Back Pain

Back Pain

Putting an End to the Ache

It used to be that the last thing on your mind was your back. In those days, it would bend, twist and move as needed, with nary a twinge.

Now you're past 30, and your back is more apt to protest than perform. Like millions of other Americans, you've got back pain, and it's really slowing you down.

The most common discomfort is low back pain: An estimated 80 percent of Americans have it at some point in their lives. Middle and upper back pain occur much less often.

Women and men appear to be equally affected by back pain, yet women tend to develop it later in life, says Malcolm Pope, Ph.D., director of the Iowa Spine Research Center at the University of Iowa in Iowa City. Some men tend to have problems when they're younger because the heavy manual work they do hastens the deterioration of structures in the back, he says. Women, on the other hand, usually don't run into trouble until their thirties and forties, when natural degenerative changes begin.

Why This Aching Back?

Back pain can be due to sprains or strains of the back muscles and ligaments, damage to the bones in the spinal column or injury to the shock-absorbing disks between the bones. In unusual cases, pain also arises from scoliosis and spondylolisthesis, two types of vertebral misalignment, and from illnesses like cancer. The pain can also be what doctors call mechanical low back pain--there is no apparent physical damage, but pain comes and goes.

The good news is that 80 percent of people who suffer from an episode of low back pain will improve within eight weeks. The bad news is that 80 percent of those with low back pain will experience a mild recurrence.

In women, more than 90 percent of problems doctors see are due to pregnancy, mechanical low back pain and disk injury, says Eugene Carragee, M.D., director of the Orthopedic Spine Center at Stanford University. Infections or diseases like cancer account for the other 10 percent, he says.

The Pain of Pregnancy

The number one cause of back pain in women in their childbearing years is pregnancy, says Dr. Carragee. Seventy-five percent of women who are pregnant have some low back pain, he says. Women who have their babies in their thirties and forties may experience more back pain than younger women if they're not in as good shape, he says.

Women can get back pain throughout their pregnancy, but some women report an increase in the last few weeks. The pain is usually in the low back and can radiate into the buttocks and the backs of the thighs. Walking, sitting, lifting and bending forward can worsen pain. Many women experience more back pain at night.

There are a number of reasons for the pain. For one thing, the weight and size of the fetus cause a woman's center of gravity to shift forward, so there is more curvature in her lower spinal column. This causes some low back muscles to shorten. In addition, the abdominal muscles, which normally stabilize the pelvis and support the back, are stretched and weakened by the growing uterus.

During pregnancy the body releases higher levels of the hormone relaxin. Relaxin's job is to loosen the ligaments so the pelvis can expand as the fetus grows. But relaxin also slackens the ligaments that support the back, and when more stress is placed on the more lax spine, pain develops.

Back pain during pregnancy can also be due to circulatory changes. As the uterus expands, it presses on a major vein that is responsible for collecting blood from the low back. Blood does not circulate properly and pain is the result--especially when a woman has slept or sat or walked for long periods.

Coping with It

There are things you can do to lessen back pain in pregnancy. Here's what experts recommend.

Stay active. Remaining as active and fit as you can throughout pregnancy helps, says physical therapist Sheila Reid, coordinator for rehabilitation services at the Spine Institute of New England in Williston, Vermont, because the stronger your muscles are, the better they'll respond to the increasing weight of the baby. Staying fit may also prevent back problems after pregnancy, when new mothers are lifting, reaching, doing extra laundry and manipulating bulky car seats, says Reid. There's no guarantee, however, that being in good shape will make delivery any easier. Ask your doctor about an exercise program or prenatal and postnatal exercise classes, and about classes where you can learn how to perform child-care tasks in ways that won't hurt your back.

Do back-helping exercises. Doing exercises such as pelvic tilts and side leg lifts will help relieve back pain by strengthening stomach and hip muscles that support the back. If there are exercises you want to do that require lying on your back, clear them with your physician first. If you do perform exercises on your back and notice any unusual symptoms, such as dizziness or shortness of breath, stop the exercise and notify your doctor.

