By: Dr. Pierre Ghassibi – Oct. 2021
Here is my way of looking at back pain, a very common ailment:
We call the back pain that many people get after lifting a heavy object MUSCULOSKELETAL back pain. It is very common. It is a sprain, often of the muscles, ligaments and bones of the lower back. Because the Sciatic nerve originates between the vertebrae of the lower spine and travels down the leg, it can get pinched when the bones move in the sprained back, it gets inflamed and causes pain radiating to the posterior thigh and leg.
Other rare causes of back pain are infections, cancer and autoimmune conditions like Psoriasis and Ankylosing Spondylitis.
Because we know what happens in “musculoskeletal” back pain, MRI studies do not add any information; this is why insurance companies do not cover the MRI unless there is suspicion of
Cancer or infection …
Back pain is very painful and pain killers only partly help. Pain patches are less effective. We use pain killers, physical therapy, chiropractic manipulations, Acupuncture for help. Just doing nothing can also help because in the majority of cases, back sprain goes away after a few to many weeks.
The white blood cells of the body are tiny repair agents that go to the sprained and injured areas and do their handy man job. The problem that is of concern is that the back pain happens again weeks to months later or it never goes away, and the reason is our fault: we do daily movements that prevent healing or cause recurrence. Let me explain my way of seeing this:
Take a stick of wood or any material and try to break it WITHOUT bending it. There is no way!
To break a stick, we have to bend it to an extent that snaps it.
The stick is the spine, our back. Any heavy object we lift while BENDING breaks a few fibers of muscle or ligament. A very heavy weight causes a big break with immediate pain, while lesser objects cause smaller muscle fiber breaks that accumulate over time and one day the muscle or the ligament snaps.
I still see people bending over to lift a heavy box. The way to prevent back sprain is to lift while keeping the back, the spine, vertical. Straight is not enough, it has to remain vertical. Therefore, squat, stick the heavy object to your pelvis (on your center of gravity) and lift it by standing up as if the object and you are a single entity. No space should exist between your body and the object being lifted. This is the main secret of a pain free lower back.
To repeat, low back pain is ubiquitous and the treatments we doctors give only hide the pain. It is time that heals if we avoid injuring and reinjuring our back on a daily basis. Of course, being strong and having strong muscles and a strong core is also useful. Being fit not only helps prevent many back pains, but also helps against arthritis, dementia, heart attacks, stroke and cancer. Too much sitting is as bad as smoking …
Surgery in my opinion is only considered in musculoskeletal back pain if the pinched nerve is so damaged that there is paralysis in the leg or foot. There are rare exceptions to everything and we should follow our doctor’s recommendations.
Let me end by saying that I see at the gym and at moving companies people using back braces for protection. A back brace is maybe useful as long as people do not trust it too much. It helps very little.
Pierre Ghassibi, MD