The Back Burner

The warning signs were there, but Elizabeth Wells didn’t heed them. The morning after a fall by a slippery pool patio, she awoke with some tightness in her back. Seven months later, Wells felt a back muscle pull after lifting heavy boxes, and from then on, she says, “If I slept wrong, it would hurt for a couple of days.” Two years later, Wells, 42, recalls with a smile, “I had sex all over the place with a 22-year-old. I felt a sharp pain, but I didn’t really pay attention to it.” Later, her discomfort turned into pain, and “pretty soon I started getting shooting pains on my left side from my buttocks down my leg, and all the way to my heel. The left side of my leg and foot got numb.”

Wells finally consulted a chiropractor, but not long after, she drove six and a half hours to a convention, where she dashed up and down the hotel stairs several times each day and danced all night, every night. On drive back to her San Francisco home, the executive administrator says, the back of her knee tightened up, then became numb. “I came home and alternated with heat and ice and took the herbal muscle relaxants that the chiropractor prescribed, but my biggest mistake was not going to the hospital right then.” Within 24 hours, Wells says, she was back up and getting ready for work when “I bent over, heard a snap, and just went down. I had to crawl to my bed.” When another day went by and she couldn’t stand up or control her bladder, she went to the hospital via ambulance, where she was diagnosed with a herniated disk and faced a four-day hospital stay.

Wells, a veteran of the back pain wars, is not alone. For most of us, it’s not a question of if we will suffer from back pain, but when. Almost 90 percent of adults will endure a back pain “episode” in their lifetime, and for many it will be the beginning of a recurring condition that will plague them for the rest of their lives. Lower back pain is the number two reason for absence from work, following the common cold.

The spine is pretty amazing. It can move side to side, backward and forward and it can rotate. However, it is this amazing mobility that is at the root of all our back problems.

“If we fix one joint in the low back slightly, no joint will move normally,” says Dr. Jerome McAndrews of the American Chiropractic Association. “If the problem is corrected right away – great! If not, eventually the [whole spine] will compensate.”

There are many causes of back pain but almost 90 percent of all back problems are simply due to a strain on the muscles.

The pain that is caused by a muscle strain is often called “non-specific” pain. Like that which Elizabeth Wells experienced before her disk herniated, It is often described as a general discomfort or achiness over the entire lower back, pain that shoots into the buttocks or leg, stiffness when you first get out of bed or pain that feels better when you move around.

There are a variety of tests, such as MRIs or CAT scans, that can help diagnose your pain. But the experts at BackPainAnswers.com say such tests are not necessary: “What is necessary…is a good clinical exam made by an interested and experienced physician who isn’t giving you the bum’s rush.” Often, your range of movement will tell a doctor what is wrong and what is necessary for treatment.

Initial treatment will often include some kind of painkiller and a non-steroidal anti-inflammatory medication to reduce swelling and irritation. During her hospital stay, Wells took – with gratitude – the muscle relaxant Flexural and the painkillers Demerol and Vicodin. From this point on, doctor recommendations and treatment options will greatly vary. Obviously, the kind of health care professional you are consulting may determine the kind of recommendation that is made.

“I can only say what worked for me,” remarks Caroline Brigham, 29, who recently suffered six months with her first serious back problem. “My doctor wanted to send me to a neurosurgeon. With visions of scalpels and anesthesia and hospitals in my head – not to mention disability pay – I decided to exhaust all other options first.”

When Brigham’s primary care physician refused to refer her to a chiropractor, she went on her own. Working in partnership with a spine specialist who was able to prescribe narcotic-level painkillers until the treatments began to take effect, the chiropractor had her almost back to normal in six weeks. “I think the best thing a patient can do is think for herself. If you aren’t feeling better or if you are uncomfortable with your doctor’s course of treatment, get another opinion. I’m glad I did,” she said.

The Agency for Healthcare Policy and Research has concluded that only two percent of people with back pain in the acute stage require surgery, but about 250,000 people a year have back surgery, at the cost of about $15,000 each.

“Once you have had surgery,” report Dr. Andrews, “the odds that you will have several follow-up surgeries are great.

Elizabeth Wells’ earlier experience with a chiropractor was less than ideal, so she was comfortable following her physician’s recommended course of treatment. “In the hospital, a physical therapist taught me the proper way to get out of bed and take a shower so I wouldn’t re-injure my back.” Once out of the hospital, Wells continued to take muscle relaxants and painkillers, and began what she considers to be her key to recovery – walking in the swimming pool. “I started water walking twice a day, for 20 minutes each session. The first time it was extremely painful, but by the fourth or fifth time it wasn’t bad at all.”

