back-pain

H ealth H ints

July 2009 Vol. 13, No. 7

Editor: Janet M. Pollard, MPH

Back Pain Prevention, reduction, management “If you are experiencing back pain, you are not alone. An estimated 75 to 85 percent of all Americans will experience some form of back pain during their lifetime.”1 In fact, back pain is one of the most common neurological ailments in the United States – second only to headache.2 Back pain is one of the most common reasons people go to the doctor or miss work;3 it is also the most common cause of job-related disability.2

Who Gets Back Pain? Risk Factors Some factors (controllable and uncontrollable) may put you at higher risk for back pain. These may include: • Age. “The first attack of low back pain typically occurs between the ages of 30 and

40.”4 Back pain becomes more common the older you get.4, 5 • Fitness level. “Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine.”4 • Weight. “Too much weight can stress the back and cause pain.”5 A diet high in calories and fat, combined with inactive lifestyle, can lead to weight gain and obesity.4 • Heredity. Some causes of back pain, such as disc disease, can have a genetic component and can be inherited.4, 5 • Race. “Race can be a factor in back problems. African American women, for example, are two to three times more likely than white women to develop spondylolisthesis, a condition in which a vertebra of the lower spine…slips out of place.”4 Caucasian women of northern European heritage, on the other hand, are at the highest risk of developing osteoporosis, a condition in which porous, brittle bones develop.2 • Smoking. “Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.”2 “Your body may not be able to get enough nutrients to the discs in your back if you smoke. Smoker’s cough may also cause back pain. People who smoke are

slow to heal, so back pain may last longer.”5 • Other disease. “Some types of arthritis and cancer can cause back pain.”5 • Job. “If you have to lift, push, or pull while twisting your spine, you may get back pain. If you work at a desk all day and do not sit up straight, you may also get back pain.”5

Why Does It Hurt? Potential causes “Your back is an intricate structure composed of bones, muscles, ligaments, tendons, and discs — the cartilage-like pads that act as cushions between the segments of your spine. Back pain can arise from problems with any of these component parts. In some people, no specific cause for their back pain can be found.”3 Strains and Injuries. Strains and injuries from improper lifting or sudden awkward movements are a common source of back pain. These problems may include: • muscle spasms, • sprains, and • fractures or other complications of severe injury or accident.3, 4 Structural problems. In some cases, back pain may be caused by structural problems, such as: • bulging or ruptured/herniated discs,

For information on other health topics, visit Extension’s Family & Consumer Sciences website: http://fcs.tamu.edu.

Four work-related factors associated with increased risk of back pain and injury 1. “Force. Exerting too much force on your back may cause injury. If your job is physical in nature, you might face injury if you frequently lift or move heavy objects. 2. Repetition. Repetition refers to the number of times you perform a certain movement. Overly repetitious tasks can lead to muscle fatigue or injury, particularly if they involve stretching to the limit of your range of motion or awkward body positioning. 3. Posture. Posture refers to your position when sitting, standing, or performing a task. If, for instance, you spend most of your time in front of a computer, you may experience occasional aches and pains from sitting still for extended periods. On average, your body can tolerate being in one position for about 20 minutes before you feel the need to adjust. 4. Stress. Pressures at work or at home can increase your stress level and lead to muscle tension and tightness, which may in turn lead to back pain.”6 • sciatica, • arthritis, • skeletal irregularities (e.g., scoliosis, kyphosis, lordosis, back extension, back flexion), • osteoporosis, • spondylolisthesis, or • disc degeneration.2, 3, 4, 5 Other Problems. Other problems that are not specific to the back but may resonate pain in the back include: • fibromyalgia, • stress, • pregnancy, • kidney stones or infections, and • endometriosis.2, 4 Rare but serious conditions. In rare cases, back pain may be related to very serious or severe problems, which may include: • cauda equina syndrome, • cancer in the spine, and • infection of the spine.

2, 3, 4

For more detailed information and definitions of these conditions, see Why Does It Hurt?

