Say No to the Knife
You don’t have to lift heavy objects all day at work or be a weekend warrior to suffer the scourge of back pain. Office workers, mothers, old and young people, those who exercise and those who don’t all have to endure it; back pain (often called low-back pain) is an equal opportunity ailment. With 31 million Americans experiencing it at any given time, it’s the leading cause of disability in people younger than 45.
Treating back pain is big business. In fact, the U.S. spinal surgery rate is twice that of most developed countries and five times higher than in the United Kingdom. But while some sufferers do require spinal injections or even surgery (see “When to Bring Out the Big Guns,” below), such interventions are often unwarranted, even if tests seem to reveal a potential need. “On an X-ray, almost everyone 40 and older will have something that looks abnormal,” explains Richard Deyo, M.D., M.P.H., a professor of evidence-based medicine at Oregon Health and Science University in Portland and a deputy editor of Spine magazine. The same is often true for younger people.
What complicates treatment is the fact that the converse often applies as well: “Only in a minority of people is there a clear-cut underlying cause for the pain,” says Daniel Cherkin, Ph.D., senior investigator for Group Health Research Institute in Seattle.
“The fact that so many treatments exist is testimony that none is clearly superior,” Deyo says. “Lots of claims really aren’t supported by scientific evidence, and it is almost always best to use noninvasive treatments first.” People often see improvements quickly. “Within 12 weeks, nearly 95 percent of back pain patients can return to work [without surgery],” Deyo says. So before you opt for a potentially unnecessary and ineffective invasive procedure, try these kinder, gentler remedies.
IN THE BEGINNING
When severe back pain strikes, you may be inclined to stay in bed. But Deyo advises resting for just a day or two if necessary, along with taking over-the-counter painkillers and applying heat. After two days, start taking gentle walks. If the pain doesn’t improve within a few weeks, see your primary care physician for an exam. Depending on what he finds—if he suspects a herniated (bulging) spinal disk is pressing on a nerve, for example—he may recommend an X-ray, MRI or CT scan. But such tests are often inconclusive.
If there is no obvious “why” for your pain, your doctor may suggest physical therapy, education about proper movement and an exercise program to avoid re-injury. Once your pain gets a bit better, many alternative or complementary therapies—such as those that follow—can ease muscle tension and inflammation; help prevent long-term problems by improving muscle strength and core stability (weak abdominal muscles may be a big contributor to back problems); and help you cope emotionally. And here is the silver lining—many of them feel good.
GO INTO YOGA THERAPY
Unlike a large yoga class with one instructor, a yoga therapy session is one-on-one or one-on-two, and the postures are specific for a person’s back issues. “Iyengar is the most therapeutically oriented type, but most will work,” says Loren Fishman, M.D., medical director of Manhattan Physical Medicine and Rehabilitation in New York and author of Cure Back Pain with Yoga (W.W. Norton). “Look for an instructor who has at least 10 years of experience as well as education in anatomy and pathology.” Fishman says yoga can be particularly helpful if you have arthritis of the spine or piriformis syndrome, in which a muscle in the buttock contracts and compresses the sciatic nerve.