Oh, My Aching Back!
By far most patients who come to me have either neck or low back pain. Nearly 30 million of us are chronically disabled because of neck or low back pain, and almost three quarters of us will experience neck or back pain during our life. All of this costs over $100 billion each year in both direct medical expenses and others such as lost work time. Further, back pain is the most common reason for long term use of opioid pain killers such as hydrocodone (Vicodin), oxycodone (Percocet), morphine, codeine, and similar drugs.
What is your spine?
Your spine runs from the notch in your skull at the very top back of your neck down to a hooked pointy bone at the bottom, the coccyx . It consists of a stack of 33 interestingly shaped bones, each called a vertebra; this is the vertebral column. Viewed from your right side the stack of vertebrae (plural) forms a kind of S-shaped curve with the top of the S at the top of the stack. This shape gives you excellent stability and flexibility.
Each vertebra has a cylindrical body in front and three spikes (processes) at the back. Together they surround a circular opening (foramen) through which pass all of the major nerves (nerve roots) that provide sensation and movement impulses for your body. At its back, each vertebra is connected to the vertebrae above and below it at a bone joint, and the bodies are separated by a cushioning disc that absorbs shocks and makes a space for the nerves to exit the spine.
What can go wrong to cause back pain?
Any change in the shape of the spinal curvature, in the openings in the vertebral column, or in the vertebrae themselves may put pressure on the many nerves that depend on the natural state of the spine for their smooth, pain free passage to the rest of your body. There is a myriad of possible reasons why your back may hurt. Some are relatively benign, can be treated non-surgically, and will probably be gone in three or four months without causing permanent disability.
Among the most common reasons for back pain is simply misusing your muscles.
You’ve been out shoveling snow or raking it off your roof or lifting heavy furniture or doing some other unaccustomed strenuous activity. Immediately or that night or the next day your back feels as though somebody whacked you or it’s so tired and weak and achy that you really need to rest often. This could be a natural consequence of using or over using muscles that are not accustomed to being used, and which have not been kept properly strengthened and stretched.
Sitting for long periods may have similar effects whether it’s in front of a computer or on a long drive. Some muscle in your back may also have spasmed, involuntarily cramped.
Muscle, tendon, or ligament injury.
If the pain you feel is sharp and intense as though something were tearing then something probably has been over stretched or even torn. It could be the muscle fibres themselves or one of the tendons that joins a muscle to some bone or it could be a ligament which holds two bones together. If you feel that tearing then it’s a good idea to visit your doctor to discuss whether or not further medical treatment is indicated.
Whether it’s ache or injury the first best therapy is an ice pack; even the neurologists agree. Get a good ice pack that will stay very cold for 20 minutes, and with a piece of cloth between the ice pack and your skin put the pack on the place that hurts worst. Keep it there for 20 minutes, and repeat this two or three times each day as the pain begins to resolve itself. Your doctor may recommend for relief over-the-counter non-steroidal anti-inflammatories (NSAIDs) like aspirin, naproxen (Alleve), ibuprofen (Advil), or acetominophen (Tylenol).
Another fairly common condition that increases with age is called stenosis from a Greek word that means narrowing. With stenosis the open spaces in the vertebrae narrow. Although often without symptoms, stenosis puts pressure on the nerve roots, and can cause pain, numbness, muscle weakness, and even problems with bladder or bowel function.
More serious factors.
There are other factors, however, that may indicate a more serious problem possibly requiring medical treatment.
If you have a prior history of cancer anywhere in your body, then it’s possible the cancer has spread (metastasized) to your spine. Or if you have a history of long term infection whether of the skin or lungs or urinary tract or even your teeth then this too could have invaded your spine and be a cause of your back pain. In either of these cases the pain may be worse at night or while you’re resting.
Have you had some traumatic injury to your spine? If so then your back pain may be related to ongoing results of that experience. In some cases the joint between two vertebrae may fracture or the body of a vertebra itself may fracture and compress.
There are also back pains related to rupture (herniation) of the disc cushion between each pair of vertebrae. This may be the result of injury or excessive stress, but just as likely this results from the normal deterioration of the discs as we age. When the disc extrudes some of its contents there may be painful pressure on the nerves that pass through the channel in the spine.
These same pains may be related to chronic use of steroids such as cortisone or intravenous drug use. And one may suspect some central nervous system problem if you experience the onset of some rapidly progressive neurological problem having to do with your reflexes, your ability to speak, hear, see, or understand, your walk or balance, and others.
How do I prevent back pain?
Basic prevention of back pain is a 3 step approach: stretch, strengthen, and move. You may or may not wish to join a fitness club, and it’s not really necessary in preventing back pain, but you do have to attend to your body’s needs. Where back pain is concerned this is particularly true of your muscles.
Why stretch? Muscle knows how to do one thing only, and that is to contract, get shorter. If your muscles are chronically contracted for whatever reason then when you need them to do something unusual, like shoveling snow, then they have no way to contract further, and they complain. Keeping your muscles stretched is critical to living pain free.
Even if nicely stretched, muscle that is not used regularly loses mass and strength. You don’t have to be a weight lifter to have good musculature, but you do have to use them every day.
Muscles that are stationary are muscles that are stiff, so move. Exercise every day, and the single best exercise is not running, but walking. Walking uses an incredible number of muscles in your body for forward motion and balance. When I say walk, I don’t mean stroll and I don’t mean marathon race walking. I mean purposeful continuous walking for one, two, or three miles a day, and enjoying the scenery in the process.
Regardless of the reason for your pain, it’s likely the stress or injury related to that reason has distorted your body and your nervous system alignment causing impingement on nerves in your back.
At the risk of tooting my own horn too loudly, let me say that I have had good success using medical massage treatments to relieve a wide variety of pains resulting from back and neck problems. This includes some resulting from the more serious conditions I mentioned above. Medical massage uses very precise, gentle stretch and stimulation of particular muscles to correct and balance your nervous system. This leads to changes in the organization of your nervous system and your body to relieve pain.
Bob Keller is a certified pain relief practitioner and medical massage therapist in Newburyport.