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January 26, 2000
Bad Back Basics
Why your back hurts and what you can do about it
By Matt Villano

Jack Kleintop's pain was so intense he could barely stand up. He lay in his bed, fingers numb and knees throbbing, with the worst backache he'd ever experienced. Days passed, and he wondered if he would survive.

"I thought I was a goner," says Kleintop, now 60. The pain originated from a car accident he'd had as a young man, and two years ago it recurred. "I felt like my body was falling apart," he recounts. "I had been in pain before, but this was unbearable. I'd never experienced anything like it in my life."

After nine grueling days, Kleintop managed to climb out of bed and drive himself to a local chiropractor. There, chiropractor Louis Sportelli sat him on a table and went to work. Sportelli massaged Kleintop's back, applied electrical stimulation to the injured area, and strapped him to a table that stretched his body. Forty-five minutes later, Kleintop felt cured. He was able to walk to his car standing tall. Sportelli prescribed a series of return visits, and Kleintop obliged.

Today Kleintop's back doesn't hurt a bit. "I'm lucky," he says. "It could have been much worse."

Back pain is one of the most common causes of hospitalization. Nearly 80 percent of adults experience back pain at some point in their life, and many seek medical help as a result. More than half these people are able to resume their usual activities within two weeks, and nearly all are able to within six weeks. For some, however, the pain can last longer and require more extensive medical treatment.

According to Christopher Chaput, M.D., a neurosurgeon with more than 30 years of experience, spontaneous injuries such as car accidents are a common cause of back pain. "Improper lifestyle is also a major factor," reports Dr. Chaput, "as are bad habits such as poor posture, heavy lifting, and poor diet. Even smoking has an adverse effect on the spine."

Aging also plays an important role. "There seems to be something magical about the age of 40," Dr. Chaput continues. "Degeneration of our joints and spine begins in adolescence, but it is manifested in our 40s. Usually, back pain is occupationally related, but it happens because that person has been abusing his or her body for some time -- by smoking, eating poorly, not exercising, having bad posture, or being overweight."

Misaligned mechanics

The spine, which is made up of 24 separate bones called vertebrae, is a vulnerable part of the human anatomy. The soft disks between the vertebrae move in tandem with one another, and every disk is equally important to the overall comfort and function of the spine. Generally, back pain occurs when a problem develops with a vertebra or a disk.

Eric Muehlbauer, executive director of the North American Spine Society, says that more than one-third of all back problems are disk-related. He notes that, aside from natural degeneration with age and poor lifestyle, back injuries can stem from a surprisingly wide variety of conditions. "With twenty-four vertebrae and all of the ligaments and muscles in between, there are probably dozens, if not hundreds, of problems our members see every day," Muehlbauer says.

Spinal stenosis, for instance, is a narrowing of the canal that houses the spinal cord. Sciatica is a condition in which the sciatic nerve is pinched. Other problems can result from spondelosis, a misalignment of the vertebrae that causes pain and numbness in the extremities. Vertebral fractures, scoliosis (curvature of the spine), and cervical disk disorders and dislocations also contribute to back pain.

Healing back pain

Most people's pain can be relieved with nonintrusive therapies such as chiropractic manipulations, massage, rest, anti-inflammatory medication, or physical therapy. Transcutaneous electrical nerve stimulation (TENS), which involves stimulating neurons with electrodes, can relieve the pain, and ultrasound can soothe aching muscles. More serious conditions may require surgery.

When should a patient consult a physician? Dr. Chaput recommends that "alternative" or nonintrusive therapies be attempted first, but he cautions that "if a patient has persistent pain for three months that hasn't responded to common treatments or rest, that patient needs a medical evaluation by a primary care physician." Dr. Chaput also notes that the presence of serious illness needs to be ruled out by the primary care physician before referral to a specialist. Serious back pain can be a symptom of the following illnesses:

  • Cancer
  • Low-grade spinal infections
  • Kidney infections
  • Diseases of the intestinal tract
  • Rheumatoid arthritis

If you have to see a specialist

Your primary care physician may refer you to a back specialist, such as an orthopedist or a neurosurgeon. At the specialist's office, an MRI or CT scan will likely be used to create an internal picture of the spine and pinpoint the problem. The majority of complaints are from conditions that do not require surgery, says Dr. Chaput. In these cases the patient is generally referred to a physical therapist or, if necessary, a pain management specialist.

If all else fails and surgery is required, there are two common procedures:

Laminectomy. This procedure unroofs the spinal canal and frees up the nerves if they are being compressed by disks or bone spurs.

Fusion of the vertebrae. If the cause of pain is degenerated disks, or if the procedure is so extensive that abnormal motion might be a problem after surgery, your surgeon may choose to fuse the vertebrae. This is often done by using screws and rods to stabilize the spine until the bones grow together naturally.

A relatively new but effective treatment for degenerated disks is intradiskal electrothermal annuloplasty, or IDET. A minimally invasive procedure, IDET calls for a catheter to be inserted into the injured disk and treated with heat for about 15 minutes. The heat kills painful nerves and tightens the surrounding ligaments.

Avoiding back problems altogether

Naturally, prevention is the best way to avoid a back injury. Jerome McAndrews, the national spokesperson for the American Chiropractic Association, encourages people to change their mattress and pillows every three to four years. He says men should never sit on their wallet for extended periods of time and women should never carry a purse that weighs more than 5 pounds (unless it has a strap long enough to be put overhead, so that the purse can be positioned on the opposite side of the body.) The following list of tips from back experts will help your spine stay pain-free:

Exercise. "One of the biggest causes of back pain is the television's remote control," jokes chiropractor Sportelli. The more you move, the healthier your back will feel.

Sit straight, walk tall. Physical therapists say that poor posture is another leading cause of back pain, and that you should always sit and stand as straight and tall as you possibly can.

Lift carefully. Experts say you should lift with your calves and thighs, keeping your back straight.

Use your backpack correctly. According to the American Chiropractic Association (ACA), you should never carry more than 10 to 15 percent of your body weight on your back. Second, and perhaps more important, the ACA says that if you wear a backpack, you should always wear it on both shoulders in order to distribute the weight evenly.

To learn more about back pain, click on the following link:

American Chiropractic Association