When Your Back Attacks

It's the most chronic discomfort most of us will endure. How can we fight back pain?



From getting out of bed to cleaning the dishes, there are few regular motions that don't require a healthy, pain-free back. Which is why most of us will suffer varying degrees of back discomfort at some point in our lives. We can take steps, though, to help minimize — or prevent — those days when even standing up can be a chore.

According to Dr. Raymond Gardocki of the Campbell Clinic, there are two primary kinds of back pain: muscular stress due to overactivity and injury to a disk in the spine (often leading to herniation). Causing a range of pain that the Campbell Clinic measures on a scale from one to ten, each kind of injury can be avoided and, Gardocki notes, 80 percent — when treated properly — will heal on their own.

Muscle strain (or ligament strain) in the back often occurs when a person performs an activity for the first time in a while, whether it's an exercise regimen or household chores. Bad habits alone — slouching at your desk, slumping into the couch at night — can lead to what's called "nonspecific backache," the wearing down of back muscles to the point normal activity becomes painful.

Particularly as we get older, stretching becomes a key ingredient to avoiding muscular back pain. Notes Gardocki, "The typical weekend warrior who drinks a six-pack then goes out to play softball for the first time in six months is a bad setup. You're asking for a problem."

As for damage to the disks that serve as shock-absorbers for the spine, Gardocki relies on a familiar metaphor. "A disk is sort of like a jelly donut," he explains. "Firm on the outside, soft and squishy on the inside. You can get tearing in that outer lining, which causes back pain. That can subsequently lead to disk herniation, where liquid actually squeezes outside that tear. A disk herniation will typically put pressure on a neural structure, and give you leg pain. Once people have a herniated disk, they typically complain more about the leg pain than the back pain. Based on where your pain is, we can typically tell which nerve [in the back] is compressed and where the herniation is."

The disk's nucleus loses hydration in the natural aging process, which is why, as Gardocki says, "accountants who never do anything get herniations just like heavy laborers."

Once diagnosed, how do we take arms against a disk ailment? Gardocki cites three methods, starting with physical therapy. "The best way to avoid this kind of pain is with good core strength," he says. Even regular exercisers will often focus on arms and legs at the expense of their body's core. "The classic case," according to Gardocki, "is the guy at the gym who can do 150-pound curls, but can't do two sit-ups." Crunches — in the sit-up position, but only lifting the shoulder blades from the floor — are a good place to start core strength training. (Be wary of exercise machines that require twisting motions, as they place an unnatural load on the spine.)

Beyond physical therapy, oral medication can be prescribed to reduce inflammation. And if the pain is severe enough (six or seven on the Campbell Clinic scale), an epidural steroid injection can specifically target the source. "If you reduce the pain in the leg when you do it," explains Gardocki, "you've hit the spot. It can get better within minutes in terms of acute relief. Long-term, it's variable."

Most importantly, remember there are as many reasons for back pain as there are uses for your back. "Pain complaints are 100 percent subjective," emphasizes Gardocki. "People think I can look at an MRI and immediately tell them how to fix an ailment. That may work on Star Trek. But not in the real world."

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