Caution today keeps the doctor away

TARA MUNKATCHY
Dailylocal.com

Just as home repair, restoration and renovation summer projects are taking shape around the county, so too is it important to realize the phrase "putting your back into it" shouldn't be taken literally. When tackling the toughest work around your home, remember taking a little caution now when lifting and twisting can spare you ample pain later. "

Back pain comes in different flavors. The back pain many of us might experience in the summer with more yard work, home projects and sports activities usually results from the stretching and sometimes tearing of ligaments and muscles known as strains and sprains," said Dr. Richard Donze, senior vice president for medical affairs and occupational health center medical director at Chester County Hospital in West Chester.

"Typically this will come on within 24 hours of the activity and resolve on its own in anywhere from a few days to a week or two, assuming the person doesn't keep aggravating it."
This kind of pain is what Donze said is generally referred to as "acute" or "episodic" back pain. A person who experiences some degree of backache or pain most days is experiencing "chronic" back pain, he said, noting this may be accompanied by a chronic cause that could include poor posture, arthritis, repetitive strain or a combination of any of these symptoms.

The most common causes of back pain can include lumbar strain, or a stretching injury to the lower back's tendons, ligaments or muscles; irritation of the lumbar spine nerves; bony encroachment, a condition resulting in movement or growth of the lumbar spine, limiting spinal cord and nerve space; and lumbar radiculopathy, or nerve irritation caused by wear-and-tear damage to the discs between the vertebrae, according to Dr. Anish Patel, medical director of Phoenixville Hospital's Pain Management Institute at Limerick."

From the evolutionary perspective, some experts feel we're all at risk because we haven't yet fully adapted to the erect posture, and if you've ever seen anyone with an acute back strain crawling out of bed and navigating to the bathroom on hands and knees, it'll seem like nature forcing us to return to walking on all fours," said Donze.In addition to people who work in fields that require lifting, bending or twisting, people who lead a sedentary lifestyle are at risk for developing back problems, said Patel, as are those who mismanage stress."

Warehouse workers, long-distance drivers, cyclists, golfers (both occupational and recreational), computer operators, nurses and gardeners (and) grounds people all have more incidence of lower back disorders than the general population," he said. People with pre-existing arthritis are also at an increased risk of developing back problems, according to Donze.

"We've also recently learned that the risk factors for heart and circulation problems may influence the risk for low back pain as well," he said. "Obesity has been a well-known risk factor for years, but we thought it was only for the mechanical reason of accentuating the curve in the low back, as what occurs with pregnancy; however, newer research suggests that it's a circulation problem with narrow spinal arteries unable to deliver enough blood, so things like smoking and high cholesterol can now be considered risk factors as well." Taking steps to protect your back when performing heavy lifting is the best method of injury prevention.

"Acute lumbar muscle strain/sprain is the most common cause of backache after lifting," said Dr. Ken Aksu, an orthopedic surgeon affiliated with Paoli Hospital. "Certainly, disc pain such as a herniated disc is in the differential diagnosis, especially if the backache is accompanied by leg pain."If at all possible, people experiencing chronic back pain should avoid all heavy lifting, explained Patel.

"Always lift with assistance from someone else, utilize good posture by bending at the knees, not with the back, and consider the use of a lumbar support brace," he recommended.Aksu, who said a lumbar corset can "help limit the stress on lower backs" that aren't accustomed to heavy lifting, also recommended turning your whole body when lifting instead of simply twisting."

According to NIOSH (the National Institute of Occupational Safety and Health), under ideal conditions, the most anyone should lift alone is about 50 pounds. Beyond that, a quick rule of thumb is to keep the elbows as close as possible to the sides of the body, which will automatically keep the object near the body's center of gravity, and force those doing the lifting to bend their knees and prevent them from twisting, which are the usual pieces of advice," explained Donze.

"There's an old joke in the science of ergonomics: What weighs more, a pound of lead or a pound of feathers? It's a trick question, since obviously they both weigh a pound, and so should be equal; but a pound of feathers will cause more strain on the back because it would require a huge container to hold all the feathers it takes to get the weight to a pound, forcing the lifter's elbows to leave his or her sides.

You can also protect your back by strengthening your core muscles through exercise.
"Weak muscles are often at the root of back pain, especially lower back pain. Strengthening the muscles that support the spine with back exercises, abdominal exercises and buttocks exercises, can prevent, reduce and even eliminate back pain," said Patel. "A number of exercises focus on the strengthening of the back and core muscles. Consultation with a physical therapist is advised prior to beginning any exercise regimen."Yoga can provide both therapy for back pain as well as help prevent its onset, explained Donze.

"The usual objectives of most exercise regimens, both cardio fitness and strength training, help prevent low back pain in a general way," he said. "There are also specific stretching and strengthening exercises for the low back - things like knee-to-chest, pelvic tilts, abdominal crunches - that are both therapeutic and preventive."Getting the help you need when you sustain an injury is crucial.

"Approximately 95 percent of patients who sustain an injury to their low back recover within six weeks," said Aksu. "If your low back pain worsens despite rest and anti-inflammatory medication or Tylenol, then one may want to seek treatment from a physician. Also, if your symptoms change to include leg pain or weakness, then evaluation by a spine specialist is recommended."Numbness and tingling, loss of bladder or bowel control or weakness can be symptoms accompanying back pain that could imply impending spinal damage, said Patel, and they should be evaluated by a physician. People who have back pain that affects their sleep or their occupation should consult a health care provider, said Donze.

"Finally, not all back pain is due to problems with soft tissues such as ligaments, muscles, and nerves; if the person has fallen there could be a broken bone, and sometimes cancer can start in or spread to bones and mimic a simple sprain," said Donze. "Most times, however, back pain is simple, self-limiting and, for those of us disinclined to a return to walking on our knuckles, something we'll have to deal with for now."

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