Back Care

Definition

Back care consists of any of several approaches used to maintain and restore a healthy, pain-free back.

Description

Low back pain is a major problem in our society. About 80 percent of all Americans will have a problem with back pain at some time in their lives. They will spend approximately five billion dollars annually for relief.

Each year, some 200,000 back surgeries are performed, and hundreds of thousands of prescriptions are written for medications to relieve low back pain. It is estimated that one-third of all workmen's claims and 60 percent of all long-term disability payments are used for the care of back injuries. It is no wonder there is an increasing interest in the prevention and management of low back pain.

Causes and Risk Factors

The major reason low back pain is not a simple problem to solve is that each individual's situation is unique. Pain may be the result of any combination of factors, such as day-to-day activities, lifestyle, level of fitness, nutritional status and even, the aging process. The complexity of the problem means that there is no one simple solution. Patients usually must make changes in their lifestyle and work together with various health care professionals to find solutions.

Symptoms

Pain and spasm of muscles in the lower back is the hallmark of back pain. This can occur after standing, stooping, bending, lifting, or after sitting in a chair for too long a time. Examination will often reveal point tenderness, but not always. Occasionally, pain is diffusely localized over the entire lower back.

Diagnosis

Diagnosis of low back strain syndrome is based upon a combination of history, clinical findings and x-ray results.

Treatment

There are a number of specific measures that can be taken to ensure a healthy back. These include the following:

• Exercise regularly. Low-impact aerobic exercises protect the back by keeping muscles strong and supple. It also tones abdominal and thigh muscles, which help take the strain off the back. Swimming is the best exercise for the back, because the weightless environment puts no pressure on the spine. Brisk walking and bicycling are also recommended.

• Shed some pounds if you are overweight. Excess weight puts extra stress on the back and makes it difficult to maintain good posture.

• Always bend from the knees, never the waist. Kneel or squat instead of stooping over.

• Lift objects properly. The key is to bend at the knees, not the back. Tuck in your buttocks and pull in your abdomen. Bring the object close to your body. As you stand, put the burden on your thigh muscles, not your back. If you cannot move the object close to your body (as when lifting luggage or groceries out of the trunk of a car) extend one of your legs backward as a counterweight.

• Don't try to lift something that is too heavy. Stop when you have to strain and ask for help or use a lifting tool (such as a dolly) for assistance.

• Avoid twisting while lifting. Twisting increases the chance of injury. Even garbage collectors, who usually have strong backs, are prone to injury because of the twisting involved.

• Maintain good posture. Stand with the back straight, pelvis tucked, shoulders down, head erect and chin tucked in. Poor posture increases pressure on the discs in the spine, stresses muscles and stretches ligaments so that they are unable to provide adequate leverage when lifting.

• Avoid sitting too long. No other position puts as much pressure on the back muscles and discs.

• Sit correctly. Sit with your feet flat, back straight, shoulders back and head up.

• Find a chair that supports your lower back or roll up a towel to use as back support.

• If standing for long periods, change your position often. Prop one foot on a stool, ledge or telephone book, if possible.

• Condition yourself for high-risk sports. If you enjoy sports that involve bending and twisting on impact, prepare yourself first. Start a conditioning program at least six weeks before you go downhill skiing.

• Avoid infrequent bursts of activity. This is especially important if you have a sedentary job or lifestyle.

• Make back exercise part of your daily routine. Flexion and extension exercises keep back muscles flexible. Others strengthen back and abdominal muscles.

• Push instead of pull. If you have a choice between pushing and pulling an object, push it. That allows the leg muscles to power the job.

• Don't sling a heavy purse or briefcase over your shoulder. Instead, place the shoulder strap across the body to better distribute the weight and switch shoulders frequently.

• Ask a porter to help you or use a cart to carry suitcases.

• When driving, use the lumbar support in your car seat. You can make a makeshift support by rolling up a towel and putting it behind the small of your back.

• Stop and walk around every hour during a long drive or flight. Vibration during driving and flying tires the back.

• Sit correctly during air travel. Use the airline pillows behind the small of your back and put your feet up on a briefcase or bag under the seat in front of you.

• Get plenty of sleep. Fatigue underlies many causes of back strain. It also hinders good posture.

• Sleep in a healthy position. The best sleep positions are on your back with a pillow under your knees or on your side with knees bent and, if desired, a pillow between them.

• Don't slump over a desk or keyboard. Sit as close as possible to prevent slumping.

• Adjust your desk or workstation to a comfortable height.

• Women should wear high-heeled shoes as little as possible.

The Agency for Health Care Policy and Research issued a clinical practice guideline on acute low back problems for adults, which offered a number of recommendations and suggestions, including the following:

• Medicine often helps relieve low back symptoms. The type of medicine your health care provider recommends depends on the symptoms and how uncomfortable you feel. If the symptoms are mild to moderate, you may get relief from an over-the-counter medication such as acetaminophen, aspirin or ibuprofen.

• If the symptoms are severe, your health care provider may recommend a prescription drug.

• For most people, medicine works well to control pain and discomfort, but any medicine can have side effects. Also, many medicines prescribed may cause people to feel drowsy, so they should not be taken if you need to drive or operate heavy equipment.

• Heat or cold applied to the back may help. Within 48 hours after the first back symptoms appear, you may want to apply a cold pack (or a bag of ice) to the painful area for five to 10 minutes. If the symptoms last longer than 48 hours, you may find that a heating pad, hot shower or bath helps to relieve your symptoms.

• Spinal manipulation (using the hands to apply force to the back and "adjust" the spine) can be helpful for some people in the first month of low back symptoms. It should be performed only by a professional with experience in manipulation. You should go back to your health care provider if your symptoms have not responded to spinal manipulation within four weeks.

• A number of other treatments may help in the relief of symptoms. While these treatments may give relief for a short time, none has been found to speed recovery or keep acute back problems from returning. These treatments include traction, TENS (transcutaneous electrical nerve stimulation), massage, biofeedback, acupuncture, injections into the back, back corsets and ultrasound.

Questions to Ask Your Doctor

What tests need to be done to diagnose the problem or the extent of the injury?

How serious is the injury?

If there is injury to the back, what treatment is needed?

How effective is this treatment?

Are there any alternative treatments?

How long will it take to improve the condition?

What over-the-counter medication do you recommend?