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Health October 2012

Health, Wellness & the Good Life

Important Steps to a Healthy Back

By Lynn Pribus

The latest research shows quite clearly that progressive strength training decreases pain in people with chronic back discomfort. And why wait, when strengthening your muscles can forestall back problems?

Lower back pain is one of the most frequent causes for people to miss work and play. In fact, 60 to 90 percent of us experience back pain at one time or another. Men and women experience back pain about equally, partly because of aging, but also because of sedentary life styles and the lack of a fitness program.

Miriam Nelson, Ph.D., Director of the John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention and author of the useful book Strong Women, Strong Backs (G.P.Putnam's Sons, 2006), cites three primary reasons for back pain. (See more about Dr. Nelson at

First are causes within your control, especially improper lifting or repetitive physical work. Other factors are poor posture, poor mattress, poor physical condition, smoking, remaining motionless for long periods and being overweight.

Second are physical things beyond your control such as age, a sports injury, a fall, degenerative or herniated discs, compression fractures, infections, and arthritis.

Third, says Nelson, "it is now well known that stress and depression heighten back pain." The reasons are not clearly understood, but poor sleep and constant muscle tension are likely culprits as well diminished coping ability and a feeling of lack of control over one's life.

Why Is the Back So Vulnerable?

Think of the lower back as a hinge in the middle of the body, subject to all sorts of mechanical forces such as being asked to twist and bend and sometimes at the same time. When the lower back isn't strong – that is, if the spine-supporting core muscles are weak – it's an invitation to problems. Muscles are rather like sponges and they when they are "cold," they don't have much blood in them. With some warm-ups and stretching before using the back in exercise or chores, however, the muscles become "well oiled," substantially reducing the likelihood of an injury.

When Should I Seek Medical Help?

Pay attention if you have back pain that is significantly different from what you have experienced before. It could be overworked muscles, but it could be more serious. It's important to convey accurate information, so write down symptoms and report them clearly to your healthcare professional. Be clear on the nature of the pain – sharp? constant? intermittent? – and what makes it worse or better.

How Should I Treat a Sore Back?

It used to be that people with back pain were routinely sent to bed, but no more, says Nelson. In fact, she adds, a sedentary lifestyle is a strong predictor of back pain. Instead, she recommends gentle activity within 24-48 hours of the onset of back pain. "Movement," she continues, "is nourishing to the spine. It pumps fluid into the discs that cushion the vertebrae and increases strength and flexibility of all the supporting muscles in the trunk – the abdomen as well as the back."

Experiment with heat or ice packs – or both alternately applied for 10-20 minutes every couple of hours – although heat is generally not used within the first 48 hours because inflammation is often involved. Anti-inflammatory drugs can also help to reduce both pain and inflammation.

What Can I Do to Prevent Problems?

First, try to pinpoint the cause. It may be easy to identify the moment of an injury, but other situations take detective work. Notice the times your back hurts – at work, following a tense encounter, after a long drive, in the middle of the night? When you find a pattern, seek the trigger. A mushy mattress? An awkward office chair? Anxiety or tension?

Are you sitting too long without a break or using an ill-placed computer? Your monitor should be directly in front of you and between 20 and 40 inches away. Your chair should support your entire back – especially the lower lumbar region --your feet should be flat on the floor and your hips just a little higher than your knees.

If you must stand for long periods, elevate one foot on a footrest. "I can't stress enough that whether you sit or stand, it is important to change positions regularly and take frequent breaks," emphasizes Nelson.

When lifting things: tighten your abs, visualize a forklift (straight back, bent knees) rather than a crane (bending at the waist), hold the load close to your body, and keep breathing. "If you have to hold your breath to lift something, it is too heavy and you shouldn't be lifting it," Nelson says.

Exercise Is a Preventative

The latest research, Nelson continues, shows quite clearly that progressive strength training decreases pain in people with chronic back discomfort. And why wait, when strengthening your muscles can forestall back problems? Specifically," Nelson advises, "target the scaffolding of the back – that is, the muscles in the chest, the abdomen, the shoulders and the lower, mid- and upper back."

Before beginning any exercise program, get an OK from your healthcare provider. If you have access to a personal trainer or physical therapist, that person can ensure that you do exercises properly. If you don't have in-person help, the Internet is a good resource. Various websites offer line drawings, photos and videos of basic back exercises with explanations, pointers, and cautions.

If stress might be a factor, consider "mind-body" exercises which can target the back via the brain as well as directly. These include meditation, Tai chi, yoga, Nia, and Pilates. Other approaches include massage, guided imagery, self-hypnosis and practice of the Relaxation Response.

When Is Surgery Indicated?

You can't undo back surgery and there is always a risk so it's smart to pursue non-surgical options first. Always work through your diagnosis in a systematic way. Consult with a neurologist or rehabilitation physician for a second opinion if surgery is suggested.


Sidebar: Useful links: Photos of back exercises with explanations and cautions. Drawings and explanations of more than 20 exercises which can be printed out for easy reference. Well-explained "slideshow" of basic back exercises.


Lynn Pribus, a frequent contributor on wellness topics, is very faithful about her exercises after repeated bouts of back pain.

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