|
 TREATMENTS AND
CAUSES
OF BACK PAIN:
WHY BACK PAIN
OCCURS...
The spinal column contains muscles, bones, ligaments,
nerves, and other soft tissues that provide support,
movement, flexibility, and transfer of nerve impulses
throughout the body. When these tissues are injured as a
result of lifting, twisting, falls, car crashes, or
other trauma, persistent pain may occur. Pain is a sign
of nerve irritation which occurs either as a result of
direct pressure on nerves or a reduction in blood supply
to them. Pain may not be present at first, but may
appear later as a result of inflammation, which in
itself may produce substantial pressure. (Other causes
of back pain include infection, tumors, and kidney
disease, but these are much less common.
The true major cause of back pain and spasms, simply
put, is muscle weakness. Secondary effects of spinal
weakness include loss of alignment, disc degeneration,
disc displacement, fractures, and nerve compression
leading to pain, numbness, spasms, and weakness.
We now understand that 80% of back support is muscular.
The huge erector spinae muscles and the smaller
multifidus muscles provide most of the support and
stability of the spine. (The abdominal muscles play a
very small role.) Some 85% of the population over age 15
are decompensated, i.e. they have mild to severe degrees
of back muscle weakness or atrophy.
Back pain and spasms occur as a result of our modern
sedentary life style. Inactivity causes both muscle
atrophy and decreased blood circulation.
As a result,
sooner or later most of us develop some deterioration.
No wonder then that many of us develop back pain or back
spasms for what seems to be no apparent reason. The good
news is that most of
the changes that have occurred are
almost always totally reversible.
When the first sign of
back pain is the result of even a simple
movement - e.g.
bending, twisting, walking - this is strong evidence
of
lumbar muscle weakness.
TREATING BACK PAIN - WHY MOST METHODS DON'T WORK
Acute back pain often it resolves on its own.
Occasionally it does not.
Rest, ice, anti-inflammatory
agents or pain killers may help. But acute
pain is
almost always a sign of muscle atrophy and needs to be
investigated and treated properly. And as our patients
quickly learn - rest, massage, injections, heat, and so
forth - are at best short term solutions.
When back pain results from severe trauma, a spinal X-ray or
magnetic
resonance imaging (MRI) will help rule out
major damage. And if the spine
is out of alignment or a
disk has been partly dislodged, a quick visit to the
chiropractor may provide immediate pain relief. But when
back muscles
are weak, adjustments may not hold for
long. Acupuncture likewise may
help by reducing pain and
inflammation, but many of these patients need continual
treatments over a relatively long time period. And
acupuncture does not strengthen or stabilize a weak
spine.
What about surgery? Very few back injuries require
surgery, and most surgeons are selective about choosing
their patients. For example, if
a disk is damaged and is
contacting a nerve, a microdiscectomy may
be a good
choice. But even following severe trauma, a physician
may
elect "conservative treatment," including some brief
bed rest,
anti-inflammatory agents, either by mouth or
by injection, or perhaps physical therapy.
The success
rate of most of these procedures is marginal - good data
to support these methods are sparse, the pain may go
away on its own,
but most importantly these treatments
do not address adequately the
basic problem - the
problem of muscle weakness.
Chronic back pain, i.e. pain lasting for six months or
longer, can be a
serious problem. Again, disuse of the
lumbar muscles results in severe atrophy. There may be
other changes as well. While cortisone injections may
relieve the pain of inflammation briefly, it cannot cure
chronic
low-back pain. However, a proper approach to
back strengthening
can have huge success in reducing and
eliminating back pain quickly,
even in patients who have suffered from chronic back
pain for over
thirty years.
|
