Coping with Back Pain: What Works?

However and whenever it hits you, back pain is always an unwelcome visitor. About 90% of us will suffer at least one bout of debilitating back pain in our lifetime. That's actually not such a surprising number, given the way the back is structured.

Jammed into a relatively narrow passageway in the back are the vertebrae, bones, joints and disks that protect the spinal cord, as well as the ligaments, tendons and muscles that connect everything and allow us to stand upright, rather than on all fours, like our prehistoric ancestors (see illustration).

The lower back is particularly vulnerable to insult, as it is there that stress and shock to the body are absorbed. Daily activities such as walking, lifting, twisting and turning all put stress on the lower back. Being out of shape, having arthritic joints or using poor posture will all contribute to back pain.

But there is some good news. Most episodes of back pain are short-lived and will disappear on their own. In fact, 80% of back pain cases will get better within a month with no treatment. Leave things alone for two months, and 90% will spontaneously resolve. Admittedly, two months, or even one, is a long time to be in pain. So what can you do in the meantime?

Men's Health Advisor asked the Cleveland Clinic about how patients with low back pain are helped.

What is the best way to treat low back pain?
That depends on the cause. To determine this, the doctor takes a thorough medical history and performs a careful physical examination. A plain X-ray may be ordered to detect any fractures, disk space narrowing (degenerative disease), or bony overgrowths that occur with arthritis. Often, X-rays are unnecessary. X-rays will often look normal, despite the pain.

If there are no other obvious symptoms, a strain or sprain of the muscles or ligaments may be suspected. Strains and sprains are the most common causes of run-of-the-mill back pain. The best treatment is a few days of rest and over-the-counter analgesics, such as aspirin or Tylenol, or anti-inflammatory medication such as ibuprofen. Within a week or so of this common-sense treatment, most people feel better.

If the muscles are in spasm and the patient can't straighten up, a muscle relaxant such as Methocarbamol (Robaxin) may be prescribed.

How does a patient "rest" their back?
Oddly enough, resting your back does not mean lying around in bed. In fact, studies show that prolonged bed rest contributes to muscle atrophy and general deconditioning, just making recovery harder.

Instead, get out of bed as soon as possible, at least for short periods of time. When you're up and about, change position frequently, alternate sitting and standing. Sitting is the most stressful position for the lower back, so sit only five or 10 minutes at a time at first.

Resting your back also means avoiding certain activities: Lifting, bending forward at the waist, even sitting or driving for long periods can put extreme stress on the back. If pain does not resolve with rest and over-the-counter drugs, "active exercis." may be recommended.

What is "active exercise"?
Active exercise is a unique kind of physical therapy done under the guidance of a trained specialist. The McKenzie Method, designed by physical therapist Robin McKenzie, involves simple exercises that put the back in extension, meaning stretched backward, or flexion, flexed forward. The therapist observes the body's response to these mechanical movements and designs a program of exercise that will best abolish the patient's pain. For example, some positions will decrease pressure from a herniated disk. Other positions will worsen muscular pain. Everyone is different and receives a completely individualized plan.

The therapist sees the patient for three or four weeks, changing the exercises as the patient's pain diminishes and range of motion increases. The therapist also teaches the patient how to avoid future bouts of back pain. Many doctors are great proponents of this method, because it brings great results and gives the patient the tools to keep his back strong and pain free.

Why haven't patients heard of this method before?
Although the McKenzie Method was introduced in 1959, it was not taught at medical schools until recently, so not all physicians are familiar with it. Although there are other types of exercise for back pain, the McKenzie method is one of the best.