A lot of information has been coming over the wire about all kinds of backpain issues, which would require weekly revisions to every page to keep up. This being an unpaid service, and being the lazy bum that I am, I am opting to supply this section in place of the cumbersome and largely unreadable physiology section.
This information constitutes general medical information and is not intended as medical advice in any particular case. Please consult a physician as appropriate.
Consulting a doc cannot be underrated, as I have discovered that there are a good 20-30 REALLY NASTY things that create backpain which can ultimately paralyze you or even kill you. Like meningitis for example.
Among the updates I got a report from the Berst Alert newsletter about Health web sites -- of which this page is one -- warning about scams, product advertising fronts and plain incompetence. The report stated:
- There are already an estimated 15,000 health sites on the Web (Interactive Week)
- Drkoop.com -- a leading health site -- gets 2.5 million unique visitors a month (Media Metrix)
- 45% of online consumers access the Internet for health info (Jupiter Communications)
- Health care ecommerce will be worth $370 billion by 2004 (Forrester Research)
That last figure is key. There are huge fortunes to be made in online health care. And everybody wants a piece of it. Some don't care if they have to screw you to get it.
Which is just another reason to consult with a live professional before making decisions.
This section includes the following updates, with the most recent update dates in bold.
- ALTERNATIVE THERAPIES
- BASIC TIPS
- INFORMATION SOURCES
- DR. SARNO AND PSYCHOLOGICAL ELEMENTS
- COMMENTS FROM READERS
|DEEP TISSUE MASSAGE||
|PROGRESSIVE MUSCLE RELAXATION||
The results chart indicated that these results derive from self report, and further emphasized that back pain is likely to get better after about four weeks. Clearly, a change in diet or the uptake of glucosamine will take about four weeks to show positive effect even if these therapies are everything their proponents make them out to be. As a side note, the report dumped magnet therapy, acupuncture, and virtually all of the currently faddish diet supplements such as ginko, garlic, echinacea and glucosamine into the trash bin for efficacy on a variety of other pain-related problems. The placebo effect is not to be discounted for those who claim to really have enjoyed benefits. Taking powdered milk capsules would be just as effective.
Nevertheless, pain will make people do crazy things, and sometimes these things involve the checkbook, as CR reported Americans spent about twenty-seven billion dollars out of pocket for alternative therapies, most of which, apparently, did not work.
Now that is a thought.
Cecil Williams, who writes a weekly column debunking urban myths and researching issues brought up by readers with a depth and thoroughness that is surprising in a journalist for what is essentially a local freebie magazine, did some balloon puncturing recently over putative Homeopathic remedies. Our good Cecil did the math over the 15x, 30x and 45x dosage markings commonly found and discovered not only that these remedies had no scientific basis for claims, but that the laws of physics dictated that these dosages CANNOT work at all even if the substance itself were of any use! At 45x dilution, Cecil determined that there would be less than one molecule of the given substance in one billion, and the chances are very good that the little glass bottle contains therefore nothing of the substance at all, whether it be arnica or St. Johns Wort or Eye of Newt. To drop a line to Cecil, grab an East Bay Express and look in the back for the gray section called "Straight Dope".
Basic Tips: Prevention
Update1/9/00: My basic caveat remains the same: Backpain cannot be "prevented" any more than falling asleep or stepping on a sidewalk crack. Of course, timing can be somewhat adjusted, and recovery can be speedier if attention has been paid previously, but the fact remains: the backpain epidemiology points to social conditions that have absolutely no indication of changing in the slightest. Bummer, huh!
From the CNN people come these distilled gems:
Turns out that your mother was right when she told you to stop slouching. Poor posture plays a significant role in causing back pain. When you force your body to remain in the same position for long periods of time, it becomes tense and fatigued. However, since the human body was not meant to remain static for long periods of time, there is no "right" posture or body position. "The best posture is the next posture," says Dr. Orr.
