Standing Up to Back Pain

You're doubled over or lying flat with spasms. Every little move causes agony. If it's your back that hurts, the pain becomes the centre of your universe. No wonder: the back is your physical centre it connects your upper body to your lower body, and it is needed for almost all activities of daily living.

It's an oft-cited statistic that most back pain will improve within six weeks, regardless of the treatment method, but this is small comfort when you're counting the days (42) and hours (1,008) until the pain goes away. While I can't promise instant relief, I have found there is much you can do to alleviate back pain, promote healing and prevent reinjury.

Avoid Bed Rest

If your back pain is severe, one to two days of bed rest may be appropriate to reduce pressure on the discs and avoid nerve irritation. Prolonged bed rest, however, will worsen your condition by hastening the loss of muscle, bone and cardiovascular fitness. These declines affect your posture, strength and flexibility, placing added stresses on your spine.

If you do spend a day or two in bed to recuperate, get up and walk around every few hours, even if it's painful. To soothe inflammation and ease muscle spasms, apply ice several times a day for up to 20 minutes at a time.

Relieve Pain Naturally

In the long run, drugs such as muscle relaxants, prescription painkillers and nonsteroidal anti-inflammatory drugs (NSAIDs such as Aspirin and ibuprofen) do much more harm than good. Instead, try these natural substances that relieve pain and inflammation without causing addiction, sedation, gastrointestinal bleeding and other drug-related side-effects.

Turmeric, the yellow-orange spice in curry, has perhaps the strongest anti-inflammatory activity of all the medicinal herbs. It has even been compared to NSAIDs in terms of effectiveness. Curcumin is the active component in turmeric. Take 200 milligrams of a standardized curcumin extract daily.

Ginger is another natural anti-inflammatory. Get fresh ginger at the grocery store and eat a little every day, or supplement with 100 mg daily.

Enzymes are also effective in reducing swelling and alleviating pain. My favourites are bromelain, an enzyme from pineapple (250 to 500 mg twice daily), and formulas that contain bromelain, papain from papaya and other enzymes. Take as directed on an empty stomach and avoid if you are allergic to pineapple or papaya.

Arnica is a common homeopathic for traumatic injury. Best used immediately after injury, it rapidly decreases pain and promotes tissue healing. Arnica is available in sublingual or topical preparations and is found in most health food stores. Take as directed for both types of preparations.

Don't forget the mineral magnesium, which is a natural muscle and nerve relaxant. In a 2001 German study, four weeks of supplementation with magnesium relieved back pain by 49 per cent. For optimal relief, I recommend 1,000 mg magnesium, balanced with 2,000 mg calcium, daily.

An Attractive Therapy For Pain

I became a convert to magnet therapy after one of my patients told me she relieved a painful arthritis flare-up in her back by securing a magnet to the painful area. When I began wearing a magnet over my lumbar spine, my own low back pain a result of too many marathons during my heyday as a long-distance runner was relieved.

Testimonials aside, there's solid research to support the pain-relieving benefits of magnets. In a placebo-controlled study in the Archives of Physical Medicine and Rehabilitation, the use of magnets provided significant, quick relief in patients suffering from post-polio pain. Other research has demonstrated positive findings in relieving pain from whiplash and head injuries, knee inflammation, diabetic neuropathy and carpal tunnel syndrome.

Magnets are exceptionally safe, but since their effects on pacemakers, insulin pumps, drug patches as well as pregnancy are unknown, I do not recommend using magnets if you are using one of these devices or are pregnant.

Hands-On Relief

In 2000, Consumer Reports asked 46,000 subscribers in the US and Canada which therapies they had found effective for their most serious health problems. For back pain, the hands-down (and hands-on) winner was chiropractic manipulation. It even outperformed prescription drugs!

Many of my patients swear by chiropractic, both for treatment and prevention of back pain and other types of musculoskeletal pain, and I've experienced its benefits myself. In addition to relieving pain, chiropractors are well versed in back exercises and stretches and can show you how to prevent future back problems.

In the US, health insurers have slowly begun to recognize that chiropractic is a highly effective and cost-effective therapy for back pain. And in most Canadian provinces, chiropractic services are included and partially government funded.

Another powerful hands-on therapy I heartily endorse is massage. If you think massage is a frivolous luxury, the results of the same Consumer Reports survey should change your thinking: back pain sufferers ranked deep-tissue massage second only to chiropractic. Deep-tissue massage uses slow strokes across the grain of muscles to enhance circulation, alleviate inflammation and release chronic muscular tension.

