Our prehistoric ancestors’ switch from quadrupedism to an upright, twolegged posture was a great achievement.
Unfortunately, this advance had a price attached: It heralded the beginning of human back and neck pain.
Studies have shown that even ancient civilizations, such as the Egyptians, were plagued by these pains; in fact, they devised forms of spinal manipulative therapy using their hands and other parts of the body as levers. Today, approximately 80 percent of all people will experience back pain at some point during their lives.
While neck pain is not quite as common as back pain, the two together are responsible for millions of lost work hours and billions of dollars of lost earnings, not to mention untold human unhappiness.Back ailments are especially problematic in the industrialized nations of the world, where people have lost touch with natural ways of working and using their bodies and are thus more prone to overexertion and injury.
Back-aches become a recurring affliction in over half the people who have them, and at present there are over a million people in the U.S. who have been disabled by back pain.
One study revealed that, yearly, there are approximately 19 million patients who visit doctors with this complaint.Who is the typical back pain patient? Most people with back discomfort are age 30 or older.
And people who are overweight, especially in the abdominal region, are more likely than their slimmer counterparts to be afflicted with lower back pain because of the greater amount of pressure and strain being placed upon this region.
If there is a variance in the length of a person’s legs, with one leg being l/2 or 3/4 of an inch shorter than the other, there is often an imbalance, or mechanical dysfunction, in the person’s gait and distribution of weight, which can lead to back pain.
Other causes of back pain can be spinal curvature, as well as poor muscle tone in the lower back and abdominal regions.
Finally, a major characteristic associated with the onset of back pain is the presence of unusually high stress, which can be caused by anxiety, tension, fatigue, or depression.The workplace is often not a back-friendly place.
Over half of back related injuries are caused by the lifting of equipment or products on the job.
Vibration of factory equipment tends to traumatize the spinal cord, while driving can severely aggravate lower back pain. Industrial workers who engage in prolonged bending, twisting, heavy manual labor, and repetitive processes are prime candidates for backaches.
For both blue collar and white-collar employees, the maintenance of continuously static postures at the workplace is yet another cause of back pain.
And for both, stress related to dissatisfaction with working conditions can contribute to the physical pain.
Back injuries can have lasting ﬁnancial and psychological effects on workers, in that employee who miss work for prolonged periods as a result of backaches often do not have a job to return to.
Furthermore, studies have shown that, of disabled workers who are out more than three months, those with back problem suffer more from emotional distress than do those forced to stay out as a result of injury to the extremities. Some employers, who stand to lose millions of dollars in disability payments and lost hours, have instituted “back schools” at the workplace to teach their employees how to properly bend, lift, and stand.
Back and neck pain can vary widely in severity, ranging from mild sensation to excruciating suffering that warrants immediate medical attention.
Usually, the appearance of certain symptoms requires medical attention. A burning or tingling sensation, or numbness in the arms, back, or legs accompanying back pain warrants a visit to a medical practitioner.
Also, increasing severity of pain in the back or neck, or a lack of improvement in your condition despite the application of self-help remedies, is an indication that professional advice should be sought.
The concomitant appearance of a fever, with or without a headache, is yet another indicator, as is complete immobilization.
The Importance of Seeking Treatment
When the proper therapy or combination of therapies is used, back pain patients can usually experience signiﬁcant improvement in their physical condition. As there are an inﬁnite number of possible ways to injure your back, so there is not one single treatment approach that can be applied to everyone. However, one can say that, generally, a patient’s lifestyle needs to be looked into when he or she is being treated for back pain, because this often reveals why the problem has arisen in the ﬁrst place.
Many times people, especially men, ignore back problems until they are in severe pain, and only then seek medical attention.
This is not the model to follow. If the patient deals with the problem at its onset, extraordinary pain will probably never develop.
And while studies have been conducted indicating that people with backaches are capable of recovering on their own after several months, these reports neglect the fact that people who recover are likely to experience recurrences of greater severity at a later time.
In addition, people who initially recover as a result of exercise and then discontinue their exercise programs can also experience severe recurrences.
It is important to note too that a lack of symptoms does not necessarily signify that the underlying condition no longer poses a threat.
