Back Pain

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Low back pain affects up to 80% of individuals at some time in their lives and is second only to the common cold as the leading cause of missed work days among adults 18 to 45. It is the most common musculoskeletal complaint with the prevalence increasing with age, affecting up to 50% of seniors at any given time.[1]

Back Pain
Back pain.jpg

Back Pain
Causes Posture, Lack of Activity, Injuries, Stress, Dehydration
See Also Musculoskeletal Conditions, Arthritis, Rheumatoid Arthritis, Sciatica
Books Books on Muscle, Joint and Bone Conditions
Articles Articles on Musculoskeletal Conditions

Naturopathic Assessment

Causal Factors

Check out this book The Complete Doctor's Healthy Back Bible: A Practical Manual for Understanding, Preventing and Treating Back Pain


Back injuries are typically caused by lifestyle and external factors that initiate a cumulative trauma pathway.[2] Back pain is seldom due to a single incident, unless the incident is severe. It is more commonly due to an underlying susceptibility followed by precipitating causes including the following:

Lifestyle

Article Lightening the Load: Minimizing Risk of Back Injury in Healthcare Workers , 2006 Spring/Summer Vital Link

The lifestyle factors often associated with back pain include:

  • Poor posture is one of the main contributing factors to increasing a person's susceptibility to back pain.
  • Curvatures of the spine (such as scoliosis or kyphosis), which are often inherited can result in back pain and can increase a person's risk to back pain and other conditions.
  • A prolonged stooped posture can lead to the stretching of the ligaments around a joint, which can cause local instability, leading to a hyper flexion injury, or increased shearing and bending loads at the neural arch.[2]
  • Prolonged sitting or standing, combined with a lack of physical activity, leads to weak and inflexible back muscles.[3] These muscles play a major role in supporting the spine, and in protecting the back from injury.[2]
  • Inter-vertebral disc herniation is commonly associated with back pain. Its onset is associated with a forward or laterally flexed posture, and with repeated loading. Herniation most often occurs during repeated flexion and simultaneous compression. The number of times that this occurs is more important than the load applied. Disc herniation is also associated with sedentary occupations and sitting posture.[2]
Backache illustration.jpg
  • Both too much and too little physical activity are associated with lower back pain.[4]
  • Those that are sedentary are more prone to back pain and poor posture.
  • Dehydration is a fundamental cause of back pain as it leads to a decrease in blood volume. This in turn causes a decrease in the quantity of oxygen and nutrients that reach the tissues, and also allows an accumulation of metabolic waste products in the tissues.[5], [3]
  • Being adequately hydrated helps increase muscle blood perfusion by lowering the viscosity of blood, and by facilitating the exchange of carbon dioxide and oxygen in the lung. Furthermore, when a person is dehydrated, the volume of the inter-vertebral discs decreases. This puts extra strain on the muscles of the back as they attempt to maintain the body's erect posture with less help from the inter-vertebral discs. This leads to muscle fatigue, spasm, and back pain. Also, dehydrated discs are more prone to dislocation, which is a cause of back pain and sciatica.
  • A lack of proper water and nutrient intake can slow tissue healing and decrease musculoskeletal health.[6],[5]

Social

  • Stress
  • Emotional situations that triggers feeling of not being strong enough or not having sufficient support are associated with back pain and increase a person's susceptibility to back pain and injury.
  • Emotional stress, including depression and anxiety are associated with increased occurrence of low back pain. Any stressful situation can also aggravate underlying back pain.
  • Chronic stress contributes to back pain by creating long term muscle tension which decreases blood perfusion to the muscles.[3]

External

  • Injury
  • Injury or fractures to the back can trigger back pain.
  • Ergonomics
  • Back pain can also be caused by improper ergonomics, and overly soft or hard mattresses.[3], [6] Overly soft mattresses cause the misalignment of the spine during sleep. This puts strain on supporting muscles and ligaments. If the mattress is too hard, such strain can also occur, as the waist is suspended between the hips and the shoulders.
  • Poor ergonomics at work, such as not having a proper chair, or twisting to access a computer can contribute to back pain.
  • Occupations
  • Occupations that involve lifting heavy objects, or repeated lifting of lighter ones can also cause back pain. This is especially true when lifting and twisting of the spine occur together.[4] Heavy lifting forces the osmoticaly held water out of the inter-vertebral discs of the spine, thereby lowering its shock absorbing ability.[5]
  • Occupations that involve a lot of bending and twisting, or that involves whole body vibration (such as truck driving or using a sandblaster) can contribute to back pain.
  • Improper footwear and tight and restrictive clothing can cause low back pain.
  • Smoking is associated with lower back pain.[4], [2] Smoking interferes with blood flow to the spine thereby decreasing the health of the inter-vertebral discs.[4] It also can cause breathing abnormalities that put extra strain on muscles of respiration, which can contribute to back pain.

Medical Interventions

  • Prescription Medications
  • Diuretics can deplete magnesium.[3] Magnesium is necessary to prevent muscle spasms and pain in muscles.
  • Medical Procedures
  • Surgery can cause back pain in some individuals.

