Low Back Pain: Why Me?

By Nola Peacock, DSc
Professor, Kaplan University School of Health Sciences

Does your back hurt? You are not alone.

More than one quarter of Americans have experienced low back pain in the past 3 months, and more than 30 million currently have low back pain.1 Ouch! Unfortunately, over a lifetime, more than 70 percent of all adults will suffer at least one episode of back pain.2

Back pain also hurts us in the pocketbook. A recent study indicated that Americans spend nearly $86 billion a year diagnosing and treating spine pain.3 These costs include everything from office visits to diagnostic scans to medication to surgery.

Back pain may be acute, lasting up to 3 months in duration, or chronic in nature.4 Specific back pain can be caused by trauma, infection, cancer, fracture, or other severe mechanical issues. For most of us, however, the cause is unclear.

In fact, less than 20 percent of all lower back pain cases have a definite cause.5 Nonspecific low back pain may be the result of overuse, faulty body mechanics, poor muscle strength, or diminished physical capacity. Often an acute, nonspecific spine pain episode starts when a person is performing regular daily activities.

Frank Garcia, a 46-year old retail sales associate, bent over one morning to fill his dog’s water dish and unexpectedly doubled over in pain. During an assessment by his primary care provider, Frank was asked what caused his back pain. He related the water dish story and wondered, “Why did this happen to me?”

That question can be difficult to answer. Lumbar spine anatomy is quite complicated, and pain can arise from any number of places. Sources of low back pain, or pain generators, may include lumbar spine bones, intervertebral discs, joints, ligaments, and other connective tissues, neural structures, or muscles.6 Your health care provider may use high-tech methods to diagnose your back pain or may rely on your history, pain pattern, and a physical assessment to diagnose your pain. 7

 

Often, however, an exact pain generator is not identified. The good news is that a specific diagnosis is not necessary for successful treatment.8 Also, in half of all cases, acute nonspecific back pain subsides in 4 to 8 weeks with nothing more than self-care and over-the-counter medications.9

While the cause of back pain may not always be clear, certain risks for low back pain have been identified. Some of the possible physical risk factors are repeated heavy lifting, lifting while twisting, whole body vibration, static positions, cigarette smoking, poor posture, high-impact activities, prolonged sitting, moving heavy objects, limited spinal flexibility, and poor aerobic capacity.10 Many of these risk factors can be eliminated or minimized through improved physical condition, occupational modification, or ergonomics education.

Frank Garcia did not discover his exact pain generator, but about 6 weeks after it started, his back pain resolved. Frank and his health care provider identified several of his personal back pain risk factors, which included using poor body mechanics when lifting, smoking cigarettes, and leading a sedentary lifestyle. Frank is now working on modifying his risk factors to prevent future back pain.

Consider your personal risk factors the next time you complain about back pain and wonder, “Why me?” Discuss your concerns with your health care provider. And remember, it is likely your back pain will subside naturally in a short period of time.


References

1Deyo, R.A., Mirza, S.K., & Martin, B.I. (2006). Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine, 31(23), 2724-2727.
Strine, T.W., & Hootman, J.M. (2007). U.S. national prevalence and correlates of low back and neck pain among adults. Arthritis Rheum, 57(4), 656-665.
2 Landry, M.D., Raman, S.R., Sulway, C., Golightly, Y.M., & Hamdan, E. (2008). Prevalence and risk factors associated with low back pain among health care providers in a Kuwait hospital. Spine, 33(5), 539-545.
3 Martin, B.I., Deyo, R.A., Mirza, S.K., Turner, J.A., Comstock, B.A., Hollingworth, W., et al. (2008). Expenditures and health status among adults with back and neck problems. JAMA, 299(6), 656-664.
4 Ehrlich, G.E. (2003). Low back pain. Bulletin of the World Health Organization, 81(9), 671-676.
5 Ibid.
6 Sizer, P.S., Jr., Phelps, V., & Matthijs, O. (2001). Pain generators of the lumbar spine. Pain Pract, 1(3), 255-273.
7 Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J.T., Jr., Shekelle, P., et al. (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med, 147(7), 478-491.
8 Ehrlich, G.E. (2003). Low back pain. Bulletin of the World Health Organization, 81(9), 671-676.
9 Hicks, G.S., Duddleston, D.N., Russell, L.D., Holman, H.E., Shepherd, J.M., & Brown, C.A. (2002). Low back pain. Am J Med Sci, 324(4), 207-211.
Kinkade, S. (2007). Evaluation and treatment of acute low back pain. Am Fam Physician, 75(8), 1181-1188.
10 Rubin, D.I. (2007). Epidemiology and risk factors for spine pain. Neurol Clin, 25(2), 353-371.
Skovron, M.L. (1992). Epidemiology of low back pain. Baillieres Clin Rheumatol, 6(3), 559-573.
Cecchi, F., Debolini, P., Lova, R.M., Macchi, C., Bandinelli, S., Bartali, B., et al.  (2006). Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older: the InCHIANTI study. Spine, 31(10), 1149-1155.


Nola Peacock, DSc

Nola Peacock is a professor with Kaplan University’s School of Health Sciences where she teaches classes such as Current Trends in Exercise and Fitness and Health and Wellness Programming—Design and Administration.  Dr. Peacock received her Bachelor of Science in Exercise Science from the University of Utah in 1991.  She completed her Master of Science in Physical Therapy at Chapman University in 1993.  In 2002 she received her Doctor of Science degree in Orthopedic Physical Therapy from Rocky Mountain University.  Dr. Peacock has published research in the Journal of Orthopedic and Sports Physical Therapy and authored a chapter in a forthcoming physical therapy textbook.  She currently works as a Physical therapist and wellness specialist at St. John’s Medical Center and lives with her husband and two children in Jackson Hole, Wyoming.

Kaplan Higher Education Corporation is a division of Kaplan, Inc., a subsidiary of The Washington Post Company.

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