When you slouch or lean with your head, your limbs are stretched in an awkward, unnatural position, and your run an increased risk of injuring yourself. Instead of slouching or leaning with your head, use your hips to rotate your upper body forward.
To avoid slouching, sit against the back of a comfortable, firm chair. Keep your spine aligned in a neutral position, and keep your shoulders relaxed. Your elbows, hips and knees should be bent at a right angle, and your wrists should be straight, not bent. Refrain from putting pressure on the back of the knees. Most importantly, move around, and take frequent breaks.
Here are some tips to avoid back injuries in the workplace:
- Don't stretch for objects, either above you or out of your reach
- Keep frequently used items within your reach.
- Keep stacks of objects at waist level
- When carrying a stack of objects, make sure you can see in front of you
- Don't pull heavy objects
- If you turn while lifting, make sure you turn your whole body
- Wear sturdy shoes with good traction to avoid slips and falls
If you have to lift heavy objects at work, here is some advice:
- Bend at the knees
- Tighten your stomach muscles
- Use both hands to get a firm grip on the object
- Lift with your legs
- Keep your back upright in its natural posture
- Hold the object close to your body
- Lift steadily and smoothly without jerking
- Don't twist your body
Exercise regularly to help keep your muscles strong and flexible, and maintain your proper body weight.
So much for CNN, which provided this largely reductive list of things for minor aches.
Is Prevention Even Possible?
Given that the preventitive measures listed by CNN echo what virtually every doctor says anyway, and appear to be such common sense items, one begins to wonder why back injuries continue to happen with such frequency. One real-world article explains why:
"Many Ignore Prevention Until Back Injury Occurs, Study Finds"
Rhonda Rowland, July 30, 1997
(CNN) -- Lower back pain afflicts millions of people. And a new study casts doubt on a widely used method for preventing this common -- and expensive -- ailment.
"We found that it didn't make a difference," Lawren Daltroy of Brigham and Women's Hospital said. He's referring to a regimen of courses that are supposed to teach people ways to avoid back strain.
"We trained 2,500 workers; had another 2,500 or so controls. We followed them up for 5 1/2 years and found no difference in injury rates, in cost per injury or time off per injury in the two groups," according to Daltroy.
A lot of money is at stake. Lower back ailments cost U.S. companies $49 billion in 1992. The injuries accounted for 15 percent to 20 percent of workers' compensation injuries and about 35 percent of workers' compensation costs.
Physical therapists had long assumed their instructions were preventing injuries. "That's why I think this study is somewhat surprising," said _David Pittman_ of NovaCare Inc., a nationwide provider of physical rehabilitation services.
Pittman suggests that healthy people may not be motivated to learn. "It's their back," he said. "Maybe this study does point out the fact that we have to find a better way of imparting this to individuals so that they will personally take accountability for it."
Experts aren't saying that teaching people how to care for their backs is fruitless. But such instruction seems most effective for patients who are feeling the first signs of a back injury.
"We have very good scientific data that shows that proper lifting and handling and posture can reduce stresses and strains on the lower back, which theoretically ought to prevent injury," Latroy said.
PHILADELPHIA (AP) -- Researchers have identified a mutant gene that may be responsible for some cases of sciatica, a sometimes severe and chronic type of back pain. . . .
Sciatica is most often caused by a slipped or ruptured disk, which occurs when the soft material in the center of a disk protrudes from its cartilage container and pinches the sciatic nerve in the spine.
Scientists still believe that obesity, smoking and occupational factors put people at higher risk for sciatica, but this gene may be another factor in about 5 percent of sufferers, said biochemist Dr. Leena
Ala-Kokko of MCP Hahnemann University in Philadelphia, who led the study.
"Knowing that you carry this mutation, I would advise these people to avoid these other possible risk factors," Ala-Kokko said. "In finding this gene, we may have put the missing piece in the puzzle."
The research was published in Friday's issue of the journal Science.
Another far more common gene defect has also been found that may be responsible for a higher percentage of sciatica sufferers, Ala-Kokko said, though that research has yet to be published. . . .
