Back Pain! You Can Beat It!

The concierge’s wife has back pain due to a prolapsed inter-vertebral disc (a “slipped” disc).

Then, I woke up this morning with a stiff neck, due a poor sleeping posture (and a dose of dairy in the form of ice cream last night!)

It got me to thinking I should write a little bit about back pain: neck pain and low back pain constitute the most common musculoskeletal complaints in primary care clinics.

Few of us will go through life without at least one episode of severe incapacitating back pain, whether due to a fall, repetitive strain injury or excessive lifting. Here’s some great information you can share with family and friends, if any of them should suffer with this problem.

Low back pain

First a warning: low back pain can be a sign of serious pelvic disease, such as cervical or prostatic cancer. Make sure you are OK in this regard before accepting that the problem is merely back pain.

Real back pain is caused usually by a pulling injury or a displacement. Ricking your back due to tearing muscle fibers is common. But the problem is more serious if a part of your back becomes mis-aligned (the so-called “slipped disc”).

If the sciatic nerve is affected – a long nerve down the back of the leg – pain is felt from the lower back all the way down to the foot. This is called sciatica and it is very unpleasant. The least unguarded movement and a jolt of pain runs down the leg that is close to unbearable.

Unaccustomed effort or bad lifting posture is the cause of low back injury. Bad sleeping posture is by far the commonest reason for neck pain, especially if it is present on waking).

Most back pain is transient and where it persists, the real cause is spasm of the muscles. The initial pain causes the muscles to contract hard and that is sufficient to continue the squeeze on the tender nerves. A vicious circle is set up, where pain causes muscle spasm and muscle spasm causes further pain.

I say this with confidence because I have shown time and again to countless patients that if you can break the muscle spasm, the pain melts away. Here’s what I do for it.

Lie on the floor in the anatomically natural position – on your back, arms and legs out straights, palms upwards and neck in line with the rest of the spine. You will probably find this uncomfortable at first.

Then by gradually wriggling and making small adjustments, you search for a position where you don’t feel the pain. It may seem a strange idea but, no matter the pain you are in, you will always find such a posture. Usually it will be somewhere in this anatomically “correct” position - but don’t be rigid and force it, as if you were standing upright on parade in the army! Relax!

Once you find the pain-free position, then you hold it for as long as possible: 15 minutes at least, 30 minutes is better. In that time the muscle spasm will gradually soften and release, as it is pain that causes the muscle spasm.

If you are lucky, you may have broken the vicious circle. When you get up (carefully, making sure you do not trigger the hurt) the pain is gone. At the very worst it will have lessened considerably and this is far better than taking pain killers.

You can resume the anatomically-true position any time you like. When you go to bed get yourself into the correct position and follow the procedure I described above. If you can only sleep on your side, make sure you look “ahead”, as if you were lying on the floor looking up. Make sure the pillow is exactly the right thickness to have your head in such a way that the spine is straight.

Do not lie on your front because this will force you to twist your neck. Never never sleep on your front normally, for this same reason. If you don’t have neck damage now you certainly will have as you age.

Cervical spondylosis

When the pain is in the neck area, this is usually labeled “spondylosis” (not to be confused with spondylitis, which is an inflammatory condition). Usually this problem is present on waking, a “rick” in the neck, and is caused by a bad sleeping posture trapping a nerve. Carrying heavy shopping bags can also do it, because the nerves of the arm are dragged downwards and pulled across the bony protrusions of the vertebrae.

There is pain on most neck movements. First warning here: don’t snap your neck from side to side, just to see how it feels. Every time you aggravate the pain doing this it slows down recovery. Look straight ahead and don’t turn your neck. If you want to see something to the side, rotate your whole body and shoulders.

That means you should not drive a car because that requires you to turn your head right back, to see into your blind spot, or to reverse while parking.

This leads to the first rule for beating pain: don’t provoke the pain. Pain means damage; damage means delayed recovery! It’s logical if you think it through – but most people don’t.

Chronic Back Pain

If the pain persists, acupuncture is a good option. I have seen awesome results. A randomized trial of 55 subjects with low back pain demonstrated that acupuncture significantly improved disability scores, and the superior outcomes in the acupuncture group remained significant through 4 weeks after the cessation of treatment. Participants receiving acupuncture also experienced fewer side effects related to analgesic therapy compared with patients receiving conventional therapy alone [Rheumatology. 2003;42:1508-1517].

Exercise Can Play A Part

A Finnish study published investigating female office workers with chronic back pain and published in the December 2006 issue of Medicine & Science in Sports & Exercise showed that effective exercise was very successful at reducing chronic neck pain. Now you know why: the proper toning of muscle helps prevent spasms. [Med Sci Sports Exerc. 2006:38:2068-2074]. Incidentally, this study excluded prolapsed intervertebral disk.

Another studies, published last year, showed that yoga was moderately effective in reducing chronic back pain of all kinds. “Yoga was more effective than a self-care book for improving function and reducing chronic low back pain, and the benefits persisted for at least several months,” according to the authors. “It is important to note that some styles, such as Bikram and Vinyasa, may be too vigorous for patients with back pain who are unfamiliar with yoga whereas other styles (for example, Iyengar) may need modification from normal practice to be appropriate for patients with back pain.”

[Ann Intern Med. 2005;143:849-856]

Finally, the conventional approach

Conventional therapy is based on bed rest (if severe, like sciatica) and pain killers. It is rather passive and not addressing any causal issues. For that reason, it has little to offer.

In cases of severe intractable pain, generally over many years, surgery may be suggested. Reject it fully. Published studies show that surgery produces no better results than conservative management. So why endure the risks and trauma of major surgery?

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