Health ShortsBack Pain
Are You Taller in the Morning? You may not realize it, but you are probably taller in the morning than in the evening. And your back also offers better shock absorption. The fibrocartilaginous discs that provide shock absorption in the spine have a high water content that tends to become compressed through the day. [SOURCE: Susan Bajnoczy, “Artificial Disc Replacement–Evolutionary Treatment for Degenerative Disc Disease,” AORN Journal, August, 2005] If you have back pain so bad you think your brain is crying out for relief, you’re right. A Northwestern University study using MRI images found that the gray matter of a person’s brain may shrink 5 to 11 percent a year as a consequence of persistent back pain–equivalent to the effect of 10 to 20 years of aging. One explanation, researchers said, is that nerve cells are working overtime to cope with the pain. After a year of cognitive-behavioral therapy plus exercise, patients with low back pain and evidence of disk degeneration showed improvement comparable to that of similar patients undergoing lumbar fusion surgery. Subjects in both groups showed significant reduction of pain and need for medication plus improvement in quality of life and ability to work. The subjects in the cognitive therapy/exercise group showed gains in muscle strength seen in the surgical patients. The cognitive-behavioral therapy encouraged patients to bend and use their backs in ways they had previously been unwilling to do because of fear of causing more pain and damage.
[SOURCE: Diana Mahoney, "Nonsurgical Care Relieves Back Pain: Behavioral Intervention," Internal Medicine News, September 15, 2003] Balance Balls as Office Chairs? Large, inflatable balance balls have become popular tools in health clubs for developing balance. Because even sitting on these balls can help strengthen and tone core body muscles, some have recommended daily use in the office as a measure to head off back pain.
While admitting the need for sedentary workers to activate trunk muscles, many ergonomics experts question the wisdom of sitting on a balance ball all day. As they point out, it’s as easy to slump on a ball as on a chair, and the balls are not height adjustable as a chair would be. Positions that would allow sitting on the ball all day could put prolonged compression on discs in the spine. There is also a safety hazard should the ball roll out from under the person.
[SOURCE: Peter Budnick, “Opinion: balls as office chairs a bad idea,” Ergonomics Today, April 11, 2005] Core Body Strength Protects Back Core body muscles are those in the trunk and abdomen that provide balance and stability to the spine. Studies have shown that strength in these muscles decreases the risk of back injury.
Treatment of recurring back injuries typically involves routines to strengthen core body muscles, taking stress off of smaller muscles and ligaments.
[SOURCE: Jerrold S. Petrofsky, et al, “Improving the outcomes after back injury by a core muscle strengthening program,” the Journal of Applied Research, 2008; Vol. 8, No. 1] Distress No Reason for Back Surgery Chronic back pain can lead to a great deal of distress, but distressed persons may be among the least likely to benefit from back surgery, according to research presented at the 2005 meeting of the American Academy of Orthopaedic Surgeons. Jeffery C. Wang, M.D., a UCLA spine surgeon, reported that psychologically distressed patients often have poor surgical results even though they may otherwise appear to be good candidates. [SOURCE: Jeffery C. Wang, M.D., American Academy of Orthopaedic Surgeons; Salynn Boyles, WebMD Medical News, June 15, 2005] The number of Americans choosing surgery as treatment for back pain is increasing rapidly, but one recent study of back pain patients with evidence of disk degeneration found that a combination of cognitive-behavioral therapy plus exercise was more effective than surgery in relieving pain. The cognitive therapy was designed to "help patients identify and overcome their pre-existing negative, and often false, beliefs and fears about back pain." Through the exercise component, these subjects experienced significant increases in muscle strength.
[SOURCE: Diana Mahoney, "Nonsurgical Care Relieves Back Pain: Behavioral Intervention, September 15, 2003] Forgiveness Is Good Medicine Emotions such as anger and stress create muscle tension which in turn can lead to chronic pain, particularly in the neck or back. In a study of 58 males and females with lower back pain, researchers at Duke found that subjects who practiced forgiveness experienced a significant reduction of physical pain as well as emotional stress. In this instance, forgiveness was defined as a long-term effort to replace anger and resentment with understanding toward someone who has done you wrong.