The study, conducted with scientists at the University of Oulu in Finland, analyzed the DNA of 180 Finnish patients with sciatica. Nine patients were found to have the mutation, and none of 230 patients in a
control group without back pain had it.
Follow-up with four families of the nine patients with the defect revealed a total of 23 relatives with the mutation, all of whom suffered disk problems.
(AP July 16, 1999)
What I am telling you is well researched, but you dont have to take my word for it. The US government has excellent publications available and I suggest you get copies for yourself and to distribute everywhere. Contact addresses and telephone numbers are listed below:
To receive a free copy of *Understanding Acute Low Back Problems*, call toll-free 800-358-9295, or write to:
Agency for Health Care Policy and Research
P.O. Box 8547
Silver Spring, MD 20907
For the "Back in Action" pamphlet, write to:
U.S. Department of Health and Human ServicesAsk for AHCPR Publication No. 95-0644, December 1994
Public Health Service
Agency for Health Care Policy and Research
Executive Office Center, Suite 501
2101 East Jefferson Street Rockville, MD 20852
An excerpt from the first pamphlet is included below because of what it says about exercise.
The web is also a good source of info. I subscribe to a couple newswires on backpain and one of the best is the WebMD. View some good whitepapers or signup at http://my.webmd.com
One reader supplied an excellent pamphet from a medical university.
Bed Rest (updated 1/9/00)
If your symptoms are severe, your health care provider may recommend a short period of bed rest. However, bed rest should be limited to 2 or 3 days. Lying down for longer periods may weaken muscles and bones and actually slow your recovery. If you feel that you must lie down, be sure to get up every few hours and walk around--even if it hurts. Feeling a little discomfort as you return to normal activity is common and does not mean that you are hurting yourself.
I have to insist here that the main key to getting well is getting up and about and mobile. This does not mean picking up the same old schedule right where you left off. It means sensible and considered motion that articulates the joints and areas of damage without high stress.
About Work and Family
Back problems take time to get better. If your job or your normal daily activities make your back pain worse, it is important to communicate this to your family, supervisor, and coworkers. Put your energy into doing those things at work and at home that you are able to do comfortably. Be productive, but be clear about those tasks that you are not able to do.
Things You Can Do Now
While waiting for your back to improve, you may be able to make yourself more comfortable if you:
- Wear comfortable, low-heeled shoes.
- Make sure your work surface is at a comfortable height for you.
- Use a chair with a good lower back support that may recline slightly.
- If you must sit for long periods of time, try resting your feet on the floor or on a low stool, whichever is more comfortable.
- If you must stand for long periods of time, try resting one foot on a low stool.
- If you must drive long distances, try using a pillow or rolled-up towel behind the small of your back. Also, be sure to stop often and walk around for a few minutes.
- If you have trouble sleeping, try sleeping on your back with a pillow under your knees, or sleep on your side with your knees bent and a pillow between your knees.
EXERCISE: What the government says
A gradual return to normal activities, including exercise, is recommended. Exercise is important to your overall health and can help you to lose body fat (if needed). Even if you have mild to moderate low back symptoms, the following things can be done without putting much stress on your back:
- Walking short distances
- Using a stationary bicycle
It is important to start any exercise program slowly and to gradually build up the speed and length of time that you do the exercise. At first, you may find that your symptoms get a little worse when you exercise or become more active. Usually, this is nothing to worry about. However, if your pain becomes severe, contact your health care provider. Once you are able to return to normal activities comfortably, your health care provider may recommend further aerobic and back exercises.
