The New Year is a typical time for resolutions, and one of the most common ones is to get healthier. For many of us, a common stumbling block is dealing with low back pain. As a rehabilitation medicine physician, my focus is nonoperative spine care within one of the top orthopedic practices in the country. Let’s talk about the causes of low-back pain and what we can do about it.
1. Can we blame COVID? Actually, maybe we can! A majority of those with desk jobs witnessed a dramatic shift to working from home. Sitting is the position that places the greatest pressure on our lumbar discs, and when we sit for long periods of time, in theory, we accelerate the degeneration of these discs. While discs themselves are not typically painful, when they move out of place and touch a nerve, we can create sciatic symptoms. Start by being conscientious of your posture.
Avoid slouching down to your laptop and try to raise it to eye level. When possible, stand for periods of time while working (you’ll need to modify your workstation to do so).
2. Actually, let’s blame our parents. Casting this blame is not so easy. While I’m sure most of us have parents that have complained of back pain at some point, only a portion of degenerative changes are inherited. The vast majority of them come from typical wear and tear that we all experience. Think of your body as a car. The parts are known to wear down over time. As we start to live longer than our predecessors, we have our own parts that show their wear and tear. Call them the “gifts of old age.”
3. We need to be frank about our weight. We can accelerate our degeneration by placing a larger amount of weight on our spine. Think of our spine like the inner structure of a building. The more weight you place around the structure, the sooner it starts to wear over long periods of time. When we are overweight, we can predispose ourselves to all kinds of injuries, and our spines are not immune.
4. Exercise makes it worse.
Sometimes exercise causes our backs to hurt, so start off with something simpler, like walking. Walking is excitingly effective, and everyone has access to it. Start with 20 minutes of brisk walking at least five days a week religiously, and move up from there.
If your back hurts even after you walk, go see your doctor. Often a course of physical therapy will give you the confidence and the ability to tolerate exercise better, and you’ll have a firmer understanding of your limitations (or usually lack thereof) when it comes to exercise.
5. It’s not your back at all. The kidneys, the gastrointestinal system, and the gynecologic system are a few of the organs whose problems can mask as back pain. Your primary doctor or a back specialist should be able to sort out what is coming from your back and what is not. Additionally, depression and anxiety have been implicated in back pain, as well as smoking.
6. Sleep. Our sleep position can have an impact on back pain. We are laying in one position for hours at a stretch, and certain positions can worsen the pain. While lying on your stomach for short periods is okay, sleeping on your belly for hours likely places a larger strain on your neck and back than is normal. Try a pillow between your legs when on your side or one behind your knees while lying flat.
7. Other causes of back pain. Back pain is usually a benign condition, but there are uncommon instances when it is not. If your back has been hurting for longer than a few weeks, if it is worsening, if you are losing weight, if you have trouble controlling your bowel/bladder, or if the pain wakes you up from a restful sleep, then you need to see your doctor.
While a primary care physician is very equipped to deal with low back pain, seeing a nonoperative spine doctor is a great place to start. Look for a physical medicine and rehabilitation specialist or a pain management specialist near you. Typically, we start with X-rays of the low back and a course of physical therapy or chiropractic care. Sometimes medications are added. When the pain persists, or when a more serious issue is occurring, an MRI is ordered. Your doctor can talk to you about injections or surgical referral whenever indicated.
One thing that you definitely should pass on to your children, if not your genes, is your mother’s voice, reminding you to sit up straight!
Madhu Singh is a physical medicine and rehabilitation physician.
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