How to Treat Back Pain
Back Pain Causes
The source of your backache shouldn't be hard to find. If you're a woman under 50, you can probably blame one of these common culprits.
Muscle Strain It's easy to pull the large muscles in your upper or lower back: Reaching for something or carrying your kids' lacrosse gear to the car can do it. The injured muscle will feel stiff and sore, especially the next morning. In some cases the muscle will "knot up" in painful spasms within a few hours of being hurt.
Misaligned Facet Joint Poor posture and prolonged sitting can send the small structures that link the vertebrae of the spine out of whack. This can cause a slightly one-sided pain that gets worse when you arch your back.
Herniated Disc Normal wear and tear can cause the cushions between your vertebrae to rupture or bulge. The injured disc may press on nerve roots along the spine, causing pain. If the disc pushes on a main leg nerve, it's known as sciatica—sharp, shooting pain through the buttock and back of one leg.
Relief for Sudden Back Pain
Simple do-it-yourself remedies help most back pain sufferers start to feel better within a month's time, according to Timothy S. Carey, M.D., professor of internal medicine at the University of North Carolina at Chapel Hill. But there are some caveats. For instance, you should call your doctor or head to an emergency room right away if you lose sensation or movement in your legs, you no longer have control of your bladder or bowels, or your pain is absolutely unmanageable. Otherwise, follow these self-treatment tips to find relief fast:
Keep active. When Finnish researchers looked at nearly 200 back pain sufferers three weeks after they were injured, they found that those who went about their ordinary tasks as much as possible missed fewer days of work and experienced less pain than those who climbed into bed. As little as two days of bed rest slowed recovery.
Ice it. During the first two days of discomfort, as often as once an hour, put ice cubes or a package of frozen peas in a resealable bag, wrap in a towel, then place on your back for 15 minutes. Cold applied to strained muscles combats swelling and inflammation, which reduces pain and speeds tissue repair.
Take NSAIDs. Over-the-counter nonsteroidal anti-inflammatory medicines, such as ibuprofen, aspirin, or naproxen, make the pain more manageable and reduce inflammation too. Follow the bottle's dosing schedule for three to seven days.
What Won't Help Sudden Back Pain
Avoid the following pain management methods; they won't be effective in relieving your back pain:
Overdoing exercise. Wait until you're healed to start any new back strengthening and stretching routine. According to the Finnish study, adults who did back-specific exercises in the first weeks of being injured had six more days of pain than those who simply stuck to their normal movement patterns.
Using heat at first. Wearable heat wraps and heating pads increase blood flow to the area, which can amp up inflammation and soreness in the first two days. But in subsequent days, when swelling subsides, heat may soothe tense muscles, reduce pain and increase your range of motion.
Relying on pain-relieving creams. The warmth they generate may feel good to you, but there's no evidence they actually help healing, says Jack Stern, M.D., a New York City neurosurgeon who specializes in treating back pain.
Treatments for Back Pain That Lasts Several Weeks
Be patient with the healing process—but not too patient. "You don't want the problem to become a long-term one," says Todd Sinett, a NYC chiropractor and coauthor of The Truth About Back Pain (Perigee). After consulting with your primary care doctor, try one of these "hands-on" treatments:
Physical TherapyBest for: Most types of back pain.What to expect: You may get "passive" treatments, like ice or heat therapy, and "active" ones, such as medically proven workouts using weights, stationary bikes, and other exercise equipment. The emphasis is often on correcting the underlying body mechanics problem, such as bad posture or weak abs.For how long: It's standard to work one-on-one with a therapist twice a week for at least six weeks.
Spinal ManipulationBest for: Pain in one area.What to expect: Chiropractors, osteopaths, and some physical therapists use their hands to apply sudden force to specific joints. The aim is to relieve pressure on the spine's structures and restore range of motion. You may hear a pop or crack as your vertebrae shift.For how long: You'll generally need eight sessions, but you should start to feel better after the first or second "adjustment." If you don't, consider switching practitioners or trying a different therapy.
MassageBest for: Upper back stiffness or low back pain, especially if due to muscle strain or prolonged sitting.What to expect: A masseuse uses hand pressure to knead knotted-up muscles. You might feel minor discomfort during or shortly after the massage. But tell your therapist if a touch triggers intense pain.For how long: In a recent analysis, back pain sufferers who received 6 to 10 sessions of massage over 3 weeks or more felt and functioned better for at least 1 year.
AcupunctureBest for: Dull achiness in your upper back, or lower back pain that covers a wide area.What to expect: Hair-thin needles are inserted at various points into your skin, which may interrupt pain pathways and boost your body's natural painkillers.For how long: Go at least weekly. If you don't feel noticeable improvement within three weeks of your first treatment, talk to your primary care physician about trying something else.
Treatment for Chronic Back Pain
To tackle a chronic backache, your best bet is to enlist the help of a spine specialist—an orthopedic surgeon or neurosurgeon who has received advanced training in diagnosing and treating back problems. These physicians may recommend treatments other than surgery. Visit spine.org and click on "Spine Care Provider Search." Then consider your next steps.