Lie on your side. An expanding belly may make lying on your back less comfortable. That's because the weight of the fetus can press on the inferior vena cava, the vein that returns blood from the lower body to the heart, and can aggravate backache. Instead, doctors recommend that you lie on your side with your upper knee bent and supported on a pillow. This position allows blood to flow unrestricted to your heart and to the placenta. It also relieves back strain.

Change positions often. Prolonged sitting or standing can worsen the pain. So if you are sitting at a desk or computer all day, take breaks every 15 minutes and walk around for 30 seconds, says Anne McCue Canty, a physical therapist in Yorktown, Virginia. A chair with a tilt adjustment on the seat can help change your positioning slightly, as can the use of a footstool, she says. If you've got to be on your feet for extended periods of time, stand with one foot up on a footstool, alternating periodically between your left and right foot.

Lift things carefully. When you are pregnant, never lift anything over 50 pounds, says Dr. Pope. And do your best to lift only objects that are already at waist height, he says. Avoid awkward twisting postures and lift objects straight up. If there's an object on the floor that needs to be moved, try to find someone to help you, he says.

Other Back Pain Bad Guys

Mechanical low back pain is the second most common type of back problem for women, says Dr. Carragee. Women who do heavy labor and those who are very sedentary are at greatest risk, he says. Improper lifting, poor posture and sitting for long periods can lead to this type of pain, but often a specific cause cannot be identified, according to Dr. Carragee.

Disk problems are the third most common cause of back pain. Normally disks are cushiony, but sometimes they dry up and crack, or herniate, which is sometimes incredibly painful. People with herniated disks may have low back pain as well as radiating pain down the leg, known as sciatica. The pain is a result of the herniated disk compressing a spinal nerve root that runs from the back through the buttock and down the leg. With management, pain from herniation can be resolved in six weeks in 75 percent of individuals, says Dr. Carragee. Two percent of herniations require surgery, he says.

There are several habits that can increase a woman's risk for mechanical low back pain and disk herniation.

The first is smoking, which interferes with the supply of nutrients to the disks, says Dr. Pope. Without them, the disks eventually flatten, shrink and dry out, leading to herniation and pain. Also, surgery to alleviate back pain has been less successful in patients who smoke, he says.

The demands of working and raising a family can also contribute, says Reid. Busy women often don't have time to stay in shape and keep their backs strong, and they're under a lot of stress. "When you are under a lot of stress, you experience muscle tension. The muscles are in contraction and are not relaxed and don't respond in the same way to movement," Reid says. That makes them more susceptible to strain.

The workplace is another source of pain, says Reid. "More women work in sedentary jobs than in jobs that require physical activity," she says. "Sedentary workers have the second highest incidence of back pain." As with smoking, sitting in a fixed posture for a prolonged period of time prevents the natural pumping of nutrition in and out of the disks, says Dr. Pope.

High heels are a problem, Reid says, because they throw off a woman's center of gravity. As the heels bring you upright and forward, you get increased curvature, often called swayback, in the lower back. And the higher the heel, the more the body is thrown off-kilter.

Having a family history of back pain places women, as well as men, at increased risk, says Edward Hanley, M.D., chairman of orthopedic surgery at the Carolinas Medical Center in Charlotte, North Carolina. Researchers aren't sure why, but back pain runs in families.

Basic Back Pain Prevention

Just about everyone has back pain at some time. Here are strategies to prevent it.

Watch your posture. The spine is healthiest when it's in its natural neutral position. Poor posture such as slouching in a chair, sitting hunched over a desk or standing in a slumped position takes the spine out of position and places excess stress on the back muscles. Do your best to maintain good posture while sitting and standing. One quick method that will help you is to place two fingers on your upper lip and gently push your head back, without lifting your chin, until your ears are in alignment with your shoulders, says physical therapist Mark Taranta, director of the Physical Therapy Practice in Philadelphia.

Give your back support. Another way to help maintain good posture is to place a small pillow or rolled towel in the arch of your lower back when sitting. This provides support to the lower back and keeps excess stress off the muscles. When sleeping, try placing a pillow beneath your knees when you are on your back and between your knees when lying on your side, says Taranta.

Adjust your workstation. If you sit at a desk or computer all day, use a chair that's the right height, says Reid. Your feet and back should be supported. Your knees may be slightly lower or higher than your hips, whichever is most comfortable for you. Adjust your computer monitor so that you do not have to bend your neck back or hunch forward to read the screen, she says. Close your eyes and then open them; wherever your gaze falls is where the center of your screen should be.