When to See a Doctor Warning signs Though most back pain resolves within a matter of time, there are some signs that indicate the immediate need to see a doctor. These signs include the following:

o nausea, vomiting, stomachache; o weakness; o sweating; or o fever;7 or • unexplained weight loss.7, 8 Also seek medical care for back pain if you have any of the following “red flags:” • advanced age, • disability, • history of cancer, • trauma, • prolonged use of corticosteroids, or • osteoporosis.11 You may want to use the following flow chart from FamilyDoctor.org12 as a guide in helping you know when to seek medical care, or try answering the following back pain warning sign questions from the North American Spine Society.13

• numbness or tingling;7 • pain that goes down your leg below your knee;8 • severe pain that doesn’t improve with rest (note: resting is not recommended for more than one to two days, since prolonged rest can make back pain worse and decrease function; individuals should resume activities as soon as possible)7, 9 or pain so intense you can’t move around;8 • severe pain that doesn’t improve within three days;10 • pain after a fall or injury;7 or • pain plus any of these problems: o trouble urinating;

HealthHints: Back Pain

o numbness in your leg, foot, groin, or rectal area;

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Tests & Diagnosis What to expect at the doctor’s visit Diagnosing the cause of back pain requires a medical history and physical examination. During Texas AgriLife Extension Service

the medical history, you might be asked the following questions: • Have you fallen or injured your back recently? • Does your back feel better – or hurt worse – when you lie down? • Are there any activities or positions that ease or aggravate the pain? • Is your pain worse or better at a certain time of day? • Do you or any family members have arthritis or other diseases that might affect the spine? • Have you had back surgery or back pain before? • Do you have pain, numbness, or tingling down one or both legs?4 During the physical exam, your doctor may: • watch you stand and walk; • check your reflexes to look for slowed or heightened reflexes, either of which might suggest nerve problems; • check for fibromyalgia by examining your back for tender points, which are points on the body that are painful when pressure is applied to them; • check for muscle strength and sensation; and • check for signs of nerve root irritation.4 Often, a doctor can find the cause of your pain with a physical and medical history alone.4 Diagnostic tests aren’t usually necessary to confirm the cause of back pain; however, if there is reason to suspect that a tumor, fracture, infection, or other specific condition may be causing your back pain, your doctor may order one or more tests.

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Watchful Waiting Self care and non-invasive strategies If you have back pain, it does not necessarily mean you need medical attention. Sometimes, medical care is not needed right away or at all for back pain. If you do need medical attention, it doesn’t necessarily mean that you need an invasive treatment like surgery to make you feel better.11 “Most low back pain can be treated without surgery,”9 and surgery (depending on the type) may have only a 5060 percent success rate or positive outcome – i.e., reduced pain and/or increased function.14

acute back pain, you give the pain a chance to improve with conservative, self-care approaches (see practical postural tips). And even if you have chronic back pain, you see what active, self-care steps you can take on your own before assuming that you need a more aggressive, invasive approach (see self-care and non-invasive treatment options). Most people are able to deal with low-level, nagging, or even annoying back pain using self-care, adjustments, and other coping skills. You may not need any higher level of treatment unless your pain interferes with your work, your leisure, or your sleep.”11

Back pain can be acute or chronic: • Acute or short term back pain usually comes on suddenly and lasts from a few days to a few weeks.9, 10 “Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight.”9 • “Chronic back pain is pain that persists for more than three months. It is often progressive, and the cause can be difficult to determine.”9 Though as a back pain sufferer you may want to immediately seek a “quick fix” through strong medications or back surgery, watchful waiting is often required. “Watchful waiting… doesn’t mean that if you have back pain you simply do nothing and see what happens. What it may mean, though, is that if you have 3

Note: If you have ‘red flag’ indications associated with your chronic low back pain,11 see your doctor. You can decide together if immediate treatment is needed or if watchful waiting with self-care or non-invasive treatment is an option. The goal of self-care and noninvasive treatment for back pain is: • to reduce, but not necessarily eliminate, back pain; • to help improve or restore function and strength to the back so that normal routines or work and leisure activity can be resumed; and • to prevent any recurrence of injury to the back.9, 11

HealthHints: Back Pain

When Conservative Treatments Don’t Help Pros & cons of surgery & other invasive treatments “In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries.”9 “You and your doctor may discuss a surgical or other invasive approach if conservative approaches haven’t appeared to relieve your low back pain or improve your function. Your preferences, concerns, and lifestyle play a large role in determining the best choice about these more aggressive approaches. Before deciding on surgery or another invasive procedure, consider these points”11 from the Mayo Clinic11 (see table). For information on specific types of surgery, talk with your doctor, and see the following articles:

Pros & Cons of Back Surgery/Invasive Procedures Pros

Cons

Invasive procedures to damage nerve endings can sometimes effectively block pain when other methods have failed.

