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    Low Back Pain Is Inevitable, Expert Says


    Similarly if raising and crossing your leg causes pain, this "indicates that there is very likely a herniated disc." Herniated discs do not require surgery, says Deyo, who adds that after age 60, "36% of the population has herniated discs, but those herniated discs do not cause pain." Deyo says that although 60% of adults seek treatment of back pain, only "about 1% to 2% of these cases go to surgery, and even that may be more surgery than is really necessary."

    He says he is not opposed to short-term spinal manipulation therapy because it may help with pain relief, but he cautions against "going to a chiropractor who says that you will need a treatment once a week for the rest of your life to avoid a return of symptoms. That's just not needed." He also says that he is opposed to a common practice by chiropractors of "routine total spine X-ray. Again, this isn't needed and is an unnecessary radiation exposure."

    Asked whether corsets or support garments can help, Deyo says that the best studies suggest there is no benefit, but some people find them helpful. "If a patient tells me that something works, then I tell the patient to go for it." He says, too, that there is "very little science behind the so-called orthopaedic mattresses, and the advice about firm mattresses or bed boards really probably has more to do with a caution about avoiding sagging mattresses, which may make movement difficult."

    Finally, Deyo says, the best way for doctors to treat people with back pain is to assure the patients that they will most likely get better soon and to follow up that advice with tips about strategies for limiting further episodes of back pain.

    For example, patients with desk jobs should be urged to "get up and move around every hour or so," he says. People should also consider exercises that extend and flex the back, to strengthen the muscles. But the best advice is to "avoid activities that bring on symptoms. A few years ago, I found that running brought on back pain, so I switched to biking."

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