Treating and Prevening Back Pain

In this installment of regular column, a pair of guest authors examine the causes of back pain and recommend self-care behaviors aimed at preventing back pain.

| May/June 1985

On any given day, more than a million North Americans are confined to bed because of lower back pain. New cases of back pain occur at the rate of 1.5 million a month, and more than 200,000 North Americans have back surgery every year.

We’ll get to what we consider is the best way of treating the condition and why preventing back pain is better, but first, a little physiology.

The Perils of Being a Vertebrate

As you probably know, the word backbone is a misnomer; the correct term is spinal column: a structure composed of 33 vertebrae, most of which are separated by flexible cartilage disks. From top to bottom, there are seven cervical vertebrae in the neck, 12 thoracic vertebrae in the chest, and five lumbar vertebrae in the lower back; then five vertebrae fused together to form the sacrum , and four fused to form the coccyx or tailbone. The vertebral column supports the body and houses the spinal cord, encased in the spinal canal, a tunnel formed by holes in the vertebrae.

When our ancestors made that bold evolutionary gesture of standing up, they imposed tremendous stress on the vertebrae. Their backs became more susceptible to sliding out of alignment. The most vulnerable area is in the small of the back where the five lumbar vertebrae are located.

In front of the spinal canal is the vertebral body; behind it, each vertebra has four protruding bony processes that form joints with the adjoining vertebrae. The vertebrae are also connected by a network of muscles and ligaments, any of which may be strained and cause pain.

Between each vertebra and the next is an intervertebral disk, notorious for "slipping," which is something it does not actually do. The disk is a thin cartilage pad. Its center, the nucleus pulposus, is made of gelatinous material, 80% water, which cushions the vertebrae and makes the back elastic and flexible. Surrounding the nucleus pulposus is a harder fibrous ring, the annulus fibrosus. This is where serious back trouble usually starts. Accident, injury, or years of poor posture can weaken the annulus, and a rupture (hernia) can occur. A portion of the nucleus can protrude through the annulus. If the protruding portion of the nucleus presses against a nerve or ligament, the result is back pain. If the sciatic nerve, which runs down the leg, is affected, there may also be leg pain. Once a disk herniates, it's never quite the same. "The herniation," says San Francisco orthopedic surgeon Stanford Lazar, "can move back away from the nerve and the pain will resolve. But the disk does not return to normal. It's unstable, and can pop out again."

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