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No. 1, 2001

This issue covers back pain. It is not meant to replace appropriate medical care, but to serve as an educational factoid.


Back Talk

RESPONSIBILITY FOR INJURIES

As early as the 1930's, researchers pointed out that 80 to 90 percent of all accidents are caused
by the "unsafe acts of persons" as opposed to "unsafe mechanical or physical conditions." Human
failure, they indicated, is the primary cause of accidents. Therefore, you are most often the cause
of these injuries and you must assume the responsibility to prevent them.

Our human failures are in three major areas:

The cognitive area: Our thoughts, attitudes and opinions.
The psychological area: Our feelings and emotions.
The physiological area: Our strength, reaction times and health.


Combining these human failures compounds the risk of injury. Example: If we "think" (cognitive)
that lifting a bulky 100 pound object is safe, if our "macho" emotion (psychological) encourages us to prove it, but our strength (physiological) fails, the result can be a serious back injury, not caused by the heavy object, but by human error. Our beliefs, our feelings, and our own physical
limitations get us in trouble.

Combining these human failures compounds the risk of injury. Example: If we "think" (cognitive)
that lifting a bulky 100 pound object is safe, if our "macho" emotion (psychological) encourages us to prove it, but our strength (physiological) fails, the result can be a serious back injury, not caused by the heavy object, but by human error. Our beliefs, our feelings, and our own physical
limitations get us in trouble.

Poor physical condition, poor posture, lack of exercise, and excessive body weight contribute to
the number and severity of sprains and strains. Degeneration of the spine, due to aging, is also a
major contributor to lower back pain, but is frequently misdiagnosed as a sprain or strain. Only
four percent of all serious back injuries are true sprains, strains or fractures, and most are the
results of degeneration of the spine caused by aging and the abuse we give our back. Most back
injuries, however, occur in persons 24 to 40 years of age.

There is little evidence that heavy vs. light work affects back problems; indeed, it appears that
individuals who regularly do heavy work have fewer back problems. Dr. David Imrie, a noted
back specialist, in his book "Goodbye Backache" says, "If you go to underdeveloped countries
where people work much harder physically than we do, you hardly hear of backaches. You have
to wonder if the problem is not that people these days do too much, but too little." It is not so
much how much we lift or move, it's how we do it and how we maintain our body. It seems that
back injuries, sprains, strains and degenerative problems are associated more with physical
conditioning and body mechanics. Back injuries can be minimized by better physical conditioning, which results in stronger muscles to hold the spine in proper alignment, as well as by less body weight for the back to support.


Back Pain Facts
-Both back and neck pain is usually preventable
-Most of us will suffer one or both of these within our lifetime
-9 out of 10 acute back injury will heal on their own within 6 to 12 weeks
-Back pain is one of the most common reasons for hospitalization in the United States


Symptoms
-persistent aching or stiffness anywhere along your spine
-sharp, localized pain in the neck, upper back, or lower back, especially after lifting heavy objects or engaging in strenuous activity
-chronic ache in the middle back, especially after sitting or standing for extended periods

Possible Causes of Back Pain
-Overuse or sudden or improper movement can result in strain or sprain to the spinal ligaments, the muscles in the back, or sacroiliac joints (joints between the spine and the pelvis).
-Damage to the vertebral discs (rips, tears or rupture). If the tear is large enough, jelly-like substance inside may leak out and press on a nerve. The nerve then becomes irritated due to swelling or inflammation in other parts of the back.
-Sometimes back pain can occur for no apparent reason.

Any of these mentioned injuries can result in 2 to 3 days of acute pain and swelling in the area of injury, followed by slow healing and a gradual reduction in pain.

Back pain can also be caused by conditions of the bone and joint of the spine such as arthritis, cancer and osteoporosis (the later two can lead to compression fractures).

The Goals Related to Back Pain: self-care that relieves pain, promotes healing and avoids re-injury.

Begin With Prevention
The foremost key to prevention of back pain is proper body mechanics and a lifestyle of good health habits, such as regular exercise, avoiding tobacco, proper nutrition and maintaining the proper weight.

