The holiday season may involve a fair amount of lifting, as we decorate, cook and shop.
If an engineer were to design the human back, it might well be less vulnerable to strain. I would recommend, for example, consideration of a second spinal column, and more soft tissue reinforcement. The current design is a bit unstable and vulnerable to injury. Indeed, 90 percent of us will suffer an episode of acute low back pain at least once in our lives.
Stanford University researchers, however, recently demonstrated that exercise may protect our backs. According to associate professor of orthopedic surgery Matthew Smuck, as little as 20 minutes of activity a day may ward off back aches, even if the activity is fairly nonstrenuous.
Walking, bike riding and ballroom dancing, for example, provided considerable benefit.
Smuck and his collaborators relied upon motion detectors, attached to 7,000 subjects, in performing their analyses. Overweight patients, in particular, experienced up to 38 percent less back pain if they exercised even to a small extent.
Strengthening your abdominal muscles buttresses the spinal column, including disks and ligaments, from within. One might expect, therefore, to see less back pain in people engaging in strenuous abdominal strengthening routines. It is surprising, however, to learn that even modest activity, including household chores, might have a similar salutary effect.
In medicine, however, we try to rely on study data, rather than common-sense speculation. Thus, it may seem logical to associate exercise with back protection, but it is also useful to quantify and verify this hypothesis, as the Stanford researchers did.
Sometimes counterintuitive findings emerge from research. For example, we now appreciate that there is a correlation between cigarette smoking and low back pain. No one discussed this link decades ago, but now it is recognized widely. Rigorous studies also link smoking to rheumatoid arthritis and systemic lupus, inflammatory arthritic conditions. More studies may reveal newer findings that no one can anticipate. New ideas in medicine may often appear to go against the status quo. For example, the early advocates for sterility in surgery were scorned in the 19th century.
With respect to obesity, we no longer simply approach body weight by looking up normal levels on insurance company tables. Generally, we rely on the body mass index (BMI), which represents the ratio of body weight to body surface area. For example, a BMI of 18 to 25, roughly, is normal, but values below 18 suggest the possibility of a nutritional deficiency or other illness. Similarly, once the BMI reaches 26 to 30, one is “overweight,” and above 30 you are in the obese range. Extremely high BMIs, above 40 or so, may be considered “morbidly obese,” and may often be cited as justification for pursing dietary interventions or bariatric surgery. Unfortunately, obesity is associated with hypertension and diabetes, as well as back pain.
Using diet and exercise to prevent low back pain and obesity appeals to me, for economic and medical reasons. Exercising is generally not very costly, unless we consider specific sports or private fitness instruction. Walking, for example, is essentially free. By contrast, medications to treat low back pain are expensive. Moreover, they may require a prescription or cause side effects.
Prevention is superior to treatment. Low back pain, fortunately, generally has a good prognosis. With a simple strain, 80 percent of people recover within two weeks, 90 percent within a month and 93 percent within six months. Unfortunately, the 7 percent of low back pain sufferers with chronic symptoms for more than six months consume a disproportionate percentage of health care dollars dedicated to addressing this problem.
Many fit and healthy people do develop back pain in spite of their best efforts to avoid it, since virtually all of us strain our backs at some point in time.
Recall, therefore, that there are “red flags” that may suggest a more serious underlying condition. These include fever, weight loss or unremitting pain at night that interferes with sleep. If back pain persists for more than a few days, it may be wise to seek medical attention. Recall that “back pain” is not a specific diagnosis, after all.
Your family physician may be able to render a more specific diagnosis. In many cases, radiographs and expensive tests are not even necessary. In other cases, a more detailed evaluation may be in order.
Have a healthy and safe holiday season!
Scott T. Anderson, M.D., Ph.D. (firstname.lastname@example.org) is clinical professor of medicine, UC Davis. This column is informational, and does not constitute medical advice.