[SOURCE: Susan Hayes, "Surprise Help for Sore Backs," Prevention, June, 2004] Hard Mattress for a Bad Back? If you’re sleeping on a hard mattress because you think it will soothe your aching back, you might want to re-consider. A study published in Spine found that low back pain patients sleeping on a firm mattress reported increased pain and less sleep while patients sleeping on body-conforming foam mattresses or water beds had slightly less pain and better sleep.
The authors theorized that those sleeping on the hard mattresses may have turned more frequently during the night because of increased pressure on body parts.
[SOURCE: “Wellness facts,” University of California, Berkeley Wellness Letter, August, 2008] Heat Soothes Low Back Pain In a study of 371 low back pain patients, subjects who wore a heat wrap (104 degree Fahrenheit) for eight hours a day got better relief from muscle stiffness and pain than those taking ibuprofen (Advil, Motrin), acetaminophen (Tylenol) or other over-the-counter pain killers.
[SOURCE: "Remedies," Johns Hopkins Medical Letter: Health After 50, September, 2002] How About Seeing a Chiropractor? About 15 percent of Americans call on a chiropractor for at least part of their medical care, and studies have found that chiropractic spinal manipulation is about as effective as other non-surgical treatments for back pain. Chiropractors have expertise in the alignment of bones, joints and cartilage. Some but not all chiropractors, however, make claims that are not supported by medical practice. · There is no scientific evidence that adjustments to bones or vertebrae will correct specific conditions such as asthma, bronchitis, kidney disease or constipation. · Most scientists agree that good spinal health is no substitute for the protection against disease offered by immunization. · Use of spinal manipulation for neck pain carries a small but significant risk of serious adverse effects, including stroke. · Special supplements sold from the doctor's office for "hidden" allergies or imbalances in body chemistry should be regarded with suspicion. [SOURCE: "What Chiropracters Can-And Can't-Do for You," Tufts University Health & Nutrition Letter, February, 2003; Chiropractic for Back Pain," Family Practice News, September 1, 2003] Ignoring the Pain Sometimes Helps When you have excruciating pain, it's common sense to avoid any activity that makes the pain worse. For back pain that course of action is not always best. Staying in bed, once recommended for back pain, is now known to be the worst thing you can do and supervised exercise is usually prescribed to re-build strength and reduce stiffness. A Dutch study involving 134 employees of KLM Royal Dutch Airlines used a graded activity program-hour-long exercise sessions that included tasks that were part of the workers' daily lives, such as lifting suitcases. Tasks were made gradually more difficult, and therapists were trained to ignore complaints of pain and focus on building subjects' confidence in being able to complete the assigned tasks, regardless of pain. Results: Subjects given the graded activity program went back to work a month sooner than patients on standard treatment with no greater recurrence of back injury.
[SOURCE: Daniel DeNoon, "Lower Back Pain: Hurt Doesn't Mean Harm," WebMD, January 20, 2004; Annals of Internal Medicine, January 20, 2004] Intensive Rehab Is Good Option A study of 349 patients with low back pain found that those getting 75 hours of intensive rehabilitation had similar benefits over a two-year period as those undergoing spinal surgery. The subjects getting surgery showed slightly less disability, but the difference was dubbed “marginal” by the researchers. The rehab consisted of exercises for flexibility, strength and endurance plus cognitive behavioral approaches to manage pain. [SOURCE: B.J. Fairbank, “British Medical Journal Online first, May 23, 2005] If you've had previous episodes of back pain, you may be afraid to exercise for fear of "throwing your back out" again. Such fears may be unwarranted. Back pain patients who exercise as part of their recovery have fewer repeat episodes and fewer days lost from work. In the general population, studies have found that persons who exercise have no greater risk than others and may have at least slight protection against hurting their backs.
[SOURCE: James Rainville, "Exercise Tops Options for Treatment of Chronic Back Pain-Overcoming Fear of Pain Allows Patients To Reduce Disability and Improve Quality of Life," Biomechanics, July 1, 2003] Lift Safely To Prevent Back Injuries Many back injuries can be prevented merely by taking a few precautions when lifting.
