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  » Medical Topic Archive  »  Take Back Your Back

Take Back Your Back

We sort the out-of-date from what really works

by Aimee Whitenack

If dust bunnies slowly took over Susan Cameron's home, she would have a good excuse: "My husband does the vacuuming," says the 47-year-old teacher from North Andover, MA. She has to bow out of housework to keep her back pain from flaring up.

Though it doesn't sound like much of a sacrifice, Cameron has been forced to forgo pleasures, too. I haven't been to a cocktail party in years, she says. All that standing triggers such pain. Even an achoo is hazardous: I don't dare sneeze while standing straight up my back will pay dearly.

Like Cameron, at least 80% of the population will have a significant episode of lower-back pain at some point in life. And as if debilitating discomfort weren't enough, a chronic ache could even cause your brain to shrink as much as 11% over 10 years, notes recent research from the Northwestern University Institute of Neuroscience. Brains normally lose volume with age, but constant pain may double the deficit.

Experts, however, are hopeful that some of the atrophy can be reversed if the pain is effectively treated. So the question becomes: How should you treat an aching back? There are so many options out there. Use ice or heat? See a chiropractor or a surgeon? Get rest or exercise? It's hard to know what to do. Researchers say that a lot of the standard advice is unhelpful, and sometimes even harmful. Don't worry, though: We've got your back.

OUT-OF-DATE Get plenty of rest
For years, back-pain sufferers were told to avoid activity and hit the hay. If you go to bed for a week, however, muscles deteriorate, which can worsen pain, says Jeffrey Wang, MD, chief of orthopaedic spine service at the UCLA Comprehensive Spine Center.

THE LATEST Up and at 'em
Even if you're hurting, it's best not to spend more than 3 days in the sack. As soon as you can bear it, get into a mild form of exercise.

When 101 adults with chronic back pain did gentle yoga, they experienced a faster recovery than those who consulted a self-help book or took more strenuous exercise classes, say researchers at the University of Washington. And after 3 months, the yogis were using less than half the pain meds their peers were taking.

Other low-stress activities like swimming and walking help, too. Ironically, a new UCLA study found that these kinds of workouts are more effective than the back exercises frequently prescribed by physical therapists probably because people often do doc-recommended moves incorrectly. OUT-OF-DATE Anti-inflammatories are the drug of choice
Although anti-inflammatory meds such as ibuprofen and naproxen are a great way to ease occasional pain, back experts now say that another kind of drug may be worth trying when discomfort is chronic.

THE LATEST Antidepressants help relieve persistent pain
An analysis of seven studies found that chronic lower-back pain sufferers who took antidepressants called serotonin-norepinephrine reuptake inhibitors--Effexor XR is one--showed up to a 45% improvement in pain. That's more relief than is typical with anti-inflammatories.

OUT-OF-DATE Cold is the only temp that quells sharp pain
Traditionally, docs have recommended icing acute pain (the kind that comes on quickly); heat was for chronic soreness.

THE LATEST Bring on the heat
New research from Johns Hopkins University shows that wearing a portable heat wrap for 8 hours on 3 consecutive days reduces the intensity of back pain by 60% and benefits last up to 14 days. For more help, John Mayer, PhD, research director at the US Spine & Sport Foundation in San Diego, suggests stretching, too. He found that 72% of those who do both treatments for 5 days quickly bounce back to their normal selves.

OUT-OF-DATE Everyone can benefit from chiropractic manipulation
At least, that's what some chiropractors and doctors would've had you think. Many have routinely advised this approach with mixed results.

THE LATEST It can help the right patients
New research from the University of Utah suggests a simple way to predict if you'll benefit from an adjustment. Has your pain lasted for fewer than 16 days? Does all discomfort remain above the knee? If you can answer yes to both questions, there's an 84% chance that manipulation would do you good. (Further research is needed to understand why it works best on these patients.)

OUT-OF-DATE Sleep on a firm mattress
While supersquishy beds are definitely bad for your back, very firm ones can increase pressure on the spine and worsen pain, say Spanish researchers.

THE LATEST Go softer
A study of 313 people revealed that those who caught Zzzs on a medium-firm mattress were more likely to report pain improvement than those on a firmer one. To help ease nighttime discomfort even more, tuck a pillow under your knees if you sleep on your back, between your knees if you're a side sleeper, or beneath your stomach and hips if you snooze on your belly.

Cutting surgery down to size
Although the number of back surgeries is increasing about 429,000 in 2003, compared with 279,000 in 1990 this isn't necessarily a good thing. I believe the upswing is due to the growing number of surgeons who find more reasons to operate.

Unfortunately, research hasn't kept up, says Richard A. Deyo, MD, a professor of medicine at the University of Washington and a deputy editor of the journal Spine. Bottom line Going under the knife is the last resort. Sometimes when new technology arrives, people forget that, says Scott D. Boden, MD, director of the Emory Spine Center at the Emory University School of Medicine. Surgery is only for a very select group of patients who are often hard to identify.

Bonus: 6 more ways to sidestep pain

Nix the high heels
They force you to arch your back, making your spinal muscles work harder.

Move it
When standing for a long time, rock from heels to toes or shift your weight from one foot to the other to keep your spine mobile. And for every 20 minutes of sitting, get up and walk for 3.

Use a step stool
It'll curb over-reaching, which often triggers pain.

Don't smoke
It diminishes the blood supply to discs, leading to degeneration.

Shed pounds
If you're obese, losing weight can significantly improve pain.

Drink milk
Daily doses of calcium and vitamin D will help prevent osteo-porosis and painful spinal fractures.

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