If your back aches, you're not alone. In fact, 70% to 80% of American men will experience low back pain. Back pain is the fourth most common reason people seek medical care. And it's also expensive, running up a tab of over $50 billion annually in the United States.
Back aches are common, painful, and expensive — but they're rarely serious. Half the episodes resolve in less than a week, and three-quarters are gone in a month.
If you've found a way to live with your back, don't change a thing. But if you need more help, here are some practical answers to common questions.
A group of sturdy ligaments holds the vertebrae together, and strong muscles run along the sides of the spinal column to provide additional support. The abdominal, pelvic, and hip muscles help maintain the normal curvature of the back and support a share of the body's weight.
There are almost as many explanations for back pain as there are backs. The most common reasons are:
Poor posture, tight muscles and abnormal alignment of the spine follow closely behind. More serious problems, such as osteoporosis, compression fractures, tumors and infections are much less common. And truth be told, in most cases, the exact cause of back pain remains a mystery.
Pain is always serious to the person suffering, but it doesn't necessarily indicate a major medical problem. Whether your pain is severe or mild, it calls for medical evaluation and care when you have any of these warning signs:
You should see a doctor without delay if you have any of these warning symptoms. But if you have garden-variety back pain, you may be able to handle it on you own.
Medication won't speed recovery, but it can take the edge off the pain and help you get up and around. For ordinary low-back pain, you can treat yourself with non-prescription drugs. Use only what's necessary. Start with a simple pain reliever like acetaminophen. It's not as strong as some other medications, but it has fewer side effects. Don't take more than 1,000 milligrams four times a day. (Exceeding 4,000 milligrams (4 grams) in 24 hours can injure the liver.)
Most doctors recommend a nonsteroidal anti-inflammatory medication (NSAID) as the next treatment. You can try a non-prescription product such as aspirin, ibuprofen or naproxen, or you can ask for one of the many prescription NSAIDs. Stronger prescription painkillers and narcotics are rarely needed. If you have intense muscle spasms, your doctor may prescribe a muscle relaxant, such as diazepam, cylobenzaprine, carisoprodol, or methocarbamol. Finally, an anti-seizure medication, such as gabapentin, may help relieve the nerve pain from sciatica; doctors can prescribe it for this purpose even though the U.S. Food and Drug Administration (FDA) has not approved it for this use.
Although most acute low-back pain will resolve with a simple, conservative, self-help program, some people require additional therapy for difficult or chronic pain. A physical therapy-rehabilitation program can be very helpful. It typically begins with an exercise program and adds modalities, such as heat or cold treatments, ultrasound, traction or electrical stimulation.
If physical therapy doesn't do the trick, doctors may treat selected patients by injecting steroids into the painful area.
People with complicated back pain (see warning signs) may need surgery, but it should be the last resort for uncomplicated pain. If a herniated lumbar disc is the cause of pain, a lumbar discectomy is usually the preferred approach. Laser surgery, endoscopic procedures and other less invasive operations are being used, but experience with them is limited.
Keep your back flexible and your abdominal muscles strong. Good posture and body mechanics are essential. In particular, be careful when you lift. Get help if an object is too heavy for you to lift comfortably. Keep heavy objects close to your body, and be sure to bend your knees and lift with your legs, not your back.
A good mattress and supportive chairs also make sense. But the best way to prevent back pain is to keep the rest of your body healthy. Aerobic conditioning is the key. Active, fit men have less back pain than sedentary, out-of-shape gents. Swimming, walking and biking are particularly desirable for those who've had back pain in the past. A good diet will also help — not by nourishing bones and joints, but by preventing obesity. The old-time docs had it right when they said you can never be too thin for your back.
Because it's so common, back pain is a hot topic for both health care professionals and the general public. Everyone with a back, it seems, is an expert. Programs for prevention spark debate, theories about causation ignite controversy and treatment plans start wars. Listen to the options and then decide what's best for you. For most men, a simple self-help program will control acute low-back pain. But whether you treat yourself or get professional help, you should always listen to your body and stay alert for the warning signs that could indicate serious trouble. Fortunately, such warnings are uncommon. For most men, basic care will banish backaches.
Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.
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