Low-Tech Options for Low-Back Pain
For: Don't Back Away From Exercise, February
2002
Low back pain is one of the most common ailments in the U.S. and Canada, second only to the common cold. According to Dr. Richard Deyo of the University of Washington, a pioneer in the field, 80% of adults experience back pain at some time in their lives. The annual bill for our backs, including medical care and disability compensation, may reach $50 billion in the U.S. And besides the discomfort, back pain complicates your life—it's hard to work, exercise, or enjoy life when your back hurts.
Though the chances of your having low-back pain eventually are high, chances are also good that it will get better without any kind of treatment. Chances are also good, unfortunately, that it will recur. Thanks to a lot of new research, we know more than we used to about back pain—or at least we recognize that some old treatments did more harm than good. It's also true that for many sufferers, almost any type of program that pays attention to the pain can provide some relief.
What causes back pain?
Back pain is often mysterious. Injury to muscles, ligaments, nerves, or the spine can sometimes be responsible, but most people with back pain cannot recall a specific incident that caused the pain. Weak muscles in the back and abdomen are sometimes the cause. Medical practitioners have a hard time diagnosing back pain. MRIs and other imaging tools often reveal no identifiable abnormalities in very painful backs, while painless backs may show herniated disks and other abnormalities.
One unexplained puzzle: People do less heavy physical labor now than at any time in history, but disability from back pain has steadily risen as physical work has declined. Perhaps our sedentary life-styles have weakened our back muscles.
What should I do for low-back pain?
Self-care is usually the best option. Stay as active as you can, and don't stay in bed more than a day or two. Take nonprescription pain relievers, such as aspirin, ibuprofen, or acetaminophen. Resume normal activity as soon as possible. There's good evidence that more than a day or two in bed weakens muscles and delays recovery.
When is medical advice a good idea?
Call your doctor if you don't get better in two or three days, if your back pain is severe or radiating, or if it is accompanied by numbness, tingling, weakness in the limbs, bowel or bladder problems, nausea, fever, and/or vomiting. A child or elderly person with sudden back pain needs medical attention. Back pain may be a sign of arthritis, osteoporosis (thinning bones), nerve inflammation, bone infections, or another serious illness. But most back pain is not caused by underlying illness or spinal abnormality.
Should the diagnosis of back pain always include X-rays?
X-rays should never be done until low-tech treatments and time itself have been given a chance. Most back pain gets better on its own. MRIs (which use magnetic fields and radio waves and reveal the spine in more detail than an X-ray) and other imaging tests are expensive and some may expose you unnecessarily to radiation. They may reveal nothing despite the pain. In fact, abnormal-looking disks are just as likely to show up in people with no back pain as in those with pain.
Is surgery a good option?
The rate of back surgery in the U.S. is twice as high as in other industrialized countries. Surgery usually does not provide long-term relief. If your doctor recommends surgery, by all means get a second opinion.
Is there some psychological element to back pain?
There may be. One of the quite believable gags in the movie The Odd Couple is that Felix (Jack Lemmon), who's miserable because his wife has left him, has constant crises with his back. It's hard to say which comes first—back pain or depression—but studies have suggested that the two may go together. Money problems and high-stress jobs are also risk factors for back pain; again, it's difficult to say which is the cause and which the effect. Depression is a treatable illness, however, and if you suspect it as an element in your back pain, consider psychological counseling. This does not mean, however, that the pain is "all in your head."
What about ice, heat, massage? What about traction?
None of these has been proven effective. If you know from experience that ice, heat, or a massage will provide relief, or you want to try them out, fine. But don't let your doctor put you in traction for back pain.
What about prescription medications?
Some doctors prescribe muscle relaxants, which may allow you to get a good night's sleep—but don't remain in bed all day. Prescription pain medication should not be used for more than a defined period, usually a week. Steroid injections, once widely used, "appear to be no more effective than injections with saline solution," according to Dr. Deyo. TENS (transcutaneous electrical nerve stimulation) has not been shown to provide benefits.
Does acupuncture work?
Some people find that it provides relief. In 1997, as we reported, a Consensus Panel at the National Institutes of Health concluded that acupuncture might be useful as an adjunct treatment for low back pain in a "comprehensive management program." (Such a program would include preventive measures—see below.) A study in Archives of Internal Medicine last year found acupuncture more effective than conventional treatments (including surgery), but possibly no better than sham acupuncture (placebo). However, acupuncture is hard to study scientifically.
What about chiropractic?
Chiropractic may be worth trying, but the problem is that spinal manipulation does not appear to be any more effective than medical treatments at the other end of the spectrum. A study from the North Carolina Back Pain Project in 1995 found that the benefits from treatment provided by primary-care physicians, chiropractors, or orthopedic surgeons were about equal. The most recent study (in the New England Journal of Medicine in November) compared patients receiving physical therapy (the McKenzie method, which consists of certain exercises), chiropractic mani-pulation, or simply a good informational booklet about back pain. All three groups fared about the same. X-rays done by a chiropractor are no more likely to be useful than those done by an M.D.
How can I prevent back pain, or prevent recurrences?
• If you are overweight, try to lose weight. Shedding even a few pounds can help your back.• Don't sit for long periods. On a long drive, stop often and get out for a stroll. At your job, get up and walk.
• If you are sedentary, try to become active—but gradually. Walking and swimming are good for your back and provide other benefits, too. Becoming active may be the most important step you can take.
• Do exercises to strengthen your back. For starters, see our articles on stretching (December 1998) and sit-ups (June 1998). Both types of exercise are excellent for the back. Or get a referral to a physical therapist who can teach you beneficial exercises for your back.
• If you smoke, quit. Smoking aggravates back pain.
• Wear comfortable shoes that provide good support. Avoid high heels.
• If you have to stand for long periods, try resting one foot on a stool.
UC Berkeley Wellness Letter, June 1999
