If you have lower back pain, you are not alone. Nearly everyone at some
point has back pain that interferes with work, routine daily activities, or
recreation. Americans spend at least $50 billion each year on low back pain,
the most common cause of job-related disability and a leading contributor to
missed work. Back pain is the second most common neurological ailment in the
United States — only headache is more common. Fortunately, most occurrences
of low back pain go away within a few days. Others take much longer to resolve
or lead to more serious conditions.
Acute or short-term low back pain generally lasts from a few days to
a few weeks. Most acute back pain is mechanical in nature — the result of
trauma to the lower back or a disorder such as arthritis. Pain from trauma may
be caused by a sports injury, work around the house or in the garden, or a
sudden jolt such as a car accident or other stress on spinal bones and
tissues. Symptoms may range from muscle ache to shooting or stabbing pain,
limited flexibility and/or range of motion, or an inability to stand straight.
Occasionally, pain felt in one part of the body may “radiate” from a
disorder or injury elsewhere in the body. Some acute pain syndromes can become
more serious if left untreated.
Chronic back pain is measured by duration — pain that persists for
more than 3 months is considered chronic. It is often progressive and the
cause can be difficult to determine.
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What structures make
up the back?
The back is an intricate structure of bones, muscles, and other tissues
that form the posterior part of the body’s trunk, from the neck to the
pelvis. The centerpiece is the spinal column, which not only supports the
upper body’s weight but houses and protects the spinal cord — the delicate
nervous system structure that carries signals that control the body’s
movements and convey its sensations. Stacked on top of one another are more
than 30 bones — the vertebrae — that form the spinal column, also known as
the spine. Each of these bones contains a roundish hole that, when stacked in
register with all the others, creates a channel that surrounds the spinal
cord. The spinal cord descends from the base of the brain and extends in the
adult to just below the rib cage. Small nerves (“roots”) enter and emerge
from the spinal cord through spaces between the vertebrae. Because the bones
of the spinal column continue growing long after the spinal cord reaches its
full length in early childhood, the nerve roots to the lower back and legs
extend many inches down the spinal column before exiting. This large bundle of
nerve roots was dubbed by early anatomists as the cauda equina, or horse’s
tail. The spaces between the vertebrae are maintained by round, spongy pads of
cartilage called intervertebral discs that allow for flexibility in the lower
back and act much like shock absorbers throughout the spinal column to cushion
the bones as the body moves. Bands of tissue known as ligaments and tendons
hold the vertebrae in place and attach the muscles to the spinal column.
Starting at the top, the spine has four regions:
- the seven cervical or neck vertebrae (labeled C1–C7),
- the 12 thoracic or upper back vertebrae (labeled T1–T12),
- the five lumbar vertebrae (labeled L1–L5), which we know as the lower
back, and
- the sacrum and coccyx, a group of bones fused together at the base of
the spine.
The lumbar region of the back, where most back pain is felt, supports the
weight of the upper body.
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What causes lower back
pain?
As people age, bone strength and muscle elasticity and tone tend to
decrease. The discs begin to lose fluid and flexibility, which decreases their
ability to cushion the vertebrae.
Pain can occur when, for example, someone lifts something too heavy or
overstretches, causing a sprain, strain, or spasm in one of the muscles or
ligaments in the back. If the spine becomes overly strained or compressed, a
disc may rupture or bulge outward. This rupture may put pressure on one of the
more than 50 nerves rooted to the spinal cord that control body movements and
transmit signals from the body to the brain. When these nerve roots become
compressed or irritated, back pain results.
Low back pain may reflect nerve or muscle irritation or bone lesions. Most
low back pain follows injury or trauma to the back, but pain may also be
caused by degenerative conditions such as arthritis or disc disease,
osteoporosis or other bone diseases, viral infections, irritation to joints
and discs, or congenital abnormalities in the spine. Obesity, smoking, weight
gain during pregnancy, stress, poor physical condition, posture inappropriate
for the activity being performed, and poor sleeping position also may
contribute to low back pain. Additionally, scar tissue created when the
injured back heals itself does not have the strength or flexibility of normal
tissue. Buildup of scar tissue from repeated injuries eventually weakens the
back and can lead to more serious injury.
