By Dorothy Foltz-Gray, Special to Lifescript
http://www.lifescript.com/Health/Conditions/Back_Pain/Doctor-Recommended_Back_Pain_Remedies.aspx?p=1
http://www.lifescript.com/Health/Conditions/Back_Pain/Doctor-Recommended_Back_Pain_Remedies.aspx?p=1
Published April 29, 2011
Bending over your desk, twisting in the car seat, walking down stairs – all make you feel as if gnomes are beating tiny hammers on your back. Whatever its source, backaches are bad news, putting you out of sorts – and out of sync. Discover the common causes and how to relieve back pain. Plus, how bad is your back pain? Take our quiz to find out…
With all those years of toting tots, groceries, laundry, computer bags – even oversized purses with everything but the kitchen sink – it’s no wonder that women are no strangers to back pain.
But heavy loads aren’t the only culprits. Posture, arthritis and pregnancy are other triggers.
Women are particularly vulnerable “because they may develop osteoporosis, which is a weakening of the vertebrae,” says Reza Ghorbani, M.D., a pain management specialist at Suburban Hospital in Bethesda, Md. “And then they don’t have stability in their spines.”
But that doesn’t mean you have to live with the misery. Here’s a guide to 7 common culprits of backaches, plus doctor-recommended remedies to relieve back pain:
1. Back strainMany activities women do daily – hoisting shopping bags, climbing in and out of cars, bending to pick up dirty clothes or kids – strain muscles and ligaments around the spine.
“The muscles start stretching and that can irritate the nerve ending in the muscles,” Ghorbani says.
What you can do: For starters, lift things correctly.
“Many people bend straight down to pick something up instead of squatting before lifting,” Ghorbani says.
The right way? Lift from the knees, using muscles in your legs and arms –not your back (see right).
Doctor’s fix: For minor, occasional back pain, “the first line of treatment is over-the-counter anti-inflammatory drugs, such as Advil or Motrin,” Ghorbani says. “Use as directed on the package.”
He also recommends topical pain relief creams because they act only where it hurts, not on your whole body.
Also, treat a sore back with a warm bath, he advises. “Heat increases the blood flow to the muscles, which helps ease the pain.”
To make a heating pad, fill a sock with rice, tie off the end and heat it in a microwave for a minute. Wrap this – or any heating pad – in a cloth to prevent burns and hold against your back for 15-20 minutes.
2. SlouchingPoor posture hurts your back, says rheumatologist Harris McIlwain, M.D., author of The Pain-Free Back (Henry Holt & Co). Sitting or standing with shoulders slouched forward strains muscles.“If you sit leaning forward, the pressure on the spine is much greater than if you're sitting straight,” McIlwain says.
Normally, your lower back has a slight inward curve, adds Sheeraz Qureshi, M.D., assistant professor of orthopedic surgery at Mount Sinai School of Medicine in New York City.
“Poor posture causes your back to come out of that curve, which puts more pressure on your spinal discs and back muscles,” he says.
What you can do: “Get a comfortable desk chair that has arms and allows you to put your feet on the floor,” McIlwain says
(see right).
Then elevate your feet with a stool or something similar, which relieves pressure on your back, Qureshi says.
Don’t have an aerodynamic office chair? Then you’ll need lumbar, or lower back, support. So tuck a pillow behind your lower back and keep your shoulders back, with head aligned over your shoulders.
Also, don’t sit in the same position all day, McIlwain says: Get up and walk around the desk or do a few stretches every half-hour.
When standing, lift your breastbone, straighten your shoulders, keep your chin level and spine neutral, with buttocks neither too far out (a swayback) nor too tucked under.
And try the following exercise in your chair several times a day, McIlwain advises:
Tighten your buttocks' muscles and count to 10, then relax them. Do two more times. This strengthens the gluteus muscles, the large muscles in the buttocks that help support the hips.
When they aren’t strong, back muscles jump in to do their work. The result? Lower-back pain.
