Articles

Easing Back Pain
By Ken Whitlow, Physical Therapist

Back pain is no laughing matter. Even the simplest movement can provoke pain, but in most instances back dysfunction is the accumulation of months or even years of bad posture, poor body mechanics, stressful living and work habits, loss of flexibility and an overall lack of physical fitness. The good news is that most back injuries can be prevented.

Our spine was designed to achieve three definitive purposes: (1) to provide a structure for dynamic movements (2) to protect the central nervous system specifically the spine and (3) to work as a shock absorber. The vertebrae, discs and ligaments comprise the structure. Muscles support this structure and joints allow movement. The nervous system provides the spark and control of the body. The spine is not straight but made up of three basic curves. The curvature of the spine allows for flexibility and helps to act as a natural shock absorber.

A back dysfunction begins long before the first episode of pain is experienced, and the problem is usually still there after the symptoms resolve. The painful movement can be caused by a simple twist, a slip and fall, or even sneezing. Often, a minor trauma agitates the stiff and weak soft tissue of the back causing a painful episode of muscle spasm and inflammation. After the pain subsides one of the key components becomes preventing a re-injury.

Some of the most common disorders of the back include muscle spasms, a disc strain or bulge, acute strains and sprains, postural strains and sprains, joint stiffness and osteoarthritis. One of the first responses to any kind of pain is muscle guarding. The muscles hold or brace the area where you feel pain. Sustained muscle guarding produces muscle spasm. The two most common causes of a bulging disc are sitting or standing with poor posture or lifting with a forward lean. However, this is almost always a result of months or years of bad posture. Also closely related is lack of flexibility and poor physical fitness. Acute strains and sprains are caused by improper lifting, twisting, falls or even trauma such as whiplash. Postural strains and sprains are also time related injuries. Examples would include poor sitting posture at work, while driving, standing with the stomach muscle relaxed and slumped over for hours, or holding the head in a forward position too long. Joint stiffness may be the result of an acute sprain or strain healing without restoring normal movement. In addition, long standing poor posture can cause stiffness. For example, someone who always stands in a forward standing posture loses his or her ability to lean backward. Osteoarthritis often occurs as result of a long standing back disorder whether it is a disc injury, strains or sprains or general overuse syndrome.

Prevention of back and neck pain is essential to living the quality of life we expect as we age. A regular exercise program is critical to maintaining a strong healthy back. Gradual conditioning is essential to preventing injury. Make sure your routine includes exercises which will keep you flexible and tone your abdominal and spinal muscles. Be constantly aware of good posture and body mechanics. Sometimes a back support may be effective in reducing physical stress when performing aggravating activities. It may also prompt you to maintain better posture. Good nutrition is extremely important for good health. Excess weight promotes increased wear and tear on the joints and can cause poor posture which ultimately leads to back problems. Stress management is also vital.

A tense person will usually have a backache. Increased back pain frequently occurs at the height of a stressful situation. Learn various coping mechanisms which help to reduce your stress. Many studies validate the importance of regular, adequate rest. One cannot maintain good health without appropriate periods of sleep. Finally, there is strong evidence illustrating a close relationship between smoking and back pain. Smoking obviously restricts circulation and slows down healing when injury occurs.

Exercise could be the single most important intervention you can do to have a healthy neck and back. Exercise should be performed regularly, gradually increased and slight pain should not linger more than thirty minutes after you have stopped exercising. Exercise generally consists of three components: aerobic, flexibility and strengthening.

Aerobic exercise increases heart and lung activity which improves overall cardiovascular fitness. In fact recent studies indicate that individuals who are in good cardiovascular shape are less likely to suffer from neck and back pain. Walking, running, swimming, bicycling and other sport activities are all good for the back if approached with good common sense.

Flexibility exercises are also integral to good health. If a joint or muscle is stiff, pain will be felt at end range. As a general rule, if some stiffness is felt at the end of a movement, that is an exercise that needs your attention. Conversely if you have full movement, flexibility exercises in that direction do not need to be performed.

To maintain good posture and a healthy back you must have well balanced muscular strength. For strengthening exercises to be effective, the muscles must become fatigued while exercising. Breaking down the muscle tissue causes the muscle to grow stronger. If your muscles are weak, only a mild work load will be needed to fatigue the muscle. As you get stronger, more repetition or resistance must be added in order to make the muscle grow. Generally speaking, exercise with heavy resistance and fewer repetitions build power, while exercise with mild resistance and greater repetitions build endurance. Power is needed for heavy work activities and various sports. Endurance is more important for good posture and most of our activities of daily living. On a final note, an exercise program should emphasize the type of exercise missing at work.

*Saunders, Duane Self-Help Manual for Your Back, 1992.