Back pain is a widespread phenomenon. The American Chiropractic Association reports than half of the American working class experiences back pain at least once a year. Fortunately, most of these instances are acute, or short-term. Acute back pain generally resolves itself within a couple of days.
For some, though, back pain becomes chronic. Contrary to what some might believe, chronic back pain is not necessarily caused by an immediate injury. Many cases are the result of progressive conditions, ones that develop over a period of time and worsen if not addressed. Behavioral causes, such as overuse, improper biomechanics and poor or static posture, are responsible for much of the back pain people feel today. Age can also be a cause. It is important to know the difference between acute pain and chronic pain.
Muscle strain is often a short-term cause of back pain, unless whatever caused the strain is a chronic occurrence. For example, if you are not in peak shape but decide to play a rigorous game of basketball over the weekend, you can expect your muscles to be strained by this sudden use. Lifting an object in an awkward way or sitting for a prolonged period without standing up or significantly changing posture will also strain muscles, particularly in the lower back. The body was designed to be active; blood flow decreases when we are still, depriving muscles and other tissues of oxygen and nutrients. They can become rigid and sore as a result.
Muscle strain only becomes chronic if you continue the activities that cause it on a regular basis. This happens often enough with posture; the modern lifestyle encourages long periods of time seated at work, at home and while commuting. Lower back muscles can become chronically strained if steps are not taken to change position and strengthen the abdominal muscles, which help the lower back muscles to support the upper body’s weight.
For acute muscle strain, the best medicine is often ice and rest. Ice will limit inflammation at the site of strain. The immune system attempts to isolate dangers from the rest of the body by flooding damaged areas with inflammatory materials that form a barricade and help to heal the area. Often, this inflammatory response is overly dramatic, and creates more pain than good. Ice will help to modulate this response.
Heat should be used only if inflammation is not a factor. Heat is better used for muscles that are chronically tense; it will increase blood flow to the area, flushing out toxins that build up when muscles are tense, like lactic acid. If this treatment, along with stretching, helps to keep your pain in check, then medical help is likely not needed.
The most common age-related back pain cause is osteoarthritis. As the body ages, the cartilage surrounding bones at a joint begins to degenerate, due to both simple wear and tear and changes in the body’s biochemistry. The facet joints of the spine, which link vertebrae together, can suffer osteoarthritis.
Another common age-related back condition is degenerative disc disease. The discs between vertebrae act to cushion the bones and absorb shock. As discs age, their ability to absorb nutrients declines and they begin to dehydrate. This flattens them somewhat, changing the space between bones in the spine and creating less stability.
Both arthritis and degenerated discs merit treatment from a medical professional. For arthritis, medications and a referral to a physical therapist may be needed. Anti-inflammatory medicines, whether over-the-counter or prescribed like cortisone shots, can relieve a significant amount of the pain associated with arthritis of the spine. These medications only provide temporary relief, however, and are best employed as a means to facilitate exercise than as an end in themselves. A physical therapist may develop an exercise program with you that you are able to perform without exacerbating your pain, so that you can build muscles in the back and stomach that support the spine taking pressure off of joints. Water aerobics may be your best bet, since this allows for strength-building and increasing range of motion of joints without the jarring effects of gravity.
Those with degenerated discs can benefit from medicine, exercise and chiropractic care. Strong core muscle help support the spine, leading to less jarring and instability. A chiropractor may help to realign the spine if a worn disc has caused vertebrae to move out of place. In very severe cases, surgery will be recommended. Usually, the disc is removed and the vertebrae around it are fused together. This comes with the downfall of limiting flexibility of the spine and adding extra stress on the discs surrounding the area of fusion. See a doctor before this becomes necessary, and ask about exercise programs and chiropractic care.
Behavior patterns have a lot to do with the health of our backs. Years of poor posture, improper lifting techniques and inactivity can lead to conditions like herniated discs, pinched nerves, and premature onset of the age-related conditions discussed above. Though these conditions can arise in other ways, we’ll focus on very common behavioral causes here.
Poor posture strains the spine and the muscles of the lower back. Stooped shoulders and a tilted pelvis disrupt the natural curvature of the spine, placing uneven and abnormal pressure on spinal discs. Chronically tense lower back muscles will increase the risk of developing a condition of the spine, since tight muscles pull on the structures around them. Over time, the tough exterior of a disc can weaken, and the fluid in the center can be forced to bulge the weakest side of the disc by pressure placed on it from bones and muscles. If the exterior cracks and the fluid leaks out, you have a herniated disc, a painful condition characterized by both an inefficient cushion for the spine and inflammatory fluids from within the disc possibly irritating nerves around it.
Herniated discs are the most common cause of sciatica; the bulge of the disc presses on the sciatic nerve in the lower back, or the fluids that leak irritate the nerve. Either way, shooting pain is experienced in the lower back that radiates down into the leg, sometimes as far as the foot.
Herniated discs can also be caused by an immediate injury, such as attempting to lift a very heavy object while twisting. Sciatica can also arise due to weak gluteus muscles in the buttocks that cause other muscles within the hip to be tense by compensating for the weak glutes. The piriformis muscle in the hip can become inflamed and impinge the sciatic nerve, which in some individuals runs through the muscle. This type of situation is called a muscle imbalance. These can take place between any muscle set in the body, including the core group. If the lower back muscles have been compensating for weak abs, for example, they will be tight and shortened, and will exert a pull on the lumbar spine. This, too, can cause damage to discs.
All behavior-related back pain causes should be discussed with a medical professional if possible. In addition to treating the problem, you must reshape your habits to avoid creating the problem again. This can be more difficult than it sounds.
Being assessed by a physical therapist trained to recognize muscle imbalances and postural dysfunction is important if a specific cause of your pain is not known. Often, it is difficult to diagnose the exact cause of a back condition; when you have not had an injury and are young, it is likely that your behavior is at the bottom of it.
Herniated discs are best treated by exercise that builds strength in the core and by decompression. Spinal decompression stretches the spine out to increase space between vertebrae. Over time, fluids can be reabsorbed into discs and normal disc shape and function can be restored. Some chiropractors have large decompression machines in their offices; there are also simpler home devices that can be purchased.
Sciatica treatment involves removing pressure off the sciatic nerve and reducing inflammation. Since the pain of sciatica can be devastating, you will likely have more success with a trained physician or physical therapist when it comes to stretching and exercising than you would on your own. The professionals can tailor a program to pinpoint your specific cause of sciatica, make sure your pain is managed, and help you to learn ways to prevent the recurrence of sciatica in the future.
Diagnosing Back Problems
As said above, diagnosing conditions causing back pain is difficult, since a number of possible causes exist. You will likely be given an X-ray to see if there is any obvious bone damage. Your back will be examined by a doctor for any overt abnormalities. An MRI test may be ordered to examine the condition of the tissues in your back (muscles, ligaments, and tendons).
These tests may not reveal any cause, or may indicate a problem that is not actually causing your pain. The best thing you can do is take careful note of your pain experience and relay every bit of insight you have to your doctor. Describe the pain precisely: its location, its intensity and its sensation, whether burning, aching, sharp or shooting. Convey what type of actions make the pain worse and what actions make it better. Tell your doctor if you are unable to sleep or carry on essential activities. Most importantly, do your own research. Make sure you do not settle for medication to numb the pain over a real answer to the root of your problem.
A doctor should be consulted whenever significant pain lasts for more than a few days, unless you know that the cause of your pain is a strenuous activity you just began performing. Acute back pain will resolve itself without the need for doctors. Pains that cannot be attributed to an unusual activity or resolved with heat or ice should be considered the sign of a potentially serious condition meriting medical intervention.