Learning to Beat Back Pain by Going Back to School

I didn’t ruin my back overnight. It took years of desk work, bad posture and poorly toned muscles--the kind of spinal abuse that ought to be in the penal code--to create the stabbing pain that starts in my lower right back and shoots through my leg to my heel.

But it wasn’t until my daughter was born four months ago that I came to know the true meaning of back pain.

People who have never experienced back pain--and that’s just 20% of the U.S. population--cannot understand how lifting 8 pounds, 6 ounces of child can be the straw that breaks an adult back. But each time I lifted Julia out of her infant seat in the rear of our two-door car, I paid the price for the next few days.

I went to Dr. Steven Garfin, UCSD Medical Center’s spinal specialist, who ruled out tumors and other abnormalities too horrible to mention. Surgery was out of the question. Garfin had one other suggestion: attend the UCSD Back School.

Unlearned Bad Habits

The 6-year-old Back School is a two-day, five-hour instructional course where I unlearned 29 years of back-breaking habits. Like traffic school for speeders or summer school for dropouts, back school is a reform school. I was eager to change my ways. Nothing else has helped so far.

Originated in Sweden about two decades ago, Back Schools have shown a strong record of success. At least four follow-up studies have shown that the lessons taught in the schools reduced back pain for many of the students. In one study by two physicians of 6,418 participants, 69% reported significant improvement; 92% reported that they follow the back care routine; 79% reported that they did their back care exercises and 97% considered back school helpful.

The Back School technique is a simple one, and a common refrain in medicine: preventing back pain is easier, less costly, and less painful than treating back pain. And only the sufferer can do it.

“It’s not only much more difficult, it’s a longer process (to treat back pain),” said Sonja Harlow, director of the Back School. “You lose money, sometimes, as the employee. The employer loses money. The insurance company loses money.”

In Hands of Therapist

If it seems ridiculous to spend so much time learning how your back works, and how to keep it from making your life miserable, then you’ve probably never had low back pain. After six years of orthotic devices, muscle relaxants, pain relievers, quackery and self-help manuals, it was comforting to be in the hands of a clearly competent physical therapist named Sandy Martin.

Martin said that she had one goal: “to provide you with the ability and knowledge to cope with back pain independently and not seek secondary treatments.”

Though most back pain starts at about the age of 35, mine started about seven years ago, when I graduated from college and took a journalism job. Maybe I sat too much and got too little exercise. Maybe it was my uneven desk chair in our cramped office. One of the most maddening things about backs is that you often don’t know why they hurt.

“Why backs? Nobody can really put their finger on it,” Harlow said. “It’s possible that it’s a weak area. As you start to get wrinkles on your face and gray hair on your head, the inside of your body starts to get older too. The discs (cushions between vertebrae) start to degenerate. If you’re not careful and you don’t take care of yourself, by the time you’re 35, you start to get some back pain.”

No Defects Shown

Since no defects have shown up on X-rays, the best guess I’ve received from doctors over the years is that one of my discs has pushed out from the stack of bones making up the spinal column and is irritating the thick sciatic nerve that runs from my lower back to my heel. That would account for the pain that radiates down my leg.

All I know is that when the humidity goes up, so does my pain. When I twist or bend or lift the wrong way, I can touch off pain that stays for days. While the pain does go away for weeks at a time, it’s more often present than absent.

Over time, I’ve had to adapt. I wear only soft-soled shoes with orthotic supports in them. I sit only on cushioned chairs, when possible. I cannot keep so much as a pencil in my right back pocket without sending pain rolling from my waist down to my heel.

I also have developed a tendency to lean to the left as a way of taking my weight off my right foot, where the pain is often the worst after a few minutes of standing. Standing or sitting, I’ll often find myself tilting slightly to port.

Disc Irritates Nerve

Martin tried to teach our class of eight how we brought this situation on ourselves. Back pain is most often caused when the gel-like interior of a disc bulges through its tough exterior, irritating one of the many nerve roots that begin there, or diminishing the amount of cushion between two vertebrae, Martin said.

This can happen from an acute tear, but more often it is because of the pressure placed on a disc by improper use or overuse, Martin said. Sitting, for example, places 300 pounds per square inch of pressure on discs, more than any other position. Thus, it is not surprising that 53% of workers in jobs that don’t involve heavy lifting have back problems. The figure is little different from the 64% of those doing heavy work who complain of back pain.

Bad habits are the true culprits. Poor posture and excess flab throw the spinal column out of alignment. Poor lifting techniques require tiny back muscles to bear weight they cannot support and shear micro-fibers in the discs. Inadequate exercise leads to overall inflexibility and a greater tendency toward injury.

The keys to a healthier back are getting adequate aerobic exercise, developing good nutritional habits, relaxing at least 20 minutes a day to reduce overall stress levels and performing flexibility exercises demonstrated by Martin.

Methods of Protection

But beyond those the best way to protect my back is to relearn ways of moving through life to minimize stress on my back, she said. “You’re stuck in habits and you’ve got to change those habits,” Martin told us. “The hardest thing about what you learn in back school is remembering to do it every day.”

The key is maintaining one’s spine as close as possible to its normal straight-up-and-down position (known as “spinal neutral”) while allowing the large muscles in the arms and legs do heavy work. Once I get in the habit of doing that, following the rest of Martin’s advice will help even more. Some of her recommendations:

- When lifting an object off the floor, never bend at the waist. Squat down, bring the object close to your body and lift it with your legs. Don’t twist your trunk to transfer the object to another place. Turn your whole body by moving your feet.

- When sitting or standing, it is important to keep a balanced trunk and correct posture. Take a break every 20 minutes. When sitting, support your feet and back and use armrests. When standing, keep one foot on a step or platform to relieve pressure on the weak psoas muscle, which connects the spinal column and thighbone. Keep work surfaces between hips and shoulders.

- The best position for sleeping is on your side with knees bent slightly. If you have to sleep on your back, tuck a pillow under your knees. Sleeping on your stomach is the worst possible position. Always sleep on a firm mattress or a mattress with a board beneath it.

- If you have to bend your spine out of its neutral position (to lift a child from the back seat of car, for example,) tighten stomach and gluteal muscles and use one leg as a counterweight. Always look for alternative ways of accomplishing a task before asking weak back muscles to bear a heavy load. Use a dolly or other mechanical device; ask a friend for help.

- Push an object instead of pulling it whenever possible. Pulling is more difficult and tougher on the back.

I wish I could say Back School has made my life pain free. It hasn’t. I wish I could say that I go home every night and dutifully perform my flexibility exercises. I don’t. I wish I could say I’ve lost the extra flab that I’ve been battling for too many years. I haven’t.

But I am bicycling four times a week, which Martin said is a terrific form of exercise. I do perform the special pre-bicycling stretching exercises that she recommended when I saw her two weeks after Back School for physical therapy.

I’ll keep fighting the battle of the back, armed with more knowledge and better techniques than I had before I went to Back School. After all, my only other choice is back pain.