If you've never had lower back pain, just wait. Federal health experts say most Americans will eventually experience back pain severe enough to interrupt work, school, sports or the activities of daily living like carrying groceries, getting dressed or combing your hair. The causes vary: twisting the wrong way, heavy lifting, trauma from a car accident, arthritis or simply getting older. As we age we lose muscle flexibility and strength. By the time we reach our 40s and 50s we also have less fluid lubricating our spines. The disc-shaped cartilage that holds the fluid and acts as a cushion between those bones can become compressed and bulge out — the infamous herniated disc — putting pressure on nerves in the spine. One seemingly routine reach or turn may be all it takes to strain the muscles, upset those nerves and make even the most simple activity very painful. But most sufferers will improve with low-tech remedies.
"Just because you go to see a doctor doesn't mean you have to be thinking surgery,'' said Florida Orthopaedic Institute spine surgeon Antonio Castellvi. "We operate on only about 10 percent of patients.''
For the other 90 percent, treatment options include medications, exercise, physical therapy, injections, chiropractic procedures, massage and acupuncture. In the longer term, dropping even a few pounds helps sufferers who are overweight by reducing strain on the back.
Forget lengthy bed rest — doctors now know it's important to keep moving.
Stretch and strengthen
Among the best remedies for back pain are stretching and strengthening the abdomen and other core muscles that support the back. Castellvi is a big proponent of Pilates — the exercise system many dancers swear by to stretch and strengthen their bodies — for back pain patients. "It's core strengthening," the Tampa doctor says. "Strengthen your abdomen and your back muscles will follow. Then you can get by for a long time without having anything invasive."
Dr. John Gianoli agrees. An internal medicine and pain management specialist in St. Petersburg, Gianoli advocates stretching for back pain patients, particularly yoga. He became involved in the discipline in high school in the mid '70s to improve his performance in sports and later as part of his recovery from two car accidents.
Two years ago he became a certified yoga instructor and spends 20 minutes to an hour every day stretching and meditating. On Feb. 12 and 13, he'll help lead a two-day workshop on yoga for back pain sufferers under the photos).
"Yoga stretches tendons, ligaments and muscles,'' he said. "It makes a larger space for the nerves in the back, the source of most lower back pain."
Time for an intervention?
Back pain that lasts more than a week or 10 days needs medical attention. Castellvi has patients take it easy for a couple of days to get their pain to a manageable level, then recommends some form of careful exercise or physical therapy.
"Back in the old days," Castellvi says, "we used to put them in the hospital for a week to 10 days of bed rest. Now we know that's not good and can lead to muscle weakness. But once things have cooled down, after a few days, stretching and strengthening core muscles is key."
And as for medications known as muscle relaxers, Castellvi says they don't relax anything but your brain. "They are like tranquilizers. They make you stupid and have no effect on strained muscles." He says heat, moist heat, is a far better muscle relaxer.
Most patients improve after four to six weeks of conservative treatment like stretching and strengthening. Generally, most physicians say that after 6 to 12 weeks of conservative treatment, if the patient has no relief and still can't get back to normal activity, more aggressive treatment, such as surgery, may be warranted.
But Castellvi stresses that surgery is your last resort. His top prescription: patience.
"You have to follow the plan, do the physical therapy, do the exercises at home, take the anti-inflammatories if they are prescribed, and understand it's not a 10-minute deal" to heal an aching back, he said.
Irene Maher can be reached at imaher@sptimes.com or (813) 226-3416.
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