Back pain seems to be nearly ubiquitous among the elderly, but did you know that signs of back pain begin to develop around the age of 40, and as young as 30 in some cases? This is just one among many facts that highlights how widespread back pain is and has been – yet a lot pain is left unsaid in the general public.
While the conversation around chronic pain has grown considerably in the past few years, many facts surrounding the various common forms of chronic pain and why they occur aren’t part of the mainstream knowledge. Despite the fact that nearly every human is at risk for developing back pain in the latter half of their lifespan, few know exactly why, or how the pain can manifest and differ from normal, acute pain.
In some cases, this extends to people who are struggling with back pain – too many are struggling silently, considering their pain to be “normal”, despite the fact that there are many effective ways to combat the effects of aging on the spine and rest of the body, both preventatively and therapeutically. If you’re fighting back pain, there are a couple things you should know, and several questions you should be asking a physiotherapist or pain management professional.
Back Pain Is the Most Common Form of Chronic Pain
At any given moment, over 10% of the US population will be experiencing a form of lower back pain, and it’s estimated that 80% of Americans go through some form of back pain throughout their lives. Back pain is characterized by consistent discomfort usually in the lower back, not always indicative of chronic pain.
The most common causes include aging and musculoskeletal stress, from posture, weakness, injury, and improper technique during physical exertion. Other factors include spinal health issues, slipped or damaged discs, an inflammation in or around the nerves of the spine, and nerve damage from an injury or illness somewhere in the back. Back pain can also be linked to complications or damage in organs throughout the lower back, including kidney stones, infections, or blood clots.
Worldwide, back pain is the leading cause of disability. 40% of missed work days are due to low back pain. For most Americans, back pain comes and goes – however, it is commonly recurring compared to other forms of pain. Only a small percentage of Americans experiences consistent, chronic, and debilitating back pain, the kind that lasts for 12 weeks or longer. While rare, this type of back pain can end careers, leave people miserable, and be the start for a cascade of related mental issues, including depression. It is also the most common form of chronic pain, next to knees and neck pain.
Part of the reason back pain is so common is because of the way the that spinal discs deteriorate over time. Spinal discs are jelly-like cartilaginous elements in between every vertebrae. As we move, twist, bend over and lean back, these discs allow us to move, compress, and decompress the spine without grinding each vertebrae together. However, over time, these discs thin out, break, bulge, herniate, or grow weaker. This can lead to spinal problems, often including pain. Knee injuries are common for the same reason – our knees absorb the impact of walking, jumping, running, and lifting for decades before slowly deteriorating over time. This can lead to swelling, arthritis, and tendon damage.
Out of the rest of the body, pain is more common in the lower back because the spine often has to absorb the most force down there. As we move, lift, bend and live, it’s the lower back that happens to take up the most force while having the least protection. The upper back is protected and stabilized by a series of rips and powerful musculature, while the neck, sacral section, and tailbone are not usually exposed to much shearing forces. While keeping the thoracic upright is relatively easy, years spent sitting, squatting, or bending over takes its toll on the lumbar.
Nevertheless, thoracic back pain also occurs, most frequently due to injury or spinal disorders such as scoliosis and abnormalities in the shape or form of the upper back.
Training Can Help (or Hurt)
Contrary to what might be sensible, loading the spine appropriately can help alleviate back pain in the right context, depending on the severity of the pain and the cause for it. That definitely does not mean you should start exercising if you’re experiencing back pain. The exact cause of the pain is important to determine how much strength training can help.
If the origin of the pain allows loading of the spine, then back-strengthening exercises can help take pressure off the spine by distributing it along a stronger musculature, get the blood pumping through the back (which can greatly reduce pain), and release painkilling endorphins during and right after each workout. The added benefit of regular exercise is, if you’re overweight, it can help you lose a few pounds and further decrease the pressure on your back. Note, however, that bodyweight is mostly affected by how you eat rather than how often you exercise.
Going straight for heavy compound movements like the squat or deadlift isn’t always wise, although in some cases, these can tremendously help build strength in the back under professional supervision, and with careful form. Simple exercises that can help you strengthen the muscles of the back (and surrounding musculature) includes:
- Hip thrusts
- Goblet squats
- And many more
Exercise recommendations are difficult to make and depend entirely on your level of familiarity with a given movement, your strength, as well as the exact nature of your pain and/or injury. Always be sure to consult a medical professional before trying out a fitness regime, if you’re concerned about your back pain. Any exercises that primarily focus on strengthening the erectors, glutes, hamstrings, and external obliques can be very helpful. Collectively, these muscles are often identified as the posterior chain.
Remember to Stretch
Aside from strengthening the muscles around the back, it’s important to seek out a physical therapist or professional masseuse experienced with back pain to help you continue to relieve your pain after training.
Muscle tenderness is very common after training, and while exercise can help you alleviate pain in the long-term, regular stretching and massages can help you alleviate the soreness that accompanies exercise. Ask your doctor what stretches to avoid, as some forms of back pain may prohibit you from excessively flexing the spine, even if only to stretch the muscles along the back.
Invasive Options Are a Last Resort
Pain management today – especially in the face of the opioid crisis and the havoc it’s wreaked in countless lives throughout the country – is focused on non-invasive, non-opioid treatments. These include heat therapy, shockwave therapy, yoga and acupuncture, to minimally-invasive treatment options such as corticosteroid injections, nerve blocks, platelet-rick plasma therapy, and more.
Invasive options – including surgery to cut out scarred tissue, or further address damaged discs/nerve compression – are always a last resort, due to the risks, costs, and irreversible nature of some treatments. Pain management can be effective without a syringe or a scalpel, but it all depends on the nature of the pain, and its best course of treatment.