Lower Back Pain

WHEN TO SEE YOUR DOCTOR

* Your pain lasts more than 72 hours.

* Your pain is so severe that it interferes with your work.

* Your pain seems to radiate to your legs, feet or toes.

What Your Symptom Is Telling You

There's no doubt about it: Lower back pain can be a real pain in the you-know-where—interrupting your work, keeping you from your hobbies, forcing you to hobble around the house.

Complain if you want—just don't buy the myth that you have to put up with it. While a tiny group of back pain sufferers (less than 1 percent) do end up needing surgery, your pain is probably nothing more than your body serving notice that you've been overdoing it. You've pushed your back ligaments, muscles and joints to do too much, and now they're rebelling.

"If you ask someone what caused their problem, they usually tell you they did too much. They exercised too much or they worked too hard or they lifted too much or they slipped . . . something of that nature," says David Imrie, M.D., coauthor of The Back Power Program and medical director of Medifit of America in Teaneck, New Jersey. "The problem, I believe, is that we are generally involved in too little physical activity, so when we do too much, we get into trouble.

"Most back pain comes from muscle weakness, muscle tightness and joint problems—things you can't see on an x-ray," he says.

Another cause of lower back pain is a slipped or injured disk—the jellylike cushion that works as a shock absorber between the vertebrae of the spine. How can you tell if you've slipped a disk? Severe pain may radiate from your back into one of your legs.

Symptom Relief

Before you try any self-help treatments, you can determine whether you need to see a doctor immediately by taking this test: While lying on a firm bed or mattress, straighten one leg and raise it 90 degrees. If you have pain radiating down your leg, seek medical help as soon as possible.

If your lower back is merely whimpering for help, try these treatments for fast relief.

Hit the floor. For this remedy from Brent V. Lovejoy, D.O., a member of the board of trustees of the American Osteopathic College of Preventive Medicine and director of the Rocky Mountain Medical Group in Denver, you'll need some floor space, a pillow and a small ice pack (a bag of ice wrapped in a towel or cloth will do.) Lie on your back on the floor and put a pillow under your knees—that raises them slightly, taking some of the pressure off your lower back. Now place the ice under the painful area for about 20 minutes. If lying on the ice is too uncomfortable, dispense with it. Just lying in this position will provide some relief, says Dr. Lovejoy.

Be cool. Ask your spouse or a friend to rub the painful area with ice for at least 20 minutes every couple of hours. Continue ice treatment until three days after the injury. In addition to numbing the pain and relaxing muscle spasms, ice also reduces swelling, says Hubert Rosomoff, M.D., D.Med.Sc., medical director of the University of Miami Comprehensive Pain and Rehabilitation Center in Miami Beach.

Some like it hot. You may also benefit from moist heat applied to your achy back. Try using either a hot-water bottle or a towel that has been soaked in hot water. The warmth increases the flow of blood and oxygen to the injured area, which speeds healing, says Dr. Lovejoy. Because heat can promote swelling, don't use it until 72 hours after the injury, he says.

S-t-r-e-t-c-h. Once your homemade anesthetic (ice) has kicked in, gently stretch your back. The best technique in an emergency, according to Vert Mooney, M.D., professor of orthopedic surgery at the University of California, San Diego, Medical Center and director of the Spine and Joint Conditioning Center: Lie on your stomach, then bend your arms, placing your hands flat on the floor directly under your shoulders. Slowly raise your torso onto your elbows for ten seconds, lower your body and repeat. This movement forces nutrients and oxygen into the disks of the lower spine and forces out waste products like lactic acid, helping ease muscle spasms, says Dr. Mooney.

Hit the hay. For severe lower back pain, bed rest is of some value, but the amount must be limited. In fact, for every three hours that you're down, doctors say you should be on your feet for between 20 minutes and an hour. "We know the detrimental effects of staying on your back," says Dr. Lovejoy. "You lose calcium from your bones and your muscles begin to weaken."

Hit the streets. Some people seem to improve by taking a short walk, says Dr. Lovejoy. The reason: Unlike sitting, walking reduces the amount of stress on your lower back.