Occasionally, low back pain may indicate a more serious medical problem.
Pain accompanied by fever or loss of bowel or bladder control, pain when
coughing, and progressive weakness in the legs may indicate a pinched nerve or
other serious condition. People with diabetes may have severe back pain or
pain radiating down the leg related to neuropathy. People with these symptoms
should contact a doctor immediately to help prevent permanent damage.
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Who is
most likely to develop low back pain?
Nearly everyone has low back pain sometime. Men and women are equally
affected. It occurs most often between ages 30 and 50, due in part to the
aging process but also as a result of sedentary life styles with too little
(sometimes punctuated by too much) exercise. The risk of experiencing low back
pain from disc disease or spinal degeneration increases with age.
Low back pain unrelated to injury or other known cause is unusual in
pre-teen children. However, a backpack overloaded with schoolbooks and
supplies can quickly strain the back and cause muscle fatigue. The U.S.
Consumer Product Safety Commission estimates that more than 13,260 injuries
related to backpacks were treated at doctors’ offices, clinics, and
emergency rooms in the year 2000. To avoid back strain, children carrying
backpacks should bend both knees when lifting heavy packs, visit their locker
or desk between classes to lighten loads or replace books, or purchase a
backpack or airline tote on wheels.
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What
conditions are associated with low back pain?
Conditions that may cause low back pain and require treatment by a
physician or other health specialist include:
Bulging disc (also called protruding, herniated, or ruptured disc).
The intervertebral discs are under constant pressure. As discs degenerate and
weaken, cartilage can bulge or be pushed into the space containing the spinal
cord or a nerve root, causing pain. Studies have shown that most herniated
discs occur in the lower, lumbar portion of the spinal column.
A much more serious complication of a ruptured disc is cauda equina
syndrome, which occurs when disc material is pushed into the spinal canal
and compresses the bundle of lumbar and sacral nerve roots. Permanent
neurological damage may result if this syndrome is left untreated.
Sciatica is a condition in which a herniated or ruptured disc
presses on the sciatic nerve, the large nerve that extends down the spinal
column to its exit point in the pelvis and carries nerve fibers to the leg.
This compression causes shock-like or burning low back pain combined with pain
through the buttocks and down one leg to below the knee, occasionally reaching
the foot. In the most extreme cases, when the nerve is pinched between the
disc and an adjacent bone, the symptoms involve not pain but numbness and some
loss of motor control over the leg due to interruption of nerve signaling. The
condition may also be caused by a tumor, cyst, metastatic disease, or
degeneration of the sciatic nerve root.
Spinal degeneration from disc wear and tear can lead to a narrowing
of the spinal canal. A person with spinal degeneration may experience
stiffness in the back upon awakening or may feel pain after walking or
standing for a long time.
Spinal stenosis related to congenital narrowing of the bony canal
predisposes some people to pain related to disc disease.
Osteoporosis is a metabolic bone disease marked by progressive
decrease in bone density and strength. Fracture of brittle, porous bones in
the spine and hips results when the body fails to produce new bone and/or
absorbs too much existing bone. Women are four times more likely than men to
develop osteoporosis. Caucasian women of northern European heritage are
at the highest risk of developing the condition.
Skeletal irregularities produce strain on the vertebrae and
supporting muscles, tendons, ligaments, and tissues supported by spinal
column. These irregularities include scoliosis, a curving of the spine
to the side; kyphosis, in which the normal curve of the upper back is
severely rounded; lordosis, an abnormally accentuated arch in the lower
back; back extension, a bending backward of the spine; and back
flexion, in which the spine bends forward.
Fibromyalgia is a chronic disorder characterized by widespread
musculoskeletal pain, fatigue, and multiple “tender points,” particularly
in the neck, spine, shoulders, and hips. Additional symptoms may include sleep
disturbances, morning stiffness, and anxiety.
Spondylitis refers to chronic back pain and stiffness caused by a
severe infection to or inflammation of the spinal joints. Other painful
inflammations in the lower back include osteomyelitis (infection in the
bones of the spine) and sacroiliitis (inflammation in the sacroiliac
joints).
