Back to Basics

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Back to Basics

By Marshall, www.alternativemedicine.com

We all know the phrases " Oh, my aching back " and " What a pain in the

neck. " They've been uttered so often over the years, they've become

ingrained as lighthearted clichés. But for the increasing number of

Americans whose chronic spinal problems cause them to lose sleep,

miss work, or sacrifice their favorite sports and hobbies, back pain

is no joke.

" I had to stop walking. I had to stop using the treadmill at the

gym. My wife and I used to love to travel and go on walking tours,

and I couldn't do that anymore, " says Jack Funk, 69, of the

omnipresent back ache and debilitating leg spasms he suffered for

years. " It really affected my life. "

Studies show that as many as two-thirds of adults will suffer

chronic or recurring back pain at some point, making it second only

to the cold as the most common reason for visiting a doctor. Back

pain accounts for a staggering $75 billion annually in medical

expenses, lost productivity, and disability claims and constitutes

the No. 1 reason for inactivity in people under age 45. And

according to care providers nationwide, its incidence is on the rise.

" It has been growing steadily over the past 30 years. It's a huge

problem, " says Gerald Silverman, DC, author of Your Miraculous Back:

A Step-by-Step Guide to Relieving Neck and Back Pain (New Harbinger,

2006).

But despite what many see as a troubling epidemic, there remains a

heated debate over just what causes back pain and how to treat it.

In more than 85 percent of cases, care providers can find no clear-

cut anatomical explanation for the pain, leaving them to speculate

about everything from muscle, joint, and disc damage to stress and

psychological trauma. When it comes to treatment, back surgery rates

continue to soar nationwide, with surgeons in the US performing 40

percent more back operations than in any other developed country.

Yet clinicians still argue whether the promise of pain relief

outweighs the cost and potential risks associated with surgery

(including paralysis and worsening pain), and many of them contend

that too many patients turn to drugs or go under the knife before

they exhaust other options.

" For chronic low back pain, surgery is seldom a good option, " says

Dean Neary, ND, chair of the physical medicine department at Bastyr

University, near Seattle. " It may give them some relief, but it

often comes at the cost of reducing mobility, which may down the

road lead to further complications. "

Faced with the prospect of surgery or prolonged use of pain

management drugs, many patients opt for a more holistic approach,

making back pain the most frequently stated reason people seek out

complementary and alternative therapies.

" To surgically correct something without addressing the underlying

cause is missing the boat, " says Neary.

Sitting ducks

So just what underlying causes are driving the soaring rates of back

pain in the US? According to many practitioners, our increasingly

sedentary lifestyle—centered around long car commutes and long work

days slouched in front of the computer—top the list.

Poor posture (such as sitting slumped forward with stomach muscles

at rest) can be particularly hard on the back, because it distorts

the natural curve in the spine, forcing the low back muscles to do

the work intended for the abdominals.

Lack of movement in the spinal joints can also invite inflammation

and swelling, which in itself can cause pain. And in the absence of

the sensory inputs that come with movement, the gate is left open

for pain impulses.

Silverman, who has had a practice in Hauppauge, New York, for 27

years, says the vast majority of back problems result from either

muscle sprains or strains, joint injuries brought on by overuse

(overdoing it at the gym), or prolonged inactivity. In only a small

number of cases does a serious problem such as spinal stenosis (a

narrowing of the spinal canal, which puts pressure on the spinal

cord) cause the pain. Sometimes genetic, stenosis more commonly

occurs with age, as the precarious stack of vertebrae grows uneven,

with some moving inward, closing the gap between nerve and bone.

Because stenosis can, in severe cases, lead to paralysis, surgery to

widen the spinal canal may be warranted, says Silverman, but " it

would only be indicated when the symptoms are constant and there is

unremitting neurological involvement, such as tingling or weakness

or pain in the extremities. "

Over-medicalizing the problem

One of the most common reasons people undergo surgery for back pain—

to repair a herniated disc—may be warranted in some severe cases

when the disc infringes on the nerve. But that's not to say that

everyone who has a herniated or bulging disc needs surgery—or even

suffers pain.

One landmark 1994 study found that 52 percent of adults have bulging

discs and never have any trouble with them, and many more have other

abnormalities. Only 36 percent have " normal " discs. Such data has

led many to believe that disc abnormalities are often mistakenly

blamed for pain that may actually originate elsewhere. Yet since the

advent of the MRI in the 1980s, which allows doctors to see such

disc abnormalities more clearly, the number of surgeries to correct

them has risen dramatically. The annual number of spinal-fusion

operations alone rose by 77 percent between 1996 and 2001, and

observers expect the number of back surgeries overall to rise as new

technologies, such as the artificial disc approved by the FDA in

2004, flood the market.