In short, evidence indicates that people who follow medical advice recover more quickly and stiffer from fewer recurrences.
There are numerous people one can consult when suffering from back pain, but only some are capable of offering suitable treatment.
Most individuals who seek professional help initiate their treatment with a medical doctor, such as an orthopedic surgeon, but eventually turn to nonmedical practitioners after experiencing unsatisfactory results.
This is usually due to the medical establishment’s failure to acknowledge exercise as an alternative treatment, or stress as a possible cause of the pain.
Orthopedic doctors, who specialize in injuries related to the muscles, joints, bones, tendons, and ligaments, are often inexperienced with conservative methods of treatment and are sometimes too willing to engage in unnecessary surgery.
The problem is that surgery has limited long-range beneﬁts and is completely unnecessary for many lower back pain sufferers.
When confronted with pain caused by a factor that does not show up on an x-ray, an orthopedist will generally refer the patient to another professional. If you are going to an orthopedic specialist for advice on back pain. It is recommended that you see one who does not reflexively advocate surgery or prolonged reliance on prescription drugs.
Internists and general practitioners are generally more versatile than orthopedists in their approach to helping patients cope with back pain. They’re more apt to delve into their patients’ lifestyles and exercise habits, and more willing to initiate a wide variety of treatments that do not involve dependence on prescriptions.
Internists often have a close relationship with their patients and are truly interested in helping them solve their problems. Also, an internist or general practitioner may be more open than an orthopedist to making a referral to an alternative practitioner, such as an acupuncturist.
Neurosurgeons rely on surgery and drug prescriptions to alleviate back pain, but the surgical alternative should be resorted to only when all others have failed. If a neurosurgeon suggests an operation as a back pain cure, it’s a good idea to get several other opinions, both from other neurosurgeons and from doctors in other ﬁelds.
When making a decision on surgery versus alternative methods of coping with the pain, one must factor in the risks of the surgery and the difficulty of rehabilitation.
Neurologists should also be approached with caution because of their dependence on prescription drugs, such as antidepressants and antipsychotics, which can have adverse side effects.
Physiatrists, who specialize in rehabilitative medicine, are dedicated to helping their patients discover the cause of their pain. They generally investigate all aspects of their patients’ lives until they ﬁnd the source of pain, are quite responsive to the needs of their patients, and do not rely heavily on drugs.
What they do is develop special treatment programs for their patients, which may involve a variety of techniques such as hydrotherapy, ice, exercise, heat, and even manipulation.
Unfortunately, there are fewer than 2000 physiatrists in the entire U.S.
Acupuncturists can be quite helpful in alleviating back pain, and they protide virtually risk-free care. Because acupuncture is not a part of orthodox Western medicine, many Americans are reluctant to try it, but those who have are often impressed with the results.
Rheumatologists’ specialty is treating pain that is a result of arthritis. Back pain with a gynecological basis can sometimes be treated by an obstetrician or gynecologist, but their expertise in regard to general pain is also quite limited.
Sports medicine specialists have achieved some short—term success with athletes suffering from chronic pain, but generally, they are not recommended for long-term relief.
Chiropractors have enjoyed widespread success in treating back pain and, consequently, have become the primary source for non-medicinal care in this area.
Chiropractors treat approximately 60 million patients annually, which is about three times the number seen by regular physicians.
Their therapy consists mainly of a variety of manipulative reﬂex techniques, from low-force and low velocity manipulation to powerful and deep manipulation, depending on the needs of the individual.
Evidence has indicated that gentle manipulation of the spine contributes to the release of endorphins, which are opiates produced by the body that help it cope with pain, including spinal pain caused by disc disease.
Also, chiropractors often use nutrition as part of their treatment, because patients’ eating habits can be directly connected to their strength and ability to recover.
Clinical evidence reveals that patients who are malnourished “ill not effectively respond to manipulation.
Chiropractors can be expected to study the lifestyles of their patients, as this often reveals the cause of pain.
They usually design exercise programs for their patients, which is crucial for maintaining relief over the long term.
Drug therapy, on the other hand, they generally regard as useless in the treatment of lower back pain, feeling that it can even be dangerous.