Prolotherapy For Chronic Pain

I've saved perhaps the most powerful therapy for last: prolotherapy. Prolotherapy is based on the premise that musculoskeletal pain often results from weakness of the ligaments and tendons that hold bones and muscles in alignment. When ligaments and tendons become injured, weak or lax, bones and muscles move out of position, impinging on nerves and blood vessels and causing pain and inflammation.

Prolotherapy involves injections of a mildly irritating solution, such as a dextrose (sugar) or sodium morrhuate from cod liver oil, into the affected ligaments and tendons to stimulate healing and to strengthen and stabilize these structures. Restoring proper alignment can bring rapid and dramatic pain relief.

Kathy Stevens, who has been training my dogs for the past three years, is a living testimony to the therapeutic power of prolotherapy. Kathy injured her back when she fell from a ladder. She suffered not only incapacitating back pain, but also such severe weakness in her legs that at times they would simply give out from under her.

Kathy went through the usual merry-go-round of treatments with painkillers and physical therapy and finally consulted an orthopedic surgeon, who recommended surgery. I urged her to first try prolotherapy.

After just three treatments, Kathy's pain lessened considerably, and after her fourth treatment, she regained much of the strength in her legs. Today she exercises on a treadmill, sits through movies without suffering pain and has no trouble keeping up with her dogs.

For a referral to a practitioner in your area, send an e-mail to the Canadian Association of Orthopaedic Medicine, caom@rogers.com or call 416-537-0275 extension 240.

These natural approaches can help you get on with the challenges of daily living without the extra challenge of an aching back.

Achy Numbers

• Between 65 and 85 percent of the population will experience back pain at some time in their lives. That's at least two in three Canadians.


• Each year, five to 10 percent of the workforce is off work due to low back pain, the majority for less than seven days.
• Back pain that persists for more than six months occurs in only one to five per cent of chronic back injury cases.


• Almost 90 percent of all patients with acute lower back pain get better quickly within four to six weeks.


• The remaining 10 percent are at risk of developing chronic pain and disability (about 600,000 or one in 50), and account for more than 90 per cent of the social costs for back incapacity.


• Back pain is the leading cause of workplace disability. About half of the people with long-term back injury return to work.


• It is believed that as much as 80 percent of back pain can be attributed to lack of exercise and poor physical fitness.


• Only about 10 percent of back pain is caused by an illness or disease such as osteoarthritis, ankylosing spondylitis and compression fractures.


• Back injuries among workers over 45 years old are less frequent than among those between 20 and 45.

Source: Institute for Work and Health, Canadian Arthritis Society, Canadian Centre for Occupation Health and Safety

Stages of Low Back Pain

The most common area of back injury is the lower back. Ten to 20 per cent of individuals with low back pain pass through all three of the following phases and go on to develop chronic low back pain.

• Acute: Low back pain symptoms last up to four weeks.


• Subacute: Symptoms last between four to 12 weeks.


• Chronic: Symptoms last longer than three months.

Source: Institute for Work and Health

Quiz:

How Much Do You Know About Back Pain?

1. Degeneration, bulging or herniation of a disc as seen on a CAT scan or MRI is a reliable indicator of the degree of backpain.
   A. True
   B. False


2. The worst posture for sleeping is:
   A. on your back.
   B. on your side.
   C. on your stomach.


3. What percentage of adults can expect to experience at least one episode of severe back pain during their lifetime?
   A. 20%
   B. 40%
   C. 60%
   D. 80%
   E. 100%


4. Standing puts twice the pressure on your discs as sitting.
   A. True
   B. False


5. Exercise helps prevent back pain by:
   A. preserving muscle strength.
   B. promoting weight loss.
   C. increasing circulation to tissues.
   D. improving balance.
   E. All of the above.

Answers:

1. False. Pain does not always correlate with damage seen on imaging tests. What's more, half of people over age 40 who have no back pain will show disc abnormalities on a CAT scan, and 35 per cent of asymptomatic adults (those showing no symptoms) under age 40 will show degeneration or bulging of a disc on an MRI.


2. C. Lying on your stomach creates a swayback arrangement. Sleeping on your back or side, ideally on a firm mattress, will support your spine as your back muscles relax during sleep.


3. D. 80%


4. False. Sitting puts twice the pressure on your discs as standing and four times that of lying down. If your job requires long hours of sitting, use a chair that supports your lower back's natural curve. Stand whenever possible and take breaks and walk around as often as you can.


5. E. All of the above. Both aerobic exercise and strength training are important to alleviate pain and prevent reinjury. Injury to the back occurs 10 times as often if you are not exercising regularly.