Health Wise: Lutheran Woman Today

Kelly Staikopolous can’t make a move. Not without back pain, that is. Ever since a sliding door slammed into her last April, shoving her lower back into a door jamb, searing pain has been her unwelcome companion.

"I can’t even roll over without flinching," says Staikopolous, a food editor in New York City. "I’ve tried over–the–counter pain relievers, prescription drugs, and physical therapy. Now my doctor says surgery may be the only way to fix the herniated disk caused by my accident."

Like 80 percent of Americans, Staikopolous suffers from back pain. And like many of us, she’s frustrated and flummoxed by how difficult it can be to treat.

The fifth leading reason Americans visit their doctors, back pain is more common among women than men. Why is that? Not only do we bear extra weight during pregnancy, but we are more likely to suffer from arthritis, osteoporosis, scoliosis, and stress, which can trigger and worsen back pain.

Modern living only boosts women’s susceptibility. The spine may be a wonder of engineering, with 24 vertebrae stacked along its length and 31 pairs of nerves extending from its sides. But nature designed the spine to move freely — and frequently. If we sit for most of the day, this puts extra stress on the lower back. Standing for long hours has the same effect. When we’re on our feet, the lower back supports one–third of our weight, the reason back pain usually strikes here. The back is subjected to wear and tear over our growing life expectancy (now at an all-time high of 80 years for women) and can wear down over time: its muscles strain, ligaments loosen, and the disks that cushion its vertebrae dry up and lose their shock-absorbing effect.

To keep your back healthy, maintain good posture. Sit well-supported, with your knees and hips level, and take breaks to stretch, walk, or lean back. A recent Scottish study showed that the healthiest way to sit is not ramrodstraight, but tilted back at a 135–degree angle, which puts less pressure on the spine. Do core-strengthening exercises to build abdominal and back muscles. When lifting, keep your back erect and use your legs. Sleep on your side on a medium-firm mattress.

If you do develop back pain, note that it’s usually caused by minor muscle strain and heals within 12 weeks. Apply ice, then a heating pad, for up to 20 minutes each. Try over–the–counter pain relievers and anti-inflammatory drugs. Bed rest may help, but certain types of physical activity (bicycling, walking, swimming, and other low–impact exercises) can strengthen the muscles that support the spine and thus speed recovery.

See a doctor immediately if your pain is constant or intense. Likewise, see your doctor if you have problems with your bladder or bowel control, or numbness or tingling in your legs. Those may be signs of something more serious than minor muscle strain: A disk may be herniated, with its outer coating torn and its jelly-like center protruding into the spinal canal. It could be sciatica, in which a herniated disk presses on the sciatic nerve, shooting pain down the leg. It could be spinal stenosis, in which arthritis or bone growth narrows the space around the spinal cord; spondylosis (arthritis of the spine); or spondylolisthesis, in which one vertebra slips forward over another.

Serious back problems such as these can be chronic, meaning they last for more than three months. Diagnosed through Xrays, magnetic resonance imaging (MRI), and nerve and reflex tests, they can be addressed with physical therapy (including ultrasound, muscle–strengthening exercises, or electrical nerve stimulation) and prescription drugs (such as muscle relaxants, steroids, anti-inflammatories, painkillers, and cortisone injections).

Some alternative remedies for back trouble include chiropractic (spinal manipulation) and acupuncture (the insertion of thin needles in pressure points to relieve pain).

Back treatment can entail a flurry of doctor referrals and insurance paperwork, making it, in Staikopolous’s words, "as much a pain in the neck as it is a pain in the back." One expert may recommend yoga, while another suggests a back brace. "There’s no standard treatment," says Dr. Steven Feinberg, an adjunct clinical associate professor of rehabilitation at Stanford University in Stanford, California. "Five different doctors can offer five different remedies."

When it comes to persistent cases, experts also debate the merits of surgery such as disk replacement, microdiskectomy (removal of a disk’s herniated portion), spinal fusion (the joining of two vertebrae), or laminectomy (the removal of part of the vertebra).

In November, a landmark Journal of the American Medical Association study found that for a herniated disk, having surgery and letting the body heal on its own both yield the same result: a 70 percent chance of improvement over the course of two years. "There was a small benefit to surgery, but most patients did just as well with non–operative care," says Dr. Alan Hilibrand, co–author of the study and a spokesperson for the American Academy of Orthopaedic Surgeons.

The challenge of finding the best treatment — like the challenge of back pain itself — can require a healthy dose of patience. "Studies show being angry or stressed will only make back pain worse," says

Feinberg. "That’s why it’s crucial to keep busy, take a proactive role in your recovery, and remember that laughter is the back’s best medicine."

Molly M. Ginty lives in New York. Her work has appeared in Ms., Marie Claire, Redbook, and Women’s eNews.

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