Can You Really Throw Your Back Out? - Medical Myths - Harvard Commentaries

Just the other day, a patient said, "I was working in the garden and I threw my back out." Then she asked, "When you throw your back out, what exactly is going out and where does it go? And how do you get it back in?" These were good questions and ones for which I did not have ready answers.

The fact is, you cannot actually throw your back out — it's a figure of speech, or, if taken literally, a myth. However, the experience of sudden, severe back pain is no myth to the person suffering through it. And it can certainly feel as though some major structures in the back have moved, or that to feel better something must be returned to its original location. If one could see inside the painful back — and increasingly, we can, with imaging tests such as magnetic resonance imaging (MRI) or computerized tomography (CT) — one will commonly see normal anatomy or mild abnormalities that have nothing to do with the pain, even in the face of excruciating symptoms.

When people say they have thrown their back out, what they usually mean is that while performing a specific movement (such as twisting or bending forward) they have developed sudden and severe pain. The low back is the most common site for pain of this sort, and while there are several causes of this problem, including muscle spasm, arthritis and, less commonly, a "slipped" or ruptured disc or even a fracture, the cause is often mysterious.

Many people assume that a "thrown" back is due to disc herniation (or disc bulge or rupture), meaning that a disc has stretched or "slipped" out of place and is pressing on a nerve. (That may be where the notion of "thrown out" comes from.) But more often than not, a disc cannot be blamed for back pain. Even rarer causes of severe back pain are infections or tumors; fortunately, of all back pain, these represent less than 1% of cases. In the absence of obvious injury (such as a motor vehicle accident), a sudden "movement" of the bones of the spine is not a typical cause of sudden back pain. Despite everything that's known about back pain, we still don't know why most back pain occurs; we simply do not understand it well enough to identify the cause in most cases.

For many people with back pain, the name of the condition is much less important than what can be done to reduce pain. Even though the diagnosis can sometimes direct the choice of treatment, for most of the common causes of back pain, treatments are similar. Here are some of the most popular options:

Physical therapy — This may include a program of stretching and exercises, advice about posture and how to safely lift objects.

Over-the-counter or prescription medications — Pain relievers, anti-inflammatory agents and muscle relaxants are among the most effective and often will be needed only for a short time.

Chiropractic care — Some people experience more rapid pain relief with chiropractic therapy.

Complementary and alternative therapies — Treatments such as acupuncture and massage may be helpful, although most of them are unproven remedies.

Injections and surgery — If sudden and severe pain does turn out to be due to a ruptured (or herniated) disc and other treatment options prove ineffective, an injection of corticosteroids with a long-acting anesthetic agent may be warranted, as may be surgery.

Specific recommendations will depend on your individual situation. Talk with your health care professional for advice about evaluation and treatment.

There are several reasonable ways to reduce the risk of recurrent back pain, including:

Lose excess weight.

Wear comfortable, well-cushioned shoes with low heels.

Go easy on your back. When you need to move a heavy object, get help, divide the package up, or use a dolly rather than doing it on your own.

Adjust your computer terminal and work station or have an "ergonomic evaluation" by your employer to see whether your work environment contributed to your back pain.

Stretch and exercise regularly.

Talk to your doctor about taking extra calcium, vitamin D and a weight-bearing exercise program to reduce your risk of osteoporosis and fracture. Additional bone-building drugs also may be recommended.

Sometimes a phrase used to describe an experience or a condition takes on importance and meaning beyond what it truly deserves. The concept of "throwing your back out" is one such phrase. It suggests a structural problem in the back that is not present in most cases. Rather than illuminating the condition, the term misleads and should probably be abandoned. Don't be surprised if your doctor uses different terms to describe your back condition than you do, or if different doctors use different terms (such as strain, muscle spasm, ligament injury or degenerative disc disease), because the difficult truth is that most back pain is difficult to name.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.