Physical therapists are helpful in treating an assortment of back problems, but they can only treat after they receive consent from a licensed medical doctor.
In addition to exercise and education, their healing arsenal includes electrical muscle stimulation, ultrasound, and trancutaneous electrical nerve stimulation (TENS).
Physical therapists are qualiﬁed in aiding patients who suffer from weak or tight muscles and can correctly evaluate posture and sleeping position. Sometimes, they offer at-home service for patients who are in serious pain.
A nonmedical method of coping with back pain is participation in yoga, exercises that use the strengthening and stretching of muscles, ligaments, and tendons crucial to long-term rehabilitation.
Despite yoga’s helpfulness in alleviating back pain, inexperienced participants should be warned that engaging in yoga while experiencing pain can complicate back problems further.
People interested in yoga should ﬁnd a qualiﬁed instructor; the personal touch here is much superior to an instructional video.
Although massage therapists trained in Swedish massage may offer immediate relief and pleasure, they usually are not trained to offer self-care advice, and do not provide the long-term rehabilitation program that is essential.
Shiatsu, a 20th-century Japanese massage technique that is something like acupuncture without the needles, can be used in the treatment of minimal lower back pain, but is too complex to try on your own.
Relatively controversial is the technique called Rolfing, which involves using ﬁngertips, knuckles, and elbows to deeply probe the muscles in order to relieve them from tightness, adhesions, and malfunctions. The Alexander technique, which was devised by 19th-century actor Frederick Mathias Alexander, is based on the philosophy that back pain is a result of misusing the body.
This abuse may be caused by physical elements, such as standing or moving incorrectly, or by emotional factors such as stress.
The Alexander technique can be a useful treatment for maintaining rehabilitation, but initial treatment by another trained professional is suggested.
When suffering from back pain, you should use ice during the initial 24 to 48 hours, applying it, wrapped in a towel if this is most comfortable, for 20-minute periods. Heat should not be used during this initial period because it will irritate the inflammation, but it can be used after the ﬁrst 48 hours of pain. Sometimes you can vary your treatment with four minutes of a hot compress followed by one minute of cold.
After your back has recovered, do not immediately resume exercise. Many times people engage in full range of motion (ROM) exercises immediately and continue to do so even after feeling recurrences of pain. If you feel pain while performing ROM exercises, this signiﬁes that you are not ready to do these exercises and should regress to an easier form that does not cause pain.
Nevertheless, do remember that regular exercise should serve as the basis for a proper self-help regimen. If you exercise consistently your body will be able to recover more quickly from an injury and there will be less chance of a recurrence. After receiving care—and your initial exercise go-ahead—from a health care professional, it is important to maintain your rehabilitation by adhering to an exercise program that suits your needs. Exercise that creates bodily aggravation should be immediately discontinued, and warm-up and cool-down exercises should be integral parts of your routine. Strenuous exercise immediately after you awaken is not recommended because your body lacks nutritional sustenance and your muscles are not prepared for any type of vigorous action at that particular time. Your routine should consist of a careful balance of light exercise, such as biking or swimming, and more difficult exercises. If you are lifting any type of heavy weight, forward bending—a common irritant of back problems—should not be practiced.
Before commencing your regular exercise, it is imperative to stretch smoothly and gently, avoiding jerky motions. Muscles need to be warmed up before they engage in rigorous activity, and a proper warm-up routine will enable the muscles to effectively respond to the body’s increasing demands.
Some people need more time to warm up than others, but in general, each stretching exercise should last at least 15 to 20 seconds.
When stretching the muscles, ligaments, and tendons, concentrate on the movements your body is making and be alert to any subtle twinges of pain. Be aware too that when stretching tight muscles, you shouldn’t overexert your body by stretching past the point of joint resistance, as this will only cause discomfort later. Stretching can be quite therapeutic, but only if you are aware of the signals your body is giving you. Feelings of pain, fatigue, or stiffness should provide an instant cue to stop what you are doing. Some popular stretches include trunk rotations, extension lifts, cat stretches, elbow props, pelvic swings, hip rolls, knee-to—chest rocking exercises, back leg swings, and hand -and knee exercises.
