80% of people have sought help for an aching back at least once. The commonest cause for low back pain is muscle strains or injury to the soft tissues in the back. Other causes include degeneration (breakdown) of the discs that cushion your spine. These discs may slip forward and press on nerves. The symptoms are pain in the lower back that may sometimes spread down either or both legs. Leg pain is called sciatica. Back pain may also result from injuries from a fall or heavy lifting. Sometimes back pain may be due to tightening (spasm) of the back muscles from stress. Infection, cancer and damage to the nerves may also produce back pain.

The technique of proper lifting is important. The farther from your body you hold an object you are lifting, the greater the potential for damage to your disc. Bend from your knees and keep the object close to your body when you lift. Do not twist, bend or reach while lifting as this can increase stress on the back. Back muscles play an important part in stabilizing the spine; enabling it to carry the body's weight and to withstand stress. Most back problems are related to muscle strength. When these muscles are strong the chances of injury are much less. Aerobics or regular exercise e.g. walking or biking for up to 20-30 minutes daily can build strength and flexibility in the back muscles. Water aerobics (in a swimming pool) enable you to exercise your back with less discomfort because in water, you weigh only 10% of your body weight. If you are overweight, you need to lose weight to reduce the stress on your joints. For every ten pounds you lose, you save 200 pounds of stress on your joints. Avoid sitting too long and try standing at intervals. If you drive long distance, stop frequently to walk around. On the other hand, if your work requires you to stand for prolonged periods of time, then shoe insoles may be helpful. Correct posture is important. Use a firm mattress or bed board while you sleep or rest in bed. Whenever possible sit in recliners or straight back chairs that have armrests and adjustable lumbar supports. If you do not have such a chair, you may use a regular chair and place a support pillow or rolled towel against the lower curve of your back while you sit. If you smoke, you should try to quit. Smoking may reduce blood flow to the discs in your back and cause premature breakdown. For backache, you may take aspirin or other over-the-counter pain relievers such as Tylenol. These medications decrease the production of prostaglandins that cause pain. Take the medicines with food to prevent stomach upset. If you are overweight, you need to lose weight to reduce the stress on your back. Keep your weight down by reducing fats, cholesterol and sugar.

A day or two of rest may offer some relief but more rest may delay your recovery. Sleep on a firm mattress or hard floor. The most comfortable position is usually lying on your side with knees bent. You may find additional relief by using one pillow to support your head and putting another between your legs. Avoid lying flat. Whether on your back or on your stomach, lying flat puts too much stress on your lower back. If you must lie on your back, have your knees propped up by a pillow. Take pain relievers, such as aspirin or Tylenol. If you have been injured, apply ice packs two or three times a day for one or two days. Exercises to strengthen your back muscles are very important and can be done at home (see below). If your back pain is not due to a recent injury, your doctor may give you deep heat treatment with ultrasound or diathermy machines. Deep heat allows the tissues to heal faster and reduces the pain and muscle spasm. Your doctor may prescribe medications such as muscle relaxants to ease the tension in your back muscles.

A good relaxant is Lioresal or Zanaflex. Both of these medications are very effective and do not make you as drowsy as the other relaxants e.g Robaxion, Soma, Flexeril. If you have sciatica (nerve pain running down your leg), your doctor may also prescribe antidepressant medication like Elavil or Paxil. St. John's Wort, a herbal antidepressant is just as effective. These medications have been found not only to help with depression but also to relieve sciatica and other types of nerve pain. To ease the pressure and stress on your back, you may use a back brace to support yourself - until you exercise and strengthen your back and abdominal muscles. A strong but gentle anti-inflammatory medication is Tolmetin sodium. It is 10 times stronger than Motrin and very effective if some of the pain is due to arthritis of the spine. Strong short acting painkillers such as Vicodin ES or Norco 10 may be given. If you have chronic low back pain, you may need a long acting narcotic medication like Oxycontin which is taken twice daily.

