(02 March 2000) -- "I
should have known better than to try and keep up with a 25-year-
old." Juan started to describe his pain with this
self-admonishment. "But at 50, I felt in good shape and the
invitation to play wally ball sounded like a way to add variety to my
typical workout routine that starts with the stationary bike, goes
through the Nautilus equipment and ends at the juice bar."
"Now, three months
later," Juan continued, "the annoying pain in the small of
my back that radiates down my left leg is still there when I lift
something or lean the wrong way. Aleve doesnít upset my stomach the
way aspirin did, but it also doesnít provide much relief."
Wally ball, a.k.a.
one-bounce volleyball, is a slightly modified game of volleyball for
two to 20 people, where the ball is permitted to bounce once before a
player hits it. Of course, players can still hit the ball in flight,
but letting it bounce gives those who are not as physically adept in
playing the game a chance to keep up with the younger players. Soft,
safe balls are also used in place of regular volleyballs to cut down
on hand and wrist injuries.
A common problem with
Juan is among the many
millions of Americans who suffer from back pain: in fact, eight out of
10 people in the U.S. will experience back pain during their lives. A
valid reason to seek medical attention for this condition is to rule
out rare but potentially serious conditions that might masquerade as
simple low back pain.
treatments, anti- inflammatory medicines, muscle relaxants, physical
therapy, and surgery are not very effective. Anti-inflammatory
medicine can damage the stomach, as well as cause bleeding, in
addition to kidney, bone marrow and liver problems. Muscle relaxants
cause sedation but do little to relax muscles. Physical therapy is
safe but seldom leads to long-term relief. Surgery in selected cases
may have value, but the problem is identifying those cases in which
surgery is the optimal therapy. Following surgery there is also a risk
of continued pain, probably due to the formation of scar tissue.
A comprehensive approach
Developing a treatment
strategy for low back pain should be viewed from two perspectives.
First, there is the need to provide pain relief. Second, it is
important to initiate programs with long-term benefits to the patient.
alternative therapies are used for low back pain more frequently than
for any other indication. Spinal manipulations for low back pain are
helpful when acute and subacute low back pain occurs with or without
mild neurological involvement or sciatic nerve irritation. Chiropractic manipulation
and osteopathic treatment of acute low back pain have been supported
by positive findings in randomized controlled trials and are
recommended by several regulatory agencies.
In 1994, the Federal
Agency for Health Care Policy and Research (AHCPR; renamed as the
Agency for Healthcare Research and Quality [AHRQ] in December 1999)
released guidelines for the treatment of acute low back pain, which
recommended spinal manipulation -- either osteopathic or chiropractic
-- over more typical forms of physical therapy (including traction, diathermy,
transcutaneous electrical nerve stimulation [TENS] and ultrasound).
National treatment guidelines in Canada and England recommend
chiropractic manipulation as a first-line therapy for neck and back
In addition, a 1999
survey of 50 clinical experts on low back pain concluded that for
acute uncomplicated low back pain, chiropractic and osteopathy were
effective. For chronic, uncomplicated low back pain, most experts
to be effective. Acupuncture has the additional benefit that it can be
started during the immediate post-injury period, rather than waiting
the three to five days necessary with chiropractic. The experts
perceived homeopathy generally as ineffective for any type of low back
pain, while sketchy clinical experience with herbalism for low back
pain precluded firm conclusions.
One drawback to
chiropractic (or other treatment) is that patients often re-injure
themselves and slow their own recovery by failing to pay attention to
the elementary rules of back care, which are:
- Donít bend over, and
- Donít reach to the
integrative back program also should include careful instruction and
demonstration, reinforced by helpful print or videotape instructional
tools. For example, clients/patients can be taught how to lift objects
properly using the power of the quadriceps muscles in the thigh,
sparing the back of needless strain. Some practitioners send their
clients/patients to "Back School," where they learn to
perform usual movements involved in daily activities in new and
Taking a long-term
posture for back health
It is not clear why back
pain becomes chronic. However, it may, in part, be the result of
improper movement habits and poor posture. This problem can be
addressed through the use of movement re-education techniques and
exercise programs such as Feldenkrais movement
therapy, the Pilates (pronounced
Pi-lah-tees) exercise system and rolfing.
These areas of bodywork offer new approaches to awareness and health,
although there are no scientific studies to prove or disprove their
therapy was developed to improve ease of movement. It differs from
most other schools of bodywork in that it is not designed to
structurally alter the body. Rather, the practitioner attempts to
communicate to the person a sense of improved self-image and movement
through gentle massage, stretching and exercise.
The Body Control Pilates
Method enables exercises to be performed without using the problem
area initially. It strengthens supporting muscles to assist the area
to be rehabilitated.
Finally, Rolfing, also
known as structural integration, is based on the idea that human
function is improved when the segments of the body (head, torso,
pelvis, legs, and feet) are properly aligned. Through the use of
pressure applied with the fingers, knuckles and elbows, Rolfing
attempts to achieve balance and poise by manipulating and stretching
of the bodyís fascial tissues to release adhesions.
It would be an
oversimplification to conclude that this patientís complaint is the
result of one game of wally ball. Low back pain is a common alignment
problem whose onset is probably the result of multiple contributing
factors -- an acute incident made worse by a life of movement and
posture that places excessive strain on the body combined with too
little exercise and an unhealthy diet. It is reasonable, therefore, to
conclude that optimal therapy for low back pain requires a
comprehensive approach by a team of experienced experts from
complementary fields of health care.
Russo, Jr. PharmD is senior vice president of medical
communications at Vicus.com. He is a pharmacist and medical writer
with more than 20 years of experience in medical education.