That has Deyo, MD, a professor of medicine and health

services at the University of Washington in Seattle, concerned that

we are " over-medicalizing " the problem. " MRI scans show something

abnormal in nearly everybody whether they have back pain or not.

These things can be misleading and have created a new challenge for

us, " he says. " We're taking a more aggressive approach to treatment,

and it is not at all clear to me that it is resulting in better

outcomes. "

In many cases, research shows, a herniated disc will resolve itself

over time, with as many as two-thirds of cases partly or completely

healed after six months. On the other hand, according to one study

published by Deyo in 2001 in the New England Journal of

Medicine, " there is no evidence from clinical trials or cohort

studies that surgery is effective for patients who have low back

pain, " unless they have sciatica, pseudoclaudication, or

spondylolisthesis.

One study of spinal stenosis patients found that four years after

their operations, about 30 percent of patients still had severe pain

and about 10 percent had undergone a second operation. Between

January and August 2006, according to press reports, more than 28

lawsuits had been filed against artificial disc-maker DePuy Spine

Inc. by patients complaining of worsening pain or other

complications after the surgery.

A holistic approach

Those looking beyond conventional medicine for solutions to their

back pain typically make the chiropractor, massage therapist, or

acupuncturist their first stop. All three approaches have been shown

in clinical trials to be more effective than a placebo—and sometimes

superior to medical interventions and anti-inflammatory drugs.

By manipulating the vertebrae manually to prompt movement in stiff

joints, chiropractors aim to restore mobility to the spine. Pali

, DC, of Marin County, California, adds another nuance to her

practice, using a movement-based deep-tissue massage technique aimed

at breaking through scar tissue from old injuries. This patented

Active Release Technique hinges on the notion that asymmetry often

lies at the root of pain. In essence, when scar tissue makes one

muscle rigid, another may overcompensate, throwing the body out of

balance and causing pain.

A classic example: A runner injures her hip on one side and

unknowingly overcompensates with her lower back, causing pain there.

In this case, says, she'd focus her efforts on the hip. " I'm

really working on what is causing the problem, not necessarily where

they have pain. "

At the University of Colorado Center for Integrative Medicine in

Denver, roughly 55 percent of the patients who walk in the door for

acupuncture come because of chronic pain. About half of them

complain of back pain specifically and almost all of them have

exhausted all other options. While medical doctors in the adjoining

CU Health Sciences Center reacted somewhat skeptically five years

ago when the center opened, they now often refer patients to the

clinic, says licensed acupuncturist Daisy Dong. " The patients have

either reached a plateau, it didn't work at all, or it got worse.

Then they come to us and say, `You are my last resort.' "

Dong says acupuncture works for back pain on many levels. It

stimulates the nerve endings, which distracts the brain from the

pain and promotes the production of natural painkillers. Studies

have also shown that acupuncture increases blood flow, and thus

oxygen, to the joints and muscles and that it decreases inflammation

and relaxes the patient.

Even in cases where structural problems clearly cause the pain, Dong

says she has seen obvious benefits in patients after a 20-minute

needling session. " We cannot reverse or correct the structural

problem causing it, but we can deal with their pain, and we can also

deal with their emotional turmoil, " Dong says.

Bastyr naturopath Neary incorporates dietary and lifestyle

recommendations and supplements, specifically catering his treatment

plan according to each patient. If the patient suffers muscle

spasms, he may not be getting enough magnesium and calcium. If it is

a matter of joint health, Neary may recommend glucosamine. And if it

is a more acute pain caused by inflammation, he may recommend

proteolytic enzymes, such as bromelain, which are easily absorbed

and have demonstrated anti-inflammatory properties in studies.

(See " Enzyme Therapy for Back Pain, " below.) Almost always, patients

must address underlying lifestyle problems, such as inactivity,

excess weight, poor diet, or too much stress. " Back pain is not a

disease in and of itself. It's a symptom of something else, " Neary

says.

The mind/body connection

For Diane Ruenes, the first step toward overcoming a decades-old

back problem was getting over the fear that kept her from climbing

stairs and picking up her grandchildren. She'd seen her husband go

through the agony of traction and bed rest after injuring his back,

and she feared she'd end up there too. So she started curtailing her

activities. " You are afraid to move because you are afraid the pain

is going to get more intense, " says Ruenes, an administrative

assistant and mother of three.

Her chiropractor, Silverman, calls that instinct " fear avoidance "

and believes patients allow it to prolong otherwise benign

injuries. " They are afraid of the pain, so they avoid a lot of the

activities and exercises they can do to help alleviate the pain. "

In reality, he says, too much inactivity typically worsens the

problem, making joints rigid and prompting muscles to spasm. His

advice: After the acute phase passes, get moving by doing gentle

stretching, range of motion, and core strengthening exercises aimed

at loosening up the spine and making it less prone to future injury.