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How is low back pain
diagnosed?
A thorough medical history and physical exam can usually identify any
dangerous conditions or family history that may be associated with the pain.
The patient describes the onset, site, and severity of the pain; duration of
symptoms and any limitations in movement; and history of previous episodes or
any health conditions that might be related to the pain. The physician will
examine the back and conduct neurologic tests to determine the cause of pain
and appropriate treatment. Blood tests may also be ordered. Imaging tests may
be necessary to diagnose tumors or other possible sources of the pain.
A variety of diagnostic methods are available to confirm the cause of low
back pain:
X-ray imaging includes conventional and enhanced methods that can
help diagnose the cause and site of back pain. A conventional x-ray,
often the first imaging technique used, looks for broken bones or an injured
vertebra. A technician passes a concentrated beam of low-dose ionized
radiation through the back and takes pictures that, within minutes, clearly
show the bony structure and any vertebral misalignment or fractures. Tissue
masses such as injured muscles and ligaments or painful conditions such as a
bulging disc are not visible on conventional x-rays. This fast, noninvasive,
painless procedure is usually performed in a doctor’s office or at a clinic.
Discography involves the injection of a special contrast dye into a
spinal disc thought to be causing low back pain. The dye outlines the damaged
areas on x-rays taken following the injection. This procedure is often
suggested for patients who are considering lumbar surgery or whose pain has
not responded to conventional treatments. Myelograms also enhance the
diagnostic imaging of an x-ray. In this procedure, the contrast dye is
injected into the spinal canal, allowing spinal cord and nerve compression
caused by herniated discs or fractures to be seen on an x-ray.
Computerized tomography (CT) is a quick and painless process used
when disc rupture, spinal stenosis, or damage to vertebrae is suspected as a
cause of low back pain. X-rays are passed through the body at various angles
and are detected by a computerized scanner to produce two-dimensional slices
(1 mm each) of internal structures of the back. This diagnostic exam is
generally conducted at an imaging center or hospital.
Magnetic resonance imaging (MRI) is used to evaluate the lumbar
region for bone degeneration or injury or disease in tissues and nerves,
muscles, ligaments, and blood vessels. MRI scanning equipment creates a
magnetic field around the body strong enough to temporarily realign water
molecules in the tissues. Radio waves are then passed through the body to
detect the “relaxation” of the molecules back to a random alignment and
trigger a resonance signal at different angles within the body. A computer
processes this resonance into either a three-dimensional picture or a
two-dimensional “slice” of the tissue being scanned, and differentiates
between bone, soft tissues and fluid-filled spaces by their water content and
structural properties. This noninvasive procedure is often used to identify a
condition requiring prompt surgical treatment.
Electrodiagnostic procedures include electromyography (EMG), nerve
conduction studies, and evoked potential (EP) studies. EMG assesses the
electrical activity in a nerve and can detect if muscle weakness results from
injury or a problem with the nerves that control the muscles. Very fine
needles are inserted in muscles to measure electrical activity transmitted
from the brain or spinal cord to a particular area of the body. With nerve
conduction studies the doctor uses two sets of electrodes (similar to those
used during an electrocardiogram) that are placed on the skin over the
muscles. The first set gives the patient a mild shock to stimulate the nerve
that runs to a particular muscle. The second set of electrodes is used to make
a recording of the nerve’s electrical signals, and from this information the
doctor can determine if there is nerve damage. EP tests also involve two sets
of electrodes — one set to stimulate a sensory nerve and the other set on
the scalp to record the speed of nerve signal transmissions to the brain.
Bone scans are used to diagnose and monitor infection, fracture, or
disorders in the bone. A small amount of radioactive material is injected into
the bloodstream and will collect in the bones, particularly in areas with some
abnormality. Scanner-generated images are sent to a computer to identify
specific areas of irregular bone metabolism or abnormal blood flow, as well as
to measure levels of joint disease.
Thermography involves the use of infrared sensing devices to measure small
temperature changes between the two sides of the body or the temperature of a
specific organ. Thermography may be used to detect the presence or absence of
nerve root compression.
