And what you can do about it.
One of the things we treat daily in Physical Therapy is Back pain. Back pain is the number one cause of disability world wide and the number one reason people get addicted to opiates. In order to effectively treat back pain it is important to understand where it is coming from. Often Xrays and MRIs do not tell the whole story so a good clinical
exam can help narrow down the focus of treatment and get the best possible outcome. Here are some common causes of back pain. Patients may have one or more of these things and the real skill is figuring out which one is causing the problem.
Muscular sprains and strains: By far the most common cause of short term back pain is muscle sprains and strains. This is usually caused by heavy lifting or doing more activity than you are used to, like digging up the garden in spring or starting a new sport or work out regime. These injuries tend to have muscle spasms associated and can be very painful.
Bulging or herniated discs: Intervertebral discs separate the vertebrae in the the spine at each level. They are made out of cartilage and allow the spine to be flexible. Discs can bulge or herniate either from an injury or age related degeneration. Injured discs can be painful on their own or they can create pain by putting pressure on nerve roots where they exit the spine causing pain in other areas like the buttock, legs or feet.
Spinal stenosis: Stenosis means narrowing and spinal stenosis refers to narrowing around the spinal cord or nerve roots caused by degeneration, disc bulging, bone spurs or one vertebra sliding on another.
Sacro-iliac pain: At the base of the spine there are two joints that joint it to the pelvis, these are the sacroiliac joints. SI joint pain is very common and tends to be worse with sitting or trying to sleep.
Piriformis Syndrome: Similar to Sacro-iliac joint pain, piriformis syndrome is thought to be caused by the piriformis muscle that lies close to the sciatic nerve, tightness in this muscle can cause buttock or leg pain.
One of the mysteries of back pain is that some of these things are visible on x-ray or MRI and some are not. To add to the confusion, sometimes an x-ray can show features like degeneration or disc bulges or bone spurs and the patient has no pain in that area. To get a good idea of where the pain is coming from it is important to examine (among other things) movement, strength and postural imbalances. In some cases, this is all that needs to be addressed, meaning that shots, pain pills and surgery may not be required to make a full recovery.
Read on for tips and trick to alleviate back pain.
Five strategies to ease back pain without having to take medication
Preserve the curve: Your low back has a natural inward curve. In this position, the stress and strain of holding your body up is evenly distributed amongst the discs, joints, ligaments and muscles of your back. If you can keep your back in this neutral position as much as possible, you will begin to feel better. Here are some Do’s and Don’ts
​Do sit in upright chair, use a lumbar support if you have one, if you don’t, roll up a towel and place it in the small of your back..
Don’t sit with your legs stretched out, so no recliner, no feet up on the ottoman, no sitting up in bed. If you want to rest, lie flat.
Do squat to lift, let your legs do the work.
Don’t bend to lift, even small items.
Exercise daily. Research shows that exercise, any type of exercise, eases pain. Walking is the easiest, most convenient exercise for back pain and it requires no equipment or appointments. I tell my back pain patients to get out of the house and walk ONE BLOCK every day for a week. This is super easy and gets you in the habit of exercise.The following week do the same walk but add 10% to the distance for that week (so maybe a block plus two mail boxes this time). Rinse and repeat. This slow and steady approach allows your body to adapt without discomfort. Soon you will find you are walking a mile a day and having less back pain.
Lose some weight: Pick up a gallon of milk and walk around the kitchen with it for one minute. That feels heavy, right? Well that’s only 8 pounds! Imagine carrying that around all day. That ache in your shoulder is the same stress that excess weight puts on your back. So losing 10 or 20 pounds can make a huge difference for your back. “But Paul, I can’t exercise because my back hurts!” Its easy to think exercise is the best way to shed a few pounds but, in truth, diet is the key to weight loss. There is a saying in the fitness industry: “you can’t out-train your fork” which means it doesn’t matter how much you exercise, you have to change your diet to lose weight. Find a diet you can enjoy and start lightening the load on your spine. Many diets now come with apps that make it easy for you stay on track with food and exercise.
Sensible foot wear: Your favorite, old ,worn out shoes are not your friend, they put your ankles, knees and hips out of alignment and that puts stress on your spine. Similarly, high heels limit ankle function and cause abnormal movement in the back. I recommend a low profile shoe with a medium amount of arch support.This will align you hips and knees better, which allows your back to heal.
Get some rest: Poor sleep habits make pain worse. Get to bed early and at the same time every night. Avoid, social media, news, and screens for 30 min before you retire. Read a book, make a “to do” list for tomorrow, or meditate before nodding off.
