How to Conquer Lower Back Pain Forever
Nearly everyone gets it. Here's how to treat it—and extinguish it—for good.
It all starts with a pang at the base of your spine. Maybe you were squatting too much weight at the gym. Maybe you were moving your sofa. Or maybe it was something that grew out two decades of hunching over your desk at work. Whatever the case, you've got it: the dreaded lower back pain.
You certainly wouldn't be alone. Today, in fact, some form of back pain is the number two reason that drives Americans to seek health care—right behind the common cold. According to Dr. Samuel K. Cho, MD, associate professor of orthopedics at the Icahn School of Medicine at Mount Sinai, up to 80 percent of patients suffer from some form of back pain during their lifetime. Likewise, the NIH reported that "one-quarter of adults have at least one day of lower back pain in a three month period." And it's not just old fogies throwing out their backs, either. According to data from the Agency for Healthcare Research and Quality (AHRQ), the number of emergency room admittances for back pain is similar for both the 18–44-year-old age group and the 45–64-year-old one.
There are two main forms of lower back pain: acute and chronic. Acute pain is defined by a sharp, severe, sudden onset. You got in a car accident, fell down the stairs, or "threw out your back" lifting something. But for all the misery you feel, acute lower back pain can often be healed with Advil, ice, and sufficient rest.
"Chronic low back pain is the real bugaboo," says Dr. Jack Jallo, MD, PhD, a spine surgeon and a professor of neurosurgery at Thomas Jefferson University. "It's very difficult to manage."
Chronic lower back pain comes around, again and again, like a fly to a picnic table. Only instead of simply making your turkey sandwich less appetizing, this fly makes it tough to get out of bed in the morning—and, instead of bothering you for 20 minutes, it bothers you for 20 years. "Unfortunately, there's not a machine that we can put you in that will tell you where your back pain is coming from," says Jallo. "It's one of the dilemmas of managing back pain."
Of course, the easiest fix for lower back pain is to avoid it in the first place by staying fit, active, and not sitting too much. But if you're among the unlucky 80 percent of humankind who does suffer from a "bad back," here's exactly what you need to know to face and conquer it.
Yes, Buy That Standing Desk
"The personal computer is for chiropractic treatments what candy is for dentistry," says Robert A. Hayden, DC, PhD, a leading member of the American Chiropractic Association. Every second you spend at your desk leads to added pressure on your spine, which can lead to disc degeneration or pinched nerves. "Human bodies were just not made to sit for long periods of time."
"Spinal discs are like shock absorbers in a car," adds Cho. "The more you drive and use the car, the more you're going to wear out the parts of the car. When it comes to your body, that includes the shock absorbers, or your spinal discs." Cho recommends buying an adjustable standing desk so you won't have to stand all day long, but you have the option to stand at several points throughout the day.
Exercise Your Core Without Crunches
A strong core means strong muscles that stabilize your back and keep your spine aligned. But that doesn't mean you should wake up and do 100 sit-ups every morning. In fact, Jallo says, sit-ups are one of the worst exercises for aiding your lower back pain. In addition to working your abdominal muscles, they put added stress on the base of your spine.
Jallo recommends a set of exercises known as the McKenzie Method—or "mechanical diagnosis and therapy" (MDT). MDT revolves around strengthening the core by removing stress from the spine. We're talking things like leg lifts, flexion exercises, back extensions, planks, even some light yoga and Pilates. But be careful with yoga. "Certain postures, especially poses where you flex the lower back without any support"—like upward dog—"can be harmful," says Cho. Build your flexibility over time before you attempt positions like that.
Consider Chiropractic Care
Chiropractors often get a bum rap as snake-oil salesmen in the world of modern medicine. But the truth is that chiropractic methods like spinal manipulation are terrific for lower back pain. In fact, the American College of Physicians recently recommended that patients begin with non-drugs treatments like these before moving on to more traditional medicine. Chiropractors utilize over 150 different techniques to literally put bones back in their correct place. "We also use ultrasound," says Hayden. "Ultrasound reaches deep inside the tissue and creates warmth," which facilitates circulation in the spinal discs, aiding in the regenerative process.
Hayden relayed the story of a patient he recently saw, a man who was injured back in the first Iraq War (yes, from the early '90s). He was caught in an IED blast that threw him to the ground. Hayden discovered that one of his vertebrae had been out of whack for more than two decades.
So Hayden rolled the soldier onto his side and moved the bone. Apparently, you could hear it move. ("Scared him into next week," says Hayden.) But then the guy stood up, walked around, and burst into tears. For the first time in decades, he could walk without pain.
Focus on Your Mental Wellbeing
If you're suffering from chronic lower back pain, taking steps to reduce your anxiety and stress can go miles in relieving your pain. "For some people, stress and anxiety contributes to back pain [of all types]," says Jallo. And then this leads to a self-fulfilling prophecy: you get stressed and anxious because of the pain.
"Anxiety compounds and intensifies the pain experience," says Hayden. "Frankly, it's scary to have repetitive pain." He likens chronic lower back pain to patients who suffer from migraines. With a migraine, you feel the aura, you know the pain is coming, you tense up and prepare for the worst—all of which is anxiety-inducing.
Any reprieve from the pain, no matter how brief, can break that cycle. Focusing on your mental wellbeing—assuaging your anxiety and your stress—is the other side of the coin: a more permanent, rock-steady solution to breaking that cycle.
If the pain from a slipped disc is tortuous enough, you may wish to consider microdiscectomy, a minimally invasive procedure where surgeons will go in and shave off the part of the disc that has protruded out of its proper place. This relieves pressure on the nerve, and you'll be walking tall again in no time.
But this should be your last resort. "One of the issues we deal with in medicine is we tend to over-treat people," says Jallo. "Maybe you do have a herniated disc. But if it's not limiting your daily activities, there's no reason to do anything about it. Surgery is not especially good for back pain."
However, it is effective at relieving ancillary effects of lower back pain, like numbness, tingling, or pain in the extremities.
The Right Drugs
For truly agonizing moments of lower back pain, narcotics and muscle relaxants can be a quick solution. "A muscle relaxant requires a prescription, but it does get you over that acute back pain," says Jallo.
Muscle relaxants—like Flexiril, Valium, and Oxycodone—take about 30 minutes to kick in. Once they do, the muscles at the base of your spine will loosen up, get you moving again. If your lower back pain is extreme, the doctor will prescribe a schedule for you to take them. Combine that with some bed rest and, in a few days, you'll be up and about, albeit with a few residual pangs and twangs. And this should go without saying: don't overdo it.
"If you have a chronic condition, narcotics are terrible," Jallo carefully adds. Your body grows used to the dosage, the pain returns, you up your dosage, and next thing you know, you're in a potentially addictive cycle, where your body needs the medication to get through the pain. "As a rule, the public doesn't want [narcotic] treatment; the addicts do," says Hayden.
That aforementioned American College of Physicians report, aptly titled Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain, offers more or less everything a physician today needs to know to cure lower back pain. Assuming you don't have time to read the thing, here's the biggest takeaway: get ample rest, preferably on a comfortable bed. For acute back pain, you'll just want to rest for a couple of days, maybe take some Advil or Ibuprofen. For chronic pain, the solution is the same: when pain rears its ugly head, keep your back cozy and horizontal, and you'll be back to better before you know it. If, after a few days, the pain hasn't cleared up—or if the pain is severe to the point of debilitation—that's when you should consider going to the doctor.
And as always, if this is a medical emergency, don't wait to get an appointment with your PCP, don't wait until the urgent care place opens, and certainly don't consult a guide on the Internet. Call 911.
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