Aligning the Spine

The spine serves as the backbone of human mobility, but back pain flattens eight out of 10 people at some point in their lives. So how do we stand up to this all-too-common ailment?

WRITTEN BY Alex Keith
PHOTOGRAPHS BY Scott Henderson

We view the backbone as a pillar of strength. But back pain can—and frequently does—bring us to our knees. According to the Centers for Disease Control, low back pain causes more global disability than any other condition. Some 16 million U.S. adults—that’s a spine-chilling eight percent of us—experience persistent back pain that limits everyday activities. Ranging in intensity from a dull, constant ache that just won’t subside to a sharp, shooting pang that stops us in our tracks, back pain can drastically alter our quality of life.

Comprised of a remarkably complex combination of discs, ligaments, tendons, muscles and highly sensitive nerves, the back is responsible for the flexibility and mobility we often take for granted, until something goes wrong. “The lumbar spine wears out just like our hips and our knees and every other joint in our bodies,” explains Roper St. Francis Healthcare affiliated neurosurgeon Dr. Byron Bailey. “These areas are in constant motion.” Involved in every movement we make, even while sitting, the back bears the brunt of both our daily activity and inactivity.

Spine by Design

The foundation of our spine, the vertebral column, is divided into three groups: seven cervical vertebrae (C1 through C7), 12 thoracic vertebrae (T1 through T12) and five lumbar vertebrae (L1 through L5). Stacked one on top of the other, the vertebrae are separated by spongy cartilage discs that act as shock absorbers and allow for flexibility and motion. The lumbar spine, or the low back, is the most common culprit for pain, costing Americans at least $50 billion in healthcare expenses each year. Add in lost wages and decreased productivity, and that figure grows to more than $100 billion.

So, what makes low back pain more prevalent than middle or upper back pain? As the shape of our spine evolved over millennia to support our upright nature, our lower spine became tasked with supporting the weight of our upper body and facilitating frequent movements such as bending and squatting. While the “lazy S-shape,” as described by Dr. Bailey, is considered normal anatomy, it predisposes the lowest segments of the lumbar spine to added stress and extra wear and tear—especially for those who carry excess weight. We can help take the load off our low spine by maintaining good posture. “Do what your grandma told you, and sit up straight,” urges Dr. Bailey.

Most acute low back pain—short-term hurt that lasts a few days to a few weeks—is mechanical in nature, meaning there is some disruption to the way the components of the back fit and move together. Congenital defects such as scoliosis; injuries like sprains and tears; degenerative problems including arthritis, nerve damage and spinal cord problems; even non-spine related issues like kidney stones and endometriosis can all attribute to acute back pain. Unfortunately, about 20 percent of people with acute low back pain will develop chronic low back pain (defined as pain that continues for 12 weeks or longer), even after the source of their acute low back pain has been treated.

Back to Basics

While certain risk factors for back pain, such as age and genetics, are out of our immediate control, there’s quite a lot we can do to proactively protect our spine and the mobility it affords us. “The first thing is control your weight, because excess pounds cause increased strain, particularly on your low back,” says Dr. Bailey. A healthy diet combined with regular exercise that strengthens both the back and abdominal muscles can go a long way in keeping us out of the doctor’s office. But there’s no need to become a bodybuilder. Making moderate physical activity a daily habit does much more to protect your spine than one vigorous weekend workout after a week of inactivity, which can result in injury due to ill-prepared and underworked muscles.

Additionally, avoiding repetitive movements that put strain on the low back can help to prevent overuse of these muscles. “Use good body mechanics,” explains Dr. Bailey. When lifting heavy objects, bend from the knees rather than the back. If you work in a field that requires manual labor or strenuous repetitive movements, be aware of your body positioning and take care to stretch thoroughly. Dr. Bailey recommends 15 to 20 minutes of stretching each morning, a habit that helps minimize inflammation and lessen the severity of any episodes that do occur.

Fred Spina, 67 North Charleston
DIAGNOSIS: Thoracic spinal stenosis & cord compression
SYMPTOMS: Blockages prevented fluid from flowing through the spinal cord, a dangerous scenario that left Fred struggling during his daily walks.
TREATMENT: Surgery replaced loose rods and screws from a previous spinal fusion procedure (the result of degenerative disc disease). Fred then wore a back brace for four months.
OUTCOME: “Dr. Bailey restored my quality of life,” says this recreational boater, who is thrilled to make his return to inshore fishing this fall

A Way Forward

From easily identified injuries to chronic conditions, the spectrum of back problems encompasses a vast array of symptoms and causes. The wide-ranging complaint of back pain affects the entire population without discrimination, from school-age children to the elderly, the marathon runner to the movie marathon viewer.

When faced with back pain, the first course of action is to take it easy and hope the pain subsides on its own. “Let things cool off initially,” says Dr. Bailey, advising both restricted activity and ice. Anti-inflammatory medicines such as ibuprofen and over-the-counter topicals such as lidocaine patches are also appropriate courses of action.

If at-home remedies don’t suffice after a few weeks, it’s time for a trip to the doctor. “Certainly, if the symptoms progress rather than stay the same, you ought to see the doctor sooner rather than later,” states Dr. Bailey. More importantly, if any numbness or tingling is consistently present or there is a loss of function or weakness in the extremities, you’ll need to see a doctor to address these neurologic symptoms.

Doctors must pinpoint the pain’s exact origin before any treatment plan can be put forth, and there are numerous options to explore before considering surgery. “The first thing that we do is make sure that we understand where the patient’s pain is, where it goes and what triggers it,” explains Dr. Bailey. If there are no neurologic findings after a full exam, meaning “it’s simply back pain,” Dr. Bailey suggests transitioning to “more aggressive conservative measures,” such as prescription medicines, physical therapy and epidural steroid injections. If after a few weeks, there’s still no improvement, Dr. Bailey and his team proceed with imaging, ordering a combination of MRIs and X-rays to guide continued care.

If these therapies fail to provide relief, surgical procedures may then be discussed to relieve aches and pains caused by nerve compression, nerve damage and musculoskeletal injuries. Like the causes of back pain, a host of surgical options exist, many of them minimally invasive outpatient procedures. A spinal surgeon can help the patient determine the best course of action for the specific condition at hand. As with any procedure, there are associated risks to consider, including bleeding, infection and permanent loss of mobility.

Don’t let the idea of surgery weigh you down, however. According to a Johns Hopkins Medicine report, fewer than five percent of back pain sufferers are good candidates for surgery. With time and patience, most back pain improves within a month of home treatment. That encouraging news means we can all sit up a little taller—your spine will thank you.