Doctor’s fix: “One of the first lines of treatment is physical therapy,” Qureshi says. “The therapist can focus on strengthening the muscles around the spine.”
Many physical therapists can evaluate your work station, checking where the computer and keyboard location and the type and height of your chair.
“Then they can put you in the best position for your back,” Qureshi says.
In some cases, the doctor may recommend wearing a back brace, which will help correct your posture and relieve pain – but only temporarily.
“Don’t wear one indefinitely,” Qureshi warns. “Braces do the job of the muscles, so in the long run the muscles can weaken.”
When you have severe back pain, use a brace, such as a support belt, for around three days, allowing the back “to calm down,” he says. 3. Too much couch timeOut-of-shape muscles are the enemy here.
“You can’t stop aging,” Ghorbani says. “But by strengthening your lower back muscles with exercise and stretching, you can avoid back pain.”
What you can do: Try a low-impact aerobic exercise that gets your heart pumping – such as walking or swimming – every day, building to at least 20 minutes at a time, Qureshi says.
“Stretching and range of motion exercises, like Pilates and yoga, are also very good,” he says. (Check out our easy yoga exercises slideshow.)
Don’t have time? “Even simple things like stretching for 10 minutes a day can protect your back by improving your posture and muscle [strength].”
Doctor’s fix: Ask your doc to recommend exercises that strengthen back and abdominal muscles (which support the back). You may also be referred to a physical therapist to learn proper form for exercises and help you set up a back-boosting fitness routine.
4. Pregnancy
At least half of pregnant women have some back pain, from general lower back aches to sciatica – a searing pain from the buttocks that shoots down the leg.
Why? Blame the bundle of joy you’re carrying.
During pregnancy, “the uterus enlarges and that shifts the center of gravity forward,” says Robert Goldfarb, M.D., an obstetrician/gynecologist at Henry Ford West Bloomfield Hospital in West Bloomfield, Mich. “So you’re tilted a little backward to maintain posture and your back muscles have to work harder.”
Plus, in the third trimester, hormones relax your pelvic ligaments, loosening joints and intensifying back pain, Goldfarb says.
What you can do: The better shape you’re in physically, the less likely you are to have back pain, Goldfarb says.
“It’s hard to do sit-ups when you’re pregnant,” he says. “But get regular exercise, like walking or water aerobics.”
He also recommends stretching and flexibility exercises, like yoga.
“And make sure you have a solid mattress,” Goldfarb says. Soft mattresses don’t support the natural position of the spine, throwing it out of alignment, he says. In turn, that places stress on back muscles, ligaments and joints.
“If it’s more than 5 years old, stick a piece of plywood beneath it to make it firmer,” he suggests.
That’s a helpful tip for any back pain – pregnancy or not. Doctor’s fix: Don’t take non-steroidal anti-inflammatories drugs (NSAID), such as Advil and Motrin. They aren’t safe for pregnant women because they can affect the baby’s circulatory system, Goldfarb says.
But Tylenol gets the doctor’s nod, and for severe back pain, you may be prescribed a narcotic pain reliever such as Vicodyn or Tylenol with codeine – both are safe during pregnancy, he says.
5. Excess weightThe more you weigh, the harder it is for the spine to support your body. Add weak muscles to excess weight and you’ll soon be reaching for Advil.
What you can do: “You want to be as close to your ideal weight as [possible],” Qureshi says. Find out what it is by using our BMI calculator – or ask your doctor.
Even a loss of few pounds’ can help with back pain, doctors agree.
“If calories in are less than calories out, you’re going to lose weight,” he says.
Eating more lean meats, fruits, veggies and whole grains instead of high-fat, sugar-laden fast foods will also help you feel full on fewer calories.
And, of course, exercise more.
Doctor’s fix: If you need help to lose weight, see a nutritionist, McIlwain says.
“A nutritionist can give you personal instruction in basic diet choices,” and develop a weight-loss plan for you, he says.