Physiology

  • Poor breathing, over-breathing and under-breathing are all associated with increased occurrence of back pain.
  • During the parasympathetic nervous system stimulation that accompanies stress, breathing becomes shallow and rapid, leading to hypoxia which, if prolonged, can cause muscle tension and backache.[3][7]
  • Chronic Muscle Tension
  • Muscle pain is often associated with decreased tissue oxygenation.[3] If the muscles in the back are chronically tight and contracting, this can restrict blood flow to the area and decrease the amount of oxygen and nutrients that are reaching the tissues.[3]

Diagnostic Testing

The diagnosis of back pain is typically based on a person's subjective symptoms and a proper musculoskeletal exam. Other diagnostic testing that may be recommended include:

  • Lab Tests to assess for inflammation such as CBC, ESR and C-Reactive Protein (CRP)
  • Other diagnostic testing including X-rays, CT scan, MRI or myelogram (an x-ray or CT scan of the spine after dye has been injected into the spinal column) especially if the back pain does not resolve with rest and standard treatment.

Related Symptoms and Conditions

  • Obese people, women with large breasts, and pregnant women are at a higher risk for back pain, as the extra weight adds strain to the back.[6]
  • Inflammation
  • Systemic inflammation is associated with back pain, especially in those individuals that have a increased susceptibility.[3] For example, stabilizing insulin levels can decrease systemic inflammation and intestinal hyperpermiability can contribute to muscle and joint inflammation.
  • Much less frequently, low back pain can signal the presence of an underlying illness, such as:

Characteristics

Low back pain may present in a variety of ways:

  • sharp or dull
  • constant or intermittent
  • shallow or deep
  • mild to severe.

It may also radiate (move) to other parts of the body such as the hips, legs, or feet. Low back pain can also be linked to neck pain.

Naturopathic Treatment

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. The goal of naturopathic treatment is to provide relief from the back pain, to address the underlying causes and in the cases of chronic or relapsing back pain to identify and address the factors that are contributing the increased susceptibility.

It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.

Home Care

Home Care strategies include:

  • Proper lifting. Lifting should be done with the knees bent, back straight, legs spread, and with the superior end of the pelvis tilted posteriorly.[6][5] Objects being lifted should be held as close to the body as possible.[5] One should not twist the back when lifting, as this greatly increases the chance of injury.[5] Repetitive lifting in the same position should be avoided.[6]

Lifestyle

Lifestyle recommendations include:

  • Foods in the nightshade family, i.e., tomato, potato, peppers, eggplant and tobacco, contain solanine which causes joint pain and inflammation in people who are sensitive to this.[6], [3]
  • Ensure you drink adequate water. Water is essential for the maintenance of muscle, joint and inter-vertebral disc health as well as the shock absorbing ability of the intervertebral discs.[3], [5]
  • People who are physically fit are less likely to be affected by back pain, injury, or re-injury.[4] :* Strengthening the muscles of the back, abdomen, and upper body via properly performed exercises, can help to prevent back pain.[6]
  • Periods of exercise and lifting must be separated by periods of rest which allow for tissue to adapt and recover.[2] This process helps to increase the failure tolerance of the tissues of the back.[2]
  • Adequate time must be allowed for the back to rest and heal following an injury before exercise is begun.
  • Stretching can be done as the exclusive exercise until flexibility is achieved, after which point, low impact exercise such as swimming, yoga, walking and pilates should be performed.[5], [3]
  • Avoid sitting or standing for prolonged periods of time.[3] If sitting for extended periods is necessary, practice Kegel exercises while seated and take frequent breaks to get up and walk around.[5]
  • Practice abdominal breathing to both facilitate proper oxygenation of body tissues, and to remove excess strain from the accessory muscles of respiration.[3]
  • An adequate amount of deep sleep, or non rapid-eye-movement sleep, is necessary for proper tissue regeneration and repair.[8][5]

Naturopathic Therapies

Naturopathic Therapies for back pain include:

  • Acupuncture has been shown to decrease pain and improve functioning in people with chronic back pain.[4]
  • Ice should be applied for 20 minutes per waking hour, up to 48 hours post injury.[3] Following this, hot water should be used to warm the area during acute and chronic pain.[3]
  • Massage and Spinal manipulation are effective for relieving back pain, especially when combined with other treatments.[4]

References

Co-Authored by:

Dr. Iva Lloyd, BScH, RPE [1]
Dr. Raymond Trott, ND
  1. Pizzorno Joseph, Murray Michael, Joiner-Bey Herb The Clinician's Handbook of Natural Medicine, Churchill Livingstone.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Mcgill Stuart (2002) Human Kinetics.
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 Ivker Robert (2003) Backache Survival, the Holistic Medical Treatment Program for Low Back Pain, Jeremy Tarcher/Putnam. Cite error: Invalid <ref> tag; name "Ivker" defined multiple times with different content
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Dagenais Simon, Haldeman Scott (2011) Evidenced-Based management of low back pain Elsevier.
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 Batmanghelidj F (1997) Water, for a Healthier Pain-Free Life Audio Recording. Tape 7 side A. Global Health Solutions inc.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 Rothfeld Glenn S, Levert Suzanne (1996) Natural Medicine for Back Pain, the Best Alternative Methods for Banishing Backache Rodale Press.
  7. Chaitow Leon, Bradley Dinah, Gilbert Chris (2002) Multidisciplinary Approaches To Breathing Pattern Disorders Churchill Livingstone.
  8. Titelbaum Jacob (2003) Proven and effective treatment for chronic fatigue and fibromyalgia Tree Farm Tapes. Audio Recording. 18th Annual AANP Convention.
  9. Lu Henry (1986) Chinese System of Food Cures, prevention and remedies Sterling Publishing Co. New York.
  10. Hershoff Asa 2000 Homeopathic Remedies, A Quick and Easy Guide to Common Disorders and their Homeopathic Treatments, Avery Publishing Group, New York
  11. Ullman Robert, Reichenberg-Ullman Judyth 1997, Homeopathic Self-Care, the quick and easy guide for the whole family. Prima Publishing