Procedures that block pain may not be permanent; you may need the procedure repeated.

Invasive procedures may lessen pain considerably and allow you to fully participate in an active rehabilitation program.

Surgery and other invasive procedures don’t always work. Some people have good results; some show little change; some may even experience more pain.

Spinal fusion can stop the motion and instability in your back that cause pain.

Spinal fusion removes some of the flexibility of your spine, which means learning some adjustments in how you move after surgery.

A more aggressive approach may make it possible for you to resume work and other activities that are important to you, and more quickly than a less aggressive approach.

Surgery involves recovery time, and it can have side effects. For example, some people experience later degeneration in the area adjacent to the spinal fusion surgery. Long-term outcomes may be as good with less invasive procedures, and less costly.

• Back Surgery: When Is It a Good Idea? • Handout on Health: Back Pain • Low Back Pain Fact Sheet Consider that not all back pain lasts a long time – nor is surgery an option for many sources of back pain. “Most people will have back pain sometime during their life. And 90 percent of these people will get better, without treatment or with conservative therapies, within four to six weeks. Only 5 percent remain disabled longer than three months.”15 “In most situations, an operation won’t be considered unless conservative measures have failed, and even then it’s not often indicated.”15 For example, there are currently no effective surgical

This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

techniques for muscle- and softtissue related back pain.3 “Back surgery is usually reserved for times when a nerve is pinched, the spinal cord is compressed, or there’s too much movement between the spinal bones.”15 Most back problems respond to nonsurgical treatments, such as anti-inflammatory medication, ice, heat, exercises that strengthen back supporting muscles, and physical therapy. When conservative treatments don’t help, back surgery may offer relief; however, it doesn’t help every type of back pain. In fact, it is only needed in a small percentage of cases.11, 15, 16 To view the references used in this newsletter, go to: http://fcs.tamu.edu/health/ healthhints/2009/jul/ref.php

Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating

HealthHints: Back Pain

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H ealth H ints Why Does It Hurt? Potential causes “Your back is an intricate structure composed of bones, muscles, ligaments, tendons, and discs – the cartilagelike pads that act as cushions between the segments of your spine. Back pain can arise from problems with any of these component parts. In some people, no specific cause for their back pain can be found.”1

Strains “Back pain most often occurs from strained muscles and ligaments, from improper or heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm can cause back pain.”1

Injuries “Spine injuries, such as sprains and fractures, can cause either short-lived or chronic pain. Sprains are tears in the ligaments that support the spine, and they can occur from twisting or lifting improperly… Less commonly, back pain may be caused by more severe injuries that result from accidents or falls.”2

Structural Problems In some cases, back pain may be caused by structural problems, such as: • Bulging or ruptured/herniated discs. “Discs

act as cushions between the vertebrae in your spine. Sometimes, the soft material inside a disc may bulge out of place or rupture and press on a nerve.”1 “When one or more of the discs that Back Pain – Prevention, Reduction, Management

cushion the bones of the spine are damaged, the jelly-like center of the disc leaks, causing pain.”3 “Many people who have bulging or herniated discs experience no pain from the condition.”1 • Sciatica. “If a bulging or herniated disc presses on

the main nerve that travels down your leg, it can cause sciatica – sharp, shooting pain through the buttock and back of the leg.”1 • Arthritis. “The joints most commonly affected by

osteoarthritis are the hips, hands, knees, and lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.”1 Other various forms of arthritis, including rheumatoid arthritis and ankylosing spondylitis, can also contribute to back pain.2 • Skeletal irregularities. “Back pain can occur