But even if weight loss is difficult, you can still relieve back pain by doing exercises for the back and hamstrings to strengthen those weight-bearing muscles.
Weak hamstrings – the muscles at the back of the legs that connect to the pelvis – can make it tilt forward, which then causes muscle tightness in your lower back.
Here’s McIlwain’s exercise to strengthen hamstrings: Sitting in a desk chair, push one foot down into the floor (using your muscles) until you feel the hamstring tighten. Hold for 10 seconds, then release. Repeat with the other side. To start, perform 1-2 reps of the exercise twice a day, building up to 20 reps twice a day.
6. StressThe refrigerator’s broken, the babysitter didn’t show up and you were late to work. Now you’re feeling an angry twinge in your back. Why today?
Blame stress. It triggers the release of cortisol, adrenaline and other hormones that rev up your body to fight or flee whatever’s agitating you. That makes muscles tighten, irritating the nerves and increasing inflammation, which causes back pain, Qureshi says. What you can do: Simply realizing when you’re experiencing stress and trying to control its triggers can help relieve back pain, he says.
Then take steps to de-stress: Cut out unnecessary events in your schedule. Instead, go for a walk (which both relaxes you and improves fitness) or take a warm bath mixed with a couple cups of Epsom salts. The magnesium in the salts helps relax aching muscles.
Also try deep breathing exercises, which can help relieve back pain and stress, says Loren Gelberg-Goff, a clinical social worker in River Edge, N.J.
“Pain generally makes people tense up, causing more pain and tension,” Gelberg-Goff says. “Deep breathing changes that pattern.”
Breathe in through your nose to the count of four, feeling your stomach push out, then release slowly through your mouth to the count of four.
“Do it for at least a full minute every hour,” Gelberg-Goff recommends.
Doctor’s fix: If anxiety lies behind your back aches, you may be referred to a psychotherapist, who can help identify stressors, work to eliminate them and teach you to react less strongly to those you can’t avoid.
7. Degenerative disc diseaseAround age 30, we begin to lose some of the cushioning from the discs between the bones in our spines, due to aging, wear and tear or trauma.
“Degeneration can be a normal part of the aging process,” says Scott L. Blumenthal, M.D., an orthopedic spine surgeon at the Texas Back Institute in Plano, Texas.
The joints between vertebrae – facet joints – also begin to deteriorate, adding to the ache. Both conditions can cause a bulging (herniated) disc, Ghorbani says, which occurs when the discs shift, touching the nerves in the spine. The result is severe back pain shooting to the toes.
What you can do: “Some of the pain comes from inflammation,” Qureshi says, “so you can take over-the-counter anti-inflammatories like Advil or Aleve.”
Also apply ice for about 10 minutes every 1-1/2 hours, he says. Make sure the ice is wrapped in a cloth so you don’t get ice burn.
If you smoke, stop.
“Smoking shrinks blood vessels and without blood flow, discs become dehydrated and don’t get the nutrients they need,” Ghorbani says.
And avoid standing for long periods, he says. “When you stand, it compresses the discs further,” which is why we’re taller in the morning than in the evening. When the discs compress, “that causes pain.” Doctor’s fix: Your doctor may prescribe anti-inflammatories, physical therapy or cortisone injections – the latter relieves inflammation at the site for many.
“But if the bulging disc is causing a lot of nerve pressure and you have numbness or tingling going down the leg, you need to see a back specialist to remove the disc,” Qureshi says.
That could involve spinal fusion surgery, in which the damaged disc is removed and the vertebrae above and below are fused together.
“It’s the tried-and-true method,” Qureshi says.
The downside is that you lose some spinal mobility in the area, which places more stress on the parts of the spine that still move.
“But once you have disc and arthritic changes, you’ve already lost movement,” Qureshi says. “So the amount of movement you lose with fusion is small.”
