Work a Little 'Back' Magic

It's probably one of the most common refrains in America - "Oh, my aching back!"

The statistics are just as painful. Back pain is the second leading cause of absenteeism from work. Doctors say it's the second most common medical complaint next to the common cold, and work-related injuries are the number one occupational hazard in the United States, with 2 percent of the workforce having some kind of back injury each year. Back disabilities cost a staggering $30 billion to $60 billion dollars annually.

And one in five Americans will experience some kind of lower back injury during their lifetime, according the American Academy of Orthopaedic Surgeons.

Blame it all on how the body's designed, says Martin Grabois, M.D., chairman of Baylor College of Medicine's department of physical medicine and rehabilitation in Houston.

"We were designed to walk on four legs, not two, and so we have this long structure, called the spine, made up of 24 different vertebrae," Grabois says. "And in our modern life, where we don't use the muscles we should or we are inactive or when we are active, we do it in spurts, that structure -- the spine -- is just not prepared. The result is one of the most common complaints doctors hear."

Watch how you lift

By far, lifting heavy objects incorrectly is the most common cause of back injury, Grabois says. "Most people bend over to pick up a heavy object and put strain on the back by only using the spine and the back muscles to pick it up.

The correct way to lift a heavy object is to put that object close to your body, squat down and then use your knees and hip joints to help you do the lifting."

While you may think doing exercises that strengthen back muscles is the surefire way to avoid back strain, working on your abdominal muscles may be just as important, Grabois says. "Weak abdominal muscles cause the burden of lifting to be taken up by the back," he says.

Abdominal muscles are important when you lift something heavy because the most important part of lifting is stabilizing the spine, Grabois explains. And you do that by pushing the abdominal contents back against the spine to support the structure.

The vast majority of back injury or sprain occurs in the lumbar sacral spine -- the curve at the base of your spine made up of five vertebrae. The lumbar spine is a complex structure allowing you to twist, turn and bend, as well as stand, walk and lift. Most injury occurs when a sudden or forceful movement injures the ligaments, (which weave together the five vertebrae of the lumbar and provide support or stability for the lower back) especially if any of those ligaments have been weakened through poor conditioning or overuse.

Being overweight is no help either, Grabois says. "Obesity causes increased weight on the spine and puts more pressure on the discs, causing back pain," he says.

Then there's the normal degeneration of the spine that occurs with age, Grabois says. "It's a combination of things: bone loss from osteoporosis or a decrease in strength and elasticity of muscles, as well as less elasticity and strength of the ligaments. And then there's disc degeneration. Between the vertebrae of the back, there are discs that cushion each of the vertebra and allow you to bend. As you get older, these tend to lose their normal structure. Impaired blood circulation tends to dry them out and they become susceptible to rupture and thinning."

If you do injure your back, usually a course of aspirin or ibuprofen to ease inflammation and a gradual return to normal activities, including exercise, should ease the problem. But it's important to start an exercise program slowly and gradually build up back strength, Grabois says. It's normal for your symptoms to get worse when you exercise or become more active. But persevere.

Recognize when to go to the emergency room. The following are "red flags" that could represent an emergency in which the roots of your spinal cord are being crushed:

• Numbness in your private parts.
• Weakness in your legs.
• Inability to have bowel movement or urinate; loss of control of bowel or bladder.

Tips for a better back

While you can't stop Father Time, Grabois says you can slow the effects of age by doing the following:

• Do sit ups and other abdominal muscle strengthening exercises to provide more spinal stability. Swimming, stationary bicycling and brisk walking are good aerobic exercises that don't put extra stress on your back.

• If you are already doing a lot of aerobic exercise, remember all that impact of your feet hitting the ground is hard on your back. Sports such as racquetball or tennis cause lots of twisting and potential injury. Remember to warm up and stretch, both before and after you exercise, when your muscles are warm.

• Use correct lifting and moving techniques - squat down to lift a heavy object; don't bend and lift. Get help if an object is too heavy or an awkward size.

• Maintain correct posture when you're sitting and standing; don't slouch.

• Avoid smoking. Smoking ties into back pain because it is a risk factor for atherosclerosis (hardening of the arteries), which has been found to cause lower back pain and degenerative disc disorders. In addition, smoking is associated with a sedentary lifestyle, which leads to back problems.

• Try reducing emotional stress, which may cause muscle tension.

What about back belts? If you do have a lot of lifting to do, back belts might not help. The National Institute of Occupational Safety and Health says there's no evidence they protect the spine during lifting, or help increase abdominal pressure to stabilize the spine. The institute does not recommend their use for workers who have never been injured.

Related Articles The Best and Worst Abdominal Exercises Treating Back Pain With Needles Back Pain

External Sources American Academy of Orthopaedic Surgeons National Institute of Occupational Safety and Health Baylor College of Medicine

This article was reviewed and updated June 2007.

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