Low Back Pain: Healing your aching back

By Jeffrey N. Katz, MD

Back pain has many causes and, as a result, many treatments. Low Back Pain: Healing your aching back, a Special Health Report from Harvard Medical School, helps you understand why back pain occurs and which treatments are most likely to help. Treatment of low back pain has undergone a recent sea change. Experts now appreciate the central role of exercise to build muscles that support the back. They also better understand which conditions surgery will help and which patients are good surgical candidates. This report describes the different types of back problems and the tailored treatments that are more likely to help specific conditions. A special section is dedicated to the self-care steps you can take to mend your back, and features information on different types of exercise and complementary therapies such as chiropractic care, acupuncture, and massage, as well as healthy back habits and tips on choosing a mattress.

• Language: English
• Publisher: BookBaby
• Release date: May 8, 2014
• ISBN: 9781614010814

Book preview

Editor

Who develops back problems?

If you’re like most adults, you’ll probably suffer from low back pain at some point in your life. Although anyone can develop backache regardless of their health or circumstances, research has found that some conditions or activities put you at greater risk for such problems. Key factors include the following.

Age

People are most likely to suffer from low back pain in midlife. During the middle years, even in the absence of any injury, the bones and joints in your lower back (the lumbar spine) begin to change (see Figure 1). Disks (the structures that serve as cushions between the bones in the spine) tend to wear out and sometimes become fragmented (see Disk abnormalities,). These structural alterations sometimes cause pain. While back pain problems may be more common in people in their middle years, in older individuals back pain attacks are more severe and last longer.

What is low back pain?

Despite its being so common, low back pain remains something of a medical puzzle. Even after extensive tests, physicians often can’t pinpoint an exact cause. Many people with low back pain visit one doctor after another only to come away with conflicting opinions. Most cases of back pain are ultimately classified as idiopathic, meaning they have no known cause—yet the pain is all too real to the person affected.

Why is low back pain such an enigma? It is important to understand that back pain does not describe a single entity. Instead, back pain is an umbrella term that includes a number of discrete medical conditions that can vary in severity. In fact, some of these conditions don’t even originate in the back.

The way you manage your symptoms will depend on the type of low back condition you have and whether the pain is acute (that is, comes on suddenly but will likely get better in a matter of weeks) or chronic (lasting more than three months with no improvement, or even getting progressively worse).

One thing is clear, whether your back pain is acute or chronic: to regain your get-up-and-go, you need to do just that—become active, at least within reason. And as is often the case in medicine, the more active a role you play in your treatment plan, the better your recovery is likely to be.

Gender

Studies suggest that back pain plagues men and women equally. However, in Western industrialized societies, men are more apt to have disk problems, and they are more likely to be treated surgically. These differences most likely reflect the fact that a greater number of men than women work in jobs that involve heavy lifting, pushing, and pulling, and that men in such jobs often feel the need to return to work as soon as possible following an absence due to back pain.

On the other hand, osteoporosis (loss of bone density and strength) occurs in women much more often than men. This disorder can cause severe weakening of vertebrae and may eventually lead to vertebral fractures. Vertebral fractures can cause a loss of height and a rounding of the back. They can also be very painful. Women are also especially susceptible to degenerative arthritis of the lower spine (a condition that generally involves the vertebral joints). They are also more likely to develop spondylolisthesis (an abnormal forward displacement of a vertebra relative to the one below it).

Family history

Heredity appears to play a role in certain types of back pain. Defects of the disks seem more common in some families; a hereditary difference in the chemical makeup of disks may render them more prone to fragmentation or herniation, conditions that can trigger back pain. Ankylosing spondylitis (see "Arthritis") and spondylolisthesis likewise seem to run in families.

Work and play

Certain jobs and activities put a greater strain on your back. Riding in motor vehicles is notoriously hard on your back, for instance, because it involves prolonged periods of sitting and exposure to vibration. The sitting positions necessary for office work—from typing to computer programming—can also eventually take a toll on your back regardless of your age.

Several other job-related activities increase the likelihood of future back problems:

• lifting or forceful movements such as pulling and pushing

• frequent bending or twisting of the back

• heavy physical exertion

• maintaining the same position for long periods

• repetitive motion patterns

• prolonged exposure to vibration.

Physical characteristics and posture

Your build, weight, and height seem to have little to do with your likelihood of developing back pain, although being overweight puts you at increased risk of having your symptoms return. Even a moderate difference in leg length (up to three-quarters of an inch) has no proven adverse effect on the lower back.

And despite your mother’s admonition to sit up straight, experts now agree that, in most cases, posture alone—whether bad or good—will neither predispose you to back pain nor shield you from it. Slumping and slouching don’t seem to have much effect on the basic health of your spine. But before you sit in your chair, note that poor posture can exacerbate existing back pain. Improving your body mechanics can help relieve your symptoms and prevent recurrences (see "Building muscles").

Psychological factors

A growing body of evidence shows that our emotions and psychological well-being have a significant influence on our physical health. It is not surprising, therefore, to learn that these factors also affect the back. Although study populations and methods vary, in general, research has shown that psychological factors such as stress, anxiety, and negative mood and emotions all increase the likelihood of developing acute (sudden) or chronic (longer-lasting) back pain (see "Acute or chronic?"). Such psychological factors seem to be especially important in determining whether an acute bout of back pain will become a chronic problem. One review of studies that examined this question, for example, found that people who were distressed or depressed were more likely to develop chronic back pain than other people. The reasons for this are not completely understood. Symptoms of chronic pain and depression share some of the same biochemical roots. The neurotransmitters serotonin and norepinephrine, for example, not only are involved in mood disorders such as depression but also are important in producing the sensation of