Back Pain and Sciatica

Description

Alternative Names

Lifestyle Changes

Between 60% and 90% of the population experience back pain at one time or another during their lifetimes. Every year, nearly 15% of American adults visit their doctors because of low back pain episodes. Men and women are equally at risk. Low back pain is second only to upper respiratory infections (such as colds and flus) as the reason for seeing a doctor. In its costs to the country, it is second only to cancer and heart disease.

High-Risk Occupations

In one study, 16 out of 100 warehouse workers reported back injuries in one year, and in two major food service organizations 30% of all injuries involved the back. A major study of work-related injuries reported that, in 1994, there were nearly 330,000 cases of back injury due to overexertion in handling objects.

Jobs that involve lifting and forceful movements, bending and twisting into awkward positions, and whole-body vibration (usually caused by long-distance truck driving) place workers at particular risk for low back pain. The longer a person is on such jobs, the higher the risk. Some workers wear back support belts, but evidence strongly suggests that they are useful only for people who are currently suffering from low back pain. They offer little added support for the back and do not prevent back injuries. In fact, in one study workers who wore the belt for prevention reported more back pain than the workers who didn't wear them.

A number of companies are developing programs to protect against back injuries. Although studies are mixed on the effects of company interventions, one analysis suggested that they do have a positive effect. Employers and workers should make every effort to create a safe working environment. Office workers should have chairs, desks, and equipment that support the back or help maintain good posture.

Too Little or Improper Exercise

Sedentary Lifestyle. People who do not exercise regularly face an increased risk for low back pain, especially during times when they suddenly embark on stressful unaccustomed activity, such as shoveling, digging, or moving heavy items. Although no definitive studies have been done to prove the relationship between lack of exercise and low back pain, sedentary living is probably a primary nonmedical culprit contributing to this condition. Lack of exercise leads to the following conditions that may threaten the back:

• Muscle inflexibility (can restrict the back's ability to move, rotate, and bend).
• Weak stomach muscles (can increase the strain on the back and can cause an abnormal tilt of the pelvis).
• Weak back muscles (may increase the load on the spine and the risk for disc compression).
• Obesity, associated with sedentary lifestyle (may put more weight on the spine and increase pressure on the vertebrae and discs). Studies report only a weak association between obesity and low back pain, however.

Improper or Intense Exercise. On the other side of the coin, improper or excessive exercise is also an important risk factor for back pain.

• The effect of high-impact exercise on the back is not entirely clear. Some research suggests that over time, it may increase the risk for degenerative disc disease. A survey of people who played tennis, however, found no increased risk for low back pain or sciatica.
• Between 30% and 70% of cyclists experience low back pain. (One 1999 study reported that 70% of cyclists reported improvement simply by adjusting the angle of the bicycle seat.)
• Improper exercise instruction and inattention to mechanics can be sources of sudden trouble. As examples, a single jerky golf swing or incorrect use of exercise equipment (especially free weights, nautilus, and rowing machines) can cause serious back injuries.

Tips for Daily Movement and Inactivity

The way a person moves, stands, or sleeps during the day plays a major role in back pain:

• Maintaining good posture is very important. This means keeping the ears, shoulders, and hips in a straight line with the head up and stomach pulled in. It is best not to stand for long periods of time. If it is necessary, walk as much as possible and wear shoes without heels, preferably with cushioned soles. Using a low stool, alternate resting each foot on it.
• Sitting puts the most pressure on the back. Chairs should either have straight backs or low-back support. If possible, chairs should swivel to avoid twisting at the waist, have arm rests, and adjustable backs. While sitting, the knees should be a little higher than the hip, so a low stool or hassock is useful to put the feet on. A small pillow or rolled towel behind the lower back helps relieve pressure while either sitting or driving.
• Riding and particularly driving for long periods in a vehicle increases stress. Move the seat as far forward as possible to avoid bending forward. The back of the seat should be reclined not more than 30 and, if possible, the seat bottom should be tilted slightly up in front. For long rides, one should stop and walk around about every hour and avoid lifting or carrying objects immediately after the ride.
• Be sure to have a firm mattress. If the mattress is too soft, a 1/4-inch plywood board can be put between the mattress and box spring. On the other hand, some people have experienced morning backache from a mattress that is too hard. The back is the best guide.

Tips for Lifting and Bending

Anyone who engages in heavy lifting should take precautions when lifting and bending:

• If an object is too heavy or awkward, get help.
• Spread your feet apart to give a wide base of support.
• Stand as close as possible to the object being lifted.
• Bend at the knees--not at the waist. As you move up and down, tighten stomach muscles and tuck buttocks in so that the pelvis is rolled under and the spine remains in a natural "S' curve. (Even when not lifting an object, always try to use this posture when stooping down.)
• Hold objects close to the body to reduce the load on the back.
• Lift using the leg muscles, not those in the back.
• Stand up without bending forward from the waist.
• Never twist from the waist while bending or lifting any heavy object. If you need to move an object to one side, point your toes in that direction and pivot toward it.
• If an object can be moved without lifting, pull it, don't push.

There are four natural curves in the spinal column. The cervical, thoracic, lumbar, and sacral curvature. The curves, along with the intervertebral disks, help to absorb and distribute stresses that occur from everyday activities such as walking or from more intense activities such as running and jumping.

Quit Smoking

Smokers are at higher risk for back problems, perhaps because smoking decreases blood circulation. The association may also be due to an unhealthy lifestyle in general. A British study found that young adults who were long-term smokers were nearly twice as likely to develop low back pain than nonsmokers.

Risk Factors for Back Pain in Children and Adolescents

The likelihood of experiencing back pain increases as children age, and pain is more common among girls than boys, according to some studies. A common cause of temporary back pain is carrying backpacks that are too heavy for children (more than 20% of their body weight, or even less for very young children). Emotional or behavioral problems may also contribute to back pain (often along with stomachaches and headaches) in children.