Ultrasound imaging, also called ultrasound scanning or sonography,
uses high-frequency sound waves to obtain images inside the body. The sound
wave echoes are recorded and displayed as a real-time visual image. Ultrasound
imaging can show tears in ligaments, muscles, tendons, and other soft tissue
masses in the back.
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How is back pain treated?
Most low back pain can be treated without surgery. Treatment involves using
analgesics, reducing inflammation, restoring proper function and strength to
the back, and preventing recurrence of the injury. Most patients with back
pain recover without residual functional loss. Patients should contact a
doctor if there is not a noticeable reduction in pain and inflammation after
72 hours of self-care.
Although ice and heat (the use of cold and hot compresses) have
never been scientifically proven to quickly resolve low back injury,
compresses may help reduce pain and inflammation and allow greater mobility
for some individuals. As soon as possible following trauma, patients should
apply a cold pack or a cold compress (such as a bag of ice or bag of frozen
vegetables wrapped in a towel) to the tender spot several times a day for up
to 20 minutes. After 2 to 3 days of cold treatment, they should then apply
heat (such as a heating lamp or hot pad) for brief periods to relax muscles
and increase blood flow. Warm baths may also help relax muscles. Patients
should avoid sleeping on a heating pad, which can cause burns and lead to
additional tissue damage.
Bed rest — 1–2 days at most. A 1996 Finnish study found that
persons who continued their activities without bed rest following onset of low
back pain appeared to have better back flexibility than those who rested in
bed for a week. Other studies suggest that bed rest alone may make back pain
worse and can lead to secondary complications such as depression, decreased
muscle tone, and blood clots in the legs. Patients should resume activities as
soon as possible. At night or during rest, patients should lie on one side,
with a pillow between the knees (some doctors suggest resting on the back and
putting a pillow beneath the knees).
Exercise may be the most effective way to speed recovery from low
back pain and help strengthen back and abdominal muscles. Maintaining and
building muscle strength is particularly important for persons with skeletal
irregularities. Doctors and physical therapists can provide a list of gentle
exercises that help keep muscles moving and speed the recovery process. A
routine of back-healthy activities may include stretching exercises, swimming,
walking, and movement therapy to improve coordination and develop proper
posture and muscle balance. Yoga is another way to gently stretch muscles and
ease pain. Any mild discomfort felt at the start of these exercises should
disappear as muscles become stronger. But if pain is more than mild and lasts
more than 15 minutes during exercise, patients should stop exercising and
contact a doctor.
Medications are often used to treat acute and chronic low back pain.
Effective pain relief may involve a combination of prescription drugs and
over-the-counter remedies. Patients should always check with a doctor before
taking drugs for pain relief. Certain medicines, even those sold over the
counter, are unsafe during pregnancy, may conflict with other medications, may
cause side effects including drowsiness, or may lead to liver damage.
- Over-the-counter analgesics, including nonsteroidal
anti-inflammatory drugs (aspirin, naproxen, and ibuprofen), are taken
orally to reduce stiffness, swelling, and inflammation and to ease mild to
moderate low back pain. Counter-irritants applied topically to the
skin as a cream or spray stimulate the nerve endings in the skin to
provide feelings of warmth or cold and dull the sense of pain. Topical
analgesics can also reduce inflammation and stimulate blood flow. Many of
these compounds contain salicylates, the same ingredient found in oral
pain medications containing aspirin.
- Anticonvulsants — drugs primarily used to treat seizures —
may be useful in treating certain types of nerve pain and may also be
prescribed with analgesics.
- Some antidepressants, particularly tricyclic antidepressants such
as amitriptyline and desipramine, have been shown to relieve pain
(independent of their effect on depression) and assist with sleep.
Antidepressants alter levels of brain chemicals to elevate mood and dull
pain signals. Many of the new antidepressants, such as the selective
serotonin reuptake inhibitors, are being studied for their effectiveness
in pain relief.
