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Low back pain
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The modern approach: a combination of treatments
By Judylaine Fine
Four out of five of us end up suffering from back pain at some time in our lives. Next to the common cold, it’s the most frequent reason for visits to the doctor’s office. Yet, until recently, we knew little about the causes of this widespread agony — and even less about treatment options.
When I started to ponder the mysteries of back pain, I embarked on a search for the one answer to curing this scourge. It started to dawn on me, that there was no single answer — and no single guru who could provide it. Ultimately, most back-pain sufferers and health-care professionals came to accept the idea that different treatment methods worked best for different people.
About five years ago, I changed my tune again. I now strongly believe that back pain — particularly chronic back pain — is an even more complex and individual problem than we used to think. Not only are different methods of treatment best for different people, but in my opinion all back pain sufferers require a variety of “treatments” in order to manage and, ultimately, conquer their back problems.
The treatment mix
The answer is a mix, and my mix is different from yours. A typical treatment mix might include:
• Remedial exercises includes, for example, the pelvic tilt, extension stretches, and sit-ups. Some work for everyone; others are helpful for some conditions but detrimental to others. (Brochures outlining useful exercises are available from the Back Association of Canada.)
• Aerobic exercise serves quite a different purpose from the remedial exercises mentioned above. In general, aerobic exercise helps with the healing process of injured tissues. It also increases the flow of oxygen to the cells, which allows them to get rid of waste products much more efficiently. Exactly which type of aerobics works best depends upon what’s wrong with your back. But aerobic exercise of some kind is crucial to having a fit back, and a fit back is less susceptible to injury than a back that’s out of condition. Only recently have exercise specialists acquired a strong enough voice to spread this fact.
• Posture improvement includes an understanding of good posture, both static (sitting) and dynamic (moving around). Many back problems can be improved by chairs that promote good sitting. And a variety of techniques exist to help you learn how to use your body without throwing it around:
• Yoga, a 4,000-year-old system that focuses on increased flexibility and improved breathing techniques;
• the Alexander technique which teaches people whose posture has become “disorganized” how to move freely;
• the Feldenkrais method finds better ways of moving that do not put unnecessary strain on the body. and even good old-fashioned western posture tips — all of which basically pursue the same thing.
• Ergonomic adjustments make pursuing your activities easier and less likely to produce pain. This is related to posture, since your choice of chair, bed, or even shoes affects how you sit, lie, and move. But it can also involve something as simple as rearranging your laundry room so you have to bend over less.
Pain management may involve using medication for acute back pain. For chronic problems, it’s more likely to include active techniques like physical exercise to help reduce stress, or more passive techniques such as massage, acupuncture or manipulation. There is definitely some validity to the theory of the power of touch; something special happens when another human being works with you to relieve your pain.
Stress Busters
The human body reacts to stress the same way it did 30,000 years ago, with the “fight or flight” response. Unfortunately, in our modern-day society, physical responses such as increased adrenaline and muscle tension often make matters worse rather than better! Strategies for coping with stress can make a major contribution to control of chronic pain.
Try these stress-busters. Some will work for you, others won’t. Stress management is a complex and very individual matter.
• Body awareness — By learning to focus on a specific part of your body, you can begin to recognize where you “store your stress.” Keeping a diary can also help you learn what stressors trigger what symptoms.
• Progressive relaxation — This technique begins with learning to feel when your various muscles are relaxed and when they are tense, then applies this skill to “real” life. For instance, perhaps you have a habit of tensing your left shoulder when you type, or a counterproductive tendency to tighten up when you are running late; either is probably a learned habit that can be broken.
• Deep breathing — Along with posture, breathing is the basis of yoga. Increased oxygen intake reduces both muscle tension and anxiety.
• Meditation — How many thousands of thoughts roar around your brain every day? Wouldn’t it be nice to be able to turn them off sometimes? Meditation can help.
• Visualization — This skill uses your imagination to help manage pain. e.g., picture your back pain as a jagged block of ice stabbing your spine — then imagine the sun slowly melting the ice as your back pain fades.
• Thought stopping — The moment you become aware that you are catastrophizing (dwelling on a stressful situation and on worst-possible outcomes often even after the situation has been resolved), you shout “STOP” — or snap an elastic band kept around your wrist, hard.
STRESS RELIEVING EXERCISES
Today’s largely sedentary lifestyle means most of us now have to go out of our way to make sure we get moving. Many of us have taken a more realistic approach to aerobic exercise, combining fitness and enjoyment. Here are some tips on four low-risk aerobic activities:
• Walking has become the most popular aerobic exercise in Canada. Thirty minutes of walking at six km an hour is enough to improve aerobic fitness for most people. Buy shoes designed for walking, not jogging.
• Bicycling can be a great aerobic work-out if you watch your posture. Set your bike so you can sit up normally rather than bent over. Adjust your seat height so when your foot rests on the lower pedal, your knee is slightly bent.
• Aqua aerobics is an excellent low-risk activity for back pain sufferers. Be careful not to overload your upper body with paddles or weights.
• Swimming is a terrific all-around activity that can be of help to back pain sufferers as long as you choose the right stroke. Backstroke is a good choice for many people, as is the side stroke — change sides every few lengths. (Breast stroke and front crawl can exacerbate certain kinds of back problems, such as facet joint syndrome or spinal stenosis.) If you’re counting your heart rate, remember your maximum rate decreases when you are in a horizontal position.
Judylaine Fine, author of the Ultimate Back Book is executive vice-president of the Back Association of Canada, a charitable foundation dedicated to educating back pain sufferers and those who treat them.
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