Upper or lower, intermittent or chronic, no matter where or how it hurts, back pain affects your quality of life. After all, who can have fun when they have an aching back to contend with?
Orthopedic back surgeon Dr. Hamilton Hall's book: A Consultation with the Back Doctor (McClelland & Stewart, 2003) offers insights into various patterns of back pain and Hall explains how our body's movements can explain why our backs ache. The following excerpt from Hall's book answers questions about how to treat back pain.
Is there something you can do to stop my pain?
There are a number of things I can do to help you control the pain. The first thing that you need to know is that most neck and back pain disappears quickly and leaves no permanent limitation. Fighting pain is challenging enough, but when you also have to fight unnecessary fear, things get worse. Some of your anxiety will be relieved just knowing that back pain is not a disease and no matter how much it hurts, the pain in your neck or low back is very rarely the mark of a serious problem.
You say my pain is not serious, but it hurts so much that I've had to stay home from work, and I don't think I can stand it much longer. What do I do now?
Some very simple things. Although back pain is seldom initiated by the muscles, muscle pain is a significant secondary feature.
The first strategy is to move. Stretching the muscles by moving your head or walking around often helps. Staying active rather than staying in bed may seem nonsensical at first, but it works. I am not talking about building a new stone patio or chopping firewood, but about taking a slow walk to the end of the driveway and back, or even around the kitchen table a couple of times. Stay on level ground and walk slowly, but keep moving.
Your body has a complex method of registering pain, and sometimes a strong sensation from one source can block out intense pain from another. This principle of counterirritation has been recognized for hundreds of years, and it still works. Rubs and liniments can help a sore back or neck feel better, at least temporarily.
A heating pad can help, but it may be no more effective than a cold pack or a bag of frozen vegetables. The idea is to find a counterirritant that reduces your pain, presumably by interfering with the pain's access to your brain's reporting centres.
So is ice or heat better?
Whatever works is best. Neither the heat from the hot pack nor the cold from the ice pack penetrates more than few millimetres into your body. In spite of the claims made in advertisements and all the lovely animations, deep heat actually goes nowhere.
Since different people respond to counterirritation in different ways, there is no hard-and-fast rule. I generally recommend ice in the summer and heat in the winter, because that is what most people like. The result is all that matters. You have nothing to lose by trying both remedies and picking the one that suits you.
What about a hot bath or a cold shower?
A cold shower could certainly take your mind off your back pain, but too much cold can generate muscle tension and increase your symptoms. I have had many people tell me that their back spasms began when they stood in front of an air-conditioning duct, or when they left the house on a frosty winter day. Although a cold pack may feel good, use it in moderation. The same is true of heat, by the way. Applying heat for too long can damage the skin and cause a fluid build-up in the tissue that can increase the pain. If you are going to use the shower, I suggest you try a warm shower first. Standing may be more comfortable if you can put your foot up on a raised surface. If your shower doesn't have one, try bringing a small wooden stool in with you.
As far as the hot bath is concerned, the warmth of the water may feel good, but your posture in the bathtub will almost certainly be uncomfortable. A bathtub pillow or similar device might help, though sacrificing comfortable posture for a little heat seems a poor exchange. If your pain is lessened when you lie on your stomach, the practical difficulty of achieving the desired posture in the tub may be insurmountable. How will you get out if your back goes into spasm?
A hot tub or a whirlpool bath can provide considerable benefit without requiring you to adopt a posture that would load your back unnecessarily. Stretching out in a hot tub or lying with your back against the jet of a whirlpool is certainly excellent emergency treatment if you have those facilities at hand.
What about massage?
Massage and manipulation are slightly different. Massage implies a repeated squeezing of the muscles. It can be uncomfortable initially, but it often ends up feeling very good. Massage makes no claim to change the structures of your spine. Although a few massage therapists allege it provides additional health benefits, the primary goal of massage is to alleviate muscle tension and thus reduce your pain. Having a friend or family member rub your neck can be helpful. A professional massage is more involved, but may be worth it.
The outcome should be rapid relief. If a treatment works, that's good. If, after a few sessions, massage has no effect or has made matters worse, that's bad. You have not done your neck or back any harm, but you are wasting your time and maybe your money as well.
How is manipulation different?
Manipulation, or adjustment, as the chiropractors call it, is intended to address structure and movement within the segments of your spine. Its goal, like that of massage, is to provide prompt pain relief and for acute mechanical neck and low back pain it is successful over half the time.
Except for surgery, manipulation is the most studied form of back- and neck-pain management. Yet we still don't know for sure what it does or why it works. Chiropractors often talk about reducing subluxations, a condition in which the bones of the spine are supposedly partly out of place. But there has never been evidence - either from clinical examination or from a number of imaging studies - that adjustment produces any change in the relationship of one vertebra to another.
Some believe that the pain relief occurs because stiff joints are put through a full range of movement and perhaps areas of tissue tightness or adhesions are loosened or broken down. Again, there is no evidence that the theory is true. No one has ever demonstrated that manipulation changes joint anatomy or range of movement.
Because of this lack of physical evidence, many practitioners believe that adjustment or manipulation produces some type of neuromuscular effect, changing the way muscles interpret the nerve impulses they receive. Supposedly a spasm is released by improving this communication, or resetting the sensor system within the muscle itself. It is an appealing theory, but one without any supporting evidence.
What is undeniable, however, is that manipulation does relieve acute mechanical neck and back pain in some cases for some people. Still, like massage, any useful result should be immediate, or at least rapid. Continuing treatment without a prompt positive effect, or despite increasing pain, makes no sense.
More on page 2
Excerpted from A Consultation with the Back Doctor by Hamilton Hall, M.D. Text copyright 2003 by Hamilton Hall, M.D. Excerpted by permission of McLelland and Stewart Ltd. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writingfrom the publisher.
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