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Dr. Bernard Presser D.C.
5696 Magnolia Woods Drive
Memphis, TN 38134
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Hibernating bears lose only about 22% of their muscle strength over 130 days. Humans confined to bed over the same amount of time lose about 80% of their muscle strength. Obviously, human bodies are meant to move, even when they have aches and pains.
Doctors USED TO prescribe bed rest - 3 to 14 days - when someone suffered a back injury or a gripping recurrence of chronic back pain. Now the advice is a day or two in bed, if absolutely necessary, then movement, light exercise, and work. Excessive bed rest can cause loss of muscle tone and bone density. One professor of orthopedic surgery estimated that, for every day a patient spends in bed, it takes another week to get the muscles back to normal. Besides, people tend to sit up in bed rather than lying flat, placing greater pressure on spinal discs.
Most experts recommend walking as soon as the really awful pain subsides. Exercise helps to relax the back muscles. Continuation of ordinary activities (within the limits permitted by the pain) results in better recovery than two days of bed rest or back immobilizing exercises. Progressive stretching exercises, if begun within the first month of injury, can result in up to a 95% success rate in reducing back pain. But the success rate drops if there are time lapses between injury or onset and activity initiation. Injury-changes to soft tissue become less and less reversible as time passes. Most back pain arises from soft tissue (muscle, ligament, etc.) injury. Tiny tears or lesions produce hemorrhage and edema. Gentle but progressive spinal motion can ease these effects. Soft tissue damage can cause the disc nucleus to become acidic, which tends to be painful. If there is an alkaline pH, even a degenerative disc may not be painful. Improved fluid exchange can reverse an acid pH state in a painful disc. Since intervertebral discs lack blood vessels, enhanced fluid exchange is the only mechanism for improved cellular nutrition and removal of waste byproducts. Better hydration is achieved by physically pumping water into and out of the disc via spinal motion. Persistent pain suggests inadequate fluid exchange and lack of movement. The sooner activity is begun, the better.
People who exercise regularly experience less pain and fewer recurrences of pain, don't require more treatment, and are more likely to return to work than sufferers who are inactive or use conventional therapy. Back-pain sufferers often have weak, poorly-functioning back muscles, yet most of them restrict activities to avoid discomfort. Aerobic, resistance, and stretching exercises would all help. Regular aerobic activities that don't strain or jolt (walking, swimming, biking, etc.) and resistance exercises (free weights, weight machines, stretch bands) can increase strength and endurance in the back, allowing muscles to work better. Strengthening abdominal muscles will support the back and improve posture. Yoga and dance exercises (ballet, ballroom, jazz, modern dance) improve balance, coordination, muscle flexibility, and agility, making the back less prone to injury and, if already a problem, less likely to hurt. Activities should gradually increase in intensity. Tips from an experienced guide along with common sense - such as stopping if the pain worsens or there is leg pain or numbness - can speed recovery and tissue health. Exercises MUST be tailored to the individual. The idea is to see what causes pain and what makes it feel better. Initially perform exercises that decrease pain. Later go back to movements that caused pain to see if they can be performed. i
FORM & FUNCTION
Water works as a lubricant for vertebral joints and acts as a weight support for the upper body (water bears the force produced by weight or tension produced by muscle action on the joint). With normal activity, vacuums are created around the joints that cause water to circulate into the joint, allowing the back to be properly lubricated. Not only is exercise important to lubrication, but so is drinking water. If a person is dehydrated, sufficient lubrication is lacking, and back or neck pain can develop. So a person's ‘drinking habits' can either contribute to or prevent pain.
About 85% of Americans will experience disabling lower-back pain at least once; 80 million now have it. The number one cause is - no, not overdoing it with a chore, workout, or sport - but poor posture. As a people, we tend to slouch and slump. We don't stand straight. We sit for hours at a desk or park in front of a computer or TV. Women wear high heels which arch the back unnaturally. We try to carry the contents of a small office or apartment in our purses, packs, or briefcases. Men carry a thick wallet in one back pocket that misaligns the pelvis and low back when sitting. It can take years for pain, stiffness, and other symptoms to develop in response to poor posture. Don't wait!! You can begin now to stand straight, keeping a level pelvic position. If standing in one place for a long time, alternately place one foot on a low footstool to take some of the load off. When sitting, keep your knees and hips level, sit up straight, and plant your feet squarely on the floor. Get up and move around or stretch whenever possible. Choose chairs with firm low back support, not soft seats such as sofas. Push rather than pull to move heavy objects. If you have to lift, let your legs do the work. Hold the load close to your body, keep your back straight, and bend only at the knees. Avoid lifting and twisting simultaneously. Learn and practice specific exercises to make muscles in your back, stomach, hips, and thighs strong and flexible. Exercises that decrease the strain on your back and stretch back muscles can relieve discomfort when it exists. Wear flat shoes or shoes with low heels. When driving, position the seat to allow knees and elbows to be slightly bent.