The short acting pain killers are then used in between for relief of breakthrough pain. These pain killer drugs should be used carefully so that they do not produce drug dependency. If you have had backache for less than six weeks duration, your doctor may not prescribe X-rays. This is because most backaches are caused by soft tissue such as muscles, ligaments or discs that don't show up on X-rays. However your doctor may order X-rays, CT-scans, bone scans or MRI if your backache does not get better or if he or she suspects a specific problem with your back such as degenerating discs, spinal curvature, arthritis of the back joints (facet joints), cancer or fracture. With chronic backache, you may sometimes get relief from electrical stimulation devices (such as TENS units) which transmit short electrical impulses that trigger the release of the body's natural pain-killing hormones. Acupuncture can reduce inflammation and swelling and is effective in many people. Acupuncture involves treatment of pain by inserting tiny solid needles at various points and depths in the skin. These needles may be manipulated by hand or electrically stimulated. The pattern of needle placement is governed by a series of body points described in ancient Chinese texts. Each body point represents an internal body part. The actual placement of the needles is based on the practitioner's interpretation of the distribution of the yin (cold or low-function) and yang (heat or high-function) in a particular body part. Spinal manipulation is another effective treatment that is often done by a chiropractor. Treatments typically consist of short level thrusts to the spine. These may be combined with massage, traction, ultra-sound or muscle stimulation. Your doctor may use biofeedback or meditation to help you learn to relax. In some instances, your doctor may perform an epidural injection of steroids and anesthetics such as Lidocaine. These medications are injected into your back and decrease swelling and nerve pain from bulging discs, or inflamed back joints (facet joints). In severe cases of back pain, a little tube may be implanted in the back (epidural or spinal catheter) to allow continuous or intermittent delivery of pain killers to the nerves coming out of the spine. Prolotherapy is another type of treatment with injections of highly concentrated Dextrose and Lidocaine to strengthen the ligaments of the back. Surgery is sometimes necessary if there is weakness in the legs, bladder or bowel problems or severe back pain which does not get better with medical treatment.

Call your Doctor if over-the-counter painkillers do not relieve your pain, if you have fever, weakness or numbness in your legs, loss of bladder or bowel controls.

National Organization: The Back Pain Association of America (P.O. Box 135, Pasadena Maryland 21122; Ph: 1-410-255-3633) and the Federal Agency for Healthcare Policy and Research (1-800-358-9295) produce informational booklets about low back problems. You may request brochures and information on water aerobic programs from The Arthritis Foundation (1-800-283-7800).

Exercises for the Lower Back

1. While flat on your back, bend your knees leaving your feet flat on the floor about a foot apart. Tighten your stomach and buttock muscles and lift your buttocks off the floor as far as you can without arching your back. Hold for a count of 10, then slowly lower your buttocks to the floor. Repeat until difficult.

2. To strengthen abdominals, lie on your back with knees bent and feet flat, about a foot apart. With your arms crossed over your chest raise your head and shoulders, but keep the small of your back flat on the floor, and count five. Slowly lower your upper body. Repeat until difficult.

3. To stretch hamstrings, stand upright and extend your right leg onto a chair or desk that's near a wall. Place your right hand against the wall and, pivoting on your left foot, turn slightly to the right. Hold the stretch for 20-30 seconds, then repeat with your left leg.

4. Standing upright, reach behind you with your right hand and pull your left foot up to touch your buttocks. Hold for 30 seconds, and repeat with right leg.

5. Lying on your bed with both feet on the floor, pull both legs up to your chest holding one and letting the other slowly drop to the floor. Hold for 20 seconds, then repeat with the other leg.

Check with your doctor before beginning any exercise program. Note: All medications mentioned on this site--including, specialty compounded ointments such as Capsaicin, Gabapentin, Ketamine, Vitamin E--may be ordered directly from L.A. Pain Clinic.