Thursday, January 3, 2008

Low Back Pain: Treatment and Prevention

Ask Glen!

Q. Glen! I am a men that suffers from Lower Back Pain, Are there any treatments available?

A. About three of every four men have endured a bout of low back pain, and many have had repeated episodes. The pain may begin gradually or suddenly; it may be mild or severe. In most cases, doctors cannot pinpoint the cause of the pain, and in most cases x-rays and blood tests are useless. In fact, even advanced imaging techniques such as MRIs and CTs are not recommended for typical patients.

Most people with low back pain can handle the problem themselves, sometimes with the aid of a phone call or visit to their doctor and the short-term use of simple medications. But there are exceptions; the list below details situations that call for prompt medical attention.

Warning signs: When to worry about your back

  • First episode before age 20 or after 55
  • Recent major trauma, including motor vehicle accidents, falls, and severe sports injuries
  • Radiation of pain down a leg, particularly if accompanied by:
    • Numbness or loss of sensation
    • Weakness or loss of muscular strength
    • Impaired bowel or bladder control
  • Constant pain that is not affected by motion
  • Pain in the upper back or chest
  • Pain that increases at night or when lying down
  • Unexplained weight loss of 10 pounds or more
  • Unexplained fever
  • A previous diagnosis of cancer
  • Use of corticosteroids or other immunosuppressive drugs
  • History of drug abuse
  • History of a major chronic medical illness

If you have one of the warning symptoms in the list, consult your doctor. But if you have garden-variety pain, you may well be able to take care of it yourself — and you certainly should take steps to keep your back in shape.

What to do

Until recently, doctors recommended elaborate programs of bed rest, traction, or therapeutic exercises for acute low back pain. Not anymore. Careful studies show that none of these programs help. The best plan is to return to normal activities as soon as you can. Don’t try to do special back exercises while you are in the throes of pain, but don’t stay in bed any longer than you have to either. In fact, gentle activity can help you walk away from pain. Above all, use common sense. Avoid prolonged sitting, heavy lifting, and repetitive bending and twisting motions. Be as active as your pain will allow, but don’t push too hard; you may not need strict bed rest, but you certainly won’t benefit from forcing yourself to be up and around in the face of pain. When you rest, lie on a firm surface such as a good mattress, a mattress with a bedboard under it, or the floor. When you sit, select a chair with good low back support. As you improve, spend less time resting, more time standing and walking.

Many people with acute back pain find ice packs helpful, at least during the first two or three days. Use a gel pack that you chill in your freezer or simply put some ice cubes in a plastic bag surrounded by a thin towel. Apply cold to the spots that hurt most for 10–20 minutes three to four times a day. After a few days, switch to a hot pack or heating pad on a similar schedule. But don’t be dogmatic; there is no firm scientific evidence favoring heat or cold, so do what feels best to you or do nothing at all.

Expect to recover, but expect it to take some time, and be prepared to accept some ups and downs as you get better. And along with the pain, expect to endure endless doses of well-intended advice. Nearly everyone has had back pain, and nearly everyone “knows” something that worked wonders. Listen politely, but don’t try anything radical.

Demystifying the scans

In an ordinary x-ray, a stationary generating tube beams x-rays through the patient; body tissues that are dense (such as vertebral bodies) impede the passage of x-rays, while tissues that are less dense (such as the disks between the vertebrae) allow them to pass through the body to a sheet of film behind the patient. Like ordinary photos, the film is developed to produce a negative that is placed on a lighted screen for viewing; dense tissues appear white. A typical series of lower spine x-rays takes about 20 minutes, and exposes the patient to 1,200 millirem of radiation, about four times the amount of radiation people get from natural sources each year.

Computed tomography (CT scanning) is an imaging technique that also relies on radiation. The x-ray generating tube rotates around the patient, beaming x-rays through the body. The x-rays that pass through are collected by detectors that produce an electrical signal that is channeled into a computer. CT scans provide much more detailed information than ordinary x-rays, and it is displayed in panels that depict very thin cross-sectional “slices” of the body’s anatomy. A CT scan of the lumbar spine takes 10–15 minutes and exposes the patient to 4,000 millirem of radiation.

