Oh, Our Aching Backs
Is that pain in your back a nagging pain, or one that comes and goes? Is the pain the reason you’ve cut out some activities you used to enjoy? Did you call in sick to work last year because of back pain? Have you put off seeing a doctor because you’re not sure you need to?
If you says “yes” to any of these questions, you’re not alone. In fact, studies reveal that half of all working Americans admit to having back pain symptoms each year, and that back pain is one of the most common reasons for missing work. Even more interestingly, it’s the second-most common reason for doctor’s visits, behind only upper respiratory infections.
The Centers for Disease Control found that lower back pain affects about a third of all women and a quarter of all men, but a survey by the American Physical Therapy Association found that 31 percent of men actually acknowledged when their condition affects their ability to work, compared to 20 percent of women. The same APTA survey found that 37 percent of all back pain sufferers do not seek professional help for pain relief.
“Back pain is an incredibly common problem being the second most [common] reason people [consult] their doctors. It can affect people at any age,” agrees Cortland Miller, M.D., a physician on the medical staff at Texas Health Allen. “The fortunate thing about back pain, though, is that the vast majority of patients will get better with back pain with a little time.”
“Typically 50 percent of patients will recover within two weeks, 70 percent by a month and 90 percent by 3 to 4 months, just from the natural course of an episode of low back pain, even without treatment,” he adds.
But maybe you’re wondering if the pain is really that bad. Should you tough it out? “If it’s getting worse, seek medical attention,” says Cyrus Wong, M.D., a neurosurgeon and physician on the medical staff of Texas Health Fort Worth, “If it’s coming and going, you might be okay to wait.”
“Most of the time it is OK to wait it out for a while before seeking medical evaluation and see if it will get better on its own, with a caveat of always trying to stay as mobile as possible,” Miller agrees. “We recommend no more than two days of bed rest, and I generally tell people to stay on their feet as much as possible and avoid the couch or bed constantly as it can lead to stiffness and further soreness.”
“If you’re having severe back pain to the point where it’s affecting your quality of life, if it’s getting worse, or if it’s associated with a fall risk, leg pain, numbness or weakness, see a doctor,” recommends Wong. “Serious signs would be a spine issue that was affecting bowel or bladder function.”
“There are some things that I would suggest seeking medical evaluation sooner [for],” Miller adds. “An episode of back pain that comes on abruptly and is associated with sudden changes in bowel or bladder function such as not being able to initiate urination, or inability to maintain continence of stool can be a sign of a condition called cauda equina syndrome, in which several of the nerve roots in the middle of the spinal canal of the low back are compressed at once.”
“It is often associated with severe leg pains and lack of sensation/numbness and tingling of the genital and perineal area, which is called saddle anesthesia,” Miller continues. “This is a condition that would need evaluation and treatment within hours to prevent chronic bowel and bladder problems, and if present, should likely be evaluated immediately.”
Other danger signs include pain in the arm or leg that is associated with muscle weakness; severe pain after a fall or trauma that could cause fracture; pain with unexplained weight loss, sweats, fevers and chills; and pain that is severe and unrelenting no matter what position you lay, Miller says.
“When in doubt, there is nothing wrong with erring on the side of getting evaluated sooner and getting some advice with your primary care doctor about symptom severity,” he says.
And treatment doesn’t always require surgery. “Back pain, and even severe back pain, does not always mean surgery is needed,” Miller says, adding that treatments can include physical therapy, massage, heat or cold therapy, therapeutic injections in the spine, medications, “or even just “watchful waiting.”
With chronic pain, he says, “A multi-pronged approach to treatment is frequently needed.”
If the idea of back surgery is worrisome to you, or if you’ve heard a neighbor’s spinal surgery horror story, you may be feeling conflicted about the idea. But Wong says that the experience of a friend of a friend isn’t necessarily going to happen to you.
“Low back, degenerative spinal disease, is one of the most common diseases affecting the
American population,” he explained. “There’s a whole wide range of problems that can happen in the back. What one friend or neighbor has wrong with their back might not be what is wrong with yours, so it’s good to see a doctor.”
So, how do you know surgery is the best option? Wong says that clear structural issues generally indicate that surgery is the best path.
“Back pain is very common. Surgically, we’re looking specifically for something structural like slippage of vertebrae, fracture or collapse of the disc,” he says. “If it’s worse sitting up, standing up, or when the spine is carrying a load, and better with lying down and rest[ing], then it’s likely something structural.”
“If conservative treatment isn’t working, or if the symptoms include numbness or weakness in the legs or [in] some of those emergency situations we’ve talked about, then surgery is going to be the best option,” Wong adds.
But even surgical options can vary from minimally invasive procedures to more involved disc replacements and bone grafts, and the type of surgery needed can vary depending on what ails the spine.
“Surgical options depend on the symptoms,” Wong says. “There is decompression surgery to take the pressure off the nerves, or stabilizing surgery to restore the back to normal alignment in the case of a slippage of the vertebrae and things like that. Those surgeries can relieve pain.”
What if you want to avoid back pain altogether? What can help? In a word, minding your posture, experts say.
“Probably the most beneficial thing about having good posture is that it decreases the stress on the spinal musculature, the spinal structure and the joints,” says Kathy Farkas, a physical therapist at Texas Health Presbyterian Hospital Dallas.
“Most people know their posture is bad because it gives rise to pain,” she says. “Or you’re looking in a mirror and you see that you’re bent over or hunched over, and you’ll know.”
Farkas recommends the following tips to help get into the good posture habit:
- If you’re sitting at a desk, make sure you change your position every 20 to 30 minutes, and make sure your feet are resting evenly on the ground, with your thighs parallel to the floor.
- Place your computer monitor at eye level or slightly lower.
- If you stand a lot for work, shift your weight and lean against something occasionally.
- If you’re a parent, carry that baby at the front (not on your hip) to better distribute the weight.