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Relieve Your Aching Back

With a little help, you may be your own best physical therapist

by Carol Krucoff

Published in health •self_care | 0 Comments, Talk about this article »

Remember the old joke about the guy who goes to his doctor, bends his elbow, and says, “Doc, it only hurts when I do that.”?

“Well,” the doctor replies, “then don’t do that.”

That strategy may work for tennis elbow or a sprained ankle, when a little rest is therapeutic, but it doesn’t always work when what’s hurting is your back. If it only hurts when you move, your doctor is likely to tell you to keep moving.

The days of bed rest for a bum back are long over. In fact, a recent British study found that people who followed an exercise plan designed for them by an expert who also helped them learn the facts about back pain—for example, that not moving because it hurts will just make it hurt more—did just as well as those who received a hands-on treatment such as spinal manipulation.

That doesn’t give you license to resume triathlon training after an acute back injury—one that lasts six weeks or less, about the amount of time it takes to spring back from musculoskeletal damage. But you should get back to your other regular activities as soon as possible and start an exercise program once the six-week healing period ends. And if you have chronic pain, exercise is also crucial.

Get Back in the Saddle

“One of the most helpful things a doctor can do for people with back pain is give them confidence to get on with their life,” says Andrew Haig, M.D., associate professor of physical medicine and rehabilitation at the University of Michigan in Ann Arbor. For one thing, he says, if you’re inactive, you may not heal as quickly because your muscles will become stiff and weak. Movement helps promote healing by stretching and strengthening muscles and getting the juices flowing in your spinal disks.

“The disks have no blood supply, so the only way they get nutrition is through the pumping action of physical activity,” says Dr. Haig, a physiatrist. (Physiatry is a relatively new medical specialty that focuses on the diagnosis and treatment of patients with musculoskeletal injuries, pain syndromes, neurological disorders, and severe impairments.) “Staying still is the enemy of people with back pain,” he says. If your job keeps you chained to your seat, he recommends that you get up and stretch at least once every half hour.

There are really only two exceptions to the move-it-or-lose-it rule: If your pain radiates below the knee, or if there’s a medical symptom associated with it—such as a fever, paralysis, or loss of bladder control—you need to see a doctor. Those are signs of more serious conditions.

Here Today and Here Tomorrow?

What if your back pain lasts longer than six weeks? “In most people, acute cases of back pain actually resolve on their own within the first four weeks,” says chiropractor Jill Hayden, D.C., a research fellow at the Institute for Work and Health in Toronto. “But a small number go on to have chronic problems with longer-term pain and disability.”

About 80 percent of all Americans have back pain at one time or another. When it comes to stay, it’s an unending misery that, one study found, may actually age the brain 20 times faster than normal. And surgery offers no relief. New research has found that surgeons are often “overly optimistic” when they advise patients on the benefits of back surgery. In fact, almost 40 percent of the patients in a Swiss study said they had experienced no difference in their back pain a year after surgery, despite assurances that they would have “a great deal of improvement.”

On the other hand, a regular exercise program can help those with chronic problems—and there’s no anesthesia, hospital stay, or recovery time, says Dr. Hayden, who led a team of researchers in analyzing dozens of studies focusing on exercise therapy for people with chronic lower-back pain. Your best bets are stretches for pain relief and strengthening exercises for restoring function to your aching back, designed for you by a professional.

While even athletes can be sidelined by back injuries, the truth is that most people with aching backs can blame only one thing: Being out of shape. Besides losing excess weight, strengthening your core muscles—especially your abdominals—is the best way to keep back pain from becoming a lifelong condition.

Don’t turn to daily crunches and expect a pain-free back, though. Crunches aren’t that effective for beefing up the abs in people with back pain, says Patrice M. Winter, a physical therapist in Fairfax, Virginia, and a spokesperson for the American Physical Therapy Association. Crunches work only the outer layer of these important stabilizing muscles. Instead, she recommends the “spinal balance” exercise, below, to strengthen the entire torso. Include it in your daily regimen, but be sure to check with your doctor, chiropractor, or physical therapist before trying it or any other new exercise.

Pain-Soothing Therapies

In addition to an exercise program, don’t be surprised if your health professional recommends a number of other techniques, including medication and these drug-free therapies.

Hands-on treatments
Manipulations by a chiropractor or physical therapist or an osteopathic physician have been shown to be effective in managing both acute and chronic back pain. A study published in 2003 also found that massage was even better than relaxation therapy and acupuncture for easing back pain; people with chronic pain who received regular massage treatments felt relief for up to a year after stopping the therapy.

Psychological counseling
If your doctor recommends that you see a therapist, it’s not because she thinks the pain is all in your head. Back pain can cause stress—and stress can cause back pain. Many people are unwittingly trapped in that cycle, says Robert D. Kerns, Ph.D., professor of psychology at Yale University and chief of psychology services at the Veterans Affairs Connecticut Healthcare System. “Under a period of stress, someone who has vulnerabilities in the lower back is likely to experience heightening muscle tension that can become very painful. Muscle tension is part of the stress response.”

Combine stress and pain, and you have the recipe for depression. “People with persistent pain can develop a sense of helplessness and hopelessness that can make the pain worse,” says Dr. Kerns, who is studying the impact of tailoring specific cognitive behavioral therapy (CBT) strategies to help relieve chronic lower-back pain. CBT is designed to help people change how they view and respond to whatever life throws at them, whether it’s anxiety, depression, stress, or back pain. Some of the techniques he is exploring for back pain relief are deep breathing, assertiveness training, and “pacing”—learning how to break up activities so you don’t overdo it.

Ultimately, the experts say, the best therapist for your back pain is you.

Frequent contributor Carol Krucoff is a former Washington Post editor and coauthor, with her husband, Mitchell Krucoff, M.D., of Healing Moves: How to Cure, Relieve, and Prevention Common Ailments with Exercise.

Tips for a Healthy Back

When driving, keep your head against the headrest.
This helps ensure good posture and can help avoid the common problem of “forward head carriage,” which can lead to spinal pain and degeneration, says chiropractor James Chestnutt, D.C., of Victoria, British Columbia, who chairs the wellness committee of the International Chiropractors Association. Adjust your rearview and side mirrors so that you’ll need to keep your head against the headrest to have a proper view, ensuring that your body will be in correct alignment. Whenever you stop at a red light, press your head back against the headrest and tuck your chin slightly to isometrically tone the muscles of your neck and upper back and improve your posture.

Stretch your hamstrings.
These muscles (in the backs of your thighs) are often tight in people with back pain, says Virginia physical therapist Patrice Winter, who recommends this stretch: Lie on your back in a doorway and extend one leg up the doorframe, with your bottom as close to the doorframe as you can comfortably get it. Keep your leg straight and bend your toes back toward your face. Don’t forget to breathe.

Pay attention to posture.
“We’re so used to pushing ourselves to get things done that we’re often completely unaware that we’re sitting or standing in uncomfortable positions for hours,” says Gwendolyn Schwinke, an instructor of the Feldenkrais Method of movement reeducation (they’re the good-posture people). If your spine is in natural alignment, your skeleton supports your body with very little muscular work, allowing the release of chronic tension. (For information on improving your posture with Feldenkrais, visit www.feldenkrais.com.)

Don’t sit like a lady.
Whenever possible, says Schwinke, sit with your legs wide apart, your feet flat on the floor, and your body supported by the “sit bones” at the base of your pelvis.