Back Pain: Finding solutions for your aching back

Treatment of back pain has undergone a recent sea change. Experts now appreciate the central role of exercise to build muscles that support the back. This Special Health Report, Back Pain: Finding solutions for your aching back, helps you understand why back pain occurs and which treatments are most likely to help. This report describes the different types of back problems and the tailored treatments that are more likely to help specific conditions.

Back Pain: Finding solutions for your aching back  Cover

Stretching: 35 exercises to improve flexibility and reduce pain

Stretching is an excellent thing you can do for your health. These simple, yet effective moves can help you limber up for sports, improve your balance and prevent falls, increase your flexibility, and even help relieve arthritis, back, and knee pain. Whether you're an armchair athlete or a sports enthusiast, this Special Health Report, Stretching: 35 exercises to improve flexibility and reduce pain, from the experts at Harvard…

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When back pain strikes, you may think the best way to get relief is to sit still or lie down until the pain goes away. But we now know exercise can be key to treating back pain. In fact, thanks to the pioneering work of back pain researchers, effective treatment has undergone a sea change.

That’s why the experts at Harvard Medical School created Back Pain: Finding solutions for your aching back. This report reviews common types of back problems and the treatments that are most likely to bring you relief. For example, you’ll discover:

  • 3 symptoms that mean your pain is probably caused by a herniated disc
  • Why men are more likely to suffer from disc problems and need surgery
  • The type of back pain that can come from being out of shape
  • Why uncovering the cause of back pain can be so difficult
  • If opioid pain relievers can ever be used safely
  • The best way to prevent repeat episodes of back pain

You’ll get a detailed overview of how your back is put together and the role your vertebrae, discs, muscles, nerves and more play in helping you to twist, turn, bend, stand, walk, run, and lift. Knowing this information makes it easier for you to understand:

  • The reason your abdominal muscles are so important to your lower back.
  • Why MRIs and X-rays are considered overused when it comes to most back pain.
  • Why the best approach to back pain is “wait and see” unless you have a red-flag symptom.
  • “Just-in-case-tests” that could lead to unnecessary surgeries.
  • Why 90% of people with sciatica or herniated discs will recover on their own within 6 months.

And this is just a fraction of the important, pain-relieving, back-pain-preventing information you’ll find in this report. You’ll see:

  • The type of compress that helps promote healing
  • Why you don’t want to spend too much time in bed after a back injury
  • 7 crucial questions to help decide if you need surgery
  • How to tell if a firm mattress is causing your back pain
  • How lack of exercise can trigger back pain
  • 9 ways to take pressure off your back
  • And so much more

This report was prepared by the editors of Harvard Health Publishing in consultation with Jeffrey N. Katz, MD, MSc, Professor of Medicine and Orthopedic Surgery, Harvard Medical School; Vice Chair for Orthopedic Surgery, Brigham and Women's Hospital. 52 pages. (2017)

  • Why is back pain so common?
    • What puts you at risk for back pain?
  • The anatomy of your back
    • Vertebrae
    • Discs: Your back’s shock absorbers
    • A flexible, protective column
    • Muscles, ligaments, and tendons
    • Nerves
  • Types of back pain
    • Sprains and strains
    • Nerve-compression syndromes
    • Arthritis, including ankylosing spondylitis
    • Spondylolisthesis
    • “Red flag” symptoms and conditions
  • Diagnosing back pain
    • Your medical history and exam
    • Diagnostic imaging: When it is and isn’t useful.
    • What tests can help diagnose back pain?
    • Tests used less commonly to diagnose back pain
  • Creating a treatment strategy.
    • Factors to consider
    • What can you do?
    • What can your doctor do?
  • SPECIAL BONUS SECTION: Beyond drugs and surgery—other ways to help your back
  • Medications for back pain
    • Over-the-counter pain relievers
    • Prescription pain relievers
  • When is surgery an option?
    • Weighing the risks and benefits of surgery
    • Surgery for disc disease
    • Surgery for spinal stenosis and spondylolisthesis
    • Surgery for compression fractures
    • Surgeries for other back problems
  • Recovering from back pain
    • Five rules for a safe comeback
  • Resources
  • Glossary

What tests can help diagnose back pain?
There are times when imaging tests are appropriate. If the pain becomes chronic—that is, it persists with little or no improvement for three months or more—imaging studies and other tests can help identify the source of the pain and rule out serious problems. If your doctor thinks you might have a serious condition such as a tumor, infection, or cauda equina syndrome, advanced medical imaging could save your life.

