The Medical Minute: Back pain -- a consequence of walking upright?

By Mark A. Knaub

If you walk on two legs you are likely to suffer from back or neck pain at some point in your life. In fact, in the United States, nearly 80 percent of the population has to deal with back pain on at least one occasion. Back pain is the second most common reason that people visit their primary care physician (upper respiratory tract infections are the most common) and it ranks second behind headache as a reason for an individual to miss work. Thankfully, the natural history of an episode of back pain or neck pain is favorable and the likelihood of an individual developing chronic, debilitating pain is small. For most people, their back and neck pain resolves with a few days of activity modification and some over-the-counter medications.

Acute episodes of back or neck pain are commonly triggered by an event such as lifting something heavy or bending or twisting awkwardly, although that is not always the case. Some people start to experience symptoms after no specific incident or injury. Regardless of how the symptoms begin, most of these episodes will improve with a few days of rest, combined with over-the-counter medications such as acetaminophen or ibuprofen. Many patients also find that moist heat or ice applied to the painful area leads to improvement in their symptoms. As these symptoms begin to improve, normal activities should resume, gradually increasing activity level to the point where it was before the symptoms began.

If symptoms do not resolve within five to seven days, a physician should be called to discuss the problem or to schedule an appointment to be seen. The physician may choose to prescribe a regular dose of an anti-inflammatory medication and have a patient treated and evaluated by a physical therapist. Patients whose symptoms last for more than a month should be evaluated with plain X-rays initially and, in some circumstances, an MRI. Referral to a specialist is appropriate when back or neck pain persists for more than six weeks despite conservative treatment.

Despite many years of research, there isn't a foolproof way to prevent episodes of back or neck pain. If a patient has suffered from one of these episodes, they are at greater risk to have another episode in the future. It should come as no surprise that obese people are more likely to suffer from back problems than those who maintain a normal weight. Additionally, people with exposure to nicotine-containing products (cigarettes, smokeless tobacco, cigars) also are at a greater risk to have back problems than those who do not use these products. Lastly, people who do not perform any regular cardiovascular exercise (this can be something as simple as a regular brisk walk around the block with a family member or dog) also are at increased risk to suffer from back problems.

Using good lifting habits, maintaining a healthy weight, avoiding nicotine products and getting regular cardiovascular exercise can lessen the likelihood that individuals will suffer from episodes of back or neck pain.

Mark A. Knaub is assistant professor, department of orthopaedics and rehabilitation at Penn State College of Medicine and associate director, Penn State Hershey Spine Center at Penn State Milton S. Hershey Medical Center.

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Last Updated October 21, 2011