Back pain – the downside of being upright

In any group of people, asking about back pain will produce nods and frowns. About 80 percent of adults experience low back pain at some point in their life, and it’s the most common cause of job-related disability, a leading contributor to missed work days. About 20 percent of people affected by acute low back pain develop chronic pain.

Back pain is often associated with general degeneration of the spine due to normal wear and tear with aging. The discs begin to lose fluid and flexibility, which decrease their ability to cushion the spine. The likelihood of back pain also increases among people who are not physically fit. An increasing amount of research points to a hereditary component, identified by DNA analysis of families with widespread back pain. Jobs that require heavy lifting, pushing, or pulling have a higher incidence of back pain. At the opposite end of the physical demand spectrum, a desk job may also contribute to back pain, as the sitting position increases the pressure within the lumbar discs. Finally, there is clear evidence that smoking leads to premature degeneration of the lumbar discs, with an increased likelihood of back pain.

Fortunately, surgery is rarely indicated, and there are a multitude of useful nonsurgical treatments, including the application of heat and/or cold and massage. Recommendation for bed rest should be limited, as those who avoid bed rest are more likely to improve faster. Other common treatment methods include over-the-counter medications, physical therapy, and spinal manipulation. More involved but less frequent options can include spinal injections provided in a pain clinic.

Once chronic back pain has developed, the emphasis should be on maximizing symptom management. For those with a desk job, standing and walking frequently during the work day can be very helpful. Ergonomically designed furniture, such as standing desks and lumbar support chairs, may help to reduce symptoms, with particular attention to the most appropriate height for the work surface.

The benefits of a regular exercise program as the most effective tool for management of chronic back pain have been clearly demonstrated. The most important factor is to identify an individual program that works best, and then remain committed to it. This can include walking, swimming, cycling, yoga, low-impact aerobics, and many other regimens.

Affliction of back pain has been noted throughout human history. With our upright posture, the spine bears significant stress regardless of our level of activity. The future of spine care will be best focused on improved means of preventing the degenerative changes that lead to back pain, as well as identification of the most effective and consistent means of diminishing its impact.

TIMOTHY MILLEA, M.D. has practiced as an orthopedic spine surgeon in the Quad Cities area of Iowa and Illinois since 1992. He is an active member of the Catholic Medical Association and serves on the board of directors, as well as being CMA’s state representative for Iowa, and president of the St. Thomas Aquinas Guild of the Quad Cities.