Low Back Pain: Healing your aching back

• Who develops back problems?
  • Age
  • Sex
  • Family history
  • Physical characteristics and posture
  • Psychological factors
  • Other factors
• The anatomy of your back
  • Disks: Your back’s shock absorbers
  • A flexible, protective column
  • Ligaments and muscles
  • A horse’s tail of nerve roots
• Why does your back hurt?
  • Sprains and strains
  • Nerve compression syndromes
  • “Red flag” situations
  • Other causes of back problems
• Diagnosing back pain
  • Physical evaluation
  • Imaging studies and other testing
  • Assessing your treatment options
  • Factors to consider
• SPECIAL BONUS SECTION: Healing your back
• Medications for back pain
  • Over-the-counter pain relievers
  • Prescription pain relievers
  • Injection therapies
• When surgery is an option
  • Surgery for disk disease
  • Surgery for compression fractures
  • Surgery for spinal stenosis
  • Surgeries for other back problems
  • Guidelines for recovery
• Resources
• Glossary

Today’s treatment decisions for most cases of back pain are patient-driven. In other words, you’re in the driver’s seat (with your doctor beside you) when it comes to deciding what would be an appropriate treatment path for you based on your type of back problem and the physical and other demands of your lifestyle. Since you have a considerable number of options at your disposal and a lifestyle to accommodate, it’s worth not rushing into a decision. Besides, if you allow yourself some deliberation time, your back problem may clear up with little or no medical intervention within a few weeks. Indeed, awareness of your condition’s timeline is the first crucial step. To a considerable extent, this knowledge determines the steps you can take toward healing yourself during an initial attack and maintaining a healthy back thereafter.

Taking time to deliberate doesn’t mean you do nothing. On the contrary, there’s much you can do to ease your pain and speed your healing from the start. Obviously, reducing pain is a No. 1 priority. In 2007, the Annals of Internal Medicine published a comprehensive review of nondrug treatments for low back pain, which are summarized in this report, along with a discussion of pain medications and other therapies. Note that for some therapies, a lack of quality studies means the effectiveness of those treatments remains unclear.

Early days: Cold and heat
Applying moderate cold or heat to your back can reduce your discomfort. It’s best to use only cold compresses or an ice pack immediately following injury, since this can alleviate pain by numbing the area and prevent or reduce swelling caused by inflammation. About 48 hours after the onset of back pain, though, applying heat to your back may be more helpful. The warmth soothes and relaxes aching muscles; it also increases blood flow, which carries oxygen and nutrients to the injured area and thus promotes the healing process. Generally, electric heating pads and hot water bottles are effective and easy to use. The Annals review noted that heat therapy helps in the early days of an acute attack only (up to a week).

Limited bed rest
Bed rest was once a mainstay of treatment for low back pain, but no longer. Bed rest can be useful, particularly if you are in severe pain while sitting and standing. But limit bed rest during the day to a few hours at a time, for no more than a couple of days. You can lie down on a bed or sofa, in any comfortable position. To ease the strain on your back, try putting pillows under your head and between your knees when lying on your side, under your knees when lying on your back, or under your hips when lying on your stomach. These positions reduce forces that sitting or standing impose on the back -- especially on the disks, ligaments, and muscles. An extended period of bed rest is not appropriate for moderate back strain at any stage of therapy. Why? Although lying in bed does minimize stress on the lumbar spine, extended bed rest creates other problems. For example, muscles lose conditioning and tone. You may also develop gastrointestinal problems, such as constipation. There is some risk of blood clotting in the veins of your pelvis and legs and thus of pulmonary embolism (a serious medical condition where a blood clot, usually dislodged from the veins of your pelvis and legs, blocks the arteries in your lungs). Depression, as well as an increased sense of physical weakness and malaise, is common among people confined to bed rest. For these reasons, it’s far better to engage in a limited amount of activity rather than lie in bed. Well-designed research trials indicate that an early return to work -- with some restrictions or light duty, if necessary -- is preferable to staying home from work for an extended period.

Traction

Traction involves using a system of pulleys and weights to stretch your back -- literally to pull your feet away from your body. This approach has been used for decades, but research suggests that traction offers no benefits and may be harmful.

Getting going: Exercise

Exercise therapy is routinely used to help the healing process during an acute episode, to prevent repeat episodes of acute low back pain, and to improve function in chronic low back pain. Developing a suitable exercise program under expert supervision will enable you to build strong, flexible muscles that will be less prone to injury. If you are suffering from acute back pain, the goal is to help you resume normal activities as soon as possible and to remain symptom-free following recovery from the acute attack. If you have chronic back pain, work with your physician to define your desired functional goal -- whether it involves being able to take a tour of European museums, play with your grandchildren, or simply sit in the backyard reading a good novel. Any exercise program should be customized to meet your individual needs and introduced gradually a couple of weeks after the onset of symptoms or when you are feeling reasonably comfortable. One golden rule about any exercise program is to stop if it becomes painful. Exercise is meant to help, not hurt. If you were exercising before an episode of back pain and then had to slow down or stop for a while because of the pain, don’t resume exercising at the same level of exercise as before the episode. Deconditioning occurs quickly; if you try to pick up your exercise routine where you left off, you might get hurt. Start by doing less (fewer minutes or repetitions) and gradually build back up to where you were before.