Oh, My Aching Back

 Why your lower spine hurts, and how to fix it



A piercing scream punctuates the air. It is the sound of my sister-in-law, Lori, a 57-year-old M.D. She is shrieking because her back has just sent her a massive shock wave of pain. She cannot move without setting her lower torso on fire. We rush into action, trying to tamp down her agony. My brother, who is also a doctor, gives her medication, and soon she falls fitfully to sleep.

This scenario occurred on Thanksgiving evening of 2011. My family had spent the whole day cooking a feast, devouring it, and then clearing up. Afterwards, we all went upstairs to watch a DVD in the bedroom. Lori scrambled onto the bed to get comfortable. As she bent over to puff up her pillow, that stabbing shot hit home. She could not move for the rest of the weekend. Back burnout. 

Such lumbar seizures may seem to come out of the blue, but in fact there are underlying reasons for these attacks. “If you suddenly throw out your back, you had a problem before that happened,” says

David Kloth, M.D., founder and director of Connecticut Pain Care in Danbury, Connecticut, and executive director of the Connecticut Pain Society. “You probably had a weak disc, already partially herniated, and that move was the straw that literally broke the camel’s back.”

That straw can come from the most banal activities. “People get hurt when doing things around the house,” notes Dr. Kloth, the co-author of Pain-Wise: A Patient’s Guide to Pain Management (with Andrea Trescott, M.D. and Francis Riegler, M.D.). Back pain can also develop from a host of injuries—such trauma as a car accident, a slip and fall, or a lifting or twisting strain. “You can even herniate a disc by sneezing,” he notes.

However, your back is much more likely to ail you if it’s in your genes. “The number one reason for back problems is always genetic—people who have a family history of back pain or degenerative disc disease,” claims Dr. Kloth. “Even someone who hurts her back lifting, if there’s a family history, may have a weaker back at the start or have multilevel problems that are part genetic.”

Aging is another culprit of spinal distress. “Most people tend to get back problems in their 30s, 40s, and early 50s, and those progress during their 50s, 60s, and 70s,” says Dr. Kloth. “There is cumulative stress and pressure on the structures that make up your spine. Just as shock absorbers on your car lose their effectiveness after a certain number of miles, your discs are the shock absorbers of your spine, and they wear out over time. Plus, people develop arthritis as they get older.”

As the years accumulate, spinal stenosis can also set in—a narrowing of the spinal column or of the openings where spinal nerves leave the column, which causes pressure on the spinal cord. “That’s a very slow, progressive process as you age,” says Dr. Koth. And men and women are equal victims, he points out. “Gender doesn’t play a big role in back deterioration, if you’re looking at two white-collar individuals.”

What kind of doctor should you see if your spine is going south? For starters, know that surgeons are, literally, the court of last resort. “Anyone who is contemplating surgery should get multiple opinions and make sure there are not more conservative alternatives. There’s a lot of unnecessary surgery,” Dr. Kloth notes.

A wide range of specialists deal with back pain. “There are anesthesiologists, chiropractors, acupuncturists, physiatrists, neurologists, rheumatologists, and orthopedists. Part of the problem is that anyone can hang out a shingle saying ‘Pain Doctor,’ whether or not the person has training. So it’s definitely a buyer-beware market. You really need to research who you’re seeing.”

Treatment options are extensive, but you need a first-rate diagnostician to pinpoint exactly what’s at fault. “I evaluate a person by looking at her overall condition and structure,” says Dr. Kloth. “I might recommend physical therapy or send someone to a chiropractor or an acupuncturist, or put her into an exercise program. Or I might recommend an injection or surgery.

“Today there are a lot of ways to fix or control pain, not just with spinal stimulator and pump devices [two types of implants], but also with minimally invasive surgeries where we pull out small pieces of a disc or repair a tear. The key is to have the right treatment for the right problem.”

Of course, prevention is more desirable than a cure. “Ways to prevent back pain and strengthen one’s back include controlling your weight; using proper lifting techniques; and doing core exercises—abdominal and back extensor exercises, using such things as big balls to work core muscles,” notes Dr. Kloth. “That’s important because you’re trying to make those muscles carry more of the support and weight of the spine.”

You can sport a backpack, he says, “but don’t put too much weight in it. If you have to carry heavy things, use a rolling device or suitcase.” Finally, admit that tottering around on stilettos is just not for you. “Do not wear very high heels” Dr. Kloth warns. “Use common sense”—and maybe stylish sneakers.

Margery Stein, a former editor at The New York Times and at several national magazines, writes about travel, health, business, and lifestyle issues for major consumer publications. She also consults, edits, and provides content for a range of online sites.