The Truth About Back Pain

You tweaked your back raking leaves and now, months later, it still hurts. All you want to do is lie in bed. You’re starting to worry you may need surgery.

While back pain is very common, the need for back surgery is rarely necessary. “Surgery is not always the answer,” explains Kumar Dharmarajan, MD, MBA, cardiologist, geriatrician, and Associate Chief Medical Officer, Clover Health.

“Sometimes surgery doesn’t help, and it could even make things worse.”

For chronic back pain— typically defined as pain that lasts longer than three months—there are many non- surgical options that can help, provided you don’t have a structural deformity in your back or acute pain from a fracture or herniated disc.

“There are therapies that can help and may even strengthen your core and your back to prevent future chronic pain and injuries,” says Dr. Dharmarajan.

Risk Factors

Many treatments for chronic back pain are focused on decreasing risk factors, says Jessica Son, MD, Chief Medical Officer, Clover Home Care. “If you’re overweight, for example, that can cause a lot of stress on the back,” she says. “Smoking is a risk factor too.”

Added weight tugging on your spine makes sense, but smoking?

Here’s how that works: Smoking restricts blood flow and oxygen to the lower back, which causes the fluid- filled discs that cushion your vertebrae to degenerate faster than they should.

Other back pain risk factors include:

Aging.

As we get older, we lose some of the fluid that acts as a cushion between the discs of our spine. We also lose strength in our bones and elasticity and tone in our muscles.

Activity level.

People who do moderate, daily physical activity are less likely to have back pain than those who don’t exercise regularly. And adults who don’t exercise at all are more prone to weak muscles in the abdomen and back, which means weak support for the spine.

Genetics.

Some causes of back pain just run in the family, such as a form of arthritis that causes the spinal discs to fuse.

Job stress.

Lifting heavy boxes, pushing or pulling large carts filled with merchandise, or bouncing around in a truck all day—there are many ways that jobs can irritate our backs. Even sitting at a desk for eight hours a day may lead to problems, especially if your posture isn’t great and your chair doesn’t provide the right support.

Mental health.

Stress often causes tension in your muscles, which can lead to chronic back pain. Additionally, anxiety and depression can affect how you perceive that pain and cause you to focus on it more.

What can you do?

First, talk with your doctor. Speak up when you first notice back pain.

Be prepared to describe the pain. Is it sharp? Dull? Does it come and go? Is it worse in the morning or evening or while doing certain activities?

Together, you and your doctor can create a treatment plan that’s unique to you and identify where you might need extra support.

For example, if your weight is causing problems, they can help you create a weight-loss plan. They can also help you find the best kind of activity for you or help you quit smoking.

“Exercise can combat back pain in multiple ways,” Dr. Son explains.

“It can help you lose weight, strengthen muscles to support the back, and release the mood-lifting chemicals that naturally occur in the brain.”

Work with your physician to create an exercise routine suited to your abilities so you don’t end up straining yourself or hurting your back more.

Ask your doctor if physical therapy is an option for you. A physical or occupational therapist can suggest targeted exercises to address your specific area of pain.

Four activities that generally help with back pain are:

1. Walking.

2. Aquatic walking—a nice option to avoid stress on your joints.

3. Tai chi—which can ease chronic osteoarthritis pain throughout the body.

4. Stretching and gentle, restorative yoga.

“The less pain you have during an activity, the more likely you are to stick to it,” notes Mehul Desai, MD, MPH, a board-certified physician who specializes in musculoskeletal pain and disease.

Although you may want to crawl into bed when your chronic back pain acts up, Dr. Desai says remaining active is the single best thing you can do when your back is actively hurting.

It’s also a prevention for future low back pain. Seemingly small activities like walking to the store or taking the stairs throughout the day help. “Little things tend to add up,” he says.

Joint Pain

Dr. Desai explains that one of the most common causes of low back pain in older adults is a type of arthritis called facet hypertrophy or facet joint disease. This condition occurs when the joints between our vertebrae wear down. Eventually, vertebrae may rub together.

Symptoms depend upon where on your spine the joints are affected. “We can feel these symptoms particularly when we stand or walk for prolonged periods,” Dr. Desai says.

“The pain might also come first thing in the morning when we try to get out of bed but get that ouch feeling as we stand. Then we tend to hunch forward a little.” Typically, facet joint issues are treated conservatively with heat therapy, anti- inflammatories, or acetaminophen. Physical therapy or stretching and strengthening exercises that focus on the abdominal and low back muscles are also helpful.

Depending on your condition, your doctor may suggest additional nonsurgical treatments.

Next Steps

While surgery may become an option if all other therapies fail, Dr. Desai warns that much of chronic low back pain is “nonspecific.”

That means it’s often difficult to have an absolute diagnosis since there could be several factors contributing to it.

For instance, you might have a pinched nerve, but you could also have arthritis in your knee that is changing how you walk and throwing off your overall alignment.

“You may trade one set of symptoms for another. There are very few surgeries that have shown outstanding effects in those circumstances where low back pain is the primary problem,” Dr. Desai explains.

Typically, the best way to treat your back pain is to work closely with your doctor to figure out what works best for your body, your lifestyle, and your goals.

This article was originally published in the winter 2022 issue of Clover Living magazine.

This article was medically reviewed by Dr. Kumar Dharmarajan

 

Published on 3/9/23

Photo credit: Getty