If Your Back Is Out of Whack There's got to be a solution for you By Christie Aschwanden from Health Penny Rickhoff remembers exactly when her pain started. "I was on the tennis court finishing up a set. The next thing I knew I was in the hospital." The 55-year-old interior designer has had two surgeries in the 15 years since that first episode, but she still faces daily pain. She's not alone. Fully 80 percent of all Americans will experience back pain at some point. "The people who never have pain are the unusual ones," says psychologist Dennis Turk, who's on a renowned team of pain researchers at the University of Washington. Luckily, things are looking up for the aching millions. The last decade has brought a revolution in back care, says physician Richard Deyo, also at the University of Washington. This shift has changed how experts diagnose and treat this vexing problem. Back when Rickhoff had her front-court collapse, the standard advice was to stay in bed. "We now know that's the worst thing you can do," says Deyo. In fact, he argues, lying around actually boosts your risk of developing chronic back pain. Physicians are also less likely to offer a diagnosis than they used to be. "There are many different diagnostic labels for back pain, but often they just cover up the fact that we don't know what's causing it," says Michael Von Korff, a back researcher at Group Health Cooperative in Seattle. "In the end, as long as you've excluded serious disease, the treatment is the same." Unfortunately, sophisticated imaging techniques are often little help in diagnosing the cause of common back pain. Eugene Carragee, an orthopedic surgeon at Stanford University, analyzed the MRIs of 96 people who had risk factors for disk degeneration. Those with damaged disks were only slightly more likely to report pain during activity than those without them. Yet the sufferers in Carragee's study had one surprising thing in common. "When we looked at who hurt the most, the best predictor was increased emotional distress like depression," he says. No one denies that the pain is real. But people's attitudes about the discomfort play a major role in how they cope--and how fast they heal. "People get back pain and become anxious," says Deyo. "Then they limit their activities, and thata makes it worse. It can be a downward spiral." So what do experts suggest you do? Not much. "Virtually all episodes of back pain go away on their own," says University of Washington neuro-surgeon John Loeser. The key is to drop the expectation of a simple diagnosis and an easy cure and instead find ways to manage your pain and prevent flare-ups. The vast majority of people can get relief with one or two of the most common treatments. Here are eight pain-busters worth trying. Self-Care You spent the morning hefting boxes, and your back has you begging for mercy. Doctors call these intense strikes acute pain. When misery strikes, they say, it's best to take immediate action. Try an over-the-counter pain medication like ibuprofen or acetaminophen. If you have recurrent back pain, you may want to get a prescription pain medication for your next bout with acute pain. Since such agony usually subsides quickly, the risk of addiction is low. Doctors suggest icing the area that hurts for 15 minutes at a time, three to five times per day. A bag of frozen peas makes a great ice pack. If the pain persists more than a few days, substitute a heating pad for those 15-minute periods. Meanwhile, remain as active as you can. To prevent further flare-ups, sleep on a firm mattress and curl up on your side with a pillow between your knees. Choose chairs that support your lower back. Rethink behaviors that ex. Kim Hedberg, a 42-year-old businessconsultant from Boulder, Colo., avoids sitting still for extended periods, lifting heavy objects and stressing herself out--all of which can bring on an attack. "Every little thing helps," she says. Cost: One bag of peas, under $2; bottle of 50 asprin, $5; finding ways to eliminate back pain, priceless. Exercise Though you might feel more inclined to moan in bed, regular exercise may be the best thing you can do for back pain. The only time you should avoid intense workouts is during the first few days of an acute attack. "Studies show that people who do as many active things as they can are the ones who recover best," says Carragee. Experts agree that no single work-out will erase your pain, but they say two categories are important: aerobic activities like brisk walking, and exercises like crunches and back extensions that strengthen your back and stomach muscles. A trainer at any gym can show you moves that will be right for you. Cost: Walking, free. Gym membership, typically about $50 per month and up. Relaxation Techniques Stress can cause your body to tense up, worsening your back pain, says Deyo. Relaxation techniques may help you let go of tensions that might be triggering your pain. In a landmark 1995 report, a panel of experts assembled by the National Institutes of Health concluded that techniques like meditation and hyypnosis can ease chronic pain. Scientists say that these activities seem to mellow out your nervous system. This appears to blunt your body's sensitivity to pain. Some relaxation techniques like yoga and tai chi have the added benefit of including exercise. Cost: Meditating at home, free. Classes, $5 to $25 per session. Acupuncture A 1997 National Institutes of Health panel concluded that acupncture is indeed helpful for treating low back pain. Researchers think that acupuncture spurs the release of endorphins, your body's natural painkillers. In one study, medical acupuncturists reported that about two-thirds of their patients said that they were pleased with the results. Many people feel at least some benefit after the first visit. If the tqechnique is going to help you, you should notice a response by the sixth treatment, says physician Robert Schulman of the American Academy of Medical Acupuncture. Cost: $50 to $150 per session. Physical Therapy Blair Hurst, 53, went to a New York pain clinic in desparate shape. "My back was so bad I could barely stand up," she recalls. A physical therapist showed her stretching and strengthening exercises that helped diminish her pain--and taught her how to move without injuring herself. A physical therapist can teach you exercises to eliminate postural problems or muscle weaknesses and imbalances that might be causing or aggravating your pain. The therapist can also show you correct ways to lift and bend. REcent research suggests that the combination of stretching and strengthening with endurance exercises and proper body mechanics speeds up people's return to work after a back injury. Cost: Typically $80 to $150 for the first session, $40 to $125 thereafter. Chiropractic Chiropractors were long perceived as back-cracking hacks, but those days are over. A number of studies have demonstrated that chiropractic manipulations can truly bring relief to an aching back. The theory behind the manipulations is simple. Chiropractors say that swelling, joint irregularities or muscles spasms can immobilize your back joints, causing chronic pain. By moving these joints with their hands, they say, they can relieve tension and allow them to move again. "It's like a concentrated exercise in the joint," sas chiropractor Daniel Hansen at the Texas Back Institute. Cost: $50 to $150 and up per visit, depending on the treatment. Surgery Only about two percent of all back-pain patients are appropriate candidates for surgery. In fact, Deyo says, there are only four reasons to consider surgery: a herniated disk that's being sciatic pain below your knee for a month; a spinal stenosis (narrowing of the spinal canal); a displaced vertebra; or a turmor or other life-threatening or disabling problem. Despite the cautionary approach of most researchers, surgeons are still performing a slew of procedures, and new methods are being touted in journals. Deyo and other experts urge people to be wary. "Many patients rush into the latest thing, and then five years later we discover that it's worthless--or worse," says Deyo. If, after getting a second opinion, you've decided that the scalpel ffers your best chance at relief, look for an experienced surgeon. And be sure you're clear on what kind of long-term outcome you can expect. Cost: Likely, tens of thousands. Worst Jobs for Your Back Some of the occupations witha hjigh prevalence of back pain attributed to activities at wor, accodring to the American Journal of Industrial Health. For Men: Construction workers Carpenters Car mechanics Truck drivers Farmers For women: Nurses & nursing aids Maids Janitors/cleaners Hairdressers Production inspectors rd.com: Go to our Health channel for exercises to get your back on track. For reprints, click on Reprints or call 800-289-6457