- Opioids such as codeine, oxycodone, hydrocodone, and morphine are
often prescribed to manage severe acute and chronic back pain but should
be used only for a short period of time and under a physician’s
supervision. Side effects can include drowsiness, decreased reaction time,
impaired judgment, and potential for addiction. Many specialists are
convinced that chronic use of these drugs is detrimental to the back pain
patient, adding to depression and even increasing pain.
Spinal manipulation is literally a "hands-on" approach in
which professionally licensed specialists (such as chiropractors, osteopaths,
and physical therapists) use leverage and a series of exercises to adjust
spinal structures and restore back mobility. These specialists do not
prescribe drugs or use surgery in their treatment of low back pain.
When back pain does not respond to more conventional approaches, patients
may consider the following options:
Acupuncture involves the insertion of needles the width of a human
hair along precise points throughout the body. Practitioners believe this
process triggers the release of naturally occurring painkilling molecules
called peptides and keeps the body’s normal flow of energy unblocked.
Clinical studies are measuring the effectiveness of acupuncture in comparison
to more conventional procedures in the treatment of acute low back pain.
Biofeedback is used to treat many acute pain problems, most notably
back pain and headache. Using a special electronic machine, the patient is
trained to become aware of, to follow, and to gain control over certain bodily
functions, including muscle tension, heart rate, and skin temperature (by
controlling local blood flow patterns). The patient can then learn to effect a
change in his or her response to pain, for example, by using relaxation
techniques. Biofeedback is often used in combination with other treatment
methods, generally without side effects.
Interventional therapy can ease chronic pain by blocking nerve
conduction between specific areas of the body and the brain. Approaches range
from injections of local anesthetics, steroids, or narcotics into affected
soft tissues, joints, or nerve roots to more complex nerve blocks and spinal
cord stimulation. When extreme pain is involved, low doses of drugs may be
administered by catheter directly into the spinal cord. Chronic use of steroid
injections may lead to increased functional impairment.
Traction involves the use of weights to apply constant or
intermittent force to gradually “pull” the skeletal structure into better
alignment. Traction is not recommended for treating acute low back symptoms.
Transcutaneous electrical nerve stimulation (TENS) is administered
by a battery-powered device that sends mild electric pulses along nerve fibers
to block pain signals to the brain. Small electrodes placed on the skin at or
near the site of pain generate nerve impulses that block incoming pain signals
from the peripheral nerves. TENS may also help stimulate the brain’s
production of endorphins (chemicals that have pain-relieving properties).
Ultrasound is a noninvasive therapy used to warm the body’s
internal tissues, which causes muscles to relax. Sound waves pass through the
skin and into the injured muscles and other soft tissues.
Minimally invasive outpatient treatments to seal fractures of the vertebrae
caused by osteoporosis include vertebroplasty and kyphoplasty.
Vertebroplasty uses three-dimensional imaging to help a doctor guide a fine
needle into the vertebral body. A glue-like epoxy is injected, which quickly
hardens to stabilize and strengthen the bone and provide immediate pain
relief. In kyphoplasty, prior to injecting the epoxy, a special balloon is
inserted and gently inflated to restore height to the bone and reduce spinal
deformity.
In the most serious cases, when the condition does not respond to other
therapies, surgery may relieve pain caused by back problems or serious
musculoskeletal injuries. Some surgical procedures may be performed in a
doctor’s office under local anesthesia, while others require
hospitalization. It may be months following surgery before the patient is
fully healed, and he or she may suffer permanent loss of flexibility. Since
invasive back surgery is not always successful, it should be performed only in
patients with progressive neurologic disease or damage to the peripheral
nerves.
- Discectomy is one of the more common ways to remove pressure on a
nerve root from a bulging disc or bone spur. During the procedure the
surgeon takes out a small piece of the lamina (the arched bony roof of the
spinal canal) to remove the obstruction below.
- Foraminotomy is an operation that “cleans out” or enlarges
the bony hole (foramen) where a nerve root exits the spinal canal.
Bulging discs or joints thickened with age can cause narrowing of the
space through which the spinal nerve exits and can press on the nerve,
resulting in pain, numbness, and weakness in an arm or leg. Small pieces
of bone over the nerve are removed through a small slit, allowing the
surgeon to cut away the blockage and relieve the pressure on the nerve.