Physicians are now less likely to offer a diagnosis for back pain than they used to be. For years, specialists tried to pinpoint the cause of their patients' pain, but a diagnosis is often not necessary for proper treatment. There are innumerable diagnostic labels for back pain, "but often they just cover up the fact that we don't know what's causing it." Only about 15% of the walking wounded have an obvious cause for pain. Innumerable theories try to explain the remaining 85%. Medical doctors typically attribute back pain to intervertebral discs (spinal shock absorbers that sit between vertebrae, preventing them from grinding together and allowing the spine to bend). Debilitating distress and gripping spasms emerge - so the medical logic goes - when ruptured, herniated, or slipped discs (all mean the same thing) start pushing into nearby tissues and nerves. Back surgery was frequently performed for that kind of diagnosis. But experts now say that surgery is often a mistake; it ‘works' for only about 1% of patients, and only as a last resort. "If your doctor suggests surgery, [run to] get a second opinion."
From one fourth to two-thirds of people with NO back pain have some spinal abnormality - such as protruding, herniated, or degenerated discs. These abnormalities may not cause pain. Although many people have damaged discs, those with obvious problems are only slightly more likely to report pain during activity than those without them. Of the people who hurt the most, the best pain predictor is psychological in nature - like anger or depression. Attitude about discomfort is also a factor in the healing process. People who get anxious and fearful limit their activities, making things worse. Folks who recover most quickly take an approach that they believe in the most and best that fits their lifestyle.
Medications like non-steroidal, anti-inflammatory drugs (NSAIDS, such as ibuprofen or aspirin) and muscle relaxants have side effects (unwanted effects) and do not approach the cause. Because they ‘numb' the pain, movements that can cause further injury - normally prevented by pain - are not controlled. And the drugs will also interfere with the natural process of inflammation that brings tissue repair. Studies show that chiropractic or osteopathic care, from an osteopath that still knows how to perform osteopathic manipulations, can be very safe and very effective therapies for treatment of back and neck pain. Mobilization and manipulation (like "a concentrated exercise in the joint") are particularly useful in speeding up recovery and return to activity. Acupuncture can effectively reduce persistent back pain, releasing and speeding the flow of natural biochemical compounds to affected areas to support repair. Massage not only feels good, but the rubbing and kneading relax tense muscles and increase circulation (thus hydration and nutrition) to the back. Neuromuscular massage therapy, a vigorous technique that targets specific pressure points, is especially effective. Physical therapy can decrease discomfort, restore normal movement, and prevent pain by exercise and hands-on-treatment.
An old saggy mattress can make pain worse, but so can an overly firm one. Having a "just right" mattress can ease back pain. Each person must discover what works best for him/her. If pillows are used for support, do not position one that forces the neck up at a severe angle. Relaxation techniques - tai chi, yoga, meditation, breathing exercises, or a warm bath - can diminish pain. Stress and anxiety can cause tension in tissues that trigger or worsen back pain. Studies have demonstrated that relaxation techniques ease chronic pain. Quit smoking! It is associated with increased low back pain and disc degeneration. Smoking depletes nutrients needed by the spine and connective tissues, making them more vulnerable to mechanical and psychological stress. ii
Some scientists like John Sarno, MD, a rehabilitation specialist, believe that, for many people, back pain is an emotional affliction. Repressed rage or anxiety, for example, may cause chronic backaches. The idea that negative thoughts can cause physical agony is dismissed by many doctors as a placebo effect. Yet physicians who are proponents of mind-body medicine are great believers in Dr. Sarno's ideas and get notable results. Childhood trauma, self-imposed pressures, and everyday stress can generate depression, anger, anxiety, and other unresolved emotional pains. Journaling, meditation, psychotherapy, support groups, or other therapies can help resolve underlying issues. While some back pain has physical causes - injury, accident, tumor, infection, misalignment - some specialists insist that chronic pain is usually a combination of physical AND emotional factors. The role played by suppressed emotions in triggering the chronic pain cycle is being increasingly recognized.