EXERCISE: What I say, reinforced by a few others
Updated 1/9/00: I found, once the condition stabilized, intelligent exercise to be the best alleviator of backpain of all the remedies employed, and I mean this with earnest sincerity. The primary agent for relief, immediate and total relief was the swimming pool. Some readers have commented that the "aerobic" exercise called "Pilates" works extraordinarily well to strengthen the deep muscles that often are not worked by major muscle-group exercise. In any case, structured exercise remains the path out of the Wilderness of Pain. To reinforce this, I found the following article:
Exercising With Chronic Back Pain
By Miriam E. Nelson, Ph.D, June 21, 1999
*(WebMD) -- Back pain is a fact of life for many Americans: … Not only is this unpredictable pain frustrating to live with, it interferes with daily activities, including exercise. But exercise is one of the most important things you can do to keep your back healthy.
The new thinking on exercise and back pain
In the past, people were told to rest and avoid exercise to manage for their back pain. We now know that this strategy actually contributes to greater dysfunction and increased pain because the muscles that support the back are not being conditioned. People with back pain are now told to be as physically active as they can tolerate.
What are the best exercises for someone with back pain?
Experts suggest a combination of stretching, aerobics and strength training for optimal back health. Stretching exercises should be done before any workout for at least 15 minutes to warm up and lengthen the muscles. Try these stretching exercises: Lie flat on your back with both knees bent, feet flat on the floor. Lift one leg (keep your knee bent) toward your chest with both hands and hold for about 15 seconds. Repeat with the other leg, doing several repetitions on each let.
Get on all fours, keeping your back flat. Slowly tuck your chin towards your chest and gently round your back (like a cat does) as you breath out. Return to a level position on the inhale. Then slightly arch your back as you exhale, looking up toward the ceiling. Return to a level position on the inhale. Repeat several times.
Aerobic Exercises - Updated 01/9/00
The best aerobic exercises for people with back problems are those that involve the lowest impact and minimize twisting: walking, swimming, bicycling on a stationary bike, and running on a treadmill or across-country ski machine. Be sure to consult your doctor before beginning any exercise program; if you feel increased pain, or an onset of pain, while exercising, call your doctor before continuing. (Sometimes the impact of jogging, for example, can cause a delayed pain response; be mindful of recurring next-day pain.)
Pilates is a structured program that focuses upon working the deep muscles, especially the back. Many Pilates instructors are former athletes who learned about the techniques after becoming injured themselves. The premise is that by learning to relax the superficial muscle groups while doing guided motions, the second and third layers can have the opportunity to perform work and thus become stronger. Although perceived by some as a "woman's thing", the premise is a good one and many body builders have benefited from the techniques.
Once your doctor has given you the go-ahead, keep several things in
Start slowly with the first few sessions, exercising no longer than 15minutes (in addition to the 15 minutes of stretching). Add another five minutes per session each week, gradually building up to 30 or 40 minutes of continuous exercise.
If you are jogging, do so on a treadmill or other soft surface, like a track, that has some degree of "give." Jogging on pavement is more dangerous because it doesn't absorb shock.
Replace your exercise shoes often -- either every six months or every 300 to 400 miles -- to ensure proper support.
Building up the muscles in your stomach, hips and thighs helps support your back and can reduce injury. The American Academy of Orthopaedic Surgeons recommends the following back-saving strengthening exercises: Floor leg lift. Lie on your stomach, tightening the muscles in your buttocks and legs. Slowly raise one leg several inches off the floor and hold for a count of 10. Return your leg to the floor and repeat with the other leg. Do several repetitions.
Roll-up. Lie on your back with knees bent, feet flat on the floor. Reaching both hands out in front of you, slowly raise your head and shoulders off the floor (don't sit all the way up). Hold to the count of10 and lower. Repeat five times.
Upright leg lift. Stand with your hands on the back of a chair. Lift one leg back, keeping the knee straight, a couple feet off the ground (don't let your back arch). Return the leg to the ground and repeat with the other leg. Do five repetitions on each leg.
[Later in this whitepaper, I detail a comprehensive training program for the back]
Dr. Sarno - Or It's all in your head
The good doctor has become something of an industry in himself, attracting singular notoriety by treating celebrities with, apparently, remarkable success.
Herein lies the age-old problem that has afflicted medical research for some four thousand years: you have a radical procedure which acquires such remarkable notoriety that only a few wealthy and highly unusual individuals can gain access to it. The population of subjects becomes self-limiting, so it becomes a truism that only people who can become cured by the procedure have direct access, hence it appears that the procedure applies for everybody.
In Dr. Sarno's case, the vast majority of his patients are white middle-class semi-professionals. And thereby the whole case for his theory is invalidated by the exclusivity of the subject pool. In later times, only very wealthy entertainers have had access to his services. Now it may be prejudicial to say that a blue-collar construction worker or a factory line worker has such a radically different job and lifestyle than, say, the well publicized case of Howard Stern, but face the facts dude. Howard doesn’t have to lift so much as a sheaf of paper in his entire workday while the line worker has to spend 10 or more hours on their feet lifting hundreds of pounds at a time.
In essence, the whole issue is this: Dr. Sarno says that the vast majority of twentieth-century backpain is psychological and without organic basis in fact. Now, the insurance companies love to hear this kind of talk, for a session with the shrink is a hell of a lot cheaper than trips to chiropractors, meds, TENS units and health club dues.
Unfortunately, Sarno is only one doctor with a limited range of practice catering largely to affluent professionals and many docs disagree with him whole-heartedly. Which is not to say psych elements might not be involved in many, a large number or most cases. Sarno indicates, rightly, that x-rays and MRI scans do not reveal anything at all conclusive. You either have a picture of hard structures, like bone, or you have an image of soft structures, like muscles. It is almost impossible to get the soft tissues imaged together with hard structures. And there is almost no correlation between damage perceived on an x-ray and the real damage and pain that occurs in life. Why? Some people show cracks in vertebrae and never feel the slightest pain, while people who show no abnormalities at all feel the most excruciating pain imaginable.
You get anxious, you get tense, and you feel pain in your back. That's what Sarno says is the cause.
I cannot tell you who is right for you. It might very well be psychological, but one thing is clear: the pain is real and something needs to change to make it stop. And there are far too many real physical causes to be ignored entirely. In fact, it may be time for medicine to own up to the fact that people's thoughts and feelings are just as important as the mechanical processes.
Worker's Compensation Treadmill
This is not related to the physical stuff, but I have been running into a large number of cases involving Worker's Comp claims and am noticing a disturbing similarity in the way events play out in California. In this state, filing a Worker's Comp claim automatically initiates a raft of legal proceedings, for a Claim is considered a lawsuit. As a result, the insurance companies inevitably contest the claim and as a matter of standard procedure inhibit, obstruct and resist any and all attempts to obtain compensation. I have seen the adjusters actively threaten, harrass and misinform the claimants with the subsequent proceedings dragging on for several years before settlement occurs in court. This includes cases in which the claimant's vertebrae were broken or pulverized in industrial accidents. Needless to say, such individuals remain out of work for some time, so hindering the due process of claims results in some serious hardship for people.
Update 5/27/05: As noted before, recent research indicates that surgery is no better in achieving results than many other less drastic measures, especially physical therapy. Look to succeeding updates for several case studies we have prepared.
Consulted med-professionals on this one. Losing weight appears to be the only path agreed upon by everyone and the prognosis is not good. In this case, as in all others, avoid surgery.
Low Level Laser Treatment
Update 6/9/05: This therapy, employed with some success in Europe over the past thirty years has only recently been given the FDA stamp of approval, but remains nevertheless within the realm of "alternative therapies" and is often lumped -- without any real cause to do so -- in the category of accupuncture, which it does not resemble in the slightest, but which tends to employ site maps created by the accupuncture specialists for treatment.
The technology was originally designed to aid arc welding -- hardly a medical application. Its first medical employment was by horse breeders.
Come again? You must bear in mind that a prize stallion who has won several important races is seen as quite a money pot in his sirage, or the foals which he produces after proving his worth in winning the Preakness and any number of other championships. Added to this factoid is the knowledge that good "horse people" can sniff out a champion within seconds -- and these people seldom go broke at the tracks betting on "also rans".
