OH, MY ACHING BACK

At some time in our lives 80 percent of us will experience back pain, caused by accidents and the natural aging process. How we use our backs plays a major role in determining our chances of back pain.

Many problems can result in back pain, and the causes may be complex. Regardless of the event that brought on the pain, most doctors agree the pain is usually produced in one of three ways muscle spasm, pressure on nerves or inflammation around the spinal structure.

Dr. Robert Kessinger of Kessinger Specific Chiropractic says chronic back pain can be caused by adaptation in the spine from the incorrect position of the upper two vertebrae and how the spine balances the skull.

"The skull weighs approximately 25 pounds," he said. "The brain stem extends through the skull and lays between the first and second upper two vertebrae in the neck. These two vertebrae can become misaligned in one of 274 locked positions. This will cause the skull to be off balance. The whole spine must adapt in order to balance the skull. This creates curvatures in different areas of the spine and stresses result."

The danger is that the brain stem controls the function of the nerve system, thus the whole body, Kessinger said, adding that as a torquing constriction is put on the brain stem by misalignment of the top two vertebrae, problems, including back pain, can occur anywhere in the body. In order to be healthy, one must have a normal working nerve system.

Virtually all specialists agree that how you move and use your body has a direct effect on the health of your back.

Judi McBride, physical therapist and director of rehab services at Southeast Missouri Hospital, teaches employees at the hospital how to take care of their backs, and she also educates patients on how to protect their backs and how to prevent re-injury.

McBride stresses body mechanics, exercise and posture. She advises her patients to use their most powerful muscles, which are the leg and arm muscles. Her lifting rules are to think before you lift, get help if you need it, and keep the load close to your body.

"One should avoid twisting," McBride explained. "Don't lift the load above your waist. Push when you can. Tighten your stomach muscles."

McBride said sitting is two times harder on the back than standing.

"The feet should be flat on the floor, weight evenly on both hips, and the bottom of the back should be on the back of the chair so there is a lumbar curve," she said.

She also maintains that exercise is really the major step in taking care of overall health and wellness, and walking is one of the best exercises.

Most health professionals now agree that back injuries are usually not just one time injuries, but an accumulation of trauma..

Brenda Nicolai, physical therapist at Physical Therapy Associates of Southeast Missouri, said that over the last few years, lower back pain is being seen in a different light. Over time, twisting and bending slowly cause fissures in a disc and it slowly deteriorates.

The prime age for a herniated disc, one of the problems associated with the back, is between the ages of 25 and 45, Nicolai said. "Past age 45, people have less herniated discs because the water content of the disc decreases and it becomes less likely to become herniated. Also, people get smarter."

According to Nicolai, younger people need to start working now to keep from having big problems later. She advises them to use leg muscles when lifting and to keep the back in a very mild arched position. When one twists, he should move the shoulders and hips together. She stresses that an exercise program needs to be individualized because even though people are hurting in the same place, their problems may be different.

Peter Fayard, clinical coordinator of occupational therapy at St. Francis Medical Center, says occupational therapists train people how to perform daily activities in a way that protects their back. He explained that some simple activities, performed improperly, put a lot of stress on the lower back and can cause pain. An example is brushing teeth while one is bent forward and over the sink.

"Another example is when people are raking leaves," he said. "Instead of maintaining good back alignment, they bend over and reach with the rake to pull the leaves toward them. They should move closer to the leaves, maintaining their back alignment, not bend over and rake with their arms."

Dr. William M. Catt of Catt Chiropractic Center agrees with other health specialists that back problems can be an accumulation of trauma. He sees athletes 30 or 40 years old who are experiencing pain from injuries accumulated years before and not corrected.

"It is like a car tire," he said. "Which pothole knocked it out of balance, the first or the last?"

Catt said that if the spine were kept in balance, there wouldn't be as many back problems.

"People have regular dental and eye checkups," he said. "They need regular spine checkups."

Dr. Khonda Andrews of Andrews Chiropractic and Acupuncture Center of Southeast Missouri agreed with Catt.

"Women will put more time and effort into makeup and cosmetics than they would think to do for their overall back care," she said.

Andrews said our own shortcomings cause back problems. These shortcomings include lack of a sound exercise program and improper nutritional and eating habits.

"What we eat affects our overall health, including the back," she said. "People in a lot of other countries don't bombard their bodies with the amount or variation of food that we do. We compound all that with day-to-day stress, and it becomes difficult to function at peak capacity when expected."

Andrews sees an increase in back patients in her office during the busy holiday season. She believes this is because people are busy and rushing, they don't choose the proper foods or they don't eat at regular intervals, and the body isn't properly fueled.

She stresses to her patients that she thinks it is rather bizarre that most of us take better care of our automobiles than we do of our backs. She believes this is because of a lack of education on back care.

Dr. Donald Metrejon of Chaffee Chiropractic Center said medicine is just now catching up with the viewpoint that back pain is from the accumulation of trauma.

"People don't get liver disease overnight," he said. "It is the result of liver abuse for 20 years. People don't get cancer overnight. What you eat or your lifestyle can determine whether you get some kinds of cancer. It is the same way with the back."

Metrejon said health professionals are now understanding that they need to provide education on back care.

"We are learning that you can't just tell the general public to take care of their backs," he said. "You have to explain what behavior is harmful to them and why. The lack of education of the general populace toward the importance of back exercise is due to the inattention of most health professionals to the importance of the back and its relationship with the rest of the body."