Taking care of your back

Most of us have experienced low back pain. It can be a frightening, frustrating and debilitating condition that never seems to go away soon enough. As a physician who cares for people with back pain, I'd like to share the answers to some of the most frequent questions that my patients ask me about the causes, treatments and prevention of simple low back pain. There is plenty of controversy surrounding management of low back pain, but I've tried to base this advice upon clinical medical research, personal experience and some common sense.

What happened, and why am I hurting?

Understandably, most patients want to know exactly what was injured and why they have pain. Unfortunately, there is usually no easy, simple answer . . . the back is a complex arrangement of bones, called vertebrae, ligaments (which connect bone to bone), muscles and tendons (which connect muscles to bone). The vertebrae are arranged one on top of another, somewhat like a stack of poker chips. There is a disc, a cushion of cartilage sandwiched between every two vertebrae. Most experts believe that these tissues are injured due to repetitive overexertion. The pain is caused by inflammation of these injured tissues. Inflammation is part of the body's repair process. In addition to being an important part of the skeleton, the vertebrae and surrounding tissues protect the spinal cord, which is made up of nerve fibers. Pain also can be caused when the inflammation of injured tissues affects the adjacent nerves.

Why can't you do some x-rays to figure out what's going on?

The problem with regular x-rays is that they aren't helpful to evaluate injuries to the soft tissues, so we consider taking x-rays only to evaluate the health of bones that might be injured due to a fall or a direct blow to the back.

Did I rupture a disc?

A ruptured or herniated disc causes pain due to inflammation's effect upon an adjacent nerve or if the disc material physically pushes on a nerve. Symptoms of a herniated disc include pain that goes down the back of the leg, muscle weakness and numbness. If your physician suspects a herniated disc, he or she may order a CAT scan or an MR scan to confirm the diagnosis. The need for surgery for a herniated disc varies from case to case. Recent research has shown that herniated discs frequently get better over time without surgery.

How can I make this pain better?

Medications like aspirin, ibuprofen and naproxen decrease pain by decreasing inflammation. Acetaminophen (Tylenol) decreases the pain, but it does not treat the pain-causing inflammation. All of these medications are available over the counter, and it's important to follow the dosage directions carefully. Your doctor can prescribe stronger medications if these non-prescription items don't work. Using an ice pack or a heating pad can help relieve the pain; which one you use is a personal choice, but most experts recommend using an ice pack such as a "Kold Pak" for 20 minutes, three or four times per day to reduce low back pain.

In addition to medications, you may benefit from a short period of bed rest, but no more than two or three days is helpful. Many experts encourage as much walking as can be tolerated to avoid deconditioning. Finally, physical therapists can teach you a set of exercises to help your back recover.

How can I prevent this from happening again?

The good news is most back pain goes away on its own in less than six weeks. Whether strengthening the muscles of the back or the abdomen can decrease the risk of future injury is controversial. There is also debate as to whether exercises to increase the flexibility of the back are helpful. Others recommend programs to increase strength of the arms and legs and to improve cardiovascular fitness. Finally, many experts believe that there are "safer" lifting techniques that may prevent back injuries. These techniques include hefting the item to estimate its weight before you lift it, keeping the item close to your body, and using the power of your leg muscles to help. A physical therapist or other health professional can evaluate your body mechanics and make suggestions to improve your way of using your back.

I've touched on only a few concerns that patients have about their back pain. For future information or counseling, contact your primary care physician.

Edward I. Galaid is director of clinical services, Environmental and Occupational Medicine, in The Emory Clinic. The publication of "Wellness" is coordinated through the Seretean Center for Health Promotion.