• Think before you lift. How heavy is the object? Will you need help? How far will you have to move it? Is it bulky? Are there objects in your path or hazards that should be taken care of first?
• Position yourself in front of the load with your feet straddling it. For balance, you may want one foot slightly in front of the other. Slowly bend your knees and bring the load as close to your body as possible using both hands. Make sure the load is distributed over both feet.
• Lift with your legs rather than your back. If you need to turn, do so with your feet rather than your torso.
• Be careful when you set the load down, again using your legs and knees rather than your back and positioning the load in front of you.
• If the load is too heavy or bulky, seek help or use a dolly.
[SOURCE: National Ag Safety Database, “Back injury prevention: script,” reviewed April, 2002] Lower Back Carries Heavy Load Whenever you lift or carry, you are likely putting a heavy load on the five vertebrae in the lowest part of the back, known as the lumbar spine. Depending on the anatomy of your spine and the way you lift and carry, the cartilaginous discs in the back are subject to movement and herniation or rupture, resulting in lower back pain. Lower back pain does not necessarily mean a herniated disc, and a herniated disc does not always mean long-term problems. For at least six months, conservative treatment for lower back pain usually includes rest (but not total bed rest), antiinflammatory medication and physical therapy, including training in how to lift without putting undue pressure on the lumbar spine. [SOURCE: Sharon Brady and Sarah jackson, “Anterior Lumbar Interbody Fusion–Advances in Spinal Fusion Technology,” AORN Journal, November, 2005] Traditional therapy for low back pain involves medication plus physical therapy. Massage and chiropractic care are often recommended as alternative or complementary treatments. In comparing the two, one recent study found that traditional therapy was more effective, but only slightly so, compared to massage therapy. The authors found that “the decline in pain using massage therapy was significant” and that massage becomes increasingly effective as treatment progresses.
[SOURCE: Bryan Melancon and Lucy H. Miller, “Massage Therapy versus Traditional Therapy for Low Back Pain Relief: Implications for Holistic Nursing Practice,” Holistic Nursing Practice, May-June, 2005] Moving Away from COX-2 Inhibitors Of 375 back pain patients taking COX-2 inhibitors prior to the withdrawal of Vioxx and Bextra from the market, 42 percent had moved to other painkilling drugs (mostly nonprescription) while 9 percent were taking dietary or herbal supplements and 13 percent were foregoing any medication while awaiting further information, according to one recent survey. About 36 percent were continuing to use Celebrex, the COX-2 inhibitor still on the market.
[SOURCE: "Majority of US Patients Have Discontinued Use of COX-2 Inhibitors," Pharma Marketletter, April 11, 2005] In a study of 65 patients who had just undergone back surgery for herniated disks, one group was prescribed pills and physical therapy while another group was asked to listen to music and visualize relaxing scenes for 25 minutes a day. After three weeks, the music listeners reported less pain and better sleep.
[SOURCE: Josh Fischman, "Soothing the Savage Backache," U.S. News & World Report, September 4, 2002] Back pain patients who had total disc replacement did better than those undergoing spinal fusion, according to a study presented at a meeting of the North American Spine Society. Subjects receiving a metal and plastic disc had shorter hospital stays, more natural spine movement and could perform daily activities better than those who had spinal fusion, a surgical procedure in which bone is grafted across a section of the spine. [SOURCE: “New Disc Bests Fusion,” Health News, January, 2007] Orthotics Don’t Prevent Back Pain Custom insoles or “orthotics” are often prescribed for persons with foot, heel or leg pain, but a recent review of six studies found that insoles were no more effective than placebo in preventing back pain. About 2,300 subjects were involved in the six studies reviewed by the nonprofit research group, Cochrane Collaboration.
[SOURCE: “Insoles do not help prevent back pain,” University of California, Berkeley Wellness Letter, February, 2008]
Physical Activity Best for Back Pain Mildly aerobic physical activity such as brisk walking or swimming for at least three hours a week was effective treatment for subjects with mild to moderate low back pain, according to a study published in the American Journal of Public Health [October, 2005]. By contrast, subjects performing specific back exercises–such as stretching, range-of-motion and strengthening workouts–were more likely to experience continuing pain and disability.
