Men and their aching backsFriday, June 15, 2012 09:22 AM Views : 352PATRICIA B. GATBONTON, MD
OH, my aching back.
Shakespeare in Hamlet's To be or not to be soliloquy laments the heartache and the thousand natural shocks that flesh is heir to. With apologies to the Bard, translated to the topic at hand, this would work just as well, "the backache and the thousand natural shocks the spine is heir to…."
Make a quick assessment; there are probably at least one or two places that hurt in your back and spine right now. That's no surprise. The physical activity and stresses of everyday living cause lower back pain frequently for both men and women.
The National Institutes of Health in the US say that some 70 percent to 85 percent of all people will have back pain at some point in their life and it is the most common cause for limiting activity in those under 45 years old. Some $80 billion goes to the treatment of back pain each year.
The anatomy of the back
Millions of years ago, Homo erectus stood tall and separated himself anatomically from his simian cousins. Allowing him to do so is the human back, particularly the lower back or lumbar spine, which is a complex structure of vertebrae, disks, spinal cord and nerves and muscles that serve as structural support, protect body tissues and aid movement.
The vertebrae stacked together connect the upper spine to the pelvis. The disks act as shock absorbers to cushion and stabilize the vertebrae. The spinal cord and nerves, which pass within the hollow of our backbone, are cables that transmit information from the brain to muscles of the lower extremities and vice versa. Powerful back muscles provide strength, support and mobility and allow us to bend, extend and rotate.
Though we often admonish those who slouch to sit up and straighten their backs, in reality this is impossible, our spine is not a straight rod--muscles maintain the natural S-shaped curvature of our spine. Obviously many structures can cause pain in the lower back from the skin without to the spinal cord within. The question is—when is back pain something to worry about?
Low back pain can range from mild, dull, annoying pain to persistent, severe, disabling pain that restricts mobility and interferes with normal functioning, making sufferers feel unwell, grouchy and—over the long term—even depressed.
Men and back pain
Since this HealthNews issue is dedicated to fathers, let's look at some common problems that could plague them. Most men are stoic and long-suffering by nature, or try to be—so it is a real statistical surprise that seven of every ten men in the US will suffer back pain at some point after they are 18. Most often the pain comes insidiously, with no apparent triggering event. Only 20 percent of men with back pain will be able to cite a specific injury that precipitated the pain.
The myriad causes of low back pain can elude even the most meticulous physician or sophisticated diagnostic test. The American Spine Society says that only five percent of all patients who consult for back pain will have an accurate diagnosis.
Physicians will commonly diagnose lumbago or "back strain," which means only that the doctor confirms the patient suffers from back pain but has not been able to pinpoint a specific reason or site of origin.
Back pain may be due to many different causes; it is a long list and includes the following:
• Muscle problems: poor muscle tone, muscle tension or spasm, sprain or strain, ligament or muscle tears
Overuse, strenuous activity or improper use (i.e., repetitive or heavy lifting)
• Injury or trauma to skin, muscle, ligament or bone
• Bone problems: vertebral fracture, from osteoporosis or trauma from stress to muscles and supporting ligaments or from aging and degeneration
• Disk problem: protruding or herniated (slipped) disk
• Infection (most commonly tuberculosis of the spine, referred pain from the visceral organs in the chest)
• Disease (i.e., osteoarthritis, spondylitis, compression fractures)
• Tumor or abnormal growth in the bones or from cancer spreading from elsewhere in the body, in men most commonly lung or prostate cancer
• Overweight or obesity — causes more pressure on the spine and disks
• Joint problems
Uniquely male syndrome
One frequent cause of lower back pain is uniquely male: A loaded wallet in the back pocket. It is now so common that the condition even has a name, hip-pocket syndrome or wallet neuropathy. Men risk damage from pressure on key nerves in the back that may lead to sciatica with pain or numbness in the lower leg. Walking, sitting and lying down can become excruciating. Those at highest risk are those that drive without unloading their wallets. Men who sit on the job for long periods during the day can experience similar problems. Trying to fit a 36-inch waist into size 34 pants can conceivably cause the same problem, especially if a too-tight belt is involved.
Physiotherapists say the easiest solution to the problem is to avoid the situation, take out the wallet and carry elsewhere on the body or in a clutch bag. Unsolicited advice to members of the low-waist gang out there: Loosen that belt another notch, or be a man—face up to the added inches, get a bigger pair of jeans and save yourself a lot of grief.
Back trouble workup
Most people with back pain will often try a couple of home remedies: warm compress, rest, massage, liniments, Salompas and over-the-counter analgesics. In most cases of back pain, these measures will afford relief.
However, if the back pain is debilitating and lasts longer than a day or two, or involves systemic symptoms like fever, weight loss, difficulty in urinating or moving bowels, or leg numbness or weakness, better go see a doctor.
A history and physical examination will help determine whether the complaint is due to simple back pain, or may stem from a potentially serious nerve root or spinal-cord problem requiring urgent referral and management.
Treatment goals for acute pain are relief of symptoms and preventing disability. To this end, the physician may prescribe mild analgesics and muscle relaxants, rest for 1-3 days and early ambulation. If the pain persists, a reevaluation with possible x-ray procedures and referral to physical therapy and an orthopedic surgeon may be required.
Depending on the cause of the pain, you may need to modify activity, lose weight, stop smoking, learn proper lifting techniques, undergo physical therapy or require a back brace for sometime. Surgery is rarely necessary.
Back in the saddle
Prevention is always better than cure. So men, sit up straight and take notice: Lift heavy weights carefully: Do not bend from the waist, but with both knees bent and your back straight. Be conscious of your posture. Exercise regularly to strengthen your back muscles, and try to stay within your desirable body weight. Do not take your back pain for granted. If you feel pain and heed this advice—the sooner you will be back in the saddle.