Watch Your Back




Your back plays a part in nearly every move you make. Whether you're reaching for a book on your nightstand, standing up, sitting down or doing the Watusi, your back is involved and will readily remind you if it is unhappy. And since 80 percent of Americans will experience back pain at some point in their life, according to the National Institutes of Health, it behooves us all to bone up on the latest strategies for avoiding or dealing with back pain. Back pain affects people of all ages, although it more frequently plagues adults than children. Sports injuries that lead to muscle strain are one of the prime sources of back trouble for pediatric patients, says James Mirazita, M.D., FIPP, medical director of Pain Solutions, which has offices in Nashua, Peterborough, Bedford and Laconia. Back pain can also stem from a variety of other causes, including aging, repeated manual labor, or a traumatic incident like a fall, motor vehicle accident or an ill-timed bend or twist while lifting or pushing something heavy, Mirazita says. There are steps you can take to help keep your back healthy: Maintain a healthy weight Obesity can "play a significant role" in back woes, says Mirazita. One of the key factors related to back pain is inflammation that causes pressure on sensitive nerves, and "obesity itself can be very inflammatory," Mirazita says. "Even small amounts of extra fat in the body can cause increased rates of inflammation and can make pain worse." So, not only does being overweight increase stress on the body, joints and spine, but the very presence of too much fat can increase the level of inflammation. Exercise Exercise helps prevent weight gain, plus it can strengthen core muscles that help support the back. "If you strengthen your core, which includes not only your lower back muscles but your abdominal muscles, you create an internal cylinder of support around your spine - it's like wearing one of those Home Depot support belts," Mirazita says. Exercise can also improve your posture, which can in turn improve your lifting technique, decreasing the chance of back injury. Kick the habit If you're a smoker, here's yet another reason to quit: Smoking reduces the blood supply to the shock-absorbing discs in your back, says Joshua Greenspan, M.D,. medical director of PainCare, which has offices in Somersworth, Merrimack and Newington. "People who smoke are actually causing premature aging of their discs because they're cutting down the blood supply," he says. "Smoking has a profound effect upon healing ability and the ability to regenerate and the ability to bring blood supply to very small areas of the body, such as the discs." Treatment If you do experience back pain, resist the urge to overly pamper your injury. In many cases back pain patients should reject the age-old advice that says the best treatment for a sore back is to lie down on your back and avoid all physical activity, Greenspan says. "Studies show that people who lie down just prolong the pain," he says. Try to alternate short walks with resting. Complete inactivity will weaken muscles and likely worsen your back problems, Greenspan says. If your back pain is severe or lasts more than three days, don't delay paying a visit to the doctor. Early intervention "dramatically" improves outcomes, Mirazita says, turning "a potentially very difficult problem into something that's more of an annoyance." Typically, the route followed by back pain patients begins with an anti-inflammatory or muscle relaxant medicine, says Greenspan. If that doesn't work, physical therapy might be the next stop. If that also fails, patients today have the option of pursuing minimally invasive procedures that are much less risky than surgery, such as injections that deliver medicine to the problem area and accelerate the healing process. Minimally invasive interventions also enable doctors to better pinpoint the source of back pain, Greenspan says. Numbing test injections, for instance, can help locate the source of pain via the process of elimination. (If your doctor numbs a specific area in the lower part of your back just to the left of your spine and suddenly you are pain-free - bingo, the problem spot has been identified.) Many back patients today consider alternative or complementary therapies like massage and acupuncture, although most insurance plans still do not cover such treatments. An approach that combines the latest technology with alternative treatments can sometimes be the best way to go, Greenspan says. Surgery is also an option for some, but when all else fails, some chronic back pain patients choose spinal cord stimulation, which involves surgical implantation of a programmable pacemaker-like device that can, in effect, jam the frequency of pain signals by blocking pain signals as they travel up the spinal cord into the brain, Mirazita says. Generally reserved for patients who have found no relief from conservative therapy, injections or even surgery, the procedure "works extremely well" in patients who are good candidates for the device, Mirazita says. "It's a way to treat chronic pain that was previously untreatable," Mirazita says, but is not prescribed for everyone because of the expense. NH

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