Babying Your Back May Delay Healing

When dealing with back pain, the inclination might be to consider surgical or other intervention options. However, in many cases, a less-is-more approach may prove effective, and traditional methods such as movement and exercise can be powerful allies in managing this common issue.

The enigma of back pain

Back pain stands out as one of the most prevalent medical issues in the United States, as indicated by the National Institutes of Health, and its characteristics defy typical ailment patterns. Unlike injuries such as a twisted ankle, where pain gradually subsides during the healing process, back pain relief doesn’t appear to be intricately tied to healing since the pain is often unrelated to a specific injury. Dr. James Rainville, an assistant professor of physical medicine and rehabilitation at Harvard Medical School, notes that back pain frequently diminishes over time, even in cases involving underlying problems like herniated discs or arthritis.

Adding to the enigma of back pain is the paradox that individuals tend to report more instances of back pain in their 40s and 50s than in their later years. This seems counterintuitive since back degeneration generally increases over time, suggesting that people should experience more pain, not less, as they age. Furthermore, approximately 80% of adults report at least one episode of back pain, while the remaining 20% never experience back pain. Interestingly, this doesn’t indicate that their spines are normal, as imaging tests on these pain-free individuals reveal comparable degeneration in their lower spine, according to Dr. Rainville. The perplexing question arises: why don’t these observed changes on imaging lead to pain?

The anomalies associated with back pain are likely attributed to a neurological healing process rather than a physical one, asserts Dr. Rainville. According to this theory, when a problem arises and triggers pain, the nervous system adapts to the pain, ultimately alleviating discomfort. Dr. Rainville suggests that exercise and movement may expedite this adjustment process within the nervous system.

Understanding back pain

The natural degeneration of the spine is an inherent aspect of the aging process, equated by Dr. Rainville to a bulging disc being akin to a wrinkle beside your eye.

Contrary to common belief, instances of back pain rarely coincide with engaging in strenuous activities or lifting heavy objects. Dr. Rainville highlights that, in cases of new-onset disc herniation or sciatica, only 5% of people were involved in physically demanding tasks like lifting heavy objects, such as an air conditioner. Such occurrences are infrequent, with most people experiencing back pain during mundane activities like leaning over to spit in the sink while brushing their teeth. Dr. Rainville notes that common scenarios include statements like “I was just reaching for a pencil” or “I sneezed.”

Back pain predominantly stems from the inevitable failure of tissues due to age-related deterioration. Dr. Rainville emphasizes that there is no evidence supporting the notion that being cautious can decelerate the process of disc degeneration. He asserts that, akin to other signs of aging like wrinkles or gray hair, being careful does not impede the natural progression of age-related changes in the spine.

The genetics of back pain

The manifestation and duration of back pain symptoms can be significantly influenced by an individual’s genetic composition, according to Dr. Rainville. The variability in pain intensity is considerable, ranging from a one-day occurrence to persisting for up to three months.

Much like how certain individuals are predisposed to heightened pain sensitivity, such as those with conditions like fibromyalgia, others fall on the opposite end of the spectrum and exhibit a reduced propensity for experiencing pain.

Research indicates a familial pattern in the likelihood of experiencing more or less back pain. Dr. Rainville cites examples, noting that identical twins often share similar back pain histories, even when leading entirely distinct lives and engaging in different experiences. This familial predisposition appears to persist irrespective of divergent lifestyles, such as one twin having a sedentary desk job while the other engages in physically demanding labor in construction. Dr. Rainville suggests that these aspects are likely highly influenced by genetic factors.

Strategies to help back pain

The National Institute of Neurological Disorders and Stroke provides recommendations for managing back pain when it flares up:

1. Stay Active: Avoid the temptation to remain in bed as prolonged bed rest can worsen pain over time, reduce flexibility and muscle tone, and increase the risk of depression. It may also elevate the risk of developing blood clots in the legs.

2. Pain Management: Utilize hot or cold packs and over-the-counter pain medications to alleviate pain. While these measures won’t cure the underlying problem, they can enhance pain tolerance. Consult with your doctor to ensure the chosen medications are suitable and safe for your condition.

3. Build Muscle Strength: Engage in exercises recommended by your doctor to strengthen your body. While hitting the gym during severe back pain may not be advisable, targeted exercises can help maintain and enhance muscle strength, contributing to pain relief.

4. Consult a Physical Therapist: Seek the expertise of a physical therapist who can guide you through exercises designed to improve mobility, flexibility, and overall function. These professionals can help you safely navigate exercises even in the presence of pain.

Changing attitudes about back pain

While back pain has been a common experience for many individuals, shifting attitudes towards the issue may be exacerbating the problem. Traditionally, people used to endure back pain without seeking extensive medical help. Dr. Rainville notes that over the last 30 years, there has been an increasing trend of people seeking healthcare for back pain. Surprisingly, this surge in seeking medical care has not led to a reduction in the prevalence of pain or disability; instead, disability resulting from back pain has seen an upward trend over time.

In 1990, back pain was ranked as the sixth most burdensome condition in the United States. By 2010, it had risen to the third position, trailing only heart disease and chronic obstructive pulmonary disease, as reported by the National Institute of Neurological Disorders and Stroke (NINDS).

Back pain, once considered a minor inconvenience to overcome, has now become a significant impediment for many individuals. Dr. Rainville highlights a shift where people have become immobilized due to advice advocating caution and reduced movement. This contradicts the guidance provided for decades, prompting some doctors to encourage a return to a more traditional approach in managing back pain, with less emphasis on intervention and more on promoting movement.

Treating back pain

Movement appears to be a crucial stimulus for normalizing pain responses in the nervous system. Dr. Rainville refers to studies on animals with spinal injuries, which indicate faster pain resolution among those compelled to exercise compared to those with restricted movement. He suggests that this phenomenon might be a survival mechanism, as animals in the wild need to move to avoid being preyed upon or starving.

This insight extends to humans, with Dr. Rainville noting that individuals who resume activities like going to the gym or cleaning the house tend to fare the best. While surgery may be necessary for specific back problems involving progressive nerve damage or structural changes, in many cases, it may be less justified, according to the National Institute of Neurological Disorders and Stroke (NINDS).

For individuals experiencing back pain due to normal wear and tear, the prevailing message is that, in most instances, it is not necessary to put life on hold and wait for healing. Instead, the emphasis is on encouraging movement. Physical therapists can play a significant role in helping individuals gradually and safely increase their activity level, desensitizing the nervous system’s response, and facilitating a return to regular daily activities.