Another option: replacing the damaged disc with an artificial one. Disc replacement, a procedure available only in the last decade, “can treat the disc problem and preserve motion,” Blumenthal says. “It’s the greatest advance in spinal surgery in 20 years.”
Still, the life span of artificial discs isn’t clear. And, says Qureshi, if you have pain and arthritis in other areas of the spine, your pain may not diminish as much as you hoped.
With all those years of toting tots, groceries, laundry, computer bags – even oversized purses with everything but the kitchen sink – it’s no wonder that women are no strangers to back pain.
But heavy loads aren’t the only culprits. Posture, arthritis and pregnancy are other triggers.
Women are particularly vulnerable “because they may develop osteoporosis, which is a weakening of the vertebrae,” says Reza Ghorbani, M.D., a pain management specialist at Suburban Hospital in Bethesda, Md. “And then they don’t have stability in their spines.”
But that doesn’t mean you have to live with the misery. Here’s a guide to 7 common culprits of backaches, plus doctor-recommended remedies to relieve back pain:
1. Back strainMany activities women do daily – hoisting shopping bags, climbing in and out of cars, bending to pick up dirty clothes or kids – strain muscles and ligaments around the spine.
“The muscles start stretching and that can irritate the nerve ending in the muscles,” Ghorbani says.
What you can do: For starters, lift things correctly.
“Many people bend straight down to pick something up instead of squatting before lifting,” Ghorbani says.
The right way? Lift from the knees, using muscles in your legs and arms –not your back (see right).
Doctor’s fix: For minor, occasional back pain, “the first line of treatment is over-the-counter anti-inflammatory drugs, such as Advil or Motrin,” Ghorbani says. “Use as directed on the package.”
He also recommends topical pain relief creams because they act only where it hurts, not on your whole body.
Also, treat a sore back with a warm bath, he advises. “Heat increases the blood flow to the muscles, which helps ease the pain.”
To make a heating pad, fill a sock with rice, tie off the end and heat it in a microwave for a minute. Wrap this – or any heating pad – in a cloth to prevent burns and hold against your back for 15-20 minutes.
2. SlouchingPoor posture hurts your back, says rheumatologist Harris McIlwain, M.D., author of The Pain-Free Back (Henry Holt & Co). Sitting or standing with shoulders slouched forward strains muscles.“If you sit leaning forward, the pressure on the spine is much greater than if you're sitting straight,” McIlwain says.
Normally, your lower back has a slight inward curve, adds Sheeraz Qureshi, M.D., assistant professor of orthopedic surgery at Mount Sinai School of Medicine in New York City.
“Poor posture causes your back to come out of that curve, which puts more pressure on your spinal discs and back muscles,” he says.
What you can do: “Get a comfortable desk chair that has arms and allows you to put your feet on the floor,” McIlwain says
(see right).Then elevate your feet with a stool or something similar, which relieves pressure on your back, Qureshi says.
Don’t have an aerodynamic office chair? Then you’ll need lumbar, or lower back, support. So tuck a pillow behind your lower back and keep your shoulders back, with head aligned over your shoulders.
Also, don’t sit in the same position all day, McIlwain says: Get up and walk around the desk or do a few stretches every half-hour.
When standing, lift your breastbone, straighten your shoulders, keep your chin level and spine neutral, with buttocks neither too far out (a swayback) nor too tucked under.
And try the following exercise in your chair several times a day, McIlwain advises:
Tighten your buttocks' muscles and count to 10, then relax them. Do two more times. This strengthens the gluteus muscles, the large muscles in the buttocks that help support the hips.
When they aren’t strong, back muscles jump in to do their work. The result? Lower-back pain.
Doctor’s fix: “One of the first lines of treatment is physical therapy,” Qureshi says. “The therapist can focus on strengthening the muscles around the spine.”
Many physical therapists can evaluate your work station, checking where the computer and keyboard location and the type and height of your chair.
“Then they can put you in the best position for your back,” Qureshi says.