if your spine curves in an abnormal way. If the natural curves in your spine become exaggerated, your upper back may look abnormally rounded or your lower back may arch excessively.”1 “These irregularities include scoliosis, a curving of the spine to the side; kyphosis, in which the normal curve of the upper back is severely rounded; lordosis, an abnormally accentuated arch in the lower back; back extension, a bending backward of the spine; and back flexion, in which the spine bends forward.”4 • Osteoporosis. “Compression fractures of your

spine’s vertebrae can occur if your bones become porous and brittle.”1 “Caucasian women of northern European heritage are at the highest risk of developing the condition.”4 • Spondylolisthesis. “This occurs when one or

more bones of the spine slip out of place.”3 African American women are two to three times more likely than white women to develop this condition.2 • Disc degeneration. “Perhaps the most common

mechanical cause of back pain is a condition called intervertebral disc degeneration, which simply July 2009 – Vol. 13, No. 7

means that the discs located between the vertebrae of the spine are breaking down with age. As they deteriorate, they lose their cushioning ability. This problem can lead to pain if the back is stressed.”2 “A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time.”4

Other Problems • Fibromyalgia. “Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple ‘tender points,’ particularly in the neck, spine, shoulders, and hips. Additional symptoms may include sleep disturbances, morning stiffness, and anxiety.”4 • Stress. “Although the causes of back pain are usually physical, emotional stress can play a role in how severe pain is and how long it lasts. Stress can affect the body in many ways, including causing back muscles to become tense and painful.”2 • Other. Other causes of back pain include pregnancy; kidney stones or infections; and endometriosis, which is the buildup of uterine tissue in places outside the uterus.2

Rare but Serious Conditions In rare cases, back pain may be related to: • Cauda equina syndrome. “This is a serious

neurological problem affecting a bundle of nerve roots that serve your lower back and legs. It can cause weakness in the legs, numbness in the ‘saddle’ or groin area, and loss of bowel or bladder control.”1 • Cancer in the spine. “A tumor on the spine can

press on a nerve, causing back pain.”1 Tumors are relatively rare causes of back pain. Occasionally,

tumors begin in the back, but more often they appear in the back as a result of cancer that has spread from elsewhere in the body. 2 • Infection of the spine. “If a fever and a tender,

warm area accompany back pain, the cause could be an infection.”1 Although they are not common causes of back pain, infections can cause pain. 2 Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine), sacroiliitis (inflammation in the sacroiliac joints4), and discitis (infection in the intervertebral disc space2, 5). Sources: 1. Mayo Clinic (2008). Back Pain [on-line]. Retrieved April 22, 2009. From http://www.mayoclinic.com/ health/back-pain/DS00171. 2. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2005). Handout on health: Back pain [on-line]. Retrieved April 22, 2009. From http://www.niams.nih.gov/Health_ Info/Back_Pain/default.asp. 3. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2006). What is back pain? Fast facts: An easy-to-read series of publications for the public [on-line]. Retrieved April 22, 2009. From http://www.niams.nih.gov/ Health_Info/Back_Pain/back_pain_ff.asp. 4. National Institute of Neurological Disorders and Stroke (2009). Low back pain fact sheet [on-line]. Retrieved April 22, 2009. From http://www.ninds. nih.gov/disorders/backpain/detail_backpain.htm. 5. Wikipedia (2009). Discitis [on-line]. Retrieved June 2, 2009. From http://en.wikipedia.org/wiki/Discitis.

Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating

July 2009 – Vol. 13, No. 7

Back Pain – Prevention, Reduction, Management

H ealth H ints Diagnostic Tests When trying to identify the source of back pain, your doctor will likely complete a physical exam and ask you about your medical history. Often, this is enough to help identify the cause of your pain. If your doctor suspects other problems, such as a fracture, infection, tumor, or other specific condition, he/she may order one or more tests. These tests may include: • X-ray. These images show the alignment of your

bones and whether you have arthritis or broken bones. X-ray images won’t directly show problems with your spinal cord, muscles, nerves, or discs. • Magnetic resonance imaging (MRI) or

