Backache

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Backache

24 Pain-Free Ideas

Here's a law of physics that you rarely hear anything about: The heavier something is, the more often you'll have to move it. Here's another law of physics: Things will look just right at the farthest spot from where you first put them.

Trying to move the suddenly immovable is the number one cause of back problems in the United States. It causes you to push, twist, bend, lift, punch, pull, and strain in ways you never thought possible. The result is often back pain—and it's not always easy to get rid of. Some back pain experts claim that four out of every five Americans experience back pain at some time in their lives. And back-related injuries cost industry more than $10 billion a year in worker's compensation claims.

So if you've heaved, and the thing you tried to lift ho ho'ed as you winced in pain, there are things you can do to get you back from a painful attack.

RELIEF FROM A BACK ATTACK

Back doctors will tell you back pain comes in two forms, acute and chronic. Acute pain comes on suddenly and intensely. It's the kind you usually experience from doing something you shouldn't be doing or from doing it in the wrong way. The pain can be from sprains, strains, or pulls on muscles in your back. It can hurt like crazy for several days, but doctors say you can be pain-free without any lasting effects by following these self-help tips.

Get off your feet. Your back will thank you for it. "For an acute problem," says orthopedic surgeon Edward Abraham, M.D., assistant clinical professor at the University of California, Irvine, California College of Medicine, "the first thing you should do is get some bed rest." In fact, it may be the only thing you'll want to do. Any physical act, even getting up to go to the bathroom, may bring you pain. So, for the first day or two, keep activity to a minimum.

Exercise Your Pain Away Exercise may be the last thing you like to think about when your back is aching, but specialists say exercise is the best thing going for chronic back pain. "For people who suffer daily from back pain, especially if the pain varies throughout the day, exercise can beneficial," says Roger Minkow, M.D., a back specialist and founder of Backworks in Petaluma, California. If you're under a doctor's care for back pain, make sure you get the okay before you begin. Here are some doctor-recommended exercises. Play press-up. Press-ups are something like half of a push-up. "Lie on the floor on your stomach. Keep your pelvis flat on the floor and push up with your hands, arching your back as you lift your shoulders off the floor," says Dr. Minkow. This will help strengthen your lower back. Dr. Minkow recommends that you do it once in the morning and once in the afternoon. Move into a crunch. While you're on the floor, turn over onto your back and do what's called a crunch sit-up. Lie flat with both feet on the floor and your knees bent. Cross your arms and rest your hands on your shoulders. Raise your head and shoulders off the floor as high as you can while keeping your lower back on the floor. Hold for 1 second, then repeat. Swim on dry land. You don't need a deep-pile rug to swim on your floor. Lie on your stomach and raise your left arm and your right leg. Hold for 1 second, then alternate with your left leg and right arm as if you were swimming. This will extend and strengthen your lower back, says Dr. Minkow. Get into the pool. "Swimming is great exercise for the back," reports Milton Fried, M.D. "A good exercise for acute low back pain is to get into a warm pool and swim." Put your mettle to the pedal. "Ride a stationary bike with a mirror set up so that you can see yourself," says Dr. Minkow. "Be sure to sit up straight without slouching. If you have to, raise the handlebars so that you're not bent over forward." Remember—no pain, no gain, no brain. In doing these or any other exercises, Dr. Minkow advises that you be careful and know your limit. "If the exercise you're doing hurts or aggravates your condition, don't do the exercise anymore," he says. "You're not going to improve anything by gritting your teeth and doing one more repetition. If you feel fine the day after, or two days after you exercise, then it's safe to continue exercising."

Don't lounge too long. How long you stay in bed depends on the severity of your pain, says Dr. Abraham. "If you're still in pain after two days, for example, an extra day in bed won't hurt. It's best, however, to get out of bed as quickly as possible. Let pain be your guide."

"Most people think that a week of bed rest will take away the pain," adds David Lehrman, M.D., chief of orthopedic surgery at St. Francis Hospital and founder of the Lehrman Back Center in Miami, Florida. "But that's not so. For every week of bed rest, it takes two weeks to rehabilitate."

In fact, research at the University of Texas Health Science Center bears this out. Researchers there studied 203 patients who came into a walk-in clinic complaining of acute back pain. Some were told to rest for two full days and others were told to rest for seven days. There was no difference in the length of time it took the pain to diminish in either group, reported Richard A. Deyo, M.D., who was one of the researchers and is now director of health services research at Seattle Veterans Administration Medical Center. And those who got out of bed after two days got back to work a lot sooner.