Kill the painkillers—if you can. Prescription pain relievers will help the most severe cases of back pain. But try limiting their use to two to three days after an injury, recommends Dr. Lovejoy. These powerful, addicting narcotics merely treat the pain—not the cause. "I rarely allow my patients to use them," he says.

Ask for an NSAID. Nonsteroidal anti-inflammatory drugs are available over-the-counter. These medications help reduce the swelling often associated with muscle and other soft-tissue injuries, says Dr. Lovejoy. Aspirin is one form of NSAID, but you may also consider taking ibuprofen, which is thought to be a more powerful NSAID, says Dr. Lovejoy.

Try a chiropractor. Either a chiropractor or an osteopath is capable of manipulating your spine to help alleviate back pain. Both use x-rays and detailed patient histories to make their diagnosis, says Dr. Lovejoy. Osteopaths are licensed to prescribe drugs, but chiropractors are not. "About 50 to 60 percent of all back problems can be seen once or twice for manipulation and be resolved," he says.

Take TENS. If your back pain just keeps on coming back, you might want to ask your doctor about transcutaneous electrical nerve stimulation (TENS), a small but powerful emergency back pain treatment. Electricity from a compact device courses through electrodes taped to your back, stimulating the lower back muscles and ending spasms. Although not a muscle strengthener, TENS units may also be used after surgery to help reduce pain, says Dr. Lovejoy.

Beating Back Pain at Work

You undoubtedly feel safe sitting at your desk in that air-conditioned office. But did you know you're just as likely to develop lower back pain as someone who works outdoors? In one study, researchers discovered that women who worked in offices had the same kind of degenerative back changes—like loss of water from their spinal disks—as meter maids, says Annie Pivarski, a back-care consultant and personal trainer in San Francisco who helped rehabilitate the back of San Francisco '49ers quarterback Joe Montana following back surgery in 1986. To keep from beating up your back at work, try these tips.

Be a clock watcher. It's not enough to merely shift your weight in your seat. You have to move. Stand up at least once an hour and stretch, says Pivarski. Here's one good stretch from Dr. Lovejoy: Stand erect and place your hands on your lower back. Bend backward slightly by lifting your chest up and out. Hold, then relax and repeat. Now slowly increase your stretch by tilting your head back and leaning backward as far as comfortable. Hold the position for just a moment. Now slowly raise your head, then your body so you are standing erect again. Repeat.

Divide and conquer. Structure your work routine so that you alternate between standing and sitting, says Pivarski. "Anything that would allow you to change your position can help remedy this overuse syndrome," she says.

Pull up the right chair. Even so-called ergonomic (user-friendly) chairs can have a devastating effect on your back if they're not right for you. If possible, get a chair that has an adjustable, contoured seat so that your hips are slightly higher than your knees. If the chair is too low, you'll feel pressure on your tailbone; too high and you'll feel pressure on your lower thighs.

If the chair has armrests, they should be adjustable so that your arms can rest freely at your sides. Armrests that are too long prevent you from you moving close enough to your desk, causing you to lean forward in your seat. Leaning forward causes more load on the lower back than just about anything else that people do," says Pivarski. Kneeling chairs can also help reduce strain on the lower back depending on the tasks at hand, she says. (Kneeling chairs are definitely not the answer for people who also have knee problems, she adds.)

Go on a roll. Whether it's a specially designed foam roll or simply a small pillow placed at the small of your back when you sit down, lumbar supports help retain the natural curve of your spine while you're seated, says Pivarski.

Do a computer chin-up. If your computer screen is too low, you run the risk of leaning forward while typing and straining your back and neck, Pivarski says. Leaning backward isn't good either. A good guide: Make sure that the center of your screen is at chin level. A couple of old phone books placed under your monitor may be all you need to push your screen up to the proper level.

Driving Dos and Don'ts

Another place where your lower back can get into trouble is the front seat of your car. Frequent driving doesn't have to put you on the road to back pain. Consider these tips.

Sit pretty. Instead of diving behind the wheel when you get into your car, back in and sit gently, then turn and swing your legs inside. "Most people don't get in and out of their cars properly," says Dr. Rosomoff.

