http://www.detnews.com/2005/fitness/0508/02/G05-266273.htm

By Rita Rubin / USA TODAY


Don't take low-back pain lying down.

That's the message public health officials, employers and doctors
are spreading about one of the leading causes of disability.

Doctors often used to prescribe bed rest for low-back pain. But
research in recent years has concluded that the best thing you can
do for low-back pain is to stay active and, possibly, stay away from
medical specialists.

"There is this misconception that people with back pain shouldn't do
anything, that exercise will cause more damage," says Jill Hayden, a
research fellow at Toronto's Institute for Work and Health.

Hayden, a chiropractor and epidemiologist, is the lead author of two
papers about exercise and back pain in a recent issue of the Annals
of Internal Medicine. After reviewing published research on the
subject, she and her co-authors concluded that exercise,
specifically stretching and strengthening exercise, is slightly
effective in reducing pain and improving function in adults with
chronic low-back pain. However, it has no effect in adults with
acute, or short-term, pain.

About two-thirds of adults will experience low-back pain at some
point in their lives, says Stover Snook, a visiting scientist in
environmental health at the Harvard School of Public Health.

Although low-back problems can be painful, fewer than 1 percent of
cases are caused by cancer or another serious disease, and fewer
than 1 percent are linked to arthritis or other inflammatory
diseases, Snook wrote in a recent paper in the Journal of
Occupational Rehabilitation. He says about 85 percent of cases are
considered "nonspecific," because the cause is not known.

Andrea Furlan, a physician who specializes in physical medicine at
Toronto Western Hospital, says patients aren't crazy about being
told their back pain is nonspecific. "If I say it's nonspecific,
then they think I don't know the answer," Furlan says.

To satisfy patients who seek a more definitive diagnosis, Furlan
says she'll sometimes use the term "mechanical low-back pain," which
pretty much means the same thing.

X-rays and MRI scans are "notoriously unhelpful" when it comes to
identifying the cause of low-back pain, says Mayo Clinic
rheumatologist Nisha Manek, who recently co-wrote a paper on the
epidemiology of back disorders for the journal Current Opinions in
Rheumatology.

"Back pain is really your muscle trying to stabilize your spine,"
Manek says. "It doesn't mean that you actually have something wrong
in your spine, by and large."

And yet, she says, patients "expect that doctors will X-ray, and
doctors will follow through. Even though we know better. I'm guilty
of it."

Another common expectation is that surgery will cure low-back pain,
when actually it should be reserved for the small percentage of
cases in which it is clearly called for, Manek says. Instead of
surgery, she says, alternative therapies, such as massage or
acupuncture, often help.

Furlan learned how to perform acupuncture while she was completing
her medical residency. In the journal Spine last month, she was the
lead author of a review of studies of the effectiveness of
acupuncture in treating nonspecific low-back pain.

Furlan and her co-authors concluded that acupuncture seems to help
relieve chronic back pain when used in conjunction with conventional
treatments such as exercise. Typically, she says, patients have two
acupuncture sessions a week for up to 10 weeks.

In an earlier published review, Furlan and her co-authors concluded
that muscle relaxants can help relieve low-back pain, but the drugs'
benefit may not outweigh the drowsiness they cause.

Snook suggests that you treat low-back pain with over-the-counter
pain relievers and common sense.

Low-back pain "hurts a lot, but it's not serious, and you shouldn't
panic. With or without medical treatment, it goes away," says Snook,
who lectured on ergonomics at the Harvard public health school for
30 years and conducted research for the Liberty Mutual Insurance
Co., a workers' compensation insurance underwriter.

Remember that your back is stiffer and more vulnerable first thing
in the morning because of increased fluid and increased pressure in
the discs, Snook says.

So, he says, do your heavy lifting, like taking the trash out,
before going to bed instead of first thing in the morning.

Don't sit bolt upright when you get out of bed. Roll over, put your
feet on the floor and push yourself up to a standing position
without bending your back. Try eating your breakfast standing up.

To minimize bending through the day, use long-handled shoehorns,
dustpans and other devices. And if possible, Snook says, take a page
from such notables as Thomas Jefferson and Winston Churchill and use
a stand-up desk.