My Aching Back: Low back problems are common neurological disorder

Share with others:

Print Email Read Later

Related Media:

Does your back ache? If so, you've got a lot of company. About 80 percent of us will suffer from low back pain at some point in our lives. Low back pain is the second most common neurological disorder (after headache), the second most common reason for why people see a doctor (after colds and flu) and the No. 1 ailment that causes people to miss work.

We spend about $50 billion a year on low back pain, according to the National Institutes of Health. We search constantly for tips on how to alleviate it. lists 14,192 books on low back pain.

Low back pain has reduced the quality of their lives, said 69 percent of respondents in a 2011 survey for the American Physical Therapy Association. Low back pain interfered most with their exercise regimen (38 percent), their sleep (37 percent) and their ability to work (24 percent).

In a survey by Consumer Reports magazine of more than 14,000 subscribers who complained of low back pain in the previous year, updated in March, 46 percent said it interfered with their sleep, 31 percent reported that it thwarted their efforts to maintain a healthy weight and 24 percent said that it hampered their sex life.

What we do most often to alleviate low back pain is to take over-the-counter anti-inflammatory medicines such as Motrin, Aleve and Tylenol. What seems to work the best are chiropractic manipulation of the spine, massage and physical therapy, the Consumer Reports survey indicated.

New minimally invasive procedures have lowered the risk of back surgery and shortened recovery time from it. But surgery should be an option in no more than 20 percent of cases, surgeons say.

The onset of low back pain comes typically between the ages of 30 and 50, and it worsens as we get older.

Most low back pain is the result of overuse, strain or injury. The most common are muscle strains (muscle fibers are stretched or torn) and lumbar sprains (the ligaments that hold bones together are torn from their attachments).

Low back pain emanates also from degenerative diseases of the spine. As we age, our bones, including the vertebrae (the bones of the spinal column), tend to lose strength, and the muscles around them that hold them in their proper place tend to lose tone. The intervertebral disks (round, spongy pads of cartilage) between the vertebrae, which allow for flexibility in the back and act as shock absorbers, lose fluid and flexibility.

For those older than age 60, two common sources of low back pain are facet joint osteoarthritis (arthritis of the spine), which causes a breakdown in the cartilage that cushions the spine, and spinal stenosis, a narrowing of the spaces through which the spinal cord and nerves travel.

Human beings have suffered from low back pain essentially ever since we started to walk erect, which meant that the lumbar (lower back) region of the spine had to support all the weight of our upper body. Records of treatment of low back pain go back thousands of years, to the ancient Egyptians. They included localized bee stings (bee venom contains melittin, an antimicrobial peptide with anti-inflammatory properties) and repeated shocks from an electric eel (electrical stimulation blocks pain messages sent to the brain, and causes the brain to release endorphins, the body's natural painkillers).

Our sedentary modern lifestyles contribute mightily to low back pain. In that survey for the American Physical Therapy Association, 54 percent of those who reported low back pain said they spent most of their work day sitting.

"Sitting is the kiss of death," said Ron DeAngelo, director of sports performance training at UPMC's Center for Sports Medicine. "We weren't designed to sit. In prehistoric days, we never sat."

Sitting upright in a conventional chair, as most of us do at work, puts pressure on the spinal disks in the lower back -- which we don't experience when standing or reclining, according to a 2006 study.

If you're overweight, you're more likely to have back pain. (The extra pounds put strain on the muscles and ligaments of the back, and put pressure on the spine.)

Sedentary adults are more likely to have low back pain, and more severe back pain than do those who exercise regularly, because "if your abdominal muscles are weak, there is more stress on the spine," said Megan Cortazzo, vice clinical chair of outpatient services for UPMC's department of physical medicine and rehabilitation.

And it is only through movement that spinal disks get the supply of blood they need, said Michael Schneider, an assistant professor of physical therapy at the University of Pittsburgh . He holds both a doctor of chiropractic degree and a Ph.D. in rehabilitation science and researches low back and neck pain.

Also increasing the risk of back pain are smoking (it accelerates the rate at which spinal disks degenerate), stress (most of us unconsciously tighten our back muscles when we're under stress) and poor posture (slouching doesn't cause back pain but tends to make the pain worse after the back has been strained or injured).

Women who are pregnant are at greater risk. So are women who wear high heels often. The elevation increases the lordosis (forward curve) of the spine, which increases stress on the joints of the spine.

In the workplace, those whose jobs involve lifting heavy objects, bending over frequently or having to work from a bent-over posture, and those, such as receptionists, who must sit for long periods of time, are at greater risk. Another risk factor is vibration, especially if it occurs in a seated position, as it does with bus and truck drivers. Back injuries are highest among truck drivers, operators of heavy equipment and construction workers, according to the Bureau of Labor Statistics.

You're at greater risk if you're male, middle-aged or older, and/or have suffered a back injury in the past.

More than a third of respondents in both the Consumer Reports and American Physical Therapy Association surveys didn't consult a professional. You should see a doctor right away if low back pain is accompanied by severe stomach pain, rapid unexplained weight loss, sudden loss of bladder or bowel control, or fever.

If you've suffered no obvious trauma, and you also have a stomach ache, your back pain could be the result of an enlargement of the aorta (large artery) in the abdomen, which would be life-threatening if it ruptures.

Rapid weight loss and loss of appetite, especially if accompanied by nausea or vomiting, chills or fever, could be a sign of a cancerous tumor on the spine.

Sudden incontinence, especially if accompanied by weakness in the hips, crotch or legs, may indicate cauda equina syndrome (a swelling of the nerves at the end of the spinal cord), which can lead to paralysis.

If back pain is accompanied by sustained fever (a temperature of 101 degrees or higher in adults), it could be caused by a spinal infection, which also could lead to paralysis if untreated.


Jack Kelly: or 412-263-1476. First Published September 2, 2013 4:00 AM


You have 2 remaining free articles this month

Try unlimited digital access

If you are an existing subscriber,
link your account for free access. Start here

You’ve reached the limit of free articles this month.

To continue unlimited reading

If you are an existing subscriber,
link your account for free access. Start here