For Jack Funk, such advice proved life altering. After years of

commuting four hours a day, then sitting at a desk all day, the

electrical engineer was devastated when his damaged back began to

catch up with him, just in time for retirement. So now he visits the

chiropractor when he needs an adjustment, does specific stretching

exercises for 10 minutes each morning, exercises regularly, and

keeps his weight in check. And his globe-trotting days are back.

Single Leg Raises

(for acute pain in the lower back or upper buttocks; decompresses

the large sciatic nerve)

Loop a strap around the ball of your left foot and lie down on your

back. Either extend the right foot out completely, pressing your

foot into a wall, or keep the right knee bent. Hold the strap

lightly in both hands and gently move your left leg toward you. Keep

your leg low enough that your lower back doesn't arch. Breathe here

for 10 to 15 seconds. Repeat on the right side.

modification: In cases of severe pain, have a friend hold your leg

at the ankle and slowly raise it up a few inches. Hold for 10

seconds, release, and change legs.

Knee-to-Chest Stretch

(for moderate pain or aches in the upper buttocks)

Lie flat on your back, bend your left leg, grab onto your knee with

both hands, and slowly pull your knee toward your chest. When you

begin to feel some moderate pulling in your lower back and upper

buttock, stay in that position for 10 to 15 seconds, let go, and

slowly straighten your leg. Do this seven to 10 times, each time

trying to bring your knee a little closer to your chest. Then repeat

the entire exercise on the right side. Never bring both knees toward

your chest at the same time.

Ten tips for preventing back problems

• Stand comfortably: Keep one foot slightly in front of the other,

and keep your knees bent slightly. It takes the pressure off the low

back muscles.

• Sit up straight: Avoid hunching over with your neck and shoulders

forward. It puts stress on the neck muscles. Instead, hold your head

upright over your shoulders and maintain a slight arch in your lower

back (a small pillow can help). Keep your shoulders in line with

your hips, your knees level with your hips, and your feet flat on

the floor.

• Take a break: Don't sit for extended periods. Instead, get up once

an hour to give your back muscles and joints a rest. Inactivity

invites inflammation.

• Use an exercise ball as a chair for part of the day: It makes

sitting less of a sedentary activity and forces the body to maintain

its core strength.

• Sleep smart: Sleeping on your back puts roughly 55 pounds of

pressure on your back muscles. Putting a couple of pillows under

your knees can cut that pressure in half. Or, lie on your side with

a pillow between your knees.

• Watch the way you bend and lift: Bend from the hips, not the

waist, and lift with the legs, not the back.

• Exercise: Some particularly back-friendly forms of exercise

include yoga, which promotes hip flexibility, spine stability, and

extension in the lower lumbar regions of the spine, and Pilates,

which emphasizes core strengthening.

• Keep your weight under control: As few as 10 extra pounds can put

unnecessary strain on the joints and muscles, hastening

degeneration.

• Wear supportive shoes: If your feet aren't healthy, it transfers

to your knees, hips, and back. Skip the high heels.

• Quit smoking: Nicotine restricts the flow of blood to the discs

that cushion your vertebrae. Sources: Gerry Silverman, DC; Pali

, DC; Dean Neary, ND; North American Spine Association

Enzyme Therapy for Back Pain

For more than 25 years, chiropractor Cichoke has heralded

one secret weapon for both preventing and treating back pain:

enzymes.

• What are enzymes? These naturally occurring substances serve to

jump-start an array of bodily functions, including the inflammatory

and digestive processes.

• How do they work? They break down matter, such as food in the

digestive tract (making healing nutrients available to the muscles

faster) or proteins responsible for inflammation in the blood

stream. If a person is lacking enzymes—often due to poor diet,

illness, or advanced age—those processes are hindered, and " you are

going to be prone to more pain and slower rehabilitation, " says

Cichoke.

• How do i use them? If you have acute pain, take large doses of

enzymes in the first days after injury (for some, that means 20 to

30 tablets per day). That should quell discomfort and promote

healing by reducing pressure-causing fluid in the blood vessels,

promoting better circulation, and ushering waste products out of the

body. Take the enzymes on an empty stomach, with water, to hasten

their entry into the bloodstream.

• Can they prevent pain? Cichoke believes they can. He says a daily

enzyme supplement, along with a diet high in enzyme-rich fruit,

vegetables, and sprouted grains, should help. Eating these raw is

best since heat destroys enzymes.

• What kind do i use? Basic proteolytic (protein-digesting) enzymes

include bromelain (which is derived from pineapple), papain (derived

from papaya), and pancreatin (from animal sources).

" For folks who don't want to take over-the-counter anti-

inflammatories, " says Dean Neary, ND, a naturopathic physician from

Seattle, " they can be a good option. "