But what if your would-be champion gets an ankle-sprain and fails to prove his genetic worth at your local Dingus Downs? Heck any champion of any sport is going to endure any number of injuries in their sports lifetime. And there is no time for downtime in sports where money is concerned. Consequently you have trainers who will try anything, heck they'll bring in a voodoo shaman from Jamaica if they believe it will get old Capistrano back into the winners circle. It was in the world of veterinary medicine that some genius first applied the cold laser on steeplechase winners and by crimminy, it worked! Research soon got applied to humans and you know what? It does work! And the FDA approved the therapy as a solid alternative to surgery.
Researchers who had severed the spinal cords of rats managed to get the little rodents up and running again in weeks.
The catch is that nobody really knows how it works. And because nobody knows how it works, nobody can really devise any realistic application for any one specific problem. Because sometimes it does not work at all.
The general idea is that it stimulates healing by stimulating the cells regional to a specific injury. There is a lot of nonsense in the literature about ATP, mitochondria and endorphins, but it is quite clear that the writers are yacking out of their hats and simply using big words they hope the readers have only a passing familiarity with.
The specific idea is that certain light wavelengths can pass through several layers of tissue to stimulate the cells somehow. We do know that light can pass through the endothelial layers -- just put a flashlight against your cheek and you will see the inside of your mouth light up. -- and we also know that light exposure is important to health.
At this point, sprains, muscle tears, inflammation and the like are being treated, but it is suggested in the literature that subluxations and possibly spinal nerve damage can be repaired. Actual damage to bone structure does not seem to be in the cards. At this point, we have to take a wait and see approach.
THAT SIX-PACK LOOK IS GOOD FOR YOU (Update 08-24-10)
Except of course the classic "six-pack" abs look is genetically unfeasible for the vast majority of Americans. Google "flat abs" and any number of folks who really know will tell you that every living human being already has a "six pack" however true cut muscle definition may be physically impossible no matter how many reps of whatever you do. Nevertheless, working the abdominal muscles intelligently will go far to easing and preventing back injuries. DON'T do leg lifts, excessive "Roman chair" with weights, or any ballistic movements involving weights combined with twisting. BAD, BAD, BAD!
DO crunches with the legs elevated, slow situps on the medicine ball, and hip raises while lying supine.
Here are a couple exercises with images.
HIP RAISES (Sometimes called "reverse crunches")
HOW TO DO
1. Lie on the floor and place hands on the floor or behind the head. Newbies should put arms along the sides to help support the back.
2. Raise the legs until the toes point to the ceiling at 90 degrees, with feet together or crossed.
3. Contract the abs to curl the hips off the floor, reaching the legs up towards the ceiling.
4. Lower and repeat for 1-3 sets of 12-16 reps.
5. It's a very small movement, so try to use your abs to lift your hips rather than swinging your legs and creating momentum.
You can add another exercise without budging from this position by doing crunches with the legs still raised. This way you avoid cheating by omitting use of the thigh muscles.
HOW TO DO
1. Lie on the ball, positioning it under the lower back.
2. Cross your arms over the chest or place them behind your head.
3. Contract your abs to lift your torso off the ball, pulling the bottom of your ribcage down toward your hips.
4. As you curl up, keep the ball stable (i.e., the ball shouldn't roll).
5. Lower back down, getting a stretch in the abs, and repeat for 1-3 sets of 12-16 reps.
Knee lifts in the "Captain's Chair" with the back supported are also good, although it is difficult for a lot of people to avoid swinging the legs to get them up while also avoiding back curl. The Captain's Chair is that thing you hang from with your forearms supported by handle-grips and pads.
- Back pain wiki
- Back and spine @ Open Directory Project
- Handout on Health: Back Pain
- American Academy of Orthopaedic Surgeons summary on back pain
- Chiropractors on Avoiding Backpain at Work
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