In some cases, the doctor may recommend wearing a back brace, which will help correct your posture and relieve pain – but only temporarily.
“Don’t wear one indefinitely,” Qureshi warns. “Braces do the job of the muscles, so in the long run the muscles can weaken.”
When you have severe back pain, use a brace, such as a support belt, for around three days, allowing the back “to calm down,” he says. 3. Too much couch timeOut-of-shape muscles are the enemy here.
“You can’t stop aging,” Ghorbani says. “But by strengthening your lower back muscles with exercise and stretching, you can avoid back pain.”
What you can do: Try a low-impact aerobic exercise that gets your heart pumping – such as walking or swimming – every day, building to at least 20 minutes at a time, Qureshi says.
“Stretching and range of motion exercises, like Pilates and yoga, are also very good,” he says. (Check out our easy yoga exercises slideshow.)
Don’t have time? “Even simple things like stretching for 10 minutes a day can protect your back by improving your posture and muscle [strength].”
Doctor’s fix: Ask your doc to recommend exercises that strengthen back and abdominal muscles (which support the back). You may also be referred to a physical therapist to learn proper form for exercises and help you set up a back-boosting fitness routine.
4. Pregnancy
At least half of pregnant women have some back pain, from general lower back aches to sciatica – a searing pain from the buttocks that shoots down the leg.
Why? Blame the bundle of joy you’re carrying.
During pregnancy, “the uterus enlarges and that shifts the center of gravity forward,” says Robert Goldfarb, M.D., an obstetrician/gynecologist at Henry Ford West Bloomfield Hospital in West Bloomfield, Mich. “So you’re tilted a little backward to maintain posture and your back muscles have to work harder.”
Plus, in the third trimester, hormones relax your pelvic ligaments, loosening joints and intensifying back pain, Goldfarb says.
What you can do: The better shape you’re in physically, the less likely you are to have back pain, Goldfarb says.
“It’s hard to do sit-ups when you’re pregnant,” he says. “But get regular exercise, like walking or water aerobics.”
He also recommends stretching and flexibility exercises, like yoga.
“And make sure you have a solid mattress,” Goldfarb says. Soft mattresses don’t support the natural position of the spine, throwing it out of alignment, he says. In turn, that places stress on back muscles, ligaments and joints.
“If it’s more than 5 years old, stick a piece of plywood beneath it to make it firmer,” he suggests.
That’s a helpful tip for any back pain – pregnancy or not. Doctor’s fix: Don’t take non-steroidal anti-inflammatories drugs (NSAID), such as Advil and Motrin. They aren’t safe for pregnant women because they can affect the baby’s circulatory system, Goldfarb says.
But Tylenol gets the doctor’s nod, and for severe back pain, you may be prescribed a narcotic pain reliever such as Vicodyn or Tylenol with codeine – both are safe during pregnancy, he says.
5. Excess weightThe more you weigh, the harder it is for the spine to support your body. Add weak muscles to excess weight and you’ll soon be reaching for Advil.
What you can do: “You want to be as close to your ideal weight as [possible],” Qureshi says. Find out what it is by using our BMI calculator – or ask your doctor.
Even a loss of few pounds’ can help with back pain, doctors agree.
“If calories in are less than calories out, you’re going to lose weight,” he says.
Eating more lean meats, fruits, veggies and whole grains instead of high-fat, sugar-laden fast foods will also help you feel full on fewer calories.
And, of course, exercise more.
Doctor’s fix: If you need help to lose weight, see a nutritionist, McIlwain says.
“A nutritionist can give you personal instruction in basic diet choices,” and develop a weight-loss plan for you, he says.
But even if weight loss is difficult, you can still relieve back pain by doing exercises for the back and hamstrings to strengthen those weight-bearing muscles.
Weak hamstrings – the muscles at the back of the legs that connect to the pelvis – can make it tilt forward, which then causes muscle tightness in your lower back.
