest, and weak muscles can perpetuate an aching back.

Turn to aspirin, Advil or Tylenol. Any over-the-counter painkiller that contains aspirin, ibuprofen (Advil) or acetaminophen (Tylenol) could ease your back pain, according to Dr. Haldeman. But don't use painkillers before the fact. "If you know you are going to have back pain if you do something such as running, it's better not to do the activity than to mask your pain with drugs," says Dr. Haldeman. And do not give aspirin to children because of the risk of Reye's syndrome.

Get a posture check. Neither a fence post nor a spaghetti noodle be. An erect but relaxed stance, both standing and sitting, puts the least stress on back muscles, experts say.

Find your most restful position. Is your lower back acting up? Try this relaxation tactic: Lie on the floor with your knees bent at a 90-degree angle and your calves resting on the seat of a chair. "This position reduces pressure in your back more than anything else," Dr. Haldeman says. "Most people find it very comfortable."

Warm up your muscles before you hit high gear. Like old rubber bands, stiff muscles can fray when they're stretched by sudden movement. So warm up first with a few minutes of relaxed walking. Swing your hips and arms as you walk, then try a few slow side-to-side twists. If you're planning a specific activity, such as a golf swing, go through the motion several times, slowly, before you add speed and force.

Try some aqua- and yoga-laxation. Water exercises, especially an arthritis range-of-motion program, are a safe and effective way to knock the rust off back muscles that haven't been stretched for a while, says Dr. Haldeman. Check with your doctor, hospital or health center to find out where these programs are offered. Many people with back problems benefit from yoga, too, according to Dr. Haldeman--provided they begin slowly and advance according to their tolerance and ability.

When to See the Doctor Seventy to 90 percent of back pain goes away by itself or with some minor home treatment," says Scott Haldeman, M.D., D.C., Ph.D., associate clinical professor in the Department of Neurology at the University of California, Irvine, and adjunct professor at the Los Angeles Chiropractic College. See a doctor if your back pain doesn't improve after three days--or if the pain is so bad you can't budge from the bed. You'll also need a doctor's advice if your legs are weak or numb or if back pain is accompanied by fever. Other call-the-doctor symptoms include stomach cramps, chest pain and difficulty breathing. In some cases, back pain may be associated with loss of bowel or bladder control. This demands immediate attention: It may indicate a severely herniated disk or spinal cord or nerve damage.

Roll on a tennis ball. It's possible to relieve pain with "acupressure'' or "trigger point" treatment using a tennis ball, says Robert King, co-director of the Chicago School of Massage Therapy and a nationally certified massage therapist. (He also recommends some of the wooden "pain relievers" designed for people who have aches and pains--such as a Backnobber.)

For the tennis ball treatment: Lie on a hard surface and position the tennis ball under you so that it is pressing against a tender spot. Roll onto the ball gradually, utilizing your body weight until the pain and tenderness subside.

To decrease back pain, don't smoke. Experimental work has shown that smoking reduces the amount of oxygen that travels, via osmosis, to spinal disks at night while you sleep. "If you smoke a pack of cigarettes a day, you'll probably double the amount of back pain you would have if you didn't smoke," Dr. Lovejoy says.

Ice it up. To get ready for a gentle icing, first freeze some water in a small paper cup. When you're ready to use it, Dr. Haldeman says, peel back the side of the cup to expose about 1/2 inch or so of ice. Lie on your stomach with a towel on your back, and have a friend or spouse massage your aching spots with the ice. (The ice should not be applied directly to the skin.) You can also lie down on your back with your knees bent and slide a bag of crushed ice (wrapped in a wet towel) under the sore spot, Dr. Lovejoy says.

Warm up the ache. A heating pad or hot water bottle can help. Or simply curl up in front of a hot wood stove to ease your aches. How do you decide whether your aching back needs heat or cold? "You pick one or the other, try it for a while and see if it helps," Dr. Haldeman says.