Goals of Treatment
The general aim is to relieve pain and restore function. For acute, uncomplicated back pain, the general approach is
conservative. Short-term rest (for one or two days), pain relievers and anti-inflammatory medicines, gentle and gradual
exercise, and a careful return to regular movement are the mainstays of treatment.
Treatment Options
Short-term rest, gentle exercise and stretching, ice or gentle heat, and finding comfortable positions are all useful treatments.
Medication is not the only element of back care. Yoga, physical therapy, and chiropractic may also be employed. Medicines
for underlying conditions such as arthritis may help, and occasionally surgery is an option.
Drugs most commonly used
For uncomplicated back pain, first choices include:
- Aspirin
- Acetaminophen (the active ingredient in Tylenol)
- Ibuprofen, available in both prescription (Motrin) and nonprescription strength (Motrin IB and Advil)
- Naproxen, available in both prescription (Naprosyn and Anaprox) and nonprescription strength (Aleve)
Second choices
The selection of a prescription medication for back pain depends on the nature of injury and the length of time you will be
taking the drug. Using these medications requires special care. Some may cause drowsiness and should not be used before
driving or operating heavy equipment, and alcohol should be avoided with all the following medications:-
NSAIDs (non-steroidal anti-inflammatory drugs) such as Voltaren (diclofenac) and Orudis (ketoprofen)
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COX-2 inhibitors such as Celebrex (celecoxib)
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Muscle relaxants such as Soma (carisoprodol) and Valium (diazepam). Unfortunately, these are often not effective.
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Tricyclic antidepressants such as Pamelor (nortriptyline) or Elavil (amitriptyline) are sometimes used to decrease pain awareness.
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Narcotic analgesics such as Percodan (oxycodone/aspirin), Tylenol #3 (codeine/acetaminophen) or Vicodin and Lortab
(hydrocodone/acetaminophen) are used when pain is severe.
Alternative Care
Chiropractic
Chiropractors use spinal manipulation to treat musculoskeletal problems, particularly back problems. Chiropractic is the
most popular form of alternative medicine in the United States.
In 1994, an expert panel of 21 M.D.s and two chiropractors reviewed the research on treatment of back pain for the U.S.
Department of Health and Human Services' Agency for Health Care Policy and Research (AHCPR). The panel's report,
"Guidelines for Acute Lower Back Pain," endorsed chiropractic as safe and effective. A few of the studies the panel cited:
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In an analysis of 25 well-designed studies that compared rest versus chiropractic for treating back pain, a researcher in Santa
Monica, Calif., found that chiropractic patients were 17% more likely to report recovery within three weeks. For sciatic
pain, recovery within three weeks was 10% more likely with chiropractic.
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California researchers surveyed a large group of back-pain sufferers treated by either family M.D.s or chiropractors. In the
M.D. group, 22% said they were "very satisfied" with the results. But 66% of those receiving chiropractic reported being
"very satisfied" -- three times as many.
Yoga
Yoga provides gentle stretching and strengthening exercises that can help relieve back pain. In England, a survey of 3,000
yoga students noted that 98% of those with back pain found yoga had helped.
Yoga classes are offered in most communities. Check your local YMCA, health clubs, or phone-book listings. If you mention
your back problems, the teacher can recommend poses that help, and modify those that might strain your back. If any posture causes pain, stop doing it.
Tai Chi
Tai chi, a popular form of exercise and martial art in China, involves slow, graceful, dance-like movements. The typical
routine contains 50 to 100 moves -- it takes a few months to learn, and a lifetime to master. Its gentleness makes it
particularly suited for rehabilitating muscle and bone injuries, including bad backs.
In one study, part of a group of 51 people
with chronic back pain were told to live their lives as usual. The rest took a weekly 90-minute tai chi class that included 15
minutes of home practice every day. After six weeks, the tai chi group reported significantly less back pain.
Alexander Technique
The Alexander technique is a program of postural re-education. The trainer closely observes how you stand, sit, and move,
and suggests subtle adjustments in your posture.
Stress Management
Chronic stress, tension, and anxiety cause chronic muscle tension that can aggravate back pain. At a San Diego clinic,
researchers gave psychological tests to 82 back-pain patients. Compared with a control group free of back pain, the
back-pain sufferers had more stressful lives; notably, problems at work. As their work difficulties increased, so did the
severity of their back pain.
There are many activities than can reduce stress: exercise, yoga, tai chi, biofeedback, having a fish tank, deep breathing,
laughing, meditation, gardening, spending time with friends, spending time in nature, playing or listening to music, and
volunteer work. Decide on an approach that appeals to you, and do it regularly.
