Health Horizons : MEDICINE : New Twist on an Old Ache : For many back problems, exercise may be more helpful than high-tech remedies. Experts suggest experimenting with various approaches to find one that works.

On the day H o mo sapiens rose up on two hind legs and said “Ow!”, the history of back pain began.

And an excruciating and expensive history it has been. Today, 8 in 10 Americans suffer serious backaches at least once in their lives. Next to sore throats, back pain is Americans’ most common--and probably most talked-about--ailment, and except for the sniffles, it is our No. 1 reason for missing work.

The price tag for treating back pain in the United States now tops $24 billion per year. That’s because on any given day, according to government health officials, about 6.5 million Americans are under some sort of treatment for low-back pain.

So if you are suffering, at least you are not suffering alone. But if your misery demands more than company, it may be time to take a serious look at what the experts say is the best new thinking on this age-old problem.

Surprisingly perhaps, the cutting edge in the battle against back pain is not high-tech surgery or fancy new drugs--although both have a role in current treatment.

The best plan of attack against back pain in the ‘90s may be a simple but serious exercise regimen.

According to editors of “The Back Almanac,” a compendium of state-of-the-art information on the causes and cures of back pain, the most successful new approaches also are among the least invasive, least painful, and least expensive.

While a consultation with a physician is a recommended first step, it often comes down to the individual patient determining which approach works best for his or her back problem. Often it is a matter of sampling myriad approaches--ranging from conventional exercise, running and swimming to yoga, acupuncture and chiropractic--before finding one that’s right for you.

If you have yet to experience your first backache, don’t wait until you have one before starting preventive care, experts say. If your back is already in trouble, a strengthening program now can reduce the pain of future attacks.

And odds are there will be future attacks. “If your back says ‘no’ once,” say almanac editors, “chances are four times more likely that it will happen again.”

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The human spine consists of 33 individual vertebrae, stacked like napkin rings one atop another in a column. Most are separated by fluid-filled disc cushions and supported by ligaments that bind the bone to muscles.

While there are hundreds of things that can go wrong with such a complex structure, back injuries fall into three main categories: lumbar strain (injuries to muscles and ligaments), disc herniations (injury to the fibrocartilage between the vertebrae) and fractures (injuries to the spine).

But if your back hurts right now, chances are nine out of 10 that lumbar strain is the reason. Hard-to-cure strains and sprains in the lower back are not only the most common and most frustrating back ailment but they also may be the most painful.

According to a recent report in the journal Neurosurgery, a survey of 250 patients with chronic low-back pain found that those with muscle injuries suffered pain just as severe as those with ruptured discs, but it was “more unrelenting.”

This was not news to Steven Thompson, a 40-year-old Pasadena insurance broker, who suffered such unrelenting pain for nearly a year. “I just woke up one October morning with this excruciating pain. It was real severe, big-time pain and it flattened me for a week,” Thompson says.

Since then, Thompson has undergone back scans, X-rays and injections of dye into his spine. He has been hung by his heels in traction, had anesthetic shot into his back and swallowed any number of anti-inflammatory, muscle-relaxing and painkilling medications.

But, until he started swimming every day, his back still hurt.

In that way, Thompson is like many other back patients: All the sophisticated diagnostic tools available to modern medicine cannot tell him why his back aches, but--for whatever reason--exercise makes it better.

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Marty Schoen is a long-distance runner with a bad back. Every week, he logs 45 miles--much of it uphill. And every week, his back feels better. Schoen first hurt his back 20 years ago while gardening. A decade later, it was diagnosed as ankylosing spondylitis, or rigidity of the spine.

The pain was disabling until a doctor suggested that the 48-year-old Schoen begin a regimen of anti-inflammatory drugs and return to his marathon running.

Exercise, even for those who suffer mechanical defects like Schoen’s, may soon become the remedy of choice, say back experts like UC San Diego orthopedics professor Dr. Vert Mooney. “We don’t challenge our muscles adequately, and they get weaker. Soon, they are unable to hold the spine in the proper position. And the result is pain.”

