Back pain has many causes and, as a result, many treatments. This Special Health Report, Low Back Pain: Healing your aching back, helps you understand why back pain occurs and which treatments are most likely to help. Treatment of low back pain has undergone a recent sea change. Experts now appreciate the central role of exercise to build muscles that support the back. They also better understand which conditions surgery will help and which patients are good surgical candidates. This report describes the different types of back problems and the tailored treatments that are more likely to help specific conditions. A special section is dedicated to the self-care steps you can take to mend your back, and features information on different types of exercise and complementary therapies such as chiropractic care, acupuncture, and massage, as well as healthy back habits and tips on choosing a mattress.
This report was prepared by the editors of Harvard Health Publications in consultation with Jeffrey N. Katz, M.D., M.S., Professor of Medicine and Orthopedic Surgery, Harvard Medical School. 48 pages. (2012)
Who develops back problems?
If you’re like most adults, you’re likely to suffer from low back pain at some point in your life. Although anyone can develop backache regardless of their health or circumstances, research has found that some conditions or activities put you at greater risk for such problems. Key factors include the following.
People are most likely to suffer from low back pain in midlife. During the middle years, even in the absence of any injury, the bones and joints in your lower back (the lumbar spine) begin to change. Disks (the structures that serve as cushions between the bones in the spine) tend to wear out and sometimes become fragmented. These structural alterations sometimes cause pain. While back pain problems may be more common in people in their middle years, in older individuals back pain attacks are more severe and last longer.
Studies suggest that back pain plagues men and women equally. However, in Western industrialized societies, men are more apt to have disk problems, and they are more likely to be treated surgically. These differences most likely reflect the fact that a greater number of men than women work in jobs that involve heavy lifting, pushing, and pulling, and that men in such jobs often feel the need to return to work as soon as possible following an absence due to back pain.
On the other hand, osteoporosis (loss of bone density and strength) occurs in women much more often than men. This disorder can cause severe weakening of vertebrae and may eventually lead to vertebral fractures. Vertebral fractures can cause a loss of height and a rounding of the back. They can also be very painful. Women are also especially susceptible to degenerative arthritis of the lower spine (a condition that generally involves the vertebral joints). They are also more likely to develop spondylolisthesis (an abnormal forward displacement of a vertebra relative to the one below it).
Heredity appears to play a role in certain types of back pain. Defects of the disks seem more common in some families; a hereditary difference in the chemical makeup of disks may render them more prone to fragmentation or herniation, conditions that can trigger back pain. Ankylosing spondylitis and spondylolisthesis likewise seem to run in families.
Work and play
Certain jobs and activities put a greater strain on your back. Riding in motor vehicles is notoriously hard on your back, for instance, because it involves prolonged periods of sitting and exposure to vibration. The sitting positions necessary for office work — from typing to computer programming — can also eventually take a toll on your back regardless of your age.
Several other job-related activities increase the likelihood of future back problems:
- lifting or forceful movements such as pulling and pushing
- frequent bending or twisting of the back
- heavy physical exertion
- maintaining the same position for long periods
- repetitive motion patterns
- prolonged exposure to vibration.
Physical characteristics and posture
Your build, weight, and height seem to have little to do with your likelihood of developing back pain, although being overweight puts you at increased risk of having your symptoms return. Even a moderate difference in leg length (up to three-quarters of an inch) has no proven adverse effect on the lower back.
And despite your mother’s admonition to “sit up straight,” experts now agree that, in most cases, posture alone — whether bad or good — will neither predispose you to back pain nor shield you from it. Slumping and slouching don’t seem to have much effect on the basic health of your spine. But before you sit in your chair, note that poor posture can exacerbate existing back pain. Improving your body mechanics can help relieve your symptoms and prevent recurrences.