MEDICAL ALERT Some Backs Need a Doctor's Care When does your back need medical backup? When you experience any of the following: Back pain that comes on suddenly for no apparent reason. Back pain that is accompanied by other symptoms, such as fever, stomach cramps, chest pain, or difficulty breathing. An acute attack that lasts for more than two or three days without any pain relief. Chronic pain that lasts more than two weeks without relief. Back pain that radiates down your leg to your knee or foot. You shouldn't always assume that back pain is a sign that something is wrong with just your back, notes Milton Fried, M.D. It could be a sign of some other disorder.

"The length of bed rest doesn't really affect recovery," says Dr. Deyo. "For some people it's just the most comfortable position for the first couple of days."

Put your pain on ice. The best way to cool down an acute flare-up is with ice, says Canadian pain researcher Ronald Melzack, Ph.D., a professor at McGill University. It will help reduce swelling and the strain on your back muscles. For best results, he says, try ice massage. "Put an ice pack on the site of the pain and massage the spot for 7 or 8 minutes." Do this for a day or two.

Try some heat relief. After the first day or two of ice, physicians recommend that you switch to heat, says Milton Fried, M.D., founder of the Milton Fried Medical Clinic in Atlanta, Georgia. Take a soft towel and put it in a basin of very warm water. Wring it well and flatten it so that there are no creases in it. Lie chest down with pillows under your hips and ankles and fold the towel across the painful part of your back. Put some plastic wrap over that, then put a heating pad turned on medium on top of the plastic. If possible, place something on top that will create pressure, like a telephone book. "This creates moist heat and will help reduce muscle spasms," says Dr. Fried.

Use heat and cold. For those of you who can't make up your mind which feels better, it's okay to use both methods, says Dr. Abraham. It may even have an added bonus. "An intermittent regimen of heat and ice will actually make you feel better," says Dr. Abraham. "Do 30 minutes of ice, then 30 minutes of heat, and keep repeating the cycle."

Stretch to smooth a spasm. "Stretching a sore back will actually enhance the healing process," says Dr. Lehman. "One good stretch for lower back pain is to gently bring your knees up from the bed and to your chest. Once there, put a little pressure on your knees. Stretch, then relax. Repeat.

"Stretching will help the muscle calm down sooner than just waiting for it to calm down on its own," says Dr. Lehrman.

Roll out of bed. When you do have to get out of bed, doctors advise that you roll out—carefully and slowly.

"You can minimize the pain of getting out of bed by sliding to the edge of the bed," says Dr. Lehrman. "Once there, keep your back rigid and then let your legs come off the bed first. That motion will act like a springboard, lifting your upper body straight up off the bed."

Car Seat Comfort Does your back drive you crazy every time you buckle up? It could be that what you're sitting on is the seat of your problem. "If you have back problems, the root of your problem could be your car seat, says Roger Minkow, M.D., a back specialist and founder of Backworks in Petaluma, California, who redesigns seats for airplane and automobile manufacturers. "German cars can be the worst when it comes to backs," he says. "American cars are usually bad, too, but you can at least fix them. Japanese cars, on the other hand, have the best seats, followed by the Swedish cars Volvo and Saab." Next time you're in the market for a car, Dr. Minkow suggests testing for cushion comfort as well as cruise-ability. The following hints will help you make a wiser choice. Take a new car for a sit. "Look for a seat with adjustable lumbar support and adjust the support down as low as it goes," he says. "See how that feels, and if you need to adjust it, do it from the lowest level." Get do-it-yourself comfort. If you have a car seat that does not suit your back and you drive an American-made car, you probably can fix the situation yourself with little effort. Most American cars have a zipper on the bottom of the back cushion. "Just unzip it and slip a homemade lumbar support inside the car seat," he says. Here's how to do it. Go to an upholstery shop and buy a cushion of high-resiliency foam, which means 2.5- to 3.5-pound foam with an ILD (indent load deflection) of between 30 to 45 pounds. Cut a strip of foam 5 1/2 inches wide by 1 inch thick with an electric carving knife. Then cut its length to fit your car seat width, being sure that you bevel the edge so that when the seat cover rolls over, it won't roll it up. Shove the foam under the seat cover, then make the necessary adjustments by either raising it or lowering it so that it fits your back over the belt line (not the small of your back). Then zip the cover back up. "It takes about 15 minutes, costs about $3, and works as well as an $80 lumbar support," Dr. Minkow says.

RELIEVING PAIN THAT LASTS AND LASTS

For some people, back pain is a part of everyday life. For whatever reason, it just lingers on and on for what can seem like an eternity. Some people suffer from recurring pain; any little movement can set it in motion. This is called chronic pain. The following tips are particularly helpful for those with chronic pain, although acute pain sufferers can benefit from them as well.

Lumber up. Lumber under the mattress will help the lumbar on top. "The object is to have a bed that doesn't sag in the middle when you sleep on it," says Dr. Fried. "A piece of plywood between the mattress and the box spring will end the sagging problem."

