Why is an integrated disciplinary approach to back pain so important? Research has shown that combining various treatment options to address a patient’s back pain is more effective than using only one treatment method. An integrative disciplinary approach may include physical therapy, pain management (such as medications, spinal injections and psychological coping strategies), body mechanics/ergonomics, and various forms of exercise methods, including methods such as Pilates or yoga. Sometimes, back pain can be resolved with one treatment approach, but not always. By combining various treatment options, patients may be able to take advantage of the benefits of multiple treatment modalities, resulting in better outcomes. The goal of this approach is to find the right combination of modalities to relieve back pain and, most importantly, to improve the patient’s overall quality of life. Back Pain Basics – Frequently Asked Questions, Simple Answers Back pain is by no means a trivial matter. In fact, almost everyone will suffer from some type of back pain in their lifetime. Since back and neck pain is a common problem, it is not surprising that there are many unanswered questions. This booklet outlines some of the most common questions NASS members receive about back pain and related treatment and prevention methods. So, what actually causes back pain? Ouch, my back hurts! Almost all of us feel this way at one time or another. Although people often feel back pain, it is often difficult to identify or find the exact source of back pain. In fact, there are many possible sources of pain, including muscles, connective tissue, ligaments, joint capsules, cartilage, intervertebral discs, and nerve tissue. People’s daily activities such as exercise, weight bearing, and sports may cause stretching, straining, or spraining of muscle tissue. Sometimes, a small tear in the outer layer of a spinal disc may cause severe pain. Many people experience pain caused by a degenerated, bulging or even herniated disc. Even if the actual tissue damage is relatively small and will likely repair itself, the pain it causes can be very severe. There is usually a chain reaction to people’s perception of pain. When tissues are irritated or damaged, the body releases large amounts of chemicals in response. These substances “stimulate” surrounding nociceptive neurons, resulting in a pain response. Some of these chemicals trigger inflammatory processes or swelling, which can also lead to pain. This inflammatory process in turn feeds back more signals to perpetuate the swelling. This cycle of inflammatory response may last for days to weeks. How long does back pain usually last? No matter how long back pain lasts, back pain is no fun when it happens to yourself or to someone you love. Unfortunately, the duration and severity of a back pain episode cannot be predicted based on the timing of the episode, the location of the episode, or the severity at the beginning. There are some basic types of pain – acute pain, chronic pain, and recurrent acute pain. The good news is that even if the exact source of the pain cannot be determined, acute pain usually resolves on its own within a month or so as the irritated tissue in the back repairs. In general, about 80% of patients who first present with low back pain can usually have their pain resolved within six weeks. Chronic pain is usually pain that lasts for several months and usually has little association with tissue damage or injury and may stem from a long-term spinal condition or other related factors such as muscle weakness, weight changes, and specific life stressors. Recurrent acute pain is intermittent and can flare up occasionally or come on suddenly. What is the best pain reliever for back pain? About one-third of Americans rely on over-the-counter medications such as acetaminophen and NSAIDs or painkillers to relieve the swelling and pain associated with back pain. These types of medications have proven to be very effective in reducing symptoms and improving comfort. A NASS Survey of Back Pain in America found that one in five people rely on doctor-prescribed medications to treat back pain. Muscle relaxants are not drugs that actually relax skeletal muscles. These drugs work by calming or sedating the central nervous system and helping with sleep and reducing emotional stress or muscle tension Narcotics or opioids are strong painkillers and can help reduce acute back pain symptoms. Because these drugs are sedatives, they also help promote sleep during the first few nights of back pain symptoms. These medications should only be taken under medical supervision as prescription medications. Do I need to lie flat on my back to rest my back when back pain occurs? In fact, the best advice for back pain treatment is not to lie down in bed, but to stay as active as you can tolerate. Consistent daily activity may be counterproductive, and the natural tendency is to lie on the couch to avoid activity. However, what you really need to do is to move as much as possible to get blood and nutrients flowing to the affected area, suppressing inflammation and reducing muscle tension. Many people suffering from back pain find they can move normally, but mainly cardiovascular controlled activities, such as walking, will usually reduce the pain. Strenuous or uncontrolled activities, or heavy lifting, competitive or physical contact sports are not recommended when pain is severe. It is best to consult your doctor before engaging in such activities. Should I ice or apply heat to my sore low back? This is probably one of the most frequently asked questions about back pain treatment. Both ice and heat can help relieve pain, but it is important to know the appropriate time to choose to use them. Ice can reduce inflammation or swelling by decreasing blood circulation. Placing an ice pack on the painful area shortly after the onset of pain (within 48 hours) can help relieve pain. Apply ice to the affected area for at least 20 minutes every two hours, but remember to pad it with a thin sheet or towel to prevent skin frostbite. Local application of ice or heat can temporarily relieve back pain, and the heat helps to stretch and relax the painful muscles, especially after 48 hours of back pain. Either