A growing body of evidence shows that our emotions and psychological well-being have a significant influence on our physical health. It is not surprising, therefore, to learn that these factors also affect the back. Although study populations and methods vary, in general, research has shown that psychological factors such as stress, anxiety, and negative mood and emotions all increase the likelihood of developing acute (sudden) or chronic (longer-lasting) back pain. Such psychological factors seem to be especially important in determining whether an acute bout of back pain will become a chronic problem. One review of studies that examined this question, for example, found that people who were distressed or depressed were more likely to develop chronic back pain than other people. The reasons for this are not completely understood. Symptoms of chronic pain and depression share some of the same biochemical roots. The neurotransmitters serotonin and norepinephrine, for example, not only are involved in mood disorders such as depression but also are important in producing the sensation of pain.
Fortunately, this dynamic can also be reversed: by changing the behaviors and thinking patterns that may aggravate and worsen the situation, it is often possible to alleviate low back pain and prevent it from becoming a long-term problem.
How you live can make you more susceptible to back pain. Research shows that smokers are at greater risk. And being physically out of condition is an important reason people have a recurrence of the “sprain and strain” type of back pain.
A person’s education level and job situation appear to have an association with back pain, according to many studies. People who are unhappy at work because a job is unfulfilling or the pay is low tend to develop more back problems than the general population. The exact reasons for this are unclear, but these findings underscore the importance of psychological and social factors.
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My father has back problems and needs surgery. He does not tend to read about medical conditions so I purchased and studied this myself. I found it very well written with clear explanations and diagrams. This had three advantages: we were able to gain a thorough understanding of his problem; and how it should be treated, including the pros and cons of various alternatives; and it helped greatly in the process of formulating questions to put to the surgeon prior to the operation.
Even someone without back problems will benefit from this information. It explains how to look after your back and prevent problems arising. Prevention is better than cure.
I bought this special report to help my mom who is 88, understand her back injury and its treatment. She really responded positively to the information in this report. She felt that the report described exactly the symptoms she was experiencing. The steps our family doctor followed were the same and she was diagnosed by x-ray with a compression fracture of a vertebrae in her lower back, as described in the report. Also, I passed my copy to my brother-in-law who has suffered from chronic lower back pain for years. I hope his response to this report will be as positive as my mom's. In the meantime, I have just ordered an additional copy of this report for my mom as per her request.
A lot of good information. Due to my wifes age and mental condition, I am not sure how much of this can be applied. It affirmed that I am doing the right things for my back.
I have had rheumatic trouble with my aching back, the lumbar region, for a long time. I visit my specialist once every year, but that takes less than 15 minutes, including filling out prescriptions. This Health Report covers a void, it's beautifully written and illustrated. It's simply great. Thank you!
"Low Back Pain" is inclusive and well-written. While my back pain is not overbearing, and I see a chiropractor regularly, I have had osteoporosis, been diagnosed with stenosis, and am 80 years old and female. I am happy to have this trusted reference on hand.
Well organized and clearly written in layman's language. I am a 72 year old female and have arthritis in my spine. I had surgery ( a laminectomy ) for spinal stenosis in my lower back ( L 5-S 1 ) about 6 years ago. The surgery was very successful and necessary due to severe symptoms from spinal compression. I was referred by the surgeon for physical therapy post op and I continued with a home exercise routine. I had several years without pain and was able to function completely normally. However, I have had a recurrence of sciatica and am looking for alternative teatment solutions. I have found that gentle yoga has been extremely helpful. I had physical therapy again prior to taking yoga and that helped too, but was not sufficient. Neither physical therapy nor yoga was even suggested to me by my Orthopedist or my Internist when sciatica recurred. I am glad to see that you are including all treatment modalities and urging people to go slowly and try alternative approaches when appropriate. Unfortunately, even good physicians, which I have, do not bring up alternative treatment possibilites. I hope physicians are being updated and better educated on this issue as well. Thank you for the very informative and balanced presentation of information.
B.D., San Diego, CA.
As a Medical Educator, I have noted that you back pain recommendations often refer to chiropractic care as a source of relief but do NOT refer to Osteopathic Medicine resources which are equal or superior to many MDs.
Michigan State University has both MD & DO programs.
Having had a back injury & TBI from ditching my USAF aircraft in the Pacific Ocean in 1958. No real relief was obtained until I joined the medical faculties of both colleges in 1972.
The Osteopathic physicians were far more effective than the chiropracters in resolving back problems.