Research has shown that, in most cases, back pain DOES NOT result from damaged or defective tissues. One landmark study found that 64% of people with NO history of back pain had evidence of abnormal discs (bulges, herniations, etc.). Many other types of abnormal spine structures were also found. Other evidence has shown that many people who suffer from disabling and chronic back pain do NOT have any such abnormalities. So an abnormality that appears on an x-ray or MRI cannot be assumed to cause the back pain. A physical injury or strain may begin the cycle of pain, but it usually heals fairly soon. What KEEPS the pain going - even sustaining misalignment or inflammation - is chronic muscle tension. Muscle tension can be the direct result of emotional stress that is not consciously acknowledged. Stress over the pain, worries about the future, financial concerns, illness in the family, marital conflicts, adverse conditions at work - any source of stress - can be a link.
Of course, serious conditions such as osteoporosis, rheumatoid arthritis, ankylosing spondylitis, tumors, kidney stones, damage to bone or connective tissue - to name a few - should be ruled out first. Then understanding the chronic back pain cycle - including stressful thoughts or emotions that make us tense up - is important to healing. Stressful emotions that are not released can be held in the form of muscle tension. If you believe your back is damaged, you may begin to brace yourself or assume postures or avoid activity to guard against further "damage". This behavior and the beliefs that fuel it can trap you in a vicious cycle of pain and fear. Fear of pain plays a central role in perception of pain, particularly back pain. Frustration, anger, and depression deepen the cycle.
Back pain is not imaginary or fake or "all in your head". But like other physical disorders that have psychological roots, most chronic back pain is in large part caused by the body's natural response to excessive stress. The cycle needs to be broken. The sufferer must learn how to work conscious and effectively with his/her stressors. For example, breath therapy - diaphragmatic breathing and awareness exercises - can significantly alleviate chronic back pain, improve coping skills, and lend new insight into the effects of stress on the body. Meditation or yoga (performed slowly in meditative fashion) can help relieve headache, neck and low back pain. Scientists more frequently conclude that psychological factors rather than mechanical factors are probably more important to back pain. iii
NATURAL AIDS AND NUTRIENTS
The herb, willow bark, may help acute flare-ups of back pain. From 21% to 39% of study participants become pain free within four weeks of use. There have been no discernable side effects and there are no restrictions on the length of treatment. Willow bark contains salicin, a substance the body converts to salicylate. Non-steroidal anti-inflammatory drugs like aspirin are salicylate derivatives - synthetic, isolated chemicals without the benefit of natural synergistic and balancing co-factors. These drugs have side effects that do not occur with willow bark extract. When capsaicin, a compound in cayenne pepper, is applied to the skin, it relieves muscle or nerve pain. It blocks production and transport of something called "substance P", a chemical that carries pain messages from nerve endings in the skin to the central nervous system. In some people, a burning sensation can last for up to three days; use should be discontinued if the skin becomes irritated. Ginger has traditionally been used to help with painful conditions of joints, muscles, and other connective tissues. These herbs do not cure the underlying problem, but can ease discomfort, improve sleep, and permit more activity.
Proteolytic enzymes - such as bromelain (from pineapple), papain (from papaya), trypsin (an intestinal enzyme), and chymotrypsin (another intestinal enzyme) - may help heal minor injuries because they can be absorbed from the gut and accelerate the processes of inflammation and repair. Both bromelain and papain have been shown to help reduce pain and swelling as well as promote faster healing in people suffering with various musculoskeletal conditions, including back strain. Both bromelain and papain should be taken on an empty stomach for their healing properties. If taken with food they become excellent digestive aids but lose their healing properties.
Vitamin B complex (with all its whole food co-workers) is a mainstay of muscle, ligament, tendon, and nerve health and function. It is involved in stimulation and action of nerves, including sensitivity to pain. B1 (thiamin), B2 (riboflavin), B3 (niacinamide), B6 (pyridoxine) and B12 can help reduce the amount of anti-inflammatory drugs needed to control pain, prevent relapses of pain, and aid healing processes. B6, for example, is essential to make nerve messengers like serotonin, one of the body's own ‘pain killers'. B6 strengthens connective tissue by improving collagen cross-linking, is a precursor to enzymes responsible for producing cellular ‘cements' (glycosaminoglycans) that allow tissues to adhere to one another, help rebuild damaged cartilage, ease joint pain, and inhibit the breakdown of cellular cements. Glucosamine and chondroitin sulfate are two ‘cement makers'. B2 helps promote uptake of B6 and other B vitamins, is required for protein production to develop and maintain muscle tissues, and improves function of adrenal hormones involved in inflammatory processes.
Substances that enhance vasodilation - opening or relaxing blood vessel walls to allow increased blood flow - can significantly reduce pain, tenