Who gets back pain?
Low back pain is one of the most common problems people have; 60 to 80% of adults will get back pain at some point in their lives. People aged 45-65 are at greater risk of having back pain. This accounts for 2% of visits to primary care offices each year, and an average of two office visits per day at Colchester Family Practice. A vast majority, 95% of people with acute back pain, will recover within three months. However, the recurrence rate – or likelihood the condition will return – is 45-75%. Most patients that seek treatment for back pain will give up on exercising and other activities. If the pain persists and a person is out of work or disabled for greater than six months, the rate of return to previous level of activity is less than 50%. Back pain is the leading cause of disability in people under age 45. In addition, people over age 45 and/or with significant life stressors often take longer to recover from acute back injury.
What causes it?
In most cases, acute onset back pain can be attributed to a muscle strain from bending, lifting or twisting. Another cause for back pain is a bulging disk, the spongy cushions that lie between the vertebrae in the spine, which can put pressure on nearby nerves and cause pain. Arthritis can also be a culprit for back pain, causing the space around the spinal cord to narrow and compress nerves. Compression fractures of the vertebrae from osteoporosis can also be a cause of pain. Rarely back pain can be a sign of a more serious condition such as infection, tumor, or a rheumatic condition.
How can I prevent it?
You can lower your risk of straining your back by practicing proper posture, maintaining a healthy weight and getting enough exercise. Specific exercises to strengthen your core and back may help prevent injury. Other factors include learning to bend and lift with proper form, sitting in supportive chairs, sleeping on a firm mattress, and wearing comfortable, low heeled shoes.
How is it treated?
Most cases will get better with self-care. If your symptoms do not improve within 72 hours, you should see your doctor. While it may be tempting to stay in bed while your back hurts, it is better to maintain a light to moderate activity level while avoiding movements that exacerbate the pain. Back pain without a serious etiology (cause) will be treated conservatively. This includes heat or ice (whichever feels better to you), nonsteriodal anti-inflammatory drugs (NSAIDs) such as ibuprofen and Aleve, muscle relaxants and physical therapy.
What if I still have pain?
If you are still experiencing pain or other related symptoms after attempting conservative treatment, please return to your doctor. If appropriate they can do more tests to rule out a more serious cause or discuss alternative therapies with you.
What are some alternative therapies for back pain?
If you have persistent or recurrent back pain, complementary and alternative therapies may help you find some relief. These include chiropractic, acupuncture, naturopathic medicine, yoga, tai chi and other forms of holistic, non-operative treatments.
The word chiropractic is derived from Greek and means “To Perform with the Hands”. Chiropractic is a health care discipline, which emphasizes the inherent recuperation power of the body to heal itself without drugs or surgery. The practice of chiropractic focuses on the relationship between the spine and nervous system and how the relationship affects the preservation and restoration of health. Chiropractic is a detailed examination of the joints of the body to determine if and where a functional misalignment exists. If misalignment exists and is isolated the chiropractor can physically restore the joint to its optimal position and range of motion. Chiropractors may also employ muscle relaxation techniques, such as heat packs, electrical stimulation of muscles, and massage.
Acupuncture is an alternative medicine technique originating in ancient China that treats patients by manipulating needles inserted on ‘acupuncture points’ found in different areas of the body. Stimulating these specific points is thought to correct imbalances of energy flow through the body. This in turn can have physiologic effects such as increasing blood flow, decreasing inflammation, decreasing swelling, relaxing muscles and decreasing pain.
Naturopathic physicians seek to restore and maintain optimum health in their patients by emphasizing nature’s inherent self-healing process, what they call the vis medicatrix naturae. Naturopathic doctors favor a holistic approach, combining conventional medicine with homeopathy, botanical medicine, Chinese medicine, nutrition and physical medicine to treat symptoms and restore whole body health and well-being.
Yoga originated in ancient India and is a term that encompasses physical, mental, and spiritual disciplines. In Western society, physical yoga postures are used as a form of exercise, physical therapy, and stress reduction. Specifically, the focus on strengthening and stretching the back and core can help relieve pain and prevent future injury. The mind-body approach of yoga has been shown to relieve stress and pain in participants.
Tai Chi is a form of Chinese gentle exercise that incorporates stretching, balance, body awareness, and strengthening techniques to promote general well-being. Studies of tai chi have shown participants have decreased pain and disability. In addition, the mind-body association discussed above may play a role in the success of tai chi.
If you are interested in physical therapy or any of the alternative therapies above, please talk to your doctor. Most insurance companies require referrals for physical therapy. Colchester Family Practice also has a patient brochure for the alternative therapies listed above with local resources provided and information about cost. Please talk with your provider about the best options for you.
Karina Eastman, Medical Student: Ms. Eastman is a third year medical student at the University of Vermont College of Medicine. CFP physicians are active teachers and regularly host on-site medical students.
Sahmon Fallahian, MD: Dr. Fallahian is a practicing family physician at Colchester Family Practice and a clinical assistant professor of Family Medicine at the University of Vermont College of Medicine.