a dry heat pack such as an electric blanket or a wet heat pack such as a hot bath or hot towel can be used. It is important to remember that ice and heat packs do not necessarily speed up long-term recovery. Is my weight important in relation to my back pain? Your physical health is good for the overall health of your spine, and weight control is an important factor in maintaining a healthy back. Being overweight, especially in the midsection or abdomen, can change your body’s center of gravity and place an unnecessary burden on the muscles and surrounding tissues of your back. We recommend keeping your weight within 10 pounds of your ideal weight to avoid suffering unnecessary back pain or related problems. However, it is possible to be underweight. Being too thin can trigger low bone mass and thus the risk of developing osteoporosis. The best advice is to keep your weight under control by maintaining a balanced diet and moderate exercise. What is the best form of exercise to relieve and prevent back pain? Exercise is one of the most important forms of treatment your doctor recommends to reduce your back pain. Regular strength (core strength and endurance or weight training), flexibility (stretching) and aerobic exercise (three to five times a week) will improve your overall health and reduce the likelihood of further back injury. Many doctors and specialists offer patients appropriate exercise skills to help relieve symptoms and prevent further episodes of back pain. Here are a few simple rules to follow when exercising: Do each exercise slowly for five repetitions of each movement, up to 10 repetitions l Remember to start and end your workout with a stretching exercise Can my sleep position and mattress choice prevent back pain? Many people don’t realize that sleeping on your back adds 55 pounds of pressure to your spine, but putting a few pillows between your knees will cut that pressure in half. Sleeping on your side with your knees bent and with pillows between your knees can also reduce the pressure on your back. There are a variety of mattresses to choose from. The mattress and springs work together to support your body while you sleep. You can choose from a variety of mattresses with different firmness and spring types. There is no one mattress that fits everyone. We recommend that when you buy a mattress, you experience it in a store now. Many companies offer a period of free experience where you can experience a new mattress for a month and make sure you are very comfortable and pain free when you sleep on it. What is the correct position to avoid back injury? When you were a child, you probably heard your parents or teachers tell you to “stand up straight”. As simple as it sounds, maintaining proper posture is an important way to keep your back structure and spine healthy, and to help reduce the frequency and severity of back and neck pain. Poor posture or not having adequate back support may increase muscle and spinal stress. Over time, the stresses associated with poor posture can alter the physiological structural features of the spine, causing constriction of blood vessels and nerves, as well as problems with muscles, discs and joints. All of these are major contributors to back and neck pain. Here are some simple guidelines to avoid damaging your back while moving: Stand: Put one foot forward, bend your knee slightly, drop the pressure on your back Sit and stand, keep your hips slightly above your knees while sitting to reduce back strain Stretch, stand on a stool, reach for something located above your shoulders Move and lift heavy objects What is the proper way to avoid damaging your back? Lifting heavy objects and bending over are usually the two main culprits of back pain. Using proper lifting and bending techniques can help reduce pressure on the lower spine and minimize injury. Follow these tips: Use leg strength: When bending or lifting weights, make sure to bend your knees so you can use your leg strength to distribute the weight more evenly. Adopt a squatting position with your chest extended forward and your hips extended backward. This position allows you to keep your lower back in a more neutral, secure position. Weights close to your body: When you lift and carry a heavy weight, the weight is as close to your body as possible. Balance the load: Holding two smaller objects in two hands (one in each hand) is easier than holding a larger object in one hand and will reduce the pressure on one side of your body. Avoid twisting your body: One way to cause damage to your back is to twist your body when lifting heavy objects, as this can cause too much pressure on your low back. Push rather than pull: It is easier to push than to pull. Use your arms and legs to push things. If you have to move heavy objects, don’t do it alone, get help with a piece of pushing. If I have chronic back pain, will I have better results with surgery? There is no simple answer to this question. Treating chronic back pain will depend on the type and source of the back pain. If a treatable source of pain is identified, then the pain can be addressed at the cause. When the underlying cause is not specific or does not submit to treatment, then symptomatic treatment will be administered. The goal of treatment is to reduce pain, improve quality of life and increase function. There are several different methods of treating chronic back pain. These include physical therapy, medications, psychological coping skills, surgery and alternative therapies. Your treating physician should tailor a treatment plan that is right for you, combining a variety of approaches to meet your needs. In fact, 90 percent of NASS care members offer non-surgical treatment options. We have found that only 1% of back pain patients require surgical treatment. How do I choose a specialist to treat my back pain? Which specialist is best? An NASS report showed that more than half of back pain survey respondents turned to a back or spine specialist, such as a chiropractor, physical therapist, physical therapist, orthopedic surgeon or neurosurgeon. Your primary care physician should help you find the best specialist for your symptoms. Each health care program is tailored to the specific medical needs of the individual patient.