computerized tomography (CT) scans. These scans can generate images that may reveal herniated discs or problems with bones, muscles, tissue, tendons, nerves, ligaments, and blood vessels. • Bone scan. In rare cases, your doctor may use a

bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, you’ll receive an injection of a small amount of a radioactive substance (tracer) into one of your

veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera. • Nerve studies (electromyography, or EMG). This

test measures the electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can confirm nerve compression caused by herniated discs or narrowing of your spinal canal (spinal stenosis).1 • Blood tests. Blood tests may be used to point to

problems such as infection or inflammation.2 Sources: 1. Mayo Clinic (2008). Back Pain [on-line]. Retrieved April 22, 2009. From http://www.mayoclinic.com/ health/back-pain/DS00171. 2. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2005). Handout on health: Back pain [on-line]. Retrieved April 22, 2009. From http://www.niams.nih.gov/Health_ Info/Back_Pain/default.asp.

Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating

Back Pain – Prevention, Reduction, Management

July 2009 – Vol. 13, No. 7

H ealth H ints

Practical Postural Tips

Whether your work, household, and family duties involve heavy physical exertion, standing in one position, or sitting for prolonged periods, you may benefit from some of these tips for preventing or reducing back pain and maintaining or improving posture. Tips from the American Physical Therapy Association: • Throughout each day, concentrate on keeping your

three natural back curves in balanced alignment.

• Keep your weight down; excess weight exerts a

constant forward pull on the back muscles and stretches and weakens muscles in the abdomen.

• Avoid staying in one position for long periods

of time; inactivity causes muscle tension and weakness.

• Sleep on a firm mattress, and use a pillow under

your head just big enough to maintain the normal cervical – neck – curve. Avoid use of oversized or several pillows.

• Exercise regularly; exercise promotes strong and

flexible muscles that keep you upright in a proper postural position. • Protect your back

by using good body mechanics; bend your knees when picking something up or putting it down; carry a heavy object by using two hands and keeping the load close to your waist.

• Wear comfortable

and well-supported shoes. Avoid continuous use of high-heeled or platform shoes, which distort the normal shape of the foot and throw the back’s natural curves out of alignment.

Back Pain – Prevention, Reduction, Management

• Walk with good posture; keep your head erect with

your chin parallel to the ground; allow your arms to swing naturally, and keep your feet pointed in the direction you are going.1

Tips from the American Chiropractic Association: • When you wash dishes, open the cabinet beneath

the sink, bend one knee and put your foot on the shelf under the sink. Lean against the counter so some of your weight is supported in front.

• When ironing, raise one foot a bit. Place it on a

small stool or a book to take some strain off of your back. • To vacuum, use a “fencer’s stance.” Put all of

your weight on one foot, then step forward and back with the other foot as you push the vacuum forward and back. Use the back foot as a pivot when you turn.

• While

talking on the phone, don’t cradle the phone between your ear and shoulder. That can lock up the spinal joints in the neck and upper back, and cause pain. Instead, hold the phone with your hand or use the speakerphone.

• While watching television or relaxing, don’t use

the sofa arm as a pillow. The angle is much too sharp for your neck.2

Tips from Texas AgriLife Extension Service Passenger Safety: • Avoid driving for more than two hours without taking a break to stretch your legs. • Change your driving position by adjusting the seat from time to time. (Many vehicles provide built-in adjustable lumbar [lower spine] supports.) July 2009 – Vol. 13, No. 7

• Cruise control may benefit you when driving on highways. • Shorter drivers may benefit from pedal extensions to avoid sitting too close to the steering wheel and air bag. (For safety, be sure to keep at least 10 inches between your breastbone and the cover of the air bag module.)

Sources: 1. American Physical Therapy Association (2009). The secret of good posture [on-line]. Retrieved April 22, 2009. From http://www.apta.org/AM/ Images/APTAIMAGES/ContentImages/ptandbody/ Posture/Posture.pdf.

2. American Chiropractic Association (2009). Housework [on-line]. Retrieved April 22, 2009. From http://www.acatoday.org/print.cfm?CID=76.

Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating

July 2009 – Vol. 13, No. 7

Back Pain – Prevention, Reduction, Management

H ealth H ints

Self-care & Non-invasive Treatment Options There are many options for self-care and non-invasive treatment of back pain. The following information comprises some of those treatments that you and your doctor may decide would benefit you alone or in combination with other treatments, medications, or self-care strategies.

Cold or Heat Therapy to Relieve Pain and Muscle Tension

Cold and hot compresses may help reduce pain and inflammation and allow greater mobility for some individuals.1 “Some studies show that heat is an effective approach for acute nonspecific back pain.”2 ”Heat therapy increases blood circulation, which can aid healing of damaged tissues. Heat also allows tissues to stretch more easily, resulting in less stiffness, greater flexibility, and less pain.”2 “To use heat therapy, take a warm bath or use warm packs, a heating pad, or a heat lamp for pain relief. Be careful not to burn your skin with extreme heat.”2 “Cold or ice applied to your back can reduce inflammation and swelling by constricting blood vessels. The cold acts to slow nerve impulses and make it less likely that your muscles will contract, in this way reducing pain.”2 “To use cold packs, wrap an ice pack or a bag of frozen vegetables in a piece of cloth. Hold it on the sore area for about 15 minutes several times a day. To avoid frost bite, don’t place ice directly on your skin.”2 You can use a combination of the two methods (heat and cold) if you find this type of therapy provides more relief.2 Note: Cold and heat therapy can provide some relief for acute low back pain, but “there isn’t scientific evidence at this time to prove that cold and heat are effective treatments for chronic low back pain.”2 Still, cold and heat therapy likely won’t cause harm and may be helpful for some chronic low back pain sufferers.2 Back Pain – Prevention, Reduction, Management

Pain Medications to Relieve Your Discomfort until Inflammation Subsides and the Body Heals Itself Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies.1 These may include over-the-counter and/or prescription forms of pain relievers and anti-inflammatory medicines,1 including aspirin, naproxen sodium (Aleve), and ibuprophen (Advil, Motrin IB, others). Topical counterirritant creams or sprays could include products such as Bengay, Icy Hot, and capsaicin (Zostrix), which stimulate the sensory receptors of heat or cold to counter or cover up pain (some may also contain salicylates to reduce inflammation). Low doses of anticonvulsants (used in people with back pain in conjunction with leg pain) and antidepressants (used to increase levels of the neurotransmitter serotonin, which is associated with pain control) may also be used. In select cases, narcotic medications (opiods) may be prescribed to treat low back pain, but severe side effects may result; the benefits and drawbacks should be seriously discussed with your doctor.2

Exercise (with or without Physical Therapy) Although it may seem counterintuitive to get active and exercise rather than rest when you have back pain, “physical activity plays a strong role in recovering from back pain and particularly in helping to prevent future pain and loss of function.”2 Bed rest is recommended for only one to two days at most; prolonged rest can make back pain worse and decrease function. Individuals should resume activities as soon as possible.1 In fact, “exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles.”1 Exercise doesn’t appear to increase the risk for future injuries and may help prevent back pain at work and elsewhere.2 “Improving the strength, endurance, and function of your back helps minimize the chance of recurrence of back pain.”2

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“Benefits of a physical activity program may include: • pain reduction, • strengthening of weak muscles, • stretching of contracted muscles, • decreasing mechanical stress on your back, • improving your fitness to prevent injury, • stabilizing your back, • improving your posture, • improving your mobility, • decreasing the rate and severity of recurring back

pain, and

• allowing quicker recovery from future flares of

back pain.”2

“Physical activity can include one or many among a wide range of exercises that you do in the presence of a physical therapist, or exercises that you do on your own at home. An exercise program can include any or all of the following components: flexing, stretching, endurance training, strength building, and aerobic. Supervised programs that include stretching and strengthening exercises, which don’t specifically target the back, are more beneficial in relieving chronic low back pain and improving function. Your doctor or physical therapist can tailor an exercise program to meet your individual needs. There is no one-size-fits-all approach. Exercise programs are individualized because people have different levels of pain and differing injuries that caused the pain initially.”2 To prevent back pain, you may want to incorporate some back exercises that increase strength and flexibility into your physical activity routine. Consult your doctor about the best exercises for you.