Here’s McIlwain’s exercise to strengthen hamstrings: Sitting in a desk chair, push one foot down into the floor (using your muscles) until you feel the hamstring tighten. Hold for 10 seconds, then release. Repeat with the other side. To start, perform 1-2 reps of the exercise twice a day, building up to 20 reps twice a day.
6. StressThe refrigerator’s broken, the babysitter didn’t show up and you were late to work. Now you’re feeling an angry twinge in your back. Why today?
Blame stress. It triggers the release of cortisol, adrenaline and other hormones that rev up your body to fight or flee whatever’s agitating you. That makes muscles tighten, irritating the nerves and increasing inflammation, which causes back pain, Qureshi says. What you can do: Simply realizing when you’re experiencing stress and trying to control its triggers can help relieve back pain, he says.
Then take steps to de-stress: Cut out unnecessary events in your schedule. Instead, go for a walk (which both relaxes you and improves fitness) or take a warm bath mixed with a couple cups of Epsom salts. The magnesium in the salts helps relax aching muscles.
Also try deep breathing exercises, which can help relieve back pain and stress, says Loren Gelberg-Goff, a clinical social worker in River Edge, N.J.
“Pain generally makes people tense up, causing more pain and tension,” Gelberg-Goff says. “Deep breathing changes that pattern.”
Breathe in through your nose to the count of four, feeling your stomach push out, then release slowly through your mouth to the count of four.
“Do it for at least a full minute every hour,” Gelberg-Goff recommends.
Doctor’s fix: If anxiety lies behind your back aches, you may be referred to a psychotherapist, who can help identify stressors, work to eliminate them and teach you to react less strongly to those you can’t avoid.
7. Degenerative disc diseaseAround age 30, we begin to lose some of the cushioning from the discs between the bones in our spines, due to aging, wear and tear or trauma.
“Degeneration can be a normal part of the aging process,” says Scott L. Blumenthal, M.D., an orthopedic spine surgeon at the Texas Back Institute in Plano, Texas.
The joints between vertebrae – facet joints – also begin to deteriorate, adding to the ache. Both conditions can cause a bulging (herniated) disc, Ghorbani says, which occurs when the discs shift, touching the nerves in the spine. The result is severe back pain shooting to the toes.
What you can do: “Some of the pain comes from inflammation,” Qureshi says, “so you can take over-the-counter anti-inflammatories like Advil or Aleve.”
Also apply ice for about 10 minutes every 1-1/2 hours, he says. Make sure the ice is wrapped in a cloth so you don’t get ice burn.
If you smoke, stop.
“Smoking shrinks blood vessels and without blood flow, discs become dehydrated and don’t get the nutrients they need,” Ghorbani says.
And avoid standing for long periods, he says. “When you stand, it compresses the discs further,” which is why we’re taller in the morning than in the evening. When the discs compress, “that causes pain.” Doctor’s fix: Your doctor may prescribe anti-inflammatories, physical therapy or cortisone injections – the latter relieves inflammation at the site for many.
“But if the bulging disc is causing a lot of nerve pressure and you have numbness or tingling going down the leg, you need to see a back specialist to remove the disc,” Qureshi says.
That could involve spinal fusion surgery, in which the damaged disc is removed and the vertebrae above and below are fused together.
“It’s the tried-and-true method,” Qureshi says.
The downside is that you lose some spinal mobility in the area, which places more stress on the parts of the spine that still move.
“But once you have disc and arthritic changes, you’ve already lost movement,” Qureshi says. “So the amount of movement you lose with fusion is small.”
Another option: replacing the damaged disc with an artificial one. Disc replacement, a procedure available only in the last decade, “can treat the disc problem and preserve motion,” Blumenthal says. “It’s the greatest advance in spinal surgery in 20 years.”
Still, the life span of artificial discs isn’t clear. And, says Qureshi, if you have pain and arthritis in other areas of the spine, your pain may not diminish as much as you hoped.