After ten days, Wells met with her physical therapist, who helped her modify standard back exercises to accommodate her large body. “Instead of doing exercises on the floor, the therapist showed me how to do them on my bed, and she modified others so I didn’t have to slide down the wall.”

A woman’s size does not effect the treatment options open to her. Some doctors, however, such as Dr. Russell Windsor, an orthopedic surgeon at the Hospital for Special Surgery in New York, feel that size can affect the time it takes to heal. According to Dr. Windsor, “Once injured, weight may significantly slow the recovery and healing process due to the [additional stress on the spine] that occurs in larger individuals,” he asserts.

Wells theorizes that many doctors assume plus-size patients will have a slow recovery. “My doctor was shocked that I got better so quickly, but I think it was because I did modified exercises and activities like water walking that are gentler on a large body. The water takes all the pressure off your body, so that you don’t have anything weighing you down, so to speak,” Wells says with a smile. Wells, who at the time of her injury worked as a buyer in a plus-size clothing store, was back at work on light duty within four weeks.

By ignoring the first signs of back pain and engaging in risky activities, Wells exacerbated the problem by not following the basic tenets of back health. Keep from making the same mistakes by following these guidelines:

Diagnosis. If you injure your back or develop back pain, see your doctor. Remember that you can always get another opinion, additional tests or see a different kind of specialist. It is especially important to see your doctor if you think the pain could be caused by any kind of infection or if you have risks for other serious illnesses.

Ice and Heat. For the first couple of days after the injury occurs, apply ice to the area. This will bring down swelling and inflammation. After that time, according to Dr. Russell Windsor, many sufferers find that moist heat brings them the most relief, because it brings a greater blood supply to the muscles in the area and helps to loosen them for easier movement.

The Team Approach. Many back pain experts are advising patients to find a pain clinic that provides a team approach to treating back pain – where physicians, chiropractors, physical therapists and mental health professionals all work together to solve back problems. According to a briefing published in January of this year by the Center for the Advancement of Health, chronic pain patients who receive this kind of treatment experience a greater reduction of pain and improvement in mood than patients treated by one kind of practitioner.

“As the pain persists, [chronic sufferers] become more anxious and depressed, engage in fewer activities, spend less time on a job or quit working, become withdrawn and more focused on their pain. The likelihood that any one specialist…could take care of all their problems is pretty slim,” says Dennis C. Turk, Ph.D., a psychologist and professor at the University of Washington in Seattle.

Movement. If your doctor determines that the pain is a muscle strain, the best thing you can do after a day or two of rest and icing the area is to keep moving.

“Bed rest is the worst thing for me,” says Debby Loraine, who has suffered from back pain for 15 years after initially lifting a heavy picnic cooler. “I stiffen up if I stay immobile too long. As much as it might hurt at first, I always feel better if I get up, get a hot shower and get moving.”

According to Dr. McAndrews, even just four days of bed rest can cause permanent muscle damage. A day in bed can cause your muscle strength to decline by up to three percent per day. At some points, the benefits your back will gain by resting will be outweighed by the future problems such deconditioning can cause. In addition, the longer you stay in bed, the greater your chances of becoming depressed.

Sleeping Positions. While bed rest may not always be appropriate, you are going to have to sleep at some point. Investing in a good mattress may solve part of the problem. Many practitioners recommend sleeping on your back, with a thin pillow under your head, with more pillows under your knees. This position takes the stress off the lower back, and allows the muscles to rest and relax. If you are uncomfortable sleeping on your back, try lying on your side with a pillow between your legs.

As a supersize woman, Elizabeth Wells finds no relief by sleeping in a bed; she swears by the wonders of a La-Z-Boy recliner. “When I sleep in a bed, the weight of my stomach presses against my back and causes pressure. But when I sleep in my recliner, there’s lumbar support and it takes the pressure off of my back.”

The Right Moves. While keeping mobile is important, be sure to move the right way. When you bend to pick something up, or, for example, to move laundry from the washer to the dryer, bend at your hips, not at the waist. When you lift something from the floor, don’t bend at the waist; squat, hold the object close to your body and return to a standing position by pushing upward with your legs. To get out of bed, roll onto your side, and let your feet drop over the side of the bed. Use your bottom arm to push your body into a sitting position and then use your legs to push yourself upward into a standing position.

