Back talk: conquering low back pain through exercise, education and stress reduction - includes related article

It is one of the most common and costly medical conditions in the United States today. It accounts for 10% of all chronic health conditions and 10% of all patient visits to a physician. The estimated cost of it ranges between $40 and $50 billion a year, including medical costs, lost wages and compensation claims. While it is costly and sometimes devastating, approximately 80% of us will experience an episode of low back pain sometime in our life.

That's the bad news. The good news is most people recover from an episode of acute low back pain quickly. Soft-tissue injuries usually heal within two or three weeks following rest, anti-inflammatory therapy and ice application. However, of the 80% of the population that will have an episode of low back pain, 5% will go on to develop chronic low back pain. In fact, the longer the pain and disability persist, the less likelihood for a good outcome.

Low back pain's precise causes are often elusive. There is still very little medical science knows about back pain. Treatments such as bed rest, anti-inflammatory drugs, ice and heat packs, painkillers, back braces and surgery may help back pain sufferers in the acute phase of their pain, but they usually have little effect on the long-term control of back pain. Traditional treatments for back pain are currently being challenged by therapy that includes exercise, education and stress reduction classes.

Identifying your individual risk factors for low back pain is the first step toward prevention. There are basically seven risk factor categories for low back pain--general, postural/structural, occupational, environmental, psychosocial, recreational and miscellaneous. Become familiar with these categories and begin to analyze your specific risk factors as they apply to your lifestyle. Once you have identified your risk factors for low back pain, start making lifestyle changes right away.

General

General risk factors include age, physical fitness, weight and height. The incidence of low back pain increases with age. A person's physical fitness is clearly associated with incidence of low back pain complaints. In this example, physical fitness is defined as good exercise tolerance, specific strength and balance of the abdominal and extensor muscular. In addition, being overweight or extremely tall correlates with a greater risk for developing low back pain.

Postural/Structural

Postural or structural abnormalities can be identified by physical examination and spinal radiology. Certain abnormalities such as severe scoliosis and kyphosis have been associated with an increased risk for low back pain. However, lordosis, a common abnormality, has not been associated with increased risk for low back pain. Other abnormalities associated with low bak pain, including spondylolisthesis, spinal fractures and multilevel degenerative disc disease, can be identified through the examination and through X-ray films. It should be noted that relatively few causes of low back pain are detectable by X-ray films alone, and many low back pain sufferers routinely undergo expensive medical test to diagnose their pain, including magnetic resonance imaging, computed tomography and myelography.

Occupational

One of the most powerful potential risk factors for low back pain is lifting. The requirement for lifting is a twisted position has also been shown to be a strong risk factor for future low back pain. Absolute weight is important when lifting, but bulk and the number of repetitions required per day are also important. Other occupational risk factors for low back pain include twisting, bending, stooping and floor surface conditions. Prolonged sitting, particularly without proper arm and spinal support, is associated with low back pain.

Environmental

Cigarette smoking is a risk factor for low back pain. Chronic coughing may be associated with intradiscal pressure. And recent experiments have indicated a direct adverse effect of smoking on the metabolic pathways for disc nutrition.

Psychosocial

A range of psychological factors (including depression and anxiety) and social problems (especially stressful job environments) are associated with an increased incidence of disabling low back pain.

Recreational

Many types of activities, including recreational, contribute to low back pain. However, there appears to be little connection between most sports and low back pain. Golfing and tennis have been slightly associated with an increased risk of disc herniation, possibly because of the twisting activities involved with these sports. Football linemen, gymnasts, javelin throwers, back-packers and oarsmen are at risk for developing low back pain symptoms. Only a minimally significant statistical association has been found between low back pain and jogging or cross-country skiing.

Miscellaneous

Multiple pregnancies have been associated with an increase in low back pain, probably due to loss of abdominal tone following pregnancy, the strain of lifting children and various hormonal effects. Low back pain complaints associated with pregnancy are quite common, but rarely require significant treatment. Some researchers speculate genetic predispositions to low back pain exist, but evidence is lacking for the most part.

Prevention of Low Back Pain

Prevention is the key to avoiding low back pain. Don't wait for an injury to happen. Make lifestyle changes today so you can prevent injuries from occurring in the future. The following are some common sense tips that are helpful in the prevention of low back pain.

* Begin and stay with an organized program of physical exercise emphasizing general fitness, aerobic capacity and specific reconditioning of the muscles that support the spine. Weight reduction should also be part of any organized physical reconditioning program. The use of extended bed rest (more than seven days) is counterproductive for the management of low back pain.

* Before and after participating in any sport, remember to do warm-up and cool-down exercises.

* Learn to match your lifting capacity to the requirements of your job. Remember that moving large bulky objects is as stressful as moving small heavy objects. Keep the load close to the body, and always face the work.

* Avoid activities that are clearly associated with previous episodes of low back pain.

* Whenever possible, use lifting tables and other lifting devices.

* Adjust table heights to a comfortable level.

* Use back rests and lumbar supports when sitting.

* Change your position (for example, from sitting to standing) regularly.

* Make sure your car or truck seats offer optimal seating comfort.

* Quit smoking

* Reduce stress and anxiety.

* Enroll in a back school to learn more about preventing low back pain

COPYRIGHT 1991 Aerobics and Fitness Association of America
COPYRIGHT 2004 Gale Group