- IntraDiscal Electrothermal Therapy (IDET) uses thermal energy to
treat pain resulting from a cracked or bulging spinal disc. A special
needle is inserted via a catheter into the disc and heated to a high
temperature for up to 20 minutes. The heat thickens and seals the disc
wall and reduces inner disc bulge and irritation of the spinal nerve.
- Nucleoplasty uses radiofrequency energy to treat patients with
low back pain from contained, or mildly herniated, discs. Guided by x-ray
imaging, a wand-like instrument is inserted through a needle into the disc
to create a channel that allows inner disc material to be removed. The
wand then heats and shrinks the tissue, sealing the disc wall. Several
channels are made depending on how much disc material needs to be removed.
- Radiofrequency lesioning is a procedure using electrical impulses
to interrupt nerve conduction (including the conduction of pain signals)
for 6 to12 months. Using x-ray guidance, a special needle is inserted into
nerve tissue in the affected area. Tissue surrounding the needle tip is
heated for 90-120 seconds, resulting in localized destruction of the
nerves.
- Spinal fusion is used to strengthen the spine and prevent painful
movements. The spinal disc(s) between two or more vertebrae is removed and
the adjacent vertebrae are “fused” by bone grafts and/or metal devices
secured by screws. Spinal fusion may result in some loss of flexibility in
the spine and requires a long recovery period to allow the bone grafts to
grow and fuse the vertebrae together.
- Spinal laminectomy (also known as spinal decompression) involves
the removal of the lamina (usually both sides) to increase the size of the
spinal canal and relieve pressure on the spinal cord and nerve roots.
Other surgical procedures to relieve severe chronic pain include rhizotomy,
in which the nerve root close to where it enters the spinal cord is cut to
block nerve transmission and all senses from the area of the body experiencing
pain; cordotomy, where bundles of nerve fibers on one or both sides of
the spinal cord are intentionally severed to stop the transmission of pain
signals to the brain; and dorsal root entry zone operation, or DREZ, in
which spinal neurons transmitting the patient’s pain are destroyed
surgically.
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Can back pain be
prevented?
Recurring back pain resulting from improper body mechanics or other
nontraumatic causes is often preventable. A combination of exercises that
don't jolt or strain the back, maintaining correct posture, and lifting
objects properly can help prevent injuries.
Many work-related injuries are caused or aggravated by stressors such as
heavy lifting, contact stress (repeated or constant contact between soft body
tissue and a hard or sharp object, such as resting a wrist against the edge of
a hard desk or repeated tasks using a hammering motion), vibration, repetitive
motion, and awkward posture. Applying ergonomic principles — designing
furniture and tools to protect the body from injury — at home and in the
workplace can greatly reduce the risk of back injury and help maintain a
healthy back. More companies and homebuilders are promoting ergonomically
designed tools, products, workstations, and living space to reduce the risk of
musculoskeletal injury and pain.
The use of wide elastic belts that can be tightened to “pull in” lumbar
and abdominal muscles to prevent low back pain remains controversial. A
landmark study of the use of lumbar support or abdominal support belts worn by
persons who lift or move merchandise found no evidence that the belts reduce
back injury or back pain. The 2-year study, reported by the National Institute
for Occupational Safety and Health (NIOSH) in December 2000, found no
statistically significant difference in either the incidence of workers’
compensation claims for job-related back injuries or the incidence of
self-reported pain among workers who reported they wore back belts daily
compared to those workers who reported never using back belts or reported
using them only once or twice a month.
Although there have been anecdotal case reports of injury reduction among
workers using back belts, many companies that have back belt programs also
have training and ergonomic awareness programs. The reported injury reduction
may be related to a combination of these or other factors.
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Quick tips to a
healthier back
Following any period of prolonged inactivity, begin a program of regular
low-impact exercises. Speed walking, swimming, or stationary bike riding 30
minutes a day can increase muscle strength and flexibility. Yoga can also help
stretch and strengthen muscles and improve posture. Ask your physician or
orthopedist for a list of low-impact exercises appropriate for your age and
designed to strengthen lower back and abdominal muscles.
