Oh, My Aching Back!

First: you cannot exercise if it causes significant pain to do so, if you cannot lie on your back and raise your straightened legs, if you have numbness or nerve tingling in your lower extremities, or if you have pain that radiates down your leg.*

Primary Prevention
Pick things up by bending at the knee
Loose weight if you need to
Exercise at least 20 minutes, 5 days a week and it does not have to be fancy.

Primary and Secondary Prevention (after you've had the twinge)
The three critical muscle groups are
1. The abdominals--the exercise is a partial sit-up. (Partial means you needn't touch your elbows to your knees). Start with tiny movements with someone or something holding down your feet while you "curl"; Do this exercise every day, if you can. Don't be a hero--start slowly, and until you get medical clearance, it is unwise to exercise if it causes any significant amount of pain!

2. The low back extensors (muscles that help you when bending back). In one of the McKenzie** exercises, you can lie on the floor and press-up (meaning you keep your pelvis on the floor while you are prone [face down]).

3. The hamstrings (back of the upper thigh) must be flexible. The best test and a convenient exercise of this nearly universal cause, especially in males, of backs "going out" is to lie on the floor against, say a door post; extend the leg that's in the door way straight out (keep the pelvis flat on the floor); try to get the leg against the door jamb to go straight up-if the knee cannot be straightened, that's a contributing problem and you have work to do getting flexibility in the hamstrings. It should be a daily procedure to slowly regain flexibility over weeks. Get it, however, and you will be cured in most cases.

Supplemental exercise: lie on one side; keep the legs relatively straight and make like a scissor - about 10 leg excursions back and forth on each side-every day.

Tertiary Prevention (Amelioration) This is doctor business, but one thing - the more you can move, the faster you will get well.***

Also, I find this article interesting: Therapeutic massage was effective for persistent low back pain, apparently providing long-lasting benefits. Traditional Chinese Medical acupuncture was relatively ineffective. Massage might be an effective alternative to conventional medical care for persistent back pain. Arch Intern Med. 2001;161:1081-1088

MRIs? Very debatable**** but certainly not to be done before a specialist's examination is completed.

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* Cherkin DC, Deyo RA, Battie M, Street J, Barlow W. The outcomes and costs of care for acute low back pain among patients seen by PCPs, chiropractors, ortho-surgeons. Carey T, et al. N England J Med. 1995; 333(14):913-917.

** "A Comparison of Physical Therapy, Chiropractic Manipulation, and Provision of an Educational Booklet (McKenzie R. "Treat Your Own Back." 6th Ed. Walkanae, New Zealand: Spinal Pub., 1985) for the Treatment of Patients with Low Back Pain." N England J Med. Oct. 8 1998;339(15):1021-1029.

*** 12-week outcomes of 183 sciatic patients randomized to 2 weeks of either bed rest or ambulatory watchful waiting. The majority of patients with sciatica improve with watchful waiting and that a 2-week period of bed rest is not more effective. 87% of patients in both groups reported improvement at 12 wks. "The results of assessments of the intensity of leg pain, the bothersomeness [sic.]of symptoms, and functional status revealed no significant differences between the 2 groups." PCA Vroomen (U. Maastricht, Netherlands).N England J Med. 1999;340:418-423.

**** A study compared the results of MRIs and vertebral disc tear tests among 96 patients who had known risk factors for disc degeneration. Such tears have traditionally been thought to directly cause lower back pain, with ruptures in the discs that cushion contact between the vertebra bones resulting in painful pressure being placed on sensitive nerves. However, the researchers were surprised to find that those patients with disc problems were only slightly more likely to have back pain then those without any disc degeneration. They also noted that 25% of those who did have disc problems had no lower back pain at all. Torn discs are not always painful, and not all lower back pain is a result of a torn disc. Psychological problems seem to have a clear relationship with both the onset of lower back pain and the manner in which it is managed: from psychological tests, the researchers found that pain is actually more accurately associated with depression and poor coping skills [than the physical findings.] They added that "treating a patient for emotional and perceptual concerns may be" [a better predictor of back pain than disc damage] and "more beneficial in reducing lower back pain than the more standard invasive, costly, and oftentimes unsuccessful back fusion surgery option." "I'm not saying back pain isn't real - very few people have back pain for absolutely no reason - but we found that of the people who have tears in their discs, some manage well with it and some manage poorly with it." Dr. Eugene Carragee, Stanford U. Medical Center in CA. Dec., 2000 Spine