Back pain can be disabling. If you have experienced an acute episode of low back pain, it is natural to think something serious has happened to your back. But keep in mind that most back problems are not caused by any serious disease or injury. In fact, most people improve over a few days or weeks. There may some minor discomfort even after the severe pain has resolved, but with time, the pain typically settles down. Unfortunately no one can predict precisely when the pain will go away, but in vast majority of people, it eventually does.
You may have heard of terms such as “slipped discs” or “herniated discs” or “degeneration”. These terms are commonly used by people who have back pain. However, most people with back pain do not have a slipped disc or herniated disc. The word “degeneration” sounds alarming, but it is a fact of life. Degeneration refers to normal wear and tear of the discs that comes with aging. It is similar to developing gray hairs or wrinkles on your face. Just like some people are genetically predisposed to having gray hair or wrinkles at an earlier age, some people have earlier “degeneration” of the discs in the low back than others. Again, this is nothing to be alarmed about. Degeneration is a normal process of aging. In most cases, it is not possible to determine whether your back pain is caused by degeneration or something else.
The sooner you get on with your life and return to your previous level of activity, the sonner you will feel better. In the “old days”, prolonged bedrest was recommended to treat back pain. We now know that bedrest is the worst thing you can do and will only worsen your pain. Your muscles and bones get weaker, your fitness level deteriorates, depression sets in, and your back gets stiff.
Your body must stay active to stay healthy. Even when you have back pain, you should find some form of activity that you can tolerate. Whether this is walking, swimming, riding a bike, yoga, etc. You may have to experiment with different forms of exercise. You may tolerate some but not others. You may feel sore after you first begin to exercise. This is normal and a sign of progress. It is not easy, and you may feel tempted to take pain pills and just rest and take it easy. But this will only lead to more pain. The choice is yours: Rest and get worse, or get active and recover!
People who cope best with back pain are those who are motivated to return to their life (despite the pain), and stay active. People who tend to suffer longterm with back pain and do poorly are those who become sedentary, change their lifestyle and let the pain take over their life.
People who develop long-term (called “chronic”) back pain tend to have the following signs:
- They believe they have a serious injury
- Feel that if they become active, they will cause more damage to their back
- They rest more than they should, become sedentary
- Do not get on with their life.
- Become depressed
- Wait for someone (a doctor for example) to fix the problem, or rely on pain medications to get rid of the pain.
Over the counter medications such as Ibuprofin or Tylenol are safe and effective. Take the dose that is recommended on the bottle, and you may need to take these medicines for a few days. Rarely do people need anything stronger.
It is generally a good idea to avoid prescription pain medications for low back pain. If you see your doctor and he recommends these medications, it is typically for a very short period of time (2 weeks or less). Your goal should be to stop taking these medications as soon as you can and rely more on over the counter medications.
Physical therapy aimed at strengthening your abdominal muscles and the muscles in your low back is the most important thing you can do to relieve your back pain. Your spine is supported by muscles and the stronger and more “fit” these muscles are, the better they can support your weight and the less stress is taken up by the spine itself. If your abdominal and low back muscles are weak, the stress of your body weight is shifted to your spine. This results in fatigue and pain as your discs and spine joints and ligaments have to take on this additional load and stress.
Your physical therapist will teach you specific exercises to target your abdominal and low back muscles. These are frequently referred to as “core muscles”. Typical duration of treatment is 6 weeks, with 2 or 3 sessions per week, each session lasting 45-60 minutes. In some cases, once you learn how to perform these exercises, you may not need to go to “formal” therapy sessions and can do these exercises at home. You may not see the benefits of therapy until at least 4-6 weeks of regularly performing these exercises. Your goal should be to consistently perform these exercises on a long-term basis.
Remember that you get out of physical therapy as much as you put into it. If you just go through the motions, and don’t commit yourself to performing the exercises regularly, your pain will probably not improve much.
Many patients feel better after a few weeks of physical therapy, then after their therapy sessions end, they stop exercising. These patients frequently have recurrence of their back pain because of recurrent muscle deconditioning and weakness. It is important to continue core strengthening exercises on your own even after you have completed your formal therapy sessions.
Doing some form of aerobic activity at least 3 days a week for 30 minutes each session is very important in treating your back pain and maintaining your back health. This can take the form of light jogging, various elliptical machines, stairmaster machines or stationary bicycles. Jogging is excellent but if you have pain in your hips, knees or feet and cannot jog for whatever reason, elliptical machines or walking at brisk pace are good alternatives. If you weight more than 240-250 lbs, running may not be good for your joints and you should consider another form of exercise.
Aerobic exercise increases the endurance and strength of your low back muscles, improves blood flow to the muscles in your back, and has many other health benefits. It improves your overall fitness and health.
It is helpful add variety to your exercise routine. For example, you may jog for 30 minutes one day, and the next session can jog for 15 minutes and use the elliptical machine for 15 minutes. You may also substitute bike-riding for either of the above to add more variety. This will prevent boredom and the monotony of performing a single exercise each session and will also help prevent overuse injuries.
Weight loss is critical to the health of your low back. If you are overweight, the stress on your low back is significantly increased and losing weight may be the most important thing you can do to relieve your pain. If you are obese and your pain limits your ability to exercise, and you have not been successful with dieting, one option to look into is gastric bypass surgery. Although there are some risks involved with such surgery (as in any surgery), the risks of being obese far outweigh any surgical risk.
Sitting has been shown to place undue stress on your low back and prolonged sitting can lead to back pain. Compared with standing and lying flat, sitting places the most stress on the discs in your low back. Click here to see how much more stress is on the discs in your low back in the sitting position. If you work on a computer or sit at a desk for several hours a day, whenever you have the opportunity, stand or go for a short walk. Of course little can be done during work or school but you can certainly modify your activities in the evening when you get home. Take frequent breaks from sitting, approximately every 30 minutes. You may go for a short walk, or take 30 minutes to exercise. Avoid sitting in a slumped position. Avoid leaning forward to type on a computer. You may also want to experiment with a different chair as some chairs are more “ergonomic”, providing better support to your low back than others.
Lifestyle change: If you live a sedentary life, without much physical activity, you are more likely to experience low back pain. People who sit several hours a day at a desk often experience back pain. On the other end of the spectrum are those who have physically strenuous jobs (for example, laborers, construction workers) and low back pain is also common in this group. The key is moderation: a sedentary job and a physically laborious job are both equally harmful.
Lifting position: when lifting an object off the ground, instead of bending over at the waist, bend your knees to pick it up. Bending over at the waist places undue stress on your low back and can lead to injury. Get into the habit of bending at the knees to pick up objects off the floor.
Mattress – sometimes your mattress can be a source of back pain. If you sleep on an excessively hard mattress and find yourself waking up with a sore or stiff back, you may want to experiment with some softer models. Do not sleep on couches or foutons.
Other things you may want to try include massage therapy and chiropractic treatment. You may feel benefit after a few sessions.
Remember that the person who can help you the most with your back pain is YOU. Your attitude towards pain, motivation to return to work and your previous activities, and your coping skills are more important to your recovery than anything else!