Magnetic resonance imaging (MRI) does not expose the patient to radiation. Instead, it applies an intense magnetic field and pulses of radio waves to the body. In response, radio signals are emitted from hydrogen atoms in the body (mostly in the body’s water). These signals are captured by detectors and analyzed by a computer to produce images of unsurpassed clarity and detail. An MRI of the spine takes about 45 minutes. MRIs and CT scans are expensive, and charges and reimbursements vary widely around the country.


In our medicated society, there is a pill for nearly everything — and in the case of back pain, there are lots of pills. None of them will actually speed your recovery, much less prevent recurrences. Still, medication can reduce pain and hasten your return to normal activity.

Use only what’s necessary. Government guidelines suggest starting with a simple pain reliever like acetaminophen (Tylenol and other brands). It may be less potent than other medications, but it has fewer side effects; use high doses, but don’t exceed 1,000 mg four times a day.

Most doctors recommend a nonsteroidal anti-inflammatory medication (NSAID) as the basic treatment. You can try a nonprescription product such as aspirin, ibuprofen (Motrin, Advil, and other brands), or naproxen (Aleve and other brands), or you can ask for one of the many prescription NSAIDs. Older people and those with gastritis or gastric bleeding problems might be better off with the selective COX-2 inhibitor celecoxib (Celebrex) — but patients with cardiovascular risk factors should use it with great caution, if at all. Stronger prescription painkillers and narcotics are rarely needed.

If you have intense muscle spasms, your doctor may prescribe a muscle relaxant such as diazepam (Valium), cyclobenzaprine (Flexeril), carisoprodol (Soma), or methocarbamol (Robaxin). These prescription drugs are of uncertain benefit and are usually recommended for short-term use. Finally, an antiseizure medication such as gabapentin (Neurontin) appears to help relieve the nerve pain from sciatica; doctors may prescribe it for this purpose even though the FDA has not approved it for this use.

Alternative therapy

Your doctor can’t do much to speed your recovery from ordinary mechanical low back pain. In most cases, he simply makes sure that you are not one of the few back patients with a serious problem, provides the medications you need for short-term pain relief, and encourages a common-sense return to normal activities instead of bed rest. But if physicians are of limited value for the average patient with acute back pain, can other practitioners do any better?

In a few cases, perhaps. Small studies have suggested that patients who receive spinal manipulation from chiropractors or osteopaths require less medication and are more satisfied with their care than people who receive standard treatment. It’s not clear if this benefit is due to the adjustment therapy itself or is the result of the extra time, hands-on care, and encouragement that patients receive. However, the differences are slight — which is no surprise, since the vast majority of patients recover with any form of intervention or with no treatment at all.

Although physical therapy and back exercises may help patients with chronic back pain, they are not effective for acute episodes. Massage therapy appears to help people feel better, but its advantage over standard care is small, and studies that demonstrate a benefit have been questioned on technical grounds. Although acupuncture can help with various types of pain, acupuncture and acupressure have had mixed success with back pain; some studies show modest benefit, others none.

Unsuccessful therapies

It’s a long list. Bed rest is the biggest surprise and the greatest disappointment; long the mainstay of treatment, it actually makes things worse. Traction, back braces and belts, lumbar supports, back school, transcutaneous electrical nerve stimulation, and antidepressants have all been flops.