If you and your physician agree an imaging test may be helpful, here are some of the standard options.

X-rays
X-rays produce images of bones and of other parts of the body that are rich in calcium. Although x-rays provide information about the condition of the bony vertebrae, x-rays of the spine provide
limited information about the discs, ligaments, muscles, and other soft tissues. Nonetheless, x-rays
are indispensable for identifying fractures as well as changes in the bones associated with tumors, infections, and certain forms of arthritis. X-rays expose you to some radiation, but the doses are low. In the absence of other significant radiation exposure, occasional x-rays don’t pose a significant danger.

Computed tomography (CT)
CT imaging provides distinct outlines of the various structures of the back, such as the vertebrae. While CT scans can show arthritis or spinal narrowing (stenosis), they may not indicate clearly whether a herniated disc is causing a problem, such as sciatica.

During a CT scan, you must lie still for 10 to 15 minutes on a table that slides into a tunnel-like scanner. An x-ray device moves along your body taking multiple pictures from slightly different angles. Instead of sending a single x-ray beam through your body, this device uses many narrow beams. A detector that rotates around you collects the beams and sends the information to a specialized computer, which instantaneously analyzes and synthesizes multiple images of your back. The result is a set of remarkably detailed views. CT has one important downside: the scanning exposes you to much more radiation than a conventional x-ray.

Magnetic resonance imaging (MRI)
MRI technology uses electromagnetic waves to create images of your tissues, thus avoiding the radiation hazard of x-rays and CT scans. Unlike CT, MRI creates images of soft tissues, including intervertebral discs, spinal nerves, and tumors.

The MRI procedure usually takes about 45 minutes.You lie motionless on a table that slides into the center of the donut-shaped scanning machine. The machine bathes you in a strong magnetic field and probes the body’s water-rich soft tissues with radio waves. The resulting scans are extremely detailed.

While in the MRI scanner “tunnel,” you may feel anxious or claustrophobic. The machine makes unpleasantly loud buzzing, clicking, and knocking sounds, so you will wear ear protection. Diagnosing certain back problems may require an injection into your bloodstream of a special contrast dye before the scan. A small percentage of people have an allergic reaction to the dye. Unless you need to have the dye injected, MRI scans are not invasive and are believed
to be harmless.

MRI scans are expensive, but when used in conjunction with a medical history and physical examination, MRI can eliminate some of the guesswork involved in making a diagnosis.

Myelography
Myelography is a form of diagnostic imaging that shows the positions of the lumbar nerve roots—the nerves that exit the spinal cord between pairs of vertebrae in the lower back. This sensitive procedure can also indicate distortions in the shape of the fluid-filled sheath that surrounds the spinal cord and the cauda equina.

It works this way: The doctor first injects a contrast medium (a fluid opaque to x-rays) into the spinal canal. This allows a type of x-ray machine called a fluoroscope to observe the flow of the contrast medium through the space around the cord and the nerve roots. The resulting images reveal abnormalities such as herniated discs, stenosis, or spinal tumors.

However, myelography is expensive and also invasive, since it requires puncturing the protective
sheath around the spinal cord with a needle. Some people find it to be quite uncomfortable. Possible complications include headache (occasionally severe), an allergic reaction to the contrast fluid, and even infection resulting from the lumbar puncture, although this is rare. Myelography is performed only when a diagnosis is particularly difficult or when it’s necessary to pinpoint the location of a problem in preparation for a complex surgery. In such cases, myelography can be done in combination with CT imaging.

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