Structural Causes of Back Pain

"Look first to the spine for the cause of disease," said Hippocrates. We couldn't agree more. If your back hurts, then checking for a structural cause is a good place to start.

The first structural issue to consider, of course, is an actual physical injury, an abnormality, or an age-related wearing away of the bone, which may cause or contribute to back pain. These issues may be relatively easy for the medical community to diagnose, but there are many routes to a cure, and we'll talk more about these in Chapter 4. In this chapter, I just want to remind you of our personal mantra: Start with the least invasive treatment and proceed from there. In autumn 2006, the Journal of the American Medical Association published a well-designed study that compared patients who had surgery for ruptured discs in their lower backs to those who did not have surgery. Those who had surgery found relief more quickly; however, when the two groups were evaluated 2 years later, the authors noted that the patients who had simply waited eventually improved to the same degree as those who had the surgery. When evaluated 5 to 7 years later, the two groups showed no discernible difference. Although one can't discount the benefit of addressing the pain early through surgery, when you factor in the expense and the possible risk factors, a definite case can be made for simply waiting it out. This means that even if you have one of the classic structural issues that can cause back pain, you don't want to book time with the surgeon just yet. There are many alternatives to surgery, which will be discussed later in the book.

Structural pain can also come from such lifestyle issues as poor posture and too much time sitting with a rounded back at the computer; it can even come from a surprising source, such as years and years of sitting on your wallet. (More about this in Chapter 5.) Iowa researchers examined 15 different studies and found that as little as 20 hours of work at the computer doubles the risk of developing shoulder and arm pain, and over time, shoulder and arm pain often resonate as pain that is felt in the back and neck.

When the muscles and spine are not aligned-often because of bad posture and other lifestyle issues-muscle function, nerve function, and blood supply are compromised. Proper posture and correct use of your muscles make for more effective functioning. Weight lifters understand this concept, and as a result, they are able to lift some impressive weight. When picking something up, most of us hinge at the waist and reach down with our hands. This lifting method compromises our breathing, blood flow, and nerve function. You could never accomplish with this method what a weight lifter could by squatting down first and letting the leg muscles do the real work.

Body form is a vital part of back health and general well-being. Good form permits us to accomplish what we need to without causing injury, and it increases strength and generally optimizes muscular function. Even sedentary acts can be done "better" when proper form is employed. Though sitting at the computer has proven to be a major cause of back pain, you can even do that for prolonged periods if you use proper form. This involves having a good chair, exerting the effort to maintain good posture, and taking regular 5-minute stretching breaks.

Throughout this site and in the book, you'll find many suggestions and some specially designed exercises to help you regain proper form so that the pain caused by structural issues will diminish. In the process, you will improve your overall health because your breathing and blood flow will be better able to send nutrients to every part of your body.