Understanding Back Pain
You're lifting groceries -- or bending to tie a shoelace -- when all of a sudden your back goes out. Or maybe you're just sitting at your desk when your lower back starts aching. Backaches can come on suddenly or gradually and their cause can be maddeningly hard to pinpoint. "Most people try to blame their pain on one thing they did or didn't do, when it's usually the buildup of a number of factors that is responsible," says Sheila A. Dugan, MD, associate professor of physical medicine and rehabilitation at Rush University Medical Center, in Chicago.
"For a vast number of people, back pain comes from multiple sources, and we're just not sure why it hurts so much," says orthopedic surgeon Howard S. An, MD, director of spine surgery at Rush. What's more, what works for one person may have no effect on another, making the search for relief a byzantine journey from orthopedist to chiropractor, rheumatologist to physiatrist (a physician specializing in rehabilitation medicine).
In the process Americans spend $85.9 billion a year on coping with back pain, according to a recent article in the Journal of the American Medical Association. Approximately 80 percent of us have at least one episode, making it the second most-frequent health complaint after the common cold.
"The irony is, most back problems can be prevented," says Stephen H. Hochschuler, MD, chairman of the Texas Back Institute, in Plano. "If you stay in shape, watch your weight, and are careful about how you move and use your body, you have a good chance of avoiding or lessening the severity of back problems." Use the following pages to see whether your habits could be setting you up for a backache -- and to find out what you should do if pain strikes.
The Anatomy of Your Back
Problem: You strained a muscle or tendon, or sprained a ligament. Bands of ligaments and tendons hold the vertebrae in place and attach muscles to the spinal column. A strain or sprain is the most common cause of back pain. Torn muscles and tendons are known as strains; the same kind of injury to a ligament is a sprain.
Why it hurts: Think of your abs and back muscles as support wires for your spine. If you have bad posture and you rely on the wrong muscles to hold up your spine, they can become fatigued. Playing sports incorrectly or when you're not warmed up can also cause this. Something as minor as bending over to pick up a toothpaste cap can also stress weakened tissues, pulling the back out of alignment and causing a painful back spasm. When you tense up or hunch over to protect the injury, you can make the spasm worse. The trigger can also be psychological rather than physical. If you are stressed, that tension can make muscles tighten, pinching nerves and setting off a spasm.
Problem: A disk is getting worn, compressing a nerve. Disks (rounds of fibrous tissue between vertebrae) function as shock absorbers for your back. More than 50 nerves branch off from the spinal cord, and when they are squeezed or irritated, pain results.
Why it hurts: When disks wear as a result of aging, osteoarthritis, degenerative disk disease, or injury, the jelly-like center herniates (or bulges), which can press on nerves (a condition colloquially known as a "slipped disk"). One possible result is sciatica (pain involving the long sciatic nerve, which runs down from the lower back through the buttocks and legs and into the feet).
Problem: One or more vertebrae are cracked or out of alignment. The spinal column has 24 vertebrae, stacked one on top of another. The five lumbar (lower-back) vertebrae carry the weight of the entire torso, making that part of the spine the most frequently injured.
Why it hurts: The usual suspects: excess weight, pregnancy or congenital conditions such as scoliosis (sideways curvature) or lordosis (exaggerated arch to lower back) stress weak muscles and joints, especially the sacroiliac joint (where the lower spine connects to the pelvis). Other culprits: bone spurs (bony growths caused by arthritis) that press on the nerves or cause spinal stenosis (narrowing of the spinal canal, which also pressures nerves) or spondylolisthesis (weak and slipped joints). And hard or sudden falls can fracture vertebrae made weak and porous by osteoporosis.
Problem: Your back hurts because something's wrong elsewhere in your body. Doctors call this "referred pain" because it's not caused by the back itself.
Why it hurts: Endometriosis, kidney stones, or pregnancy weight can trigger back pain that may become chronic. So can fibromyalgia, a disorder of widespread muscle/ligament/joint pain, fatigue, and tenderness at trigger points through the body, most often the lower back.
20 Bad Habits That Can Wreck Your Back
One reason we get -- or can't get rid of -- back pain is that we're unaware of the things we do (many of them seemingly harmless) that can wreak havoc. The majority of adults unknowingly develop habits that lead them to tighten their neck, shoulders, and back or use the wrong muscles in the wrong way," says Dr. Hochschuler. "Muscles that were not designed to support your back end up doing just that." Check out the simple changes below.
STANDING AND MOVING
1. Stand straight with weight evenly distributed between toes and heel.
2. Never reach, bend, and twist at the same time. "Combining these three movements is one of the worst things you can do," says former dancer Patricia Ladis, cofounder and director of the Kima Center for Physiotherapy and Wellness, in New York City. To move clothes from a washer to a low dryer, take a wide stance, pull clothes to you, then pivot or step to dryer and squat with back flat to put in clothes.
3. Don't reach too far or too high. Any excessive movement that causes you to tilt your chin upward compresses your spine. Use a stepladder to change a lightbulb or retrieve a can from the shelf, get in the tub to scrub it, and walk around the bed when changing sheets.
4. To pick up or lift an object, get close, take a wide stance and bend at hips and knees, not at your waist.
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