Herbs
Devil's claw root (Harpagophytum procumbens) is a traditional folk remedy for musculoskeletal pain, including bad backs.
German researchers recently confirmed its effects by testing it on a group of 118 people whose chronic low back pain
required them to take pain-relieving drugs frequently. In addition to their usual drugs, some test subjects were given a
placebo and others devil's claw root (800 mg three times a day). Two weeks later, those in the drug-placebo group reported
just one pain-free day. But the drug/herb group reported nine.
Acupuncture
In one study, half of a group of back-pain sufferers received acupuncture at all the back-pain points, while the other half were
needled at only a few back-pain points. After 10 months, 11% of the group receiving acupuncture at only a few points
reported improvement, compared with 58% in the fully treated group.
Preventing Back Pain
Don't slouch. Sit up straight. Mom was right: good posture helps prevent back pain. Poor posture places stress on your back,
making you more prone to discomfort.
Your sitting posture is even more important. Pressure on the discs between the bones in your back is higher when you're
sitting than when you're standing. It's no coincidence that those at highest risk for back pain -- truck drivers and office
workers -- have jobs that demand sitting for extended periods. If you work sitting down, try to sit less and stand more. Take
breaks. Get up at least once an hour and walk around.
Speaking of sitting, does your desk chair provide lower back support? If not, use a lumbar (lower back) pillow or cushion.
The back of your chair should lean back slightly. Keep your back against it and avoid leaning forward. If you work at a
computer, adjust the height of your chair and keyboard so your forearms and thighs are parallel to the floor and your eyes are
level with the top of your monitor. Your back and legs should form at least a 90-degree angle. Keep your shoulders down and
back.
When lifting, use your legs, not your back. No matter how light or heavy the object, lift it properly. Keep your back straight --
don't bend over and lift with your back. With bent knees, pick up the object in the midline of your body, hugging the object as
close as possible. Avoid twisting as you lift. When you set the object down, always bend your legs, never your back.
When rising from a seated position, remember that you're lifting your body weight. Use your legs, keeping your back as
straight as possible.
If you're heavy, consider losing some weight. Even a few extra pounds can add enough stress to your back to cause pain.
Weight loss often brings dramatic relief.
Wear sensible shoes. Flats are the way to go, not high heels. While fashionable, high-heeled shoes shift your natural center of
gravity, which can strain your back.
In a car, consider using a pillow or rolled-up towel for added low-back support.
Exercise also helps prevent back pain. In a study of Los Angeles firefighters, those who were the most out of shape had the
most back pain. Fitness was protective.
Self-Care Measures
Get back to normal activities as soon as possible. Doctors used to recommend long-term rest, but no longer. British
researchers analyzed 10 studies involving 3,222 back-pain sufferers who were told to either rest in bed or stay active. Bed
rest showed no benefit. In fact, those who rested recovered more slowly. Now doctors generally advise no more than a day
or two of bed rest before you return to normal activities.
Invest in back-sparing devices. Special furniture, pillows, and other products can bring relief from back pain.
Get more exercise. Avoiding it is one of the worst things you can do for your back, according to a 1994 report by the federal
Agency for Health Care Policy and Research (AHCPR). The AHCPR specifically recommended such exercises as walking,
swimming, and cycling.
Today, most back-pain experts encourage a return to exercise as soon as comfortably possible. Walking is often
recommended, as anyone can do it without special training or clothing, but do whatever you enjoy. Try to exercise daily for
about 30 minutes. Stay away from anything that stresses your back, for example, high-impact aerobics, racquet sports, and
most team ball games.
How to lift...
NEVER BEND AT THE WAIST
When have you ever heard of someone straining a thigh muscle while lifting?
Hardly ever. That's because the muscles in the legs are longer, stronger, in better
shape, and resistant to strain. The muscles and ligaments in the back are shorter
and prone to muscle spasm.
When lifting, maneuver the object close to your body so you can use the power of
your LEGS to get the object off the ground, rather than your low back.
Start with one knee on the floor, use the strength of your arms to raise the object
up onto your mid-thigh, then simply use the power of your legs to stand up. An
alternate method is to bend both knees to a squatting position, grasp the object with
fingers underneath, keep your back erect, and stand. In both examples, you are
using your leg muscles, not your back, to generate the lifting force.
WHEN YOU CAN'T GET CLOSE
Wrestling a squirming baby out of a car seat, or lifting golf clubs, luggage and
grocery bags from a car trunk are tricky because you can't get close to the object.
In these cases, your back and arms have to do more. To lift something from the
back seat of the car, brace yourself by placing one knee on the seat. To lift
something from the trunk, brace your thighs or knees against the bumper for
leverage.
info@highlands-ortho.com
