Back to health: What to do about low back pain

Our backs often bear the brunt of almost every physical movement we make. From sitting in an office chair to lifting a heavy box, we count on the lumbar system to carry most of our daily workload.

The result? Low back pain, which the National Institute of Neurological Disorders and Stroke says will affect 80% of U.S. adults. In 2018, the World Health Organization reported that low back pain is the leading cause of disability worldwide. Industries with the highest rates of days missed because of back pain (lower and upper), according to 2017 data from the Bureau of Labor Statistics, include health care, transportation, cargo handling, construction, firefighting and maintenance/repair.

“The No. 1 reason for a patient to go to their primary health care doctor in the U.S. is the common cold. No. 2 is back pain,” said A. Jay Khanna, spine surgeon; vice chair and professor of orthopaedic surgery, neurosurgery and biomedical engineering at Johns Hopkins University; and spokesperson for the American Academy of Orthopaedic Surgeons.

Lumbar overload

Why is pain so often felt in the lower back? It’s because the bones in your lumbar curve bear much of your upper body weight.

If you’re overweight, that puts added stress on the region, especially if you carry those pounds in your stomach, which pulls your pelvis and spine forward. This also puts stress on your ligaments and muscles. Over time, it can cause nerves in your spinal column to become constricted. Bulging or herniated discs also are a risk, according to the Southeastern Spine Institute and Ambulatory Surgery Center in Mt. Pleasant, SC.

Poor posture and staying in one position for extended periods of time – such as an office worker sitting at a desk or a truck driver behind the wheel – are other ways we can inflict pain on our backs. For some workers, repetitive stress is the main factor, and that stems from doing the same tasks over and over. This can cause microtraumas, OSHA notes.

“What most people don’t realize about back pain is it’s not whatever you lifted that caused the pain,” said William Marras, executive director of the Spine Research Institute at Ohio State University. “That’s just the straw that broke the camel’s back. We really believe that this is a really long (deterioration) process that happens over months or years, or even decades.”

Doctor time

If you experience low back pain, the first step is to see your primary care physician within a couple of days or a week after its onset, Khanna advises. However, seek immediate help for “red flag” symptoms such as:

• Bowel or bladder dysfunction
• Fever or chills
• Leg pain, numbness or weakness
• Severe back pain that doesn’t get better with medication or rest

When he sees patients with back pain, Khanna said he outlines three broad categories of treatment options: physical therapy with anti-inflammatory medications, epidural injections and, in most cases, surgery as “a last resort.”

“Ninety percent of back pain will resolve itself within two or three months,” Khanna said.

A pain management specialist – typically an anesthesiologist who has specialized training in injections and other non-operative methods – may help as well, Khanna notes. Others include physical medicine or rehabilitation specialists.

Treating back pain can prove “trial and error,” Marras said, often because of individual differences. Magnetic resonance imaging, or MRIs, might not prove as reliable diagnosing back pain as other ailments – especially if an occupational cause is involved. That’s because MRIs can’t be used to determine functional limitations, such as lifting or carrying objects.

Of patients who are 60 or older and have no symptoms, Khanna said MRIs reveal 93% have lumbar degeneration, including conditions such as degenerative disc disease, stenosis or small disc herniation. Among patients older than 40, that percentage is around 60.

“The patient comes in with back pain, which is very common, they go to a spine specialist and they get an MRI, which shows degenerative changes, which are very common,” Khanna said. “There is a tendency to over-intervene (e.g., recommend surgery), where a lot of patients will get better on their own.”

How to help

What can workers do to help their own cause? For starters, they should take care of themselves. This includes getting at least seven hours of sleep a night, eating right, exercising regularly, strengthening core muscles and losing excess weight.

“Weight is a huge deal,” Khanna said, adding that he sees about 10 times more patients who are obese than who are more fit.

Smokers also have a higher incidence of back problems, Marras said. Smoking reduces blood flow to the spine, which can speed up disc degeneration, according to NINDS.

Outside of work, employees with back pain should avoid activities that may put stress on the back, such as gardening or picking up children. Bed rest, formerly a recommended remedy, should be avoided for many minor back ailments because it can cause muscle stiffness.

For employers, experts tout the use of engineering controls, such as lift tables, and effective ergonomic programs. Workstation and job design “should be considered as the first step to prevent [musculoskeletal disorders],” Ming-Lun “Jack” Lu, research industrial hygienist in the Division of Field Studies and Engineering at NIOSH, wrote in an email to Safety+Health.

In addition, many organizations offer free resources for employers. NIOSH’s Elements of Ergonomics Programs is one place to start.

Marras said one of the most important ways employers can help their workers is by educating them on how and why back problems occur.

“People don’t understand how the spine breaks down,” he said. “They think they’re a he-man and can do anything and lift anything, and they don’t understand that with every lift, you could be hurting yourself. And so by educating people how this works, it gives them a reason to use the interventions that are proposed.”