Back in good health: how to keep your lumbar limber - includes tips on prevention - Healthy by Choice

Vegetarian Times, August, 1995 by Karin Horgan Sullivan

WHO KNEW that cutting tulips could be so risky? There I was, squatting down in the backyard, reaching forward to snip a few stems. Suddenly, I felt as if a huge weight had slammed down on the bottom of my spine. In an instant, a vision of the next few weeks passed before me: Endless days laid up on the couch, the stultifying boredom broken only by reruns of '70s sitcoms and the fog brought on by heavyduty painkillers. Excruciatingly painful car trips to doctors for expensive tests. General agony and unhappiness.

Though I was in a lot of pain for a couple of days, the rest of my vision never became a reality. It turns out that the latest recommendations for treating most cases of low-back pain are simply to stay as active as possible, take an over-the-counter pain medication and see a health-care practitioner who performs spinal manipulation. As I struggled to stand up while my back locked into a spasm, I never would have guessed that following this straightforward prescription would have me digging in the garden again in just a couple of weeks.

My back attack was not unusual; 80 percent of Americans will suffer from an acute episode of low-back pain in their lives. (An acute bout--our focus here--lasts a few days to several weeks, while a problem lasting longer than three months is considered chronic, and can require more medical investigation and care.) Although back pain can be scary, the vast majority of sufferers who follow simple self-care techniques will be back in good health in a short time.

THE CAUSES

"IT DOESN'T MATTER who you are--M.D., chiropractor, osteopath, acupuncturist--no one has a good idea of what is hurting in the back," says John Triano, D.C., a staff chiropractor at the Texas Back Institute in Plano, and a member of a landmark government panel that recently reviewed more than 10,000 studies to develop the current government recommendations for treating low-back pain. Even after an extensive workup, only about 15 percent of patients can be given a definitive diagnosis.

When we think of back pain, most of us think of a problem with disks, the spongy pads that separate the vertebrae; they absorb shock and keep the spine flexible. Each disk is composed of a hard outer layer, which surrounds a jelly-like core. The outer core can develop weak spots, causing the soft filling to bulge into that weak spot; the outer cover can even rupture, or herniate, causing the muscles around it to spasm. ("Slipped disk" is a misnomer.) In some cases, a bulging or herniated disk produces no symptoms. In fact, a New England Journal of Medicine study (July 14, 1994) found that 52 percent of patients with no symptoms had at least one bulging disk. In other cases, a disk abnormality can press on a spinal nerve root and cause pain in the back or leg.

Other common cause of back pain are strains, which involve stretching or tearing of muscles, and sprains, which injure ligaments. In some cases, a strain, sprain or disk abnormality can be traced to a single event: shoveling a heavy load of snow, falling down the stairs or playing basketball without proper conditioning. But often the sudden onset of pain is really the culmination of years of treating your back poorly--slouching over a desk all day, lifting objects improperly, standing with poor posture, not getting enough exercise or being overweight. This abuse causes wear and tear on the back muscles, ligaments and disks, until a single event pushes your back beyond its threshold for mistreatment.

WHAT TO DO WHEN IT HURTS

ACCORDING TO THE GOVERNMENT report, up to 90 percent of patients with acute low-back pain recover within a month; surgery is necessary in only about one in 100 cases. To rule out any serious illness, see a healthcare provider if you have any of the following: problems controlling your bowel or bladder, numbness in the groin or rectal area, or extreme leg weakness. Barring any of these red flags, you can try to ease the pain on your own. Within 24 hours of onset, apply ice to the area to reduce swelling. Unfortunately, says Triano, a lot of people make the mistake of immediately applying heat, because it feels soothing. But heat can actually increase swelling if applied too soon.

After a couple of days, use heat if it feels good. Moist heat is best; the dry heat of a heating pad can leave the area dehydrated. Soak a washcloth in hot water, wring it out and apply to the painful area. Then place a hot-water bottle on top of the washcloth. Do this for 15 minutes at a time, as often as once an hour. The heat will bring more blood to the area, which increases the tissue's metabolism, speeding the rate of healing. Increased blood flow also helps carry away the waste products of the damaged tissue.

For the first couple of days after a back attack, you may not feel like being very active. If you spend time in bed, the ideal position is on your side, with your knees bent; a pillow between the knees can reduce the twisting action of the spine. Lying on your stomach can lead to neck problems, but if that's the only way you can sleep, a pillow under your pelvis can take pressure off your lower back. If you sleep on your back, a pillow under your knees will also relieve pressure on your lumbar (or lower) spine.