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No More Back Pain

Looking at an article in BusinessWeek entitled "Medical Guesswork" in the May 29 issue, I was reminded once again that the conventional approach to treating some medical conditions is often more dependent on what's popular or traditional than what's evidence-based. Contrary to Hippocrates' famous admonition, "do no harm" this can do more harm than good.

THE LOW-TECH APPROACH TO BACK PAIN

Case in point: Spinal fusion. Each year, 325,000 of these back operations are carried out at an average cost of $50,000, when there is no significant evidence that they ease pain any more effectively than a combination of low-tech, low-cost and less risky approaches. Depending on the cause, exercise, physical therapy and good ergonomics (designing your environment to protect the body from injury) may be equally effective. Even worse, sometimes spinal procedures backfire, leaving patients in even greater pain than before.

Since New York City pain specialist Norman J. Marcus, MD, was kind enough to bring the BusinessWeek article to my attention, I took the opportunity to tap his expertise on how to address and prevent the ergonomic causes of back pain. He told me that in many cases back pain is caused by improper body mechanics such as heavy lifting, awkward posture, repetitive motion or poorly designed work stations (e.g., when you have to tilt your neck up to see your computer monitor, or rest your wrists against a hard desk).

WHAT YOU CAN DO

According to Dr. Marcus, simple, basic safety precautions will go a long way toward protecting your spine, back, neck and shoulders...

One of the best ways to protect your back is to maintain proper posture. Make sure that you stand so the spine's three natural C-shaped curves -- cervical (neck), thoracic (mid-back) and lumbar (lower back) -- are maintained. What to do...

• Keep your head up straight, chin in, shoulder blades back and chest forward.

• Avoid slouching, and do not lock or hyperextend (bend beyond normal range) your knees. In other words, keep your knees slightly bent.

• Distribute body weight evenly over both feet.

At work or at the computer...

• Use a proper chair with good lower back support.

• Make sure your work surface is at a comfortable height. Dr. Marcus recommends that your desk chair be high enough so your arms at the elbow create a greater than 90 degree angle.

• If you work at a computer, you should be reaching down to the keyboard. The monitor should be straight ahead (never to the side) at eye level or slightly below.

• When sitting for prolonged periods, rest your feet comfortably on the floor or on a low stool.

• Every half hour or so, get up, stretch and walk around.

• If you're on the phone a great deal, use a headset. A wireless headset is even better, since it allows you to move around, says Dr. Marcus.

• Avoid standing for long periods of time. If you must do so, rest one foot on a low stool. This keeps the back from arching.

• Wear comfortable, well-fitting, low-heeled shoes.

On the road...

• Move the seat close to the steering wheel to support the curve of your back and allow your feet to easily reach the pedals.

• When driving long distances, put a pillow or rolled-up towel behind the small of your back.

• Take periodic breaks in which you get out of the car for a few minutes, stretch and walk around.

At night...

• Choose a moderately firm mattress, not too soft and not too firm.

• Try sleeping on your back with a pillow under your knees, or on your side with your knees bent and a pillow between your knees. (Sleeping on your stomach is often uncomfortable for many.)

• Avoid reading or watching TV while lying in bed, says Dr. Marcus. Sitting up puts less strain on the neck muscles.

• If you feel stiff when you get up in the morning, Dr. Marcus notes that the sooner you start moving around, the better you will feel.

When you lift heavy objects...

• Practice proper body mechanics. When you lift heavy things, let the quadriceps muscles in the legs do the work, advises Dr. Marcus. Don't bend over and use your back muscles to carry or lift a load.

• Before lifting, face the object and bend your knees, keeping your back straight.

• As you stand up and lift, hold the object close to your body. Holding objects away from the body puts more load on the spine, warns Dr. Marcus.

• As you rise, stand upright without twisting.

• If the object is very heavy, ask for help.

• Use a backpack to tote your belongings. Using a traditional one-shoulder bag places strain on your back. It's better to distribute the weight evenly across your back.

LOOK BEFORE YOU LEAP

So before you resort to drastic solutions such as surgery, be sure to thoroughly investigate less invasive approaches to back pain. In addition to ergonomic adjustments, consider the Kraus exercise program, created by Hans Kraus, MD, the back doctor for President Kennedy. The exercises are created to produce minimal strength and flexibility in the key postural muscles by sequentially teaching relaxation, limbering, stretching and only then strengthening. You can find these exercises on Dr. Marcus' Web site, www.backpainusa.com. When in doubt (or in pain), a physical therapist can help you design a safe and effective program.

Daily Health News contributing editor, Andrew L. Rubman, ND, adds that it is important to check if the source of your back pain might actually be in your hips. In his 25 years of practice, 75% of lower back problems that he has treated involved hip misalignment. Most important: Go very slowly and carefully into back surgery. Odds are you may not need it.

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October 3, 2006, Carole Jackson
Bottom Line's Daily Health News