Intensive Rehabilitation Therapy Before going under the knife, experts recommend a program of supervised exercise and cognitive/behavioral therapy, in which you have several sessions a week, often around 100 hours of treatment. In a study of 300 people with chronic low back pain that lasted a year or more, those who participated in intensive rehab reached the same level of relief after two years as those who had surgery.
Medication Chronic back pain sufferers may benefit from a small daily dose of a tricyclic antidepressant or an antiepileptic medication. Studies have shown "off-label" use of these meds can ease discomfort and help with sleep difficulties.
Injections A steroid injection can provide short-term relief (six to eight weeks) if you have back pain that radiates down your leg (sciatica). In general, you can get three shots a year—there's concern that more frequent dosing increases the risk of potentially serious side effects, such as muscle weakness or bone thinning. If the first shot doesn't offer any relief, don't get more, as it's unlikely additional injections will help.
Surgery If you have sciatica that doesn't resolve in a few months, minimally invasive surgery to trim the pinched portion of the disc helps in 85% to 95% of cases, says Richard D. Guyer, M.D., an orthopedic spine surgeon at the Texas Back Institute in Plano. For back pain due to other causes, surgery may also help. In a Swedish study of almost 300 patients, 63% of those who had surgery rated themselves as "much better" or "better" after two years compared with 29% of those who didn't have surgery. Discuss the risks and benefits with your doctor beforehand.
What Medical Tests Are Necessary?
Although one in three back pain sufferers get X-rays, CT scans or MRIs, imaging studies don't necessarily reveal why you're in pain, says Jeffrey M. Spivak, M.D., director of the New York University Hospital for Joint Diseases Spine Center in New York City. "Even if an abnormality is seen, it may not be new or the source of your problem."
In fact, back pain sufferers who have an imaging study don't recover any more quickly than those who don't, yet they deal with more unnecessary worry about their pain. A good rule of thumb: Before you agree to a test, ask your doctor what it's going to look for—and how it might affect your treatment.
How to Prevent Back Pain
Once you've injured your back, there's a 40% chance you'll do it again within six months. Buck the odds with these healthy steps.
Move more. Studies indicate that walking, yoga, and workout programs designed to increase core muscle strength are helpful in preventing back pain. Aim to exercise every other day.
Wear supportive shoes. Well-cushioned shoes with arch support keep your center of gravity stable, so your back muscles aren't overworked.
Gently stretch. Every hour get up and stretch. Bend forward at the hips with your arms hanging and then tilt your head to the left and the right.
Sit properly. Keep your cheekbones directly over your collarbones.
Monitor your mood. A Canadian study of nearly 800 adults found that people who suffer from depression are four times more likely to develop troublesome neck and low back pain. Feeling unhappy may contribute to back troubles by changing brain chemistry that increases pain perception. Talk to your doctor if you think you're at risk.
Back Pain Story: "I was horsing around with my kids."
Karen Auster, a 43-year-old event planner from Brooklyn, New York, threw her back out for the first time six years ago. She was showing her kids (now 15 and 12) how to climb a tree. "As I pulled myself up, I felt a severe pain in my lower back," she recalls. A chiropractor got her back on her feet, but since then she often re-tweaks her back doing ordinary tasks. To keep new injuries to a minimum, Karen now regularly practices Pilates, which helps prevent strains by strengthening the supporting abdominal and lower back muscles.
Back Pain Story: "Stress triggers my back pain."
Karin Burgess, a public relations executive from Stonington, Connecticut, knows exactly why she gets occasional backaches. "When I'm loaded up at work I sit hunched over my desk for long hours, which causes the muscles in my shoulders and back to knot up. It was once so bad I could barely stand for days," says this mother of three girls, ages 15, 14, and 9. Like many back pain sufferers, Karin had to shop around before finding a therapy that worked for her. "A few sessions of deep massage finally loosened the tight muscles and turned me around." Now Karin occasionally has "tune-up" massages, to keep future problems at bay—and she attempts to remember to get up often from her desk and stretch.
Back Pain Story: "Surgery was my last option."
Forty-four-year-old Darla Leonard consulted with four different doctors and tried muscle relaxants and epidural steroid injections before choosing major surgery to fix her painful back in 2001. "When I couldn't sleep most nights or even bend over to pick up the laundry, I knew it was time," says this Sherwood, Arkansas, restaurateur and mother of an 11-year-old daughter. Working through an incision in her abdomen, doctors removed a degenerated disc between the vertebrae and replaced it with an artificial one. "My back felt better almost immediately—it was amazing," says Darla, who admits the recovery process required patience—21 days at home and six months of physical therapy. Still, she says, it was well worth it. "I now have a life again—pain-free, full, and energetic."
Originally published in the March 1, 2010, issue of Family Circle magazine.