Most of the subjects experiencing pain relief engaged in walking. Those with short-term back pain (less than three weeks) and those with chronic problems (three months or longer) showed similar benefits from moderate physical activity.
[SOURCE: Lori Rochelle Roniger, “Physical Activity Trumps Back Exercise for Low Back Pain,” Biomechanics, November 1, 2005] The finality of a spinal cord injury reinforces the importance of prevention. The causes of spinal cord injuries resulting in paraplegia and quadriplegia often involve car and motorcycle crashes, gunshot wounds, violence, falls and sports injuries. Diving accidents pose a high risk and are largely preventable. Teens and young adults should be aware of the risks of excessive speed, of drinking and driving and of diving into water without first checking the depth.
[SOURCE: John McDonald, "Spinal-Cord Injury," The Lancet, February 2, 2002] Quick Relief for Back Pain You bend over to pick up a paper clip and feel a sudden pain in your back so excruciating you can barely move. What do you do? Dr. Vijay Vad, a sports medicine specialist who works with professional golfers and tennis players, suggests a few simple measures: · Control your breathing. · Lie flat on your back and elevate your legs on a chair. · Try visual imagery to help you relax. Dr. Vad is the author of "BACK Rx: A 15-Minutes-a-Day Yoga & Pilates-Based Program to End Low-Back Pain." In a one-year study, back patients doing the "BACK Rx" program three days a week had a 70 percent cure rate compared to 33 percent for a control group receiving the same medication and care but without the exercise. [SOURCE: "Heal & Strengthen Your Back: Sports Medicine Specialist Offers a Clinically Proven Yoga/Pilates-Based Program To Relieve Low Back Pain without Surgery," Ascribe Health News Service, April 7, 2004] Rehab Takes Steps Forward Of the 250,000 Americans with spinal cord injuries about half have an incomplete injury, meaning that they have some movement and feeling in the lower extremities. Researchers working on new rehabilitation techniques are hoping to help many of these patients by either retraining or stimulating spinal cord nerves so that patients can regain some motor skills.
[SOURCE: "Could the Future of Rehab Include Walking Paraplegics, Quadriplegics?" Rehab Continuum Report, June, 2002] Almost everyone suffers back pain at one time or another, and the problem usually goes away in a few weeks or days with or without treatment. Back pain is rarely associated with serious illness. Immediate medical attention is called for, however, when back pain is associated with one or more of the following symptoms: · difficulty passing or controlling urine, · numbness in the anal or genital areas, · numbness, tingling or weakness in one or both legs, · unsteadiness on your feet. Which Mattress Is Best for Your Back? For years, persons suffering from lower back pain have been advised to sleep on a firm mattress. A recent study, however, found that patients sleeping on a medium-firm mattress were twice as likely to report improvements in their back symptoms. This was the first large study to address the issue, and the researchers suggested that individuals may vary in the type of mattress they need to counter back pain. While the mattress should provide enough contour to give an equal distribution of pressure, it needs to be firm enough to give support.
[SOURCE: Emma Ross, "Firm Mattress May Not Be Best for Back," AP Health, November 13, 2003] Who Benefits from Spinal Manipulation? As a treatment for lower back pain, spinal manipulation-whether performed by a chiropractor, a physical therapist or a physician-has been somewhat controversial, and studies have shown mixed results. A recent study of military personnel found spinal manipulation to be "highly effective" for lower back pain patients meeting at least four of the following five criteria: · pain that has lasted 16 days or less, · pain that does not extend below the knee, · a patient who is willing to return to normal activities, · stiffness in the lower spine but a fairly good ability to rotate the hips. [SOURCE: "Will Spinal Manipulation Help You?" Tufts University Health & Nutrition Letter, March, 2005] Youth at Risk for Spinal Injuries According to the National Institutes of Health, about 11,000 Americans suffer spinal cord injuries each year. Of those injured, 47 percent become paraplegic and 52 percent, quadriplegic. Teens and young adults ages 16 to 30 suffer 55 percent of all spinal cord injuries. There are currently 250,000 permanently paralyzed persons in the United States.
[SOURCE: "Pain and Central Nervous System Week, December 17, 2001] | ArchiveAIDS & HIV |
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