Sitting Pretty. Your chair at work should offer lumbar support and is best if hard-backed. Your feet should sit flat on the floor and your computer should be at eye level. And remember, sitting at a desk all day can be one of the worst things you can do for your back, says Dr. McAndrews, because it contracts the leg muscles, which over time can cause severe back problems. Try to get up and walk around your office at least once an hour.

Elizabeth Wells seconds that notion, saying, “At work, I try to get up and walk around. It’s so much better for my back to stand or lay than to sit.”

Most people don’t think about their car seats being bad for their backs, but they can be. The driving position (legs and arms suspended and immobile, possibly for long periods of time) puts a great deal of stress on our backs. People who drive for a living are twice as likely to have back problems. So when car shopping, test-drive the seat as well as the engine and look for lumbar support, arm rests, support on both sides of the torso, a headrest and a good deal of adjustability. And when you are taking a long car trip, make frequent stops to stretch and walk around.

Wells solved the car dilemma by buying a truck earlier this year. “It’s perfect,” she exclaims. “When I get out of the truck, my back doesn’t hurt like it does when I get out of a car. Plus, I think it helps my back that my feet aren’t cramped because my legs are so long,” says the 5’10” Wells.

Smoking. If the millions of other reasons haven’t convinced you to stop smoking, do it for your back. One effect of smoking is that it limits the blood supply to all the tissues in your body. When your back receives an inadequate supply of blood, it is more prone to injury and less able to repair damage. One study showed smokers were twice as likely to suffer from back pain than non-smokers were.

Relaxation. For many people, relaxation – not just of the back muscles, but of the mind as well – may be the key to alleviating pain. When you mentally stress, your body often tenses. It would follow, then, that stress makes lower back pain feel even worse.

Often, listening to relaxation tapes, meditating, or completing muscle relaxation exercises will help lessen back pain. For it to be truly effective, however, you should find a relaxation technique you like and practice it on a regular basis. According to the Midwest Center for Stress and Anxiety, the repetition of a meditation makes it easier for your subconscious to “retrieve” that feeling when it’s needed.

Exercise. Just as movement is important during a back episode, regular exercise is just as important in preventing future occurrences. According to Dr. McAndrews, walking is the best overall exercise for keeping leg, back and abdominal muscles strong and flexible. Swimming is another excellent choice because, although it strengthens and tones muscles, it relieves the stress and pressure on your back.

For extra insurance, ask your doctor or physical therapist for some back strengthening exercises, like those shown here, to do on a daily basis. They only take a few minutes, but you will feel a difference almost immediately. It is important that the back muscles are kept loose and conditioned so they will be better able to deflect muscle strain and unusual movements.

Recurrences

Alleviating acute pain is only the first step in the process of regaining back health. To avoid future recurrences, says psychologist Turk, “We teach people to think about ‘rehabilitation’ rather than ‘cure.'” While a cure means a permanent fix, rehabilitation involves learning to “pace your activities and to keep active to increase your strength and endurance and prevent pain flare-ups.” Concludes Turk, “The goal is to find ways to help people become much better self-managers of their own condition.”

Delving Deeper

“Alternative” Therapies

In the past, therapies outside the medical model were rarely covered by health insurance plans, and a patient who chose to try an alternative therapy was on her own financially. But as studies have shown that the cost of missed work, disability insurance and hospital stays for back surgery greatly outweigh the costs of these non-invasive therapies, some insurers are beginning to cover these treatments.

Physical Therapy: A physical therapist develops a routine that includes exercises that stretch the muscles, build strength and lessen pain, to improve your immediate condition and help prevent recurring problems in the future.

Acupuncture: An acupuncturist uses needles to stimulate the brain to release pain-reducing chemicals into the body. This method will alleviate the pain, but it won’t heal the problem in the long run.

Massage Therapy: Massage relaxes muscles to relieve spasms. It will also relieve mental tension and anxiety, and can help with healing by exploring metaphysical causes of back problems.

Yoga and Tai Chi: Yoga and Tai Chi exercises can help prevent further problems from occurring because they increase muscle flexibility and relax the mind.

Chiropractic: Most chiropractors will treat back pain with manipulation, in which they use their hands to move a joint out of its normal range of motion. This repetitive movement may cause the joint be become more mobile over time, which usually decreases pain.

TENS: In transcutaneous electrical nerve stimulation, small pads connected to cables are laid on the skin in the region of pain. Barely perceptible electrical impulses are applied to the area for a short period of time. The electrodes “interfere” with the sending of impulses of pain to the brain, causing your injured area to be less painful. This treatment is painless, and patients can rent or buy these machines to keep at home.

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