A Special to Reminder Publications
Taking proper care of your back isn't something most people learn in school or even at an annual checkup. Yet low back pain affects approximately four out of five Americans and is the leading reason for missed work, according to the National Institute of Neurological Disorders and Stroke (NINDS). To make matters worse, roughly 15 to 20 percent of those with acute back pain eventually develop prolonged back pain. Given these statistics, the odds are strong that most people will battle low back pain at some point. Understanding what causes back pain and how to prevent it can help minimize the risk of back injury.
Low back pain can be either acute or chronic. Acute low back pain lasts between a few days and a few weeks and is most often caused by an injury to muscles, ligaments or joints. If the discs (the cushions between the vertebrae or bones of the back) become overly compressed, they can develop tears and even rupture, causing severe pain. Chronic or ongoing low back pain, which afflicts two to eight percent of Americans, usually is related to either an injury or a degenerative condition of the spine. As people age, discs lose fluid and flexibility, and joints become arthritic, decreasing the space for nerves and resulting in pain.
Reducing the risk
Whatever activity you undertake, following these basic guidelines can reduce the chances of developing low back pain:
Stretch and warm up before activities to keep your back and supporting muscles flexible and strong.
Pace your activities and take breaks every hour.
When lifting, use proper techniques. Specifically, lift with your knees. Pull in your stomach muscles and keep your head down and in line with a straight back. Keep the object close to your body and do not twist when lifting it. And don't lift objects you think are too heavy.
When traveling on long trips, get up from your seat every hour and stretch; pack lightly and check heavy bags.
Prevent falls especially on ice or wet ground and at home (where most falls occur) by wearing proper foot gear, watching where you step, taking shuffling steps, and holding a railing if possible.
If you're obese, lose weight. Obesity increases the deterioration of joints and discs.
Quit smoking, which reduces blood flow to the lower spine and causes the spinal discs to degenerate.
Treating the pain, with cautions
Treat acute low back pain with a combination of bed rest (maximum of two days), over-the-counter analgesics, and stretching. This regimen can often relieve symptoms and prevent the pain from getting worse. However, warnings are in order. Over-the-counter products, while easing pain and reducing inflammation, can present problems, especially if taken with alcohol or in excess of recommended doses. NSAIDS (non-steroidal anti-inflammatory drugs), such as ibuprofen, can cause ulcers or bleeding in the gastrointestinal tract even if taken properly. Also, acetaminophen can be toxic to the liver in doses greater than four grams (and even less if taken with alcohol or by someone with liver disease). Acetaminophen is also contained in other medications, so an accidental overdose is possible if you're not careful. Read medication labels and track how much of this drug you're taking.
When to see a physician
Seek a physician's help if you experience any of these symptoms:
Back pain with fever, difficulty with bowel or bladder function, or numbness and weakness in the legs These signs could indicate serious conditions, so seek medical attention immediately, as urgent surgery may be necessary
Severe back pain, especially after an injury.
Back pain that lasts longer than two to three weeks. Alert your primary care provider who may order tests and refer you for physical therapy.
Low back pain that lasts longer than two months (chronic low back pain). Visit a board certified Pain Medicine physician who can evaluate your condition and help you manage pain and its effects with a comprehensive treatment plan. The goal is to help you recover your function.
For more information, including fact sheets and tips on exercise for prevention, visit www.ninds.nih.gov or www.familydoctor.org. Use the search function for "low back pain."
Janet D. Pearl, M.D., M.Sc. is the Founder and Medical Director of Complete Pain Care, a pain medicine practice in Framingham, Mass. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult their personal physician for treatment. Comments are welcome at PhysicianFocus@mms.org.
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