Resist low riding. Ever notice the people who sit so low and far back in their cars that they can barely see over the steering wheel? They may look cool, but they're begging for lower back problems, says Pivarski. "What often happens is that in stretching out your legs, you pull your back away from the back of the seat and you start to slump. That's bad news for your lower back," she says. Adjust your seat so you're sitting slightly reclined when you drive.

Prop yourself up. Available at most drug and medical supply stores, a low-back support is also helpful when riding in or driving a car, especially if yours has bucket seats, says Pivarski. Avoid the wooden bead kind, she warns, as they can cause problems during an accident.

Give yourself an hour. It may sound impractical, but doctors suggest that after sitting in a car for an hour, you should take time to stop, get out of your car and stretch your back. Failing that, you can also shift your rear end from side to side, wiggle your feet and tighten your stomach muscles to help give your back a break.

Home Back Savers

Instituting these back-saving steps at home will go a long way toward relieving repeated episodes of lower back pain.

Sleep sweetly. From now on, before going to sleep, place one pillow under your head and two pillows under your knees, says Dr. Lovejoy. Alternatively, you can lie on your side with your head on top of a pillow and a pillow under your feet and lower legs, he says. These positions will ensure a good night's sleep for you and take pressure off your lower back. Also, a firm mattress is better for your back than one that sags, he says.

Easy does it. Bounding out of bed may be the stuff of business legends, but it's actually a good way to beat up your back. Why? While you were sleeping, the disks in your spine were filling up with water, making them plump and causing some stiffness in surrounding muscles. To protect against sudden moves that can cause microtears in the spinal disks, simply roll onto your side and push yourself up with your arms. Finally, swing your feet onto the floor, says Pivarski.

Be sink smart. Bending over the sink to brush your teeth or shave can also strain your lower back. Instead of merely leaning into the effort, open the cabinet door below the sink and rest your foot inside. Then brace yourself with one hand, says Pivarski. You can also put your foot on a small stool or box. Switch feet every few minutes.

Get a leg up. Instead of sinking into your favorite easy chair, reduce the strain on your back by keeping one knee higher than the level of your hips. One technique: Rest one foot on a stool in front of you, says Dr. Lovejoy.

Stretching: The Right Moves

Because a flexible back is usually a pain-free back, most doctors recommend that your treatment include stretching. Dr. Lovejoy suggests including these stretches in your low back protection plan.

Knee to chest. Lie on your back and bring both knees to your chest. Hold the position for a slow count of 20. Then return your feet to the floor and relax. You can also perform this stretch with one leg at a time.

Cat stretch. Get down on your hands and knees. First relax, letting your back sink down and sag. Now arch up and stretch like an angry cat for ten seconds. Repeat ten times.

Lateral trunk stretch. Lie on your back with your knees bent and your feet flat on the floor. Now cross your right leg over the left. Let both knees drop slowly to the right toward the floor. Take the stretch only as far as is comfortable for you and then hold the position for ten seconds. Switch legs and repeat.

Building a Better Back

After you've stretched, you can increase your strength and protect against lower back pain with this following series of doctor-recommended exercises. Not convinced they're important? A study of Los Angeles firefighters found that those who exercised regularly with weights had half as many back injuries as their less-active colleagues, says Dr. Lovejoy.

Abdominal curl. Lie on your back with your knees bent and your feet flat on the floor. Now slowly lift your head and shoulders off the floor, keeping your eyes fixed on the ceiling. Hold this position for a two count, then slowly lower your head and shoulders back down. Repeat 20 times.

Opposite arm and leg lifts. Lie on your stomach with your arms stretched out in front of you. Now lift your right arm and left leg several inches off the floor and hold for a count of ten. Rest and repeat, using the opposite arm and leg. If you recently suffered back pain, do the exercise only one or two times. As your strength increases, consider strapping on one-pound ankle weights and holding a can of soup in each hand, says Jennifer Stone, head athletic trainer at the U.S. Olympic Training Center in Colorado Springs.

Get aerobic. Some of the best exercises for your lower back don't seem like back work at all. Any aerobic activity, like walking or swimming, challenges most of the body's muscles, including the ones in your lower back, says Dr. Lovejoy. Perform your favorite aerobic exercise three times a week for at least 20 minutes, he says.