When the pain is caused by herniated or slipped discs, and pressure on nerves shoots sharp pain down the leg, surgery may well be the answer. Experts warn, however, that unless the condition is life-threatening, back surgery should always be a patient’s last resort.

Surgery was the first and best answer for Tom Kiester, a Los Angeles County probation officer whose back was seriously injured in the mid-1970s when he tried to stop a fight between a pair of angry youths.

“I had no feeling in my left leg for six months. I just dragged it along and the pain was indescribable,” Kiester, 49, recalls. After surgical removal of a bulging golf-ball-sized disc, he began a slow recovery that continues today.

Kiester takes anti-inflammatory medication at the first sign of pain and works out at the gym as often as he can. But he does not lift weights--even his year-old daughter Chloe. “She only weighs 23 pounds, but picking her up can bring tears to my eyes,” he says.

For other kinds of backaches, including those caused by arthritis, surgery may not be an option. But even though the damage to age-worn vertebrae is usually irreparable, the pain can often be alleviated.

At 50, Elaine Bornstein of Portsmouth, N.H., has learned to live with two facts of mature life: First, she has arthritis, and second, she has to keep moving.

“When I first learned that degenerative arthritis was the cause of my horrible back pain and spasms, I tried every imaginable intervention short of surgery and nothing helped. I thought I would wind up in a wheelchair.”

Then Bornstein, a former ballet dancer, was introduced to an exercise program designed to stretch and strengthen the muscles around her damaged vertebrae. The most valuable exercise, she says, is a yoga-based movement in which she lies stomach-down on the floor, lifts her upper body with her arms and arches her head back.

The exercise, called the McKenzie back extension maneuver, has the backing of the American Medical Assn. and may soon have the endorsement of the federal government as well. Physical therapists who employ the McKenzie method put patients through a series of lower-back movements and then use the patient’s own assessment of pain to identify those moves that best alleviate pain in the buttocks, leg or foot.

It’s a sign of the times, say students of back pain, that non-traditional therapies such as the McKenzie method and chiropractic spinal manipulations are now being studied by the Public Health Service along with standard medical techniques like bed rest and muscle relaxants.

A $795,000 trial began last month to determine which of the therapies works best.

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For many men and women with damaged, aching backs, stress reducers such as exercise and yoga are fast becoming the way back to health.

Dr. Mary Pullig Schatz, a Nashville pathologist, was drawn to yoga 20 years ago when she could not relieve her own back pain. Author of “Back Care Basics: A Doctor’s Gentle Yoga Program for Back and Neck Pain Relief,” Schatz, 48, is among the new vanguard of health professionals who take a holistic approach to back pain.

“Back and neck pain derives from so many things in our lives--posture, our genes, our attitudes toward life. Your whole body affects your back, which is why your whole body must be involved in any therapy,” Schatz says. “Yoga helps us identify the sources of pain in our bodies and recognize their connection to our feelings, our emotions.

“Some of the best spines I’ve ever seen are from the La Brea Tar Pits, especially the saber-toothed tiger with that perfect back arch supported by legs on either end--like a bridge. What happened when we humans stood up is that the bridge got an indentation in it. What used to be a beautiful bridge is now an “S” curve and where that new curve is, we are vulnerable.”

While that puts all of humankind at risk for back trouble, experts say those most at risk are 20 to 30 pounds overweight, stressed, in poor physical shape and unable to lift and move without unnecessary strain and twisting.

A certain period of inactivity may be good for some back ailments, but recent studies have shown that rest is generally bad for connective tissues like those in the back. “The absence of physical stress is a destructive force to the soft tissues, a force that causes deterioration,” orthopedist Mooney says.

“Bodies need to be able to bend backwards and forward and twist to the right and twist to the left,” Schatz says. “Many people in our culture have never done these actions correctly. As a result, their lumbar spines are flat instead of arched.

“It’s too bad we can’t go back on all fours like our prehistoric ancestors,” she says, “but we can look for other ways to regain our physical, emotional and spiritual balance.”

Americans need to give up the mantra “I have a bad back,” she says, and replace it with a new one: “My back is getting healthier.”