Give books and papers a lift. Create a work surface that's at a 35-degree angle, says Dr. Pope. This will help you sit upright, he says. Stationery supply stores carry desktop podiums.

Take breaks and move. Women who are working in an office and sitting for long periods of time need to "get up and move around at least once an hour," Dr. Pope says. If you can't leave your office, try putting your in-box in a location where you'll have to stand up and walk over to check it. Or try standing when you're making or receiving phone calls, says Reid. Take a walk on your lunch break, she says.

Extend yourself. Stretching your back can help prevent back pain as well as relieve it, says Taranta. Stretches should be slow and steady.

Strengthen those abs. Your abdominal muscles are one of the keys to providing support for your back, so the stronger they are, the better. To strengthen them, half sit-ups are better than full sit-ups, says Reid.

Lift things properly. Lifting anything, whether it's a box, a bag of groceries or a child, can cause back pain. "Whenever you are lifting any load, keep the load as close to the body as possible," says Dr. Pope. Don't try to pick it up at arm's length, he says. And instead of bending over at the waist to pick up an object, keep your back straight and bend your knees, lowering yourself to the load. Then straighten your knees, keeping your back as straight as possible, recommends Dr. Pope.

Carry loads carefully. Hauling heavy loads places major stress on muscles and pulls your back into improper posture. If you carry an overloaded briefcase, shoulder bag or gym bag, it's better to distribute the load between two bags and carry one in each hand rather than having the weight all on one side, says Reid. Another option is to use a knapsack or luggage on wheels.

Give up smoking. Research shows a strong association between smoking and back pain, says Dr. Pope. So do your best to cut back or quit.

Get fit and trim. One way to prevent back pain is to maintain your ideal body weight. Ask your doctor what that is, rather than depending on a weight chart. "If you're overweight, muscles are in poor condition," says Dr. Pope. Doctors recommend 20 to 30 minutes of aerobic exercise four times a week. "Do what you enjoy," urges Dr. Carragee. "That way you'll be more likely to keep it up. Try not to let your exercise routine slip away as the years go by." Watch your diet by eating low-fat, nutritious foods, says Dr. Carragee.

Wear flat shoes. Heels increase the amount of curvature in your lower back, Dr. Pope says, so wear flat shoes. If you must wear heels at work, wear flats or sneakers to and from the office.

Get your calcium. Women are at increased risk for osteoporosis, which can lead to spinal fractures and back pain. Maintain bone strength by consuming enough calcium, says Dr. Carragee. Doctors recommend 1,000 to 1,200 milligrams for premenopausal women and 1,500 milligrams for postmenopausal women.

When Back Pain Strikes

Here's what to do when the pain hits.

Don't go to bed. Take it easy for a day or two, says Dr. Hanley, but "don't go to bed for two weeks." While doctors used to recommend bed rest, they now believe it leads to deconditioning of the muscles. Many recommend a wide range of back exercises.

Use heat or ice. Either can relieve back pain and help you get up and moving, says Reid. She recommends applying them for 20 minutes at a time.

Heat should be in the form of a hot shower or hot bath, since generalized heat relaxes muscles in the entire body, whereas applying localized heat may cause back muscles to swell and worsen the pain, she says. If you use ice, make sure it doesn't come in contact with your skin. Put it in a freezer bag or wrap it in a wet towel, then apply it to your back. Ice can be used several times a day. It's important to use whichever method allows you to move, says Reid.

Try medications. Taking a nonsteroidal anti-inflammatory such as aspirin or ibuprofen may help provide some pain relief by reducing any swelling and inflammation, says Dr. Hanley. Follow label directions.

Make an appointment. If your back pain persists for more than two weeks or if you have shooting pains down your legs, visit a doctor, says Dr. Hanley. Start with your family practitioner. She can refer you to a specialist, such as an orthopedic surgeon or a neurosurgeon, if necessary.

Be sure about surgery. Surgery should be considered when there is a specific diagnosis, such as fracture, scoliosis or disk herniation, says Dr. Carragee. It's not recommended as an exploratory procedure, he says.