Drown pain with a waterbed. "A modern waterbed, one that is adjustable and doesn't make a lot of waves, is excellent for most types of back trouble," says Dr. Fried.

Dr. Abraham agrees. "In waterbeds you get an equalized change in the pressure on various segments of your body," he says. "You can lie in one position for the entire night because of this."

Become a "lazy S" sleeper. A bad back can't stomach lying facedown. "The best position for someone resting in bed is what we call the lazy S position," says Dr. Abraham. "Put a pillow under your head and upper neck, keep your back relatively flat on the bed, and then put a pillow under your knees."

When you straighten your legs, your hamstring muscles pull and put pressure on your lower back, he explains. Keeping your knees bent puts slack into the hamstrings and takes the pressure off your back.

Develop fetal attraction. You'll sleep like a baby if you sleep on your side in the fetal position. "It's a good idea to stick a pillow between your knees when you sleep on your side," says Dr. Fried. "The pillow stops your leg from sliding forward and rotating your hips, which puts added pressure on your back."

Take an aspirin a day. It can keep back pain away, claim the experts. Back pain is often accompanied by inflammation around the site of the pain, says Dr. Fried, and simple over-the-counter anti-inflammatory drugs, such as aspirin and ibuprofen, can help take it away. "It can even help for a fairly severe amount of inflammation," he says.

Acetaminophen is not as effective because it is not an anti-inflammatory drug.

Bark up the right tree. If you're looking for a natural anti-inflammatory, try some white willow bark, which can be found in capsule form in health food stores, says Dr. Fried. "It is a natural salicylate, the active ingredient that gives aspirin its anti-inflammatory power," says Dr. Fried. "Taken after meals, it shouldn't hurt your stomach, and it works very well on mild to moderate back pain. Those who suffer from ulcers and heartburn, however, should not use it."

Visualize yourself pain-free. The middle of the night can be the worst time for pain. Pain wakes you up and it keeps you up. "Using visualization is a particularly good thing to do at times like this," says professor Dennis Turk, Ph.D., director of the Pain Evaluation and Treatment Institute at the University of Pittsburgh School of Medicine.

"Close your eyes and imagine a lemon on a white china plate. See a knife next to it. See yourself pick it up and slice the lemon. Hear the sound it makes cutting through. Smell the aroma. Bring the lemon up to your face and imagine its taste.

"This is just one example in how you can use your senses in visualization," says Dr. Turk. The idea is to bring as much detail to the image as possible. The more involved the image is, the more you are engaged with it and the quicker you will become distracted from the pain."

Turn your pain upside down. "Gravity inversion works wonders on back pain," says Dr. Fried. With this therapy you strap yourself to a special device that tilts back and allows you to hang upside down. "Gradually doing inversion traction with a proper, safe inversion apparatus for 5 or 10 minutes a day will really work to rid you from lower back pain," he says. You should, however, have your doctor's okay to use this kind of therapy, especially if you have disk problems. And those with a potential for glaucoma should not use it at all.

Try T'ai chi to untie muscle knots. T'ai chi is an ancient Chinese discipline of slow, fluid movements. "It's a great relaxation method that helps the muscles in your back," says Dr. Abraham, who uses the method himself. "There are a lot of breathing exercises and stretching activities that foster a harmony within the body."

T'ai chi takes time and self-discipline to learn, but Dr. Abraham feels it's worth it. "I know it's strange for an orthopedic surgeon to talk this way, but it's smart living and it will go a long way in helping people with bad backs."

PANEL OF ADVISERS

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Edward Abraham, M.D., has a private practice in Santa Ana, California, and is assistant clinical professor of orthopedics at the University of California, Irvine, California College of Medicine. He originated the concept for outpatient back therapy in the United States and is the author of Freedom from Back Pain.

Richard A. Deyo, M.D., is director of health services research at Seattle Veterans Administration Medical Center and an associate professor of medicine and health services at the University of Washington School of Medicine in Seattle. He also holds a master's degree in public health.

Milton Fried, M.D., is the founder and director of the Milton Fried Medical Clinic in Atlanta, Georgia. He also holds degrees in chiropractic and physical therapy.

David Lehrman, M.D., is a chief of orthopedic surgery at St. Francis Hospital in Miami, Florida, and the founder and director of the Lehrman Back Center, a residential facility for pain sufferers in Miami.

Ronald Melzack, Ph.D., is a professor of psychology at McGill University in Montreal. He is vice president of the International Pain Foundation and a pain researcher.

Roger Minkow, M.D., a back specialist, is founder and director of Backworks, a rehabilitation facility for people with back injuries, located in Petaluma, California.

Dennis Turk, Ph.D., is a professor of psychiatry and anesthesiology at the University of Pittsburgh School of Medicine in Pennsylvania and director of the university's Pain Evaluation and Treatment Institute.