People who deal with backaches have one message in common: Get it diagnosed, then decide whether to live with it or have it treated.

Doctors stress diagnosis because more than 80 percent of Americans will suffer from back pain at some point in their lives, and too many of them wait too long or never seek relief, even though relief may be available.

Backache is among the top five reasons for doctor’s visits, along with colds, flu, hypertension, infections and regular checkups, says Dr. Michael Cannon, associate professor of family practice at St. Louis University Medical School.

For chiropractors, it’s the No. 1 reason, says Dr. Ralph Barrale, dean of postgraduate studies at Logan College of Chiropractic.

Both say back pain is often taken lightly because it seems so common. But it’s important to know the source of the pain, they say, because it can run from sore muscles to organ failure.

When it starts

Physicians see backache as any discomfort in the back, says Cannon, who practices in Des Peres. Anyone can develop it and nearly everyone does in some form.

Most cases are due to tender muscles, which can result from repetitive work, bad posture while sitting or standing, bad form while lifting and twisting, playing sports without warming up or playing harder than your physical condition can tolerate.

The next most common group of back ailments includes malformed discs and arthritis. As the body ages, discs – the shock absorbers between the vertebrae – wear out. The discs flatten, expand, rupture and slide out of place. When that happens, they can put pressure on the nerves in the spinal column. The resulting pain can range from a nuisance to disabling.

The vertebrae age, too, in the case of arthritis and similar bone disorders. Sometimes that includes bone deposits that narrow the spinal column, causing pain.

Less frequently, pain is not actually in the back. The cause may lie in something connected to the back, such as the hips and ribs, or it can be the failure or infection of organs just behind the lower back.

The pain is an equal-opportunity nuisance. You can get it if you’re young, old, male, female and in any ethnic group. Even young adults and children can get back pain, for reasons ranging from playing too hard to obesity to congenital abnormalities.

Knowing what to do and when

Cannon suggests giving the pain a few days to go away, then seeing a family physician if it hasn’t gotten better in a week.

The doctor will determine whether the problem is mechanical, meaning that the pain is somewhere in the parts that make up the back: the muscles, the spine or body parts attached to them. If so, the next option can be painkillers, physical therapy, a chiropractor or patience.

Cannon says most back pain will go away, even though it often returns. “The only remedy that’s been shown to work best is time,” says Cannon. “Most of the time, when people have a back problem, if it’s related to muscles or joints or bones, it’ll be worse to move the back. If someone has other problems, the back movement won’t cause the same sort of pain.”

Another ailment, such as infection or organ failure, will hurt whether you’re moving or not. In that case, see a specialist.

“Essentially, serious conditions can mimic mechanical problems,” says Barrale of Logan College. “We try to put a cause and effect together – did you bend, did you twist – and we discuss the history of the occurrence.

“If we think the pain is not mechanical in nature, we’d refer that patient to the appropriate doctor, a family practitioner or a specialist.”

Doctors also can check for indications of pinched or squeezed nerves. Sometimes the doctor will order tests, including X-rays or an MRI, to get a look inside with some detail and determine the best treatment. Surgery tends to be a last resort and is warranted when the pain is incapacitating.

The chiropractor

Barrale said a chiropractor can help when the problems are from body mechanics – spinal problems resulting from the stresses of daily living, posture problems, occupational problems or injuries from stressing a body part.

Chiropractors manipulate the spine and might administer acupuncture and massage, Barrale says. They don’t prescribe medicine.

“We look at shortening of the muscles, overuse of the muscles, poor posture, repetitive activities,” he said.

“Most often, back pain generally is the result of poor posture and poor body mechanics – the way we sit, in our cars, we have a tendency to slump, we carry things on one side. Patients I’ve had tend to do a repetitive action 750 times a night with one arm, and they slowly stress the mechanics of the lower-back joint.”

Barrale agreed with Cannon that backache can be relieved but never really cured.

“Once you determine what actually occurred, then treating that with ice, stretching and adjustment, you would be able to correct that problem,” he said. “Assuming you give the patient some lifestyle-changing instructions, you’ve essentially fixed that problem. However, I don’t think you ever cure a low-back pain.”

Regardless of how many lessons people get in posture and safe ways to play sports and work, eventually people bend, slump, twist and crush the back into bad positions. Over the course of a lifetime, that will result in pain, he said.

“If we were in a vacuum of perfect posture, we’d be fine,” he said, “but there’s no way to prevent back pain. If you do certain exercises, you have less chance of serious injury, but I don’t think you ever really prevent it.”


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