What to Do About Back Pain

How to stop back pain and backaches. What to do when your back hurts.

By Elena Rover

Why Your Back Hurts

"I ache in the places where I used to play," Leonard Cohen wrote, and most of us have to agree. Of the 80 percent of Americans who experience back pain, most are women between 45 and 64. And one of the spots likely to creak is the lower back, near the low-rise belt line. This is caused in part by aging joints, but many of us also get weaker and more sedentary over time. So when we take on an intense activity — from a new sport to rearranging the furniture — we can damage the vertebrae near the waist, which bear most of our weight.

Back pain can be sharp or dull and can occur slowly or suddenly. Most back flare-ups improve in a week and are all but gone in six to 12 weeks, according to Daveed Frazier, MD, assistant clinical professor of orthopedic surgery at St. Luke’s-Roosevelt Hospital, a Columbia University affiliate in New York. But even easily remedied backaches usually return, and about 10 percent of those who experience them end up with chronic pain. Fortunately, there is plenty you can do to help yourself. The exercises used to treat back problems also help prevent them, so it’s worth the effort to build strong core muscles now — and there’s the bonus of flatter abs.

Most back pain stems from simple muscle and joint strains, yet structural problems, such as herniated discs, are common. Discs, those spongy cushions between the rings of spinal vertebrae, keep them from rubbing together when you move, yet also allow you to bend. Discs are made mostly of water, and they get dryer and flatter as we age and are less able to absorb the effects of sitting, slouching, exercising, heavy lifting, and falling.

Without enough cushioning, the vertebrae can rub against each other and on the nerves of the spine. If the discs get pushed too much, they bulge. Often it’s the lower discs that become herniated and press on a group of nerves at the base of your spine that form the sciatic nerve. This can cause sciatica, a throbbing or stabbing pain that radiates down into your leg.

A disc that bulges can also cause sudden incontinence and weakness or numbness in the legs; if either of those conditions occurs seek emergency treatment.

Smoking increases our risk of back problems, probably by reducing the nutrition flowing to the discs that help keep them healthy. Being overweight also puts strain on your back.

We’ve Got Your Back

When you hurt, the last thing you need is a headache from trying to navigate the maze of conflicting information on back pain: "A lot of the information out there is just plain wrong," Frazier says. The following guide is not a substitute for a consultation with a doctor, but it is a resource for managing your care and landing back on your feet.

Step 1: Determine the Cause

Can you point to a twist, torque, or tumble you took shortly before the pain set in? If so, you may have a simple sprain or strain, with swelling that will ease in a few hours or days. If there is no obvious reason, the most likely cause of midlife pain is osteoarthritis, degenerated discs, and weak core muscles supporting your spine. For a clue to the cause, sit or lean forward. If your pain improves, it could be spinal stenosis, a narrowing of the spinal canal that puts pressure on the nerves. If the pain is worse after sitting or when bending forward, it could signal a disc problem.

Step 2: Try Home Remedies

These self-care basics may help during the first 48 hours.

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