Using Good Body Mechanics

Part of a comprehensive physical activity program includes using good body mechanics to improve your posture and decrease mechanical stress on your back.2 Whether you are doing heavy lifting, sitting at a desk, standing at a counter or cash register, or doing household chores, concentrating on good body mechanics can help prevent back pain. “Good posture is important because it helps your body function at top speed. It promotes movement efficiency and endurance and contributes to an overall feeling of well-being. Good posture is also good prevention. If you have poor posture, your bones are not properly aligned, July 2009 – Vol. 13, No. 7

Source: American Physical Therapy Association (2009). The secret of good posture [on-line]. Retrieved April 22, 2009. From http://www.apta.org/AM/Images/ APTAIMAGES/ContentImages/ptandbody/Posture/ Posture.pdf.

and your muscles, joints, and ligaments take more strain than nature intended. Faulty posture may cause you fatigue, muscular strain, and, in later stages, pain. Many individuals with chronic back pain can trace their problems to years of faulty postural habits. In addition, poor posture can affect the position and function of your vital organs, particularly those in the abdominal region.”3 You can check your posture and improve or maintain it by learning correct sitting and standing positions. You can also do exercises to maintain or strengthen the lower abdominal muscles, which are so important for good posture, and use some practical postural tips at work and home to prevent or reduce back pain and maintain good posture.

Back Pain – Prevention, Reduction, Management

Intermittent Use of a Back Brace to Support the Spine

“The rationale behind braces is that they may support your abdomen and take some of the load off your lower back, they may restrict motion, and they may improve posture.”2 Only intermittent use for just a few hours a day is recommended, however, since extended or constant use can lead to atrophy (wasting away) of some of the muscles that support the spine.2

Electrical Stimulation

“Transcutaneous electrical nerve stimulation (TENS) delivers a tiny electrical current to key points on a nerve pathway. The current, delivered through electrodes taped to your skin, isn’t painful or harmful. It’s not known exactly how TENS works, but it may stimulate the release of pain-inhibiting molecules (endorphins) or block pain fibers that carry pain impulses. However, it’s unclear whether those who benefit from TENS achieve relief by some direct effect on their nervous system or from the belief that they will benefit from the therapy (the so-called placebo effect). Some people with chronic pain use TENS to help them function with less discomfort. But several studies have concluded that TENS has not been proved effective in relieving chronic low back pain.”2

Spinal Manipulation

In this treatment, the health practitioner uses his or her hands to apply leverage and force to the joints in the back and a series of exercises to adjust spinal structures and restore back mobility. These techniques are commonly performed by chiropractors, physical therapists, physical therapists, and osteopathic doctors.2, 4

Cognitive Behavior Therapy

This type of therapy involves talking through and identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. “It’s based on the idea that your own thoughts determine how you behave. Even if an unwanted situation hasn’t changed, you can change the way you think and behave in a positive way. The therapy may have a role in the case of chronic low back pain for which no specific physical cause is evident….Cognitive behavior therapy has been shown to be effective in relieving pain and improving function as one component of back care.”2 Sources: 1. National Institute of Neurological Disorders and Stroke (2009). NINDS back pain information page [on-line]. Retrieved April 22, 2009. From http:// www.ninds.nih.gov/disorders/backpain/backpain. htm. 2. Mayo Clinic (2008). Back pain guide [on-line]. Retrieved April 22, 2209. From http://www. mayoclinic.com/health/back-pain-treatment/ ba99999. 3. American Physical Therapy Association (2009). The secret of good posture [on-line]. Retrieved April 22, 2009. From http://www.apta.org/AM/ Images/APTAIMAGES/ContentImages/ptandbody/ Posture/Posture.pdf.

4. National Institute of Neurological Disorders and Stroke (2009). Low back pain fact sheet [on-line]. Retrieved April 22, 2009. From http://www.ninds. nih.gov/disorders/backpain/detail_backpain.htm.

Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating

Back Pain – Prevention, Reduction, Management

July 2009 – Vol. 13, No. 7