Has your back been bothering you for months -- or years -- and
still you and your doctor haven't been able to figure out why? You're not
alone. Back pain is the most common cause of job-related disability in America,
according to the National Institutes of Health, and costs about $50 billion a
year in treatments. Some 80% of Americans will experience back pain at some
time in their lives. But most cases of back pain can't be traced to a specific,
When you've got back pain, one of the best questions you can ask is, "Why is it happening?" That can be the first step to helping the problem.
Common causes for back pain include:
Muscle and ligament injuries. These are the most common causes of back pain. Shoveling snow or helping a friend move her couch can sometimes overstretch the muscles or ligaments. You can wind up with strains or sprains. Most of these injuries heal in a few days to weeks.
"It's a huge problem that we have for both conventional and
alternative techniques for treating back pain," says Daniel C. Cherkin,
PhD, a senior investigator at the Group Health Cooperative's Center for Health
Studies (CHS) in Seattle. "With this huge category of people who have
what's referred to as non-specific back pain, you can't trace it to a
This conundrum leads many back pain sufferers to seek out
"alternative" treatments -- everything from massage and acupuncture to
mind-body therapies and exercise programs like yoga and tai chi. For example,
studies show that back pain accounts for 20% of visits to massage therapists
and 14% of visits to acupuncturists, Cherkin notes. But do any of these options
In many cases, the scientific jury is still out. A recent
review of dozens of studies looking at massage, acupuncture, and spinal
manipulation (chiropractic) as treatments for low back pain, led by Cherkin,
showed some evidence pointing toward the effectiveness of massage and spinal
manipulation, but less is known about acupuncture.
"The studies we reviewed found massage to be effective for
relieving symptoms and increasing function among people with persistent back
pain," Cherkin explains. "Spinal manipulation shows small clinical
benefits for back pain -- about the same as conventional medical treatments
such as over-the-counter pain relievers and various types of physical
Based on existing studies, the effectiveness of acupuncture
remains unclear, but a new, large study recently launched at the Group Health
Cooperative aims to answer some of those questions. To be conducted over four
years, the study is recruiting nearly 700 back pain sufferers and will compare
acupuncture to conventional care.
Building a Stronger Back
"The most predictable way of resolving back problems, based
on the scientific literature, is by increasing strength," says Vert Mooney,
MD, director of U.S. Spine and Sport in San Diego. "There's good evidence
that with chronic back pain, the muscles around the spine become inhibited, and
the most rational treatment is a progressive strengthening program."
Ideally, says Mooney, such a program is best done with
calibrated equipment that allows the person with low back pain to gradually
increase the amount of strengthening involved so that performance and progress
can be measured. "With calisthenic-type exercises, it's very difficult to
increase the amount of exercise that you do, so you do enough to stimulate
repair but not enough to increase pain," he says.