Back Basics

About 80% of all Americans will have at least one backache during their lifetimes. Every year articles and books about back pain appear, espousing new and/old theories about its causes, and how to treat it. Orthopedists, chiropractors, physical therapists, neurologists, and surgeons all contribute to the debate. There’s room for controversy because the back is such a complicated, sophisticated structure, and while we can name all the bones, joints, nerves, muscles, and ligaments that comprise it, the sum total remains something of a mystery. Fortunately, most backaches aren’t serious and generally go away in a few weeks, with or without medical attention. And they are usually preventable.

Anatomy of a backache

The spine is a mechanical marvel. It is sturdy enough to support the upper body, yet pliable enough to allow the trunk and neck to bend and stretch. It’s made of 24 separate spool shaped bones called vertebrae, plus the sacrum (a triangular bone between the hipbones) and the tailbone (coccyx). These are all stacked like a flexible tower with three curves in the neck, chest, and lower back. The vertebrae are connected and held erect by ligaments and muscles that act like guy wires; much support for the lower back comes from the muscles in the abdomen. Sandwiched between the vertebrae are gel filled pads of tough connective tissue (cartilage) called disks, which act as shock absorbers. Finally, the spine serves as a protective conduit for the spinal cord, the vital network of nerves connecting your brain to the rest of your body.

Back trouble is so common because the human spine hasn’t evolved to the point where we can walk upright without some risk. Being erect puts extra pressure on the vertebrae of the lower back, or lumbar region, where the back curves most and where pain most often strikes. Backache becomes common between the ages of 30 and 50, when the disks start to lose water and elasticity and thus some of their ability to absorb shock. In middle age, too, people tend to become less active and their muscles lax, contributing to back instability.

Sprain, strain, spasm: which is it?

As small portion of all backaches do have clear causes for instance, a ruptured disk or some underlying disease. Yet in the great majority of cases the exact diagnosis isn’t known. Is the cause of your backache that sudden movement yesterday when you bent to pick up the newspaper, or is the problem that you get too little (or too much) exercise? Or it could be your poor posture, or just every day wear and tear. In fact, it’s probably a combination of these things. Yet again it may just be part of aging. A backache can range from mild discomfort to sudden excruciating pain but in some cases there’s dramatic damage to disks yet no pain whatsoever.

You may wonder if you have a back sprain or strain. These terms are often loosely applied to a broad spectrum of back disorders. Strain is generally used when a muscle is overstretched, and sprain when a ligament is partially torn. However, you seldom know whether it’s a muscle or ligament that’s been damaged, let alone whether it has been torn or not. Two other terms, muscle spasm and ruptured disk, are more clearly defined.

Muscle spasm. The most common form of spasm is a sudden onset of sustained, painful, involuntary contractions of muscles in the back. This may serve to mobilize irritated muscles, thereby protecting them and spinal nerves. A spasm usually results from a back injury but may also be caused or aggravated by poor posture, lots of sitting in the same position, tense back muscles, and weak abdominal muscles. Many researchers claim that psychological stress can also trigger spasms.

Disk problems. These are relatively uncommon. Only 2 to 4% of back ailments are due to what is commonly called a “slipped” disk. The term “slipped” is a misnomer, since the disk actually bulges from between two vertebrae and may eventually rupture or herniate. If a displaced disk presses on a spinal verve, the nerve can send a shooting pain to the legs or arms, or create a tingling or numbed sensation in them. If, as is common, the affected nerve is the sciatic, the condition is called sciatica, causing pain along the back of the hip and outer side of the leg.

Underlying diseases and structural problems, A small percentage of all back aches are related to identifiable medical problems such as disease, cancer. Arthritis, osteoporosis, or spinal infection, sideways way back curvature (scoliosis) saw back (lordosis. or excessive curve in the back). or other structural defects also be at the root of bake pain.

When to see a doctor Call your doctor if you have any of the following symptoms:

Call your doctor if you have any of the following symptoms. Radiating pain, numbness, or tingling in arm or leg back pain that continues unabated when you’re lying down; back pain that doesn’t improve after two days of bed rest; back pain resulting from a fall or car accident; vomiting or fever associated with back pain; or back ache in an elderly person or child. Any of these may indicate a more serious problem.

That leaves the great majority of backaches (less serious strains, sprains, or spasms), which usually don’t require a doctor’s attention. For soreness and minor pain in the back, avoiding physically demanding activity may be sufficient but in most backaches the pain is more severe, so you should follow your first instinct lie down. This is a good idea for two reasons: you relieve the pain, and you take mechanical pressure off you stressed or injured back during the first day or two. If you don’t allow inflamed tissue repair itself, you may fall into a chronic cycle of back injury. According to research by the Swedish orthopedist Alf Nachemson, compared to standing, reclining reduces pressure on the lumbar disks by 70%, while unsupported sitting increased it by 40%.

That said about the benefits of bed rest, you shouldn’t overdo it. The current trend in treating common backaches is to get people out of bed as soon as they can get up comfortably. While doctors traditionally recommended a week or two of bed rest, a study at the University of Texas Health Science Center at San Antonio found that two days in bed are usually sufficient for run of the mill backaches and suggested longer bed rest only for disk problems. Moreover, shorter periods of bed rest may reduce the potentially adverse effects of prolonged bed rest, such as weakening of muscles from inactivity, which may lead to further back injury. (As patients bedridden for other reasons often discover. a couple of weeks in bed can actually produce a weak and painful back.) But remember, if severe pain recurs when you get up. go back to bed and consult your doctor. And resumption of activity must be gradual, since your back needs time, to heal completely. Once the pain is gone complete take it easy heavy chores and sports for at least two weeks. Aspirin or ibuprofen will help reduce the intensity of pain and inhibit inflammation. Do not use a corset or back brace unless your doctor prescribes it.

Should you heat or ice your back? Though icing is best for many other types of injury, there is some disagreement when it comes to the back. Most physical therapists now recommend icing immediately after a sudden, wrenching back injury that causes pain in a localized portion of the back. The cold can relax a spasm and minimize swelling. Ice for 10 to 20 minutes several times a day during the first 48 hours, On the other hand, for a widespread backache that gradually sets in hours after an. injury or for chronic back discomfort a hot bath or heating pad may be soothing and promote healing. The ultimate criterion is which treatment works for you, Thus if cold therapy feels uncomfortable or doesn’t, offer relief try heat

Article extracted from this publication >> February 26, 1988