The Medical Minute: Taking control of back pain

About 80 percent of the population will experience at least one significant episode of back pain in their lifetime. When it happens, most people first want to know how to feel better, then how to prevent a recurrence.

Dr. Mark Knaub, chief of adult orthopedic spine service at Penn State Health Milton S. Hershey Medical Center, said soft tissue injuries – strains of muscles, ligaments or tendons – are the most common culprits. They can be caused by activities involving lifting, twisting or bending, or by a fall.

Anti-inflammatory drugs and muscle relaxants can ease the immediate pain, while physical therapy helps keep a single episode from turning into a more chronic problem.

“Physical therapy can give you techniques to lessen your symptoms in the short term and get you back to being active and mobile,” Knaub said. “In the intermediate to long term, it can strengthen the core muscles that support the spine, and that could decrease the likelihood of having another episode in the future.”

Even without any active treatment, Knaub said most back pain will improve on its own within a few days to a week.

Disc injuries or herniations can also cause back pain. They also tend to heal on their own. In some cases, the herniated disc pinches a nerve, causing pain to radiate down the legs.

“Those are the people who are really miserable,” said Dr. G. Timothy Reiter, director of spinal neurosurgery at Penn State Health. Arthritis can also cause bone spurs that pinch nerves and cause intermittent symptoms in the leg that worsen over time. Patients with a history of cancer or recent infections are also likely to develop back pain that is more than just a muscle strain.

Both doctors say the general rule of thumb is that if symptoms last more than a month and don't respond to rest and medication, it could be time to get an X-ray or MRI or see a specialist. Depending on the results, steroid injections or surgery might be recommended.

While it isn't always possible to prevent back pain, there are things you can do to limit your risk of developing problems.

The most important could be engaging in regular physical activity a few times a week. Exercises that strengthen the core muscles can also help prevent acute injuries and strain. Maintaining a healthy weight and avoiding tobacco products also decrease your risk.

Truck drivers, operators of heavy machinery and others who have jobs where they are subjected to vibrations may be more likely to develop back pain, as are those who have psychological conditions such as depression.

“When people have chronic back problems, there is a large psychological component to it,” Knaub said. “Being depressed causes pain, and being in pain makes you depressed.”

He said studies in Europe have shown that cognitive behavioral therapy can work as well as traditional medical treatments for that type of back pain.

“If you lack coping mechanisms and don't handle the pain and stress well, that can feed into your anxiety,” Knaub said.

Learn more:

• The Back Coach, from Penn State Spine Center
• The Medical Minute: Back pain often treatable without surgery

The Medical Minute is a weekly health news feature produced by Penn State Health Milton S. Hershey Medical Center. Articles feature the expertise of faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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