Stretching properly can provide a multitude of advantages for the body. First of all, it can improve the body’s full range of motion (ROM) because the muscles loosen up and become increasingly more mobile. As you become proficient in stretching, the amount of pain associated with the body’s movement will decrease as a result of increased circulation throughout the muscles.
The muscles will begin to pump additional blood, causing improvements in your pulse rate, blood pressure, and overall strength. Stretching also contributes to the detoxification of the body because it increases venous drainage.
Once you’ve stretched, beneﬁcial exercises include brisk walking while swinging the arms and breathing deeply, skipping or jumping rope, swimming, and bicycling. All of these exercises help to improve circulation, which is important for the healing process. Since a strong abdominal region is vital to increasing back strength, pushups and knee pushups. Which strengthen both the upper body muscles and abdomen, are also advantageous. People with a history of back ailments should start out doing three to ﬁve repetitions of each exercise and work their way up to doing ten. But if pain is experienced during the performance of an exercise, the exercise should be discontinued immediately. Remember not to strain your body. And do not hesitate to seek professional advice if a pain persists.
According to chiropractor Dr. Allen Pressman, athletic activities can be divided into three categories as a guide for back and neck patients. The ﬁrst group, low-risk activities, includes water aerobics, ballroom dancing, cycling, horseback riding, ice skating, basketball, the martial arts, skiing (without the falling aspect), soccer, swimming, and yoga. Medium-risk activities are badminton, baseball, jogging, sailing, squash, racquetball, tennis, volleyball, and wrestling. Some medium-risk activities, notes Pressman. Should be considered high-risk for people with especially injury-prone backs or necks. The high-risk category includes such activities as aerobics, ballet, football, gymnastics, rowing, track and ﬁeld, diving, weight training, and surﬁng. Activities in this ﬁnal group should be avoided by people with back or neck problems, or should be performed under close supervision. Aerobics and jazzercise are quite popular, and they can be a lot of fun, but they often involve bending, twisting, and jerky motions, which can aggravate an injured back. So if you want to move on to these advanced forms of exercise, be sure to build up your ﬁtness level at an easier low-impact level.
A ﬁnal caveat concerning your exercise regimen: Rest, as well as movement, is an integral part of it. In order to fully reap the beneﬁts of stretching and exercise, the body requires rest and relaxation after its workout to allow time for the muscles to repair themselves and grow.
To Prevent Reinjury
To prevent reinjury to your back, there are several guidelines people who partake in athletic activities should obey. First, don’t overtrain, because this can cause the body to behave as if it were in a constant state of stress. Eventually this stress will become too difﬁcult for the body to handle. and an injury will result.
The definition of overtraining, of course, varies from individual to individual, with people in better shape able to sustain more vigorous activity.
People who have had a history of back problems should beware of participating in contact sports, as this type of activity is notorious for provoking reinjury.
And remember to avoid fatigue, which will hamper your ability to correctly perform your stretches and exercise.
Eating a healthy diet is an important factor in avoiding reinjury; it also enables the body to heal quickly from back or neck pain. A nutritious diet with the correct amount of calories will prevent infection and the loss of muscle, and note that people who become involved in difficult training routines sometimes need to increase their caloric intake by up to 200 percent. A proper diet consists of at least 50 to 60 percent complex carbohydrates, such as fruits and vegetables, potatoes, pasta, and rice, and requires few or no simple carbohydrates, such as sugar.
Those who suffer from injuries will need to increase the percentage of protein in their diet to approximately l8 to 20 percent.
Be aware of your nutrient status. Deﬁciencies of iron, zinc, and other antioxidants should be avoided because an insufficient intake of these nutrients can impair the body’s ability to heal, cause a breakdown of connective tissue, and prolong the inﬂammation period.
It‘s a good idea to take 25,000 IU of vitamin A and 30 mg of zinc per day to aid in tissue repair. In general, 50 mg of B—complex vitamins daily is recommended. And a minimum of 1000 to 2000mg of vitamin C can be especially helpful for healing back injuries.
When taking C, remember to apportion your intake so that you are not taking more than 1000 mg (1 g) at a time.
Calcium and magnesium in a 1-to-1 ratio, and 10 to 50 mg per day of manganese are additional nutrients that can aid the healing process.
