Plan a defense against the back attack

Back pain is quite common, but a few simple measures can help to prevent it

Health & Fitness

November 02, 2003|By Elizabeth Large | Elizabeth Large,Sun Staff

For something that affects four out of five Americans at one time or other, it's amazing what we don't know about treating a bad back.

Should we head for the surgeon? The chiropractor? The acupuncturist? Exercise or bed rest? Heat or ice?

Often the answer boils down to something simple: whatever works.

Ellen Webb, 45, is a busy Roland Park mom with three small children. She controls her recurring lower back pain by practicing yoga and doing sit-ups to keep her abdominal muscles strong.

"I aspire to do 100 a day," she says. "I probably do 50."

If her lower back starts to feel achy, she immediately starts doing more sit-ups. It's not a treatment doctors and physical therapists might think to recommend, but it works for her.

"Everybody is so different," she says. "Know your own back."

Those are words that should be engraved over the door of everyone who has ever suffered from back pain, considering the work time lost (10 million Americans daily) and the cost ($20 million to $50 million annually, according to government estimates). Low back pain is the second most common symptom people present to their family doctor, and the most common reason they visit orthopedic surgeons and neurosurgeons. And all that for a condition usually healed by time as much as anything.

Right now, we're just coming into prime back-attack season. Homeowners are raking leaves and will soon be shoveling snow, gardeners are cleaning out beds and mulching, and many who exercise regularly in the summer are turning into weekend athletes. An ounce of prevention now is worth a pound of anti-inflammatories, heating pads and massages later.

Dr. Aleksandar Curcin, co-director of the Spine Center at Sinai Hospital in Baltimore, believes the back is a disregarded area of the body -- at least as far as prevention is concerned -- with so much emphasis these days placed on controlling cholesterol and other trendy health subjects. He suggests a low-key approach to routine maintenance. Some simple sit-ups, back arches, windmills and pelvic tilts can go a long way to avoiding a bad back. (Pelvic tilts stretch out the lower back: You lie on the floor on your back with your knees bent and your feet on the floor,

tighten your abs and press your lower back on the floor, hold a few seconds and slowly relax. Repeat.)

"It doesn't have to be a Ravens routine," Curcin says. "Fifteen or 20 minutes of stretching and gentle strengthening exercises three times a week [will do it]. It's not necessary to be doing crunches."

The back is vulnerable because the spine is such a complicated mechanism. Normal wear and tear and chemical changes due to aging can affect its discs adversely. And the core muscles that support the spine are involved in just about everything we do; it's easy to overstress them, particularly if they're weak.

The American Academy of Orthopaedic Surgeons recommends regular exercise like walking or swimming, standing and stretching once an hour if your job involves sitting, and using the proper techniques to move heavy objects. (Lift with your legs.) Extra pounds and poor posture put extra strain on your back. Smoking is also a risk factor, although it isn't clear why. One reason may be that smoking lessens the amount of oxygen going to the musculoskeletal system.

There are various contributing factors to back strains and sprains, says Dr. William Tipton, executive director of medical affairs for the Illinois-based association. "Overweight, poor muscle condition and lack of flexibility. It all speaks to one thing: exercise."

When it comes to the seasonal chores that often result in those strains and sprains, Wendy Hoy, a physical therapist with Physiotherapist Associates in Lutherville, suggests approaching them with care and common sense.

"My best advice," she says, "is to try to spread out tasks. Take a break. Do them over two or three days if possible. Recruit the kids to help. If there's a history of back pain, take an anti-inflammatory first. If you're raking and there's any irritation or discomfort, stop and ice. Stretch before and after."

Hoy believes in stretching everything to prevent lower back injuries, not just the legs. "Arms, shoulders, chest, hamstrings. The whole body. The spine is affected by everything we do."

But let's assume you've been doing your hamstring stretches and picking things up correctly (by squatting rather than bending), and your back still goes out while you're on a ladder cleaning gutters. If you've strained the large supporting muscles near the spine, it can be a cyclic problem. They start to spasm, which causes pain, which causes the muscles to spasm again.

Ninety percent of such back attacks get better on their own, says Curcin, so don't rush to call your doctor yet. Take a couple of over-the-counter anti-inflammatories like Advil or Aleve (if you can tolerate them) and take your pick: heat or ice.

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