Back pain is common and the myths surrounding it are many

The most common cause of disability in the United States, back pain is something that almost everyone encounters at some point in life.

By: Dr. Ronald Gonzalez
   Back pain is something that almost everyone encounters at some point in his or her life. In fact, it is the most common cause of disability in the United States, most often stemming from work-related injuries and automobile accidents.
   Back pain is a symptom and the causes are numerous, including muscular aches, arthritis, cancer, fractured vertebrae and herniated disks. Because there are so many things that can trigger back pain, there are many myths surrounding it, including what causes it, how to diagnose it and how to treat it.
   Many people believe that sitting is better for the back than standing or lifting, but this is not the case. Increased time spent sitting in chairs at work has led to an increase in back pain over the last few decades.
   Another common misconception is the benefit of bed rest. While those experiencing back pain are advised to rest the back by not doing strenuous lifting or bending, it is important to remain active. In addition, your risk of becoming depressed increases with the length of time you spend in bed, and it is not uncommon for those with back pain to suffer emotionally.

   Others believe that if their pain is severe enough, they can always resort to surgery; however, pain is no indication of whether surgery is the right option. It is estimated that for every 1,000 people who suffer from back pain, half of them will recover on their own, another 200 will have chronic pain and require more aggressive treatment, and another 50 of them are good candidates for surgery.
   For those experiencing back pain that does not go away within a few weeks, it is time for a good clinical exam made by an experienced physician. The physician will begin the exam by taking a complete history. When tracing the cause of the back pain, the physician will ask the patient questions such as when the ache started, if there is a connection to any specific activity, if the pain is present in the leg, if there is any numbness or muscle weakness, and if it worsens during a bowel movement or while coughing. After taking a history, the physician will examine the patient thoroughly, testing reflexes and leg strength and looking for pinched nerves.
   A clinical diagnosis is used to rule out the rare but serious causes of back pain such as a tumor or an infection. It can also help determine the presence of nerve problems. There are many tests used to diagnose back pain, including X-rays, bone scans, discograms, electromyography, myelogram, CT Scan and MRI.
   Once the clues have been collected, doctor and patient work together to alleviate the problem. For more than half of back-pain cases, sufficient treatment includes pain medication, hot packs, rest and healing time. For the remainder of the cases, half of them may be treated with muscle relaxants and physical therapy. If this is not enough, the physician may prescribe a more potent form of pain medication and may give a superficial injection or an epidural.
   There are some patients who, because of severe injury, may experience chronic back pain. The majority of back pain is caused by strains and/or sprains of the back’s muscles, ligaments and tendons. Poor posture, repetitive motions, and an inactive lifestyle can all play a role. In some cases, just bending over to pick something up can send the muscles into spasm. It is just as likely that the back pain creeps up slowly, perhaps after sitting or standing in one position for an hour or more.
   The discs between the vertebrae are another culprit. Often the disc’s outer casing, called the annulus, weakens, causing the disc to bulge and irritating a nearby nerve. Less commonly, a portion of the disc may burst, or herniate, through a tear in the annulus and pinch a nearby nerve. This may cause severe leg pain. If the herniation occurs in the lower portion of the spine, it can cause severe leg pain, often called sciatica. Those who suffer from a herniated disc are often under the age of 40.
   As we age, the discs begin to dry out slightly and become thinner, sometimes called disc degeneration. When this happens, the space in the vertebrae through which the nerves exit can become narrow, irritating the nerves. This condition is called spinal stenosis. As we age, our facet joints may also go out of alignment, especially if posture has been poor for many years. When this happens, they can wear out, causing facet joint syndrome. While these natural processes occur, the body tries to make the spine more stable. Osteophytes, or little growths of bone, can form, causing a condition called osteoarthritis.
   Further complicating things, some people suffer from a combination of these problems. To help treat patients, physical and occupational therapists use a variety of techniques that include strengthening and flexibility exercises, aerobics and patient education. Physical therapists help educate patients and teach them how to use posture to avoid recurrences. Occupational therapists, working closely with physical therapists, help patients learn modified ways to perform work and pleasure activities. In addition, yoga, which combines flexibility exercises with breathing techniques, has been used to treat back pain for centuries. Many others turn to chiropractors for joint and muscle manipulation.
   To help prevent back pain, maintain good posture, avoid putting excess strain on the back muscles and firm up the abdominal muscles so that they can do their share of the workload. When lifting objects or weeding the garden, bend at the knees to minimize back pressure. Stretch often during the day, whether you spend it sitting or standing, and keep active. Should you develop back pain, take comfort in knowing that is treatable and/or manageable and that seeking treatment can help return you to a fulfilling lifestyle.
   Dr. Ronald Gonzalez is a rehabilitation specialist on staff at The Medical Center at Princeton. This article was prepared in collaboration with Lorraine Seabrook. Health Matters appears Fridays in the Lifestyle section of The Princeton Packet and is contributed by The Medical Center at Princeton.