Reinjury frequently occurs as a result of a person’s inability to correctly perform a particular exercise or stretch.
Many people like to watch television while exercising, which causes them to be distracted and prevents them from concentrating on the body’s movement.
During the healing process it is imperative to be wary of exercises that have caused or might aggravate an injury.
Allow ample time for the body to readjust to your exercise regimen. It is also important to wear the proper attire while training.
Sneakers that do not ﬁt right do more than hurt the feet; they can cause a multitude of injuries to different parts of the body, especially the joints. Clothing that is too tight will prevent proper movement, in addition to not allowing sweat to evaporate.
Avoiding Back and Neck Pain
Preventing a back or neck injury from occurring in the ﬁrst place is preferable to having to deal with one once it happens.
First, be aware of proper lifting technique. Although the act of lifting may seem quite simple, improperly done it causes an astounding number of injuries.
The correct method involves bending the knees and using the quadriceps and hamstring muscles in your legs to support the weight of the object.
Thus, the lower back is spared strain.
Second, to minimize the chance of neck and back problems, see if you can reduce the amount of prolonged stress in your life. If reducing your stress level is out of the question, try to ﬁnd outlets to cope with the stress, so it will not have physically adverse effects. Also, correct posture is vital to averting back and neck pain, so try to refrain from slouching and slumping. People who suspect that they have a posture problem should have their posture evaluated by a trained professional, such as a chiropractor. And since a signiﬁcant portion of back injuries are caused by foot or ankle problems, people involved in athletic activities such as running or walking should wear footwear that provides adequate support. Also, women should be wary of continual use of high heels. When working out at the gym or at home. Be sure that your clothes are loose-ﬁtting.
When walking with a briefcase or gym bag, do not overload it, and shift the bag from one side of the body to the other periodically to avoid a weight imbalance.
An overweight body places a tremendous amount of strain on the lower back region, causing eventual pain and suffering, so keeping trim is a good back-preserving strategy.
If you’re sitting or driving for long periods. Support your back with a rolled-up towel or other supportive material.
In addition, avoid sitting in uncomfortable chairs or chairs that are too soft. And make sure that your wallet is not causing an imbalance in your posture. It is important to shift your weight frequently, because continuously sitting on the same place can lead to injury.
Finally, avoid crossing your legs for extended periods; instead, maintain a straight posture with your feet flat on the ground. People who have had back problems in the past should try not to sit for more than a half hour without getting up to stretch.
When you are, about to stand up from a seated position you can follow a simple procedure that will prevent you from irritating your bad back. First, push yourself gently to the edge of your seat, with one foot placed carefully in front of the other.
Remember to use the quadriceps and hamstrings in your legs to lift yourself, refrain from leaning forward, and keep a vertical center of gravity when rising.
Driving can easily aggravate an injured back.
So when you are experiencing back pain you should try to stay away from your automobile. If you do have to drive, bring your seat as close to the steering wheel as possible, allowing the knees to rise above the hips. After 30 minutes of driving, you should pull over to the side of the road and allow your body some time to stretch.
At break time, passengers suffering from back pain should lay down on the back seat, bend their knees, and try to relax their body.
When purchasing a mattress, back pain sufferers should stay away from extra-ﬁrm ones as well as from overly soft mattresses and waterbeds. A medium-ﬁrm mattress is your best bet.
In the morning, you should move your body to one side of the bed, shift onto your side, pull your knees upward, drop your feet carefully to the ground, sit up slowly, and ﬁnally, stand up using the proper technique previously described. Be sure to avoid bending at the waist when rising, as this can be detrimental to an injured back.
People who follow medical advice recover more quickly from back pain and have fewer recurrences.
Surgery should be used only after other methods of dealing with back pain have failed.
In addition to mainstream medical practitioners, acupuncturists and chiropractors can offer signiﬁcant help to those suffering from back and neck pain.
The Alexander technique may be useful in maintaining rehabilitation after an injury. First aid measures taken immediately after an injury can prevent inﬂammation, and reduce pain.
To prevent reinjury, athletes need to remember to rest, not to overtrain, and to perform stretches correctly.
Eating a nutritious diet speeds up the healing process.