Other treatments

Most acute low back pain will resolve with a simple, conservative, self-directed program. Even so, some men require additional treatment, as do many patients with chronic or recurrent pain. A physical therapy rehabilitation program can be very helpful. It typically involves an exercise program to improve posture, body mechanics, flexibility, and strength, and it may add modalities such as heat or cold treatments and ultrasound. If physical therapy doesn’t do the trick, doctors may treat selected patients by injecting steroids into the painful area. Preliminary studies suggest that injections of botulinum toxin (Botox) may relieve painful muscle spasms. Surgery is also available. It may be mandatory, even urgent, in cases of complicated back pain, but it should be the last resort for uncomplicated pain. If a herniated lumbar disc is responsible, a lumbar discectomy with magnified vision is usually the preferred approach. Laser surgery and endoscopic procedures are being studied but are still experimental. Needless to say, different surgical approaches may be required to treat other problems.

Keep your back in shape

The back exercises, posture tips, and instructions for lifting shown below may help. A good mattress and supportive chairs also make sense. But the best way to prevent back pain is to keep the rest of your body healthy. Aerobic conditioning is paramount; active, fit men have less back pain than sedentary, out-of-shape guys. Swimming, walking, and biking are particularly desirable for men who have had back pain in the past. A good diet will also help — not by nourishing bones and joints, but by preventing obesity. The old-time docs had it right when they said you could never be too thin for your back.

Hints for a happy back

Stand with your head up, your chin in, your back flattened, and your pelvis straight.

Sleep on a firm mattress. If you lie on your back, place a thin pillow under your knees.

Bend from your hips and knees, not your back.

Hold heavy objects close to your body when you lift or carry.

Sit as close to the pedals as you can without compromising air-bag safety or good driving. Consider a firm backrest if your seat is soft.

Select a firm chair with a straight back and use a footrest for prolonged sitting.

Sit up straight; when you lean forward, bend from your hips instead of slouching.

Exercises for a healthy back

Use these exercises to help prevent back pain; if you’ve had pain, wait until you are pain-free to begin. Lie on a firm mat or carpeted floor. Begin slowly, build up gradually, and back off if you experience pain. Hold each position for a count of 10; then exhale and relax. Repeat each exercise 3 times at first; then build to 8–10 repetitions. Do your exercises 3–4 times per week. Consult a physical therapist or physician if you have chronic or recurrent back pain.

Hamstring stretch

Alternate hamstring stretch

Sitting back bend

Half sit-up

Knee-to-chest raise

Pelvic tilt

Elbow prop-up


Hip hyperextension

Back to basics

Because it’s so common, back pain is the subject of intense discussion, both among health care professionals and the general public. Everyone with a back, it seems, is an expert; programs for prevention spark debate, theories about causation ignite controversy, and treatment plans start wars. If you’ve found a way to live with your back, stick with it. If you need more help, listen to the options; then decide what’s best for you. For most men, a conservative, self-directed program will control acute low back pain. But whether you treat yourself or get professional help, you should always listen to your body, staying alert for the signals that could indicate serious trouble. Fortunately, such warnings are uncommon. For most men, basic care will banish backaches.

Any personal health questions or problems mental or physical or before starting any diet or exercise program. Please consult your physician !

My mission is to provide you with "Trusted Advice for a Healthier Life."

Yours in good health

Any questions?

Ask Glen!

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Lawrenceville, Georgia, United States
Is the Founder of Fitness Builders 4 Life,the WorkOut GEM,G350,G180, G90, Eat 4 Life, Clean, Lean & Mean & Ask Glen. The mission of the Fitness Builders is to provide the community with health education and to empower people to change unhealthy lifestyles thereby increasing life expectancy. By educating the community on healthier lifestyle practices it is the intent of Fitness Builders to reduce the ravages of obesity, heart disease, cancer and other lifestyle or self inflicted diseases. Glen is also a AMA Certified Nutrition Specialist and a ACE, ACSM, NASM Certified Personal Trainer has 30+ years in Sports, Exercise Science and Nutritional Food Management, Learning and Mentoring Men and Women on a more Mental & Physical Healthy Life Style consisting of a low fat, low salt, Low carbohydrate, high protein, organic nutrition which also includes moderate exercise and mental awareness. Stay Informed, Live long and be Mentally and Physically Healthy! Any questions? Ask Glen!

Any Questions? Ask Glen!