- Always stretch before exercise or other strenuous physical activity.
- Don’t slouch when standing or sitting. When standing, keep your weight
balanced on your feet. Your back supports weight most easily when
curvature is reduced.
- At home or work, make sure your work surface is at a comfortable height
for you.
- Sit in a chair with good lumbar support and proper position and height
for the task. Keep your shoulders back. Switch sitting positions often and
periodically walk around the office or gently stretch muscles to relieve
tension. A pillow or rolled-up towel placed behind the small of your back
can provide some lumbar support. If you must sit for a long period of
time, rest your feet on a low stool or a stack of books.
- Wear comfortable, low-heeled shoes.
- Sleep on your side to reduce any curve in your spine. Always sleep on a
firm surface.
- Ask for help when transferring an ill or injured family member from a
reclining to a sitting position or when moving the patient from a chair to
a bed.
- Don’t try to lift objects too heavy for you. Lift with your knees,
pull in your stomach muscles, and keep your head down and in line with
your straight back. Keep the object close to your body. Do not twist when
lifting.
- Maintain proper nutrition and diet to reduce and prevent excessive
weight, especially weight around the waistline that taxes lower back
muscles. A diet with sufficient daily intake of calcium, phosphorus, and
vitamin D helps to promote new bone growth.
- If you smoke, quit. Smoking reduces blood flow to the lower spine and
causes the spinal discs to degenerate.
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What research is being
done?
The National Institute of Neurological Disorders and Stroke, a component of
the National Institutes of Health (NIH) within the U.S. Department of Health
and Human Services, is the nation’s leading federal funder of research on
disorders of the brain and nervous system and one of the primary NIH
components that supports research on pain and pain mechanisms. Other
institutes at NIH that support pain research include the National Institute of
Dental and Craniofacial Research, the National Cancer Institute, the National
Institute on Drug Abuse, the National Institute of Mental Health, the National
Center for Complementary and Alternative Medicine, and the National Institute
of Arthritis and Musculoskeletal and Skin Diseases. Additionally, other
federal organizations, such as the Department of Veterans Affairs and the
Centers for Disease Control and Prevention, conduct studies on low back pain.
Scientists are examining the use of different drugs to effectively treat
back pain, in particular daily pain that has lasted at least 6 months. Other
studies are comparing different health care approaches to the management of
acute low back pain (standard care versus chiropractic, acupuncture, or
massage therapy). These studies are measuring symptom relief, restoration of
function, and patient satisfaction. Other research is comparing standard
surgical treatments to the most commonly used standard nonsurgical treatments
to measure changes in health-related quality of life among patients suffering
from spinal stenosis. NIH-funded research at the Consortial Center for
Chiropractic Research encourages the development of high-quality chiropractic
projects. The Center also encourages collaboration between basic and clinical
scientists and between the conventional and chiropractic medical communities.
Other researchers are studying whether low-dose radiation can decrease
scarring around the spinal cord and improve the results of surgery. Still
others are exploring why spinal cord injury and other neurological changes
lead to an increased sensitivity to pain or a decreased pain threshold (where
normally non-painful sensations are perceived as painful, a class of symptoms
called neuropathic pain), and how fractures of the spine and their
repair affect the spinal canal and intervertebral foramena (openings around
the spinal roots).
Also under study for patients with degenerative disc disease is artificial
spinal disc replacement surgery. The damaged disc is removed and a metal and
plastic disc about the size of a quarter is inserted into the spine. Ideal
candidates for disc replacement surgery are persons between the ages of 20 and
60 who have only one degenerating disc, do not have a systemic bone disease
such as osteoporosis, have not had previous back surgery, and have failed to
respond to other forms of nonsurgical treatment. Compared to other forms of
back surgery, recovery from this form of surgery appears to be shorter and the
procedure has fewer complications.
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Where
can I get more information?
For more information on neurological disorders or research programs funded by
the National Institute of Neurological Disorders and Stroke, contact the
Institute's Brain Resources and Information Network (BRAIN) at:
BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
(Original
source/ courtesy :
National Institute of Neurological Disorders and Stroke
www.ninds.nih.gov )
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