Body Mechanics: Good body mechanics will reduce the strain on your back.
Sitting:
-Avoid sitting in one position for more than one hour at a time. Reposition yourself often.
-If you must sit a lot, see a physical therapist or athletic trainer for home exercise that you can due regularly at home.
-If your chair does not give enough back support use a small pillow or rolled towel to support your lower back.
-When driving, pull your seat forward so that the pedals and steering wheel are at a comfortable reach. Stop often to stretch and walk about. Consider a small pillow or rolled towel behind your lower back.

Lifting:
-Keep your back straight. Do not bend foreword from the waist to lift.
-Bend your knees and allow your arms and legs do the work. Tighten your buttocks and abdomen to further support your back.
-Keep the load as close to your body as possible, even if the load is light.
-While holding a heavy object, turn your feet, not your back. Try not to turn or twist your body.
-If possible do not lift heavy objects above your shoulders.
-Use a hand truck or ask for assistance to move awkward objects.
-Push, dont pull objects.

Lying Down:
-If you have pain at night try a firmer mattress or if you feel that the mattress is too firm a softer mattress.
-When sleeping on your back use a towel roll to support your lower back, or place a pillow under your knees.
-If you sleep on your side, place a pillow between your knees.
-Sleeping on your stomach is fine if it does not increase your back or neck pain.

Exercise:
Regular exercise such as stretching, strengthening and aerobic exercise will help you maintain overall fitness, flexibility and muscle strength. Exercise also contributes to healthy body weight, which in-turn reduces the load on your lower back.
Although there is no clear evidence that specific exercise help prevent back pain we know that the more healthy an individual is the less likely he will experience back pain, and if he does the quicker his recovery will be. Before initiated any exercise program consult your healthcare provider first.
Exercise to avoid because they may increase the risk of a low back injury are:
-straight-leg sit-ups
-bent leg sit-ups during a period of acute back pain
-leg lifts (lifting both legs while lying on your back)
-lifting heavy weights above the waist
-any stretches that are done sitting and placing the legs in a V
-toe touches while standing

Home Treatment
Immediately after an injury, and for the next few days to following these considerations are the most important treatments:

-As soon as possible apply ice or a cold pack to the injured back (10- 15 minutes every hour). Cold applied for the first 3 days limits swelling, reduces pain and speeds healing.
-Lie flat on your stomach with your hands at your side and your head to one side. If this increases pain, try to find a more comfortable position. Relax for 1-2 minutes.
-Do pelvic tilts: lie on you back with knees bent and your feet flat on the floor. Slowly tighten your stomach muscles and press your lower back against the floor. Hold for 10 seconds- do not hold your breath. Slowly relax.
-Take a short walk (3-5 minutes) on a level surface every 3 hours. Walk only distances that you can manage without pain, especially leg pain.
-Sit or lie in positions that promote comfort and decrease pain.
-Do not sit up in bed, and avoid soft couches and twisted positions.
-Bed rest may help relieve back pain but may not speed healing. Unless you have severe leg pain, 1-3 days of bed rest should relieve pain. More than 3 days of bed rest is not recommended, it could actually delay healing.
-Unless contraindicated in your care, take non-steroidal anti-inflammatory medication (aspirin, Motrin, Aleve) as directed.
-Tylenol may also be used. Masking pain completely may allow movement that could promote re-injury.
-Use medications wisely, when in doubt consult your pharmacist or physician.
-Avoid all meats and animal proteins until you are healed. Animal protein contains uric acid, which puts undue strain on the kidneys that can contribute to back pain. Eat no gravies, oils, fats, sugars, or rich or highly processed foods.
-When pain hits immediately drink 2 large glasses of quality water. This often gives relief in a few minutes. Muscle and back pain is frequently connected to dehydration. The body requires a minimum of eight 8 oz glasses of water daily to keep acidic wastes from building up in the muscles and tissues.
-Reduce stress.
-Reduce/ avoid smoking. Studies show that smoking aggravates problems in the discs.


After 2-3 Days of Home Treatment
-Heat may be applied 72 hours after the injury. Apply heat for 20-minute periods. Moist heat works better than dry heat.
-Some find comfort in alternating cold and heat packs.
-Try swimming. It may hurt at first but consistency will prevent back pain from reoccurring.
-When pain has improved start to exercise with activities that will not increase pain. Some have found that Tai Chi or Yoga, done on a consistent basis, has been beneficial.


When To Call A Healthcare Professional
-If you loose bowel or bladder control
-If you cannot walk or stand
-If you have new numbness in the genital or rectal area.
-If you have leg weakness not solely due to pain.
-If you have increased backpain with unexplained fever, painful urination or other signs of a urinary tract infection.
-If you have a dramatic increase in your chronic back pain, especially if it unrelated to a new or change in your physical activity.
-If you have a history of HIV infection or cancer and develop new or increased back pain.
-If after a 2 weeks of home treatment you see no positive results.
-If you develop a new or severe pain in your back that does not change with movement and is not related to muscle tension.


Back Surgery?
Surgical procedures are appropriate for certain conditions. Getting all the facts and thinking about your own needs and values will help you make a wise decision about your course of treatment. Surgery for nonspecific back pain should be considered as a last resort. For herniated discs, statistically with proper non-invasive treatment, and if one can tolerate the discomfort recovery after 5 years is equivalent to the invasiveness of surgery without the scar tissue and complications associate with both surgery itself and surgery of the spine. Consult your physician for more specifics. Numerous studies have shown that people with lower back pain who are treated by outpatient spinal manipulation recover faster, at less cost, and end up with less pain and more mobility than those treated in hospitals.

Alternative Choices
Alternative choices can be directed toward relieving immediate discomfort of back problems as well as conditioning and strengthening to body to prevent reoccurrence.

Spinal Manipulation?
Chiropractors and osteopaths relieve some back pain with spinal manipulation. Spinal manipulation often works best if you have had symptoms for fewer than 4 weeks. It is recommended that if you do not show improvement after 1 month of treatment stop, and have a reevaluation.

Accupressure
Also called shiatsu, to relieve low back pain apply 60 seconds of thumb pressure on either side of the spine just above the top of the pelvic bone, then massage at this point, as well as the hip and knee joints.

Acupuncture
Therapy involves the insertion of small, hair-like needles, by a trained acupuncturist, into specific points on the body. Acute problems can be relieved in 1-4 sessions. Chronic pain typically requires 12 or more sessions.

Herbal Therapies
Consult a trained herbalist or naturopath for proper dosages and evaluation of possible contraindications.
You may consider drinking infusions of white willow or vervain. For inflammation consider dry teas brewed from lobelia, yarrow or white willow. Valerian, as tincture or capsule, works well as a muscle relaxant and sedative. Remember that herbs pose risks just like medications so do not mix the two without being under the guidance of a knowledgeable practitioner.

Homeopathy
Over-the-counter remedies that have been reported to help non-specific back problems include Arnica for bruised and sore muscles, Bryonia and Rhus toxicodendron for sharp pain that worsens when you move. And Nux vomica for persistent backaches.

Mind Body Medicine
Positive results have occurred with use of biofeedback and/or guided imagery.

Dietary Supplementation
(Adult Dosages)
Calcium- 1500-2000 mg daily. Needed for strong bones. To assure absorption use a mixture of 3 different forms: calcium carbonate, calcium chelate and calcium asporotate.

Magnesium- 700-1000 mg daily. Works with calcium, allowing it to be better absorbed. Use a magnesium chelate form. Calcium and magnesium are best absorbed if taken prior to the nights sleep.

All Natural Multi-vitamin- 1-2 daily with food. Assists with metabolism. Natural is better that synthetic (Centrum, One-A-Day, Theragram) due to 1) its natural enzymes and phytochemicals and 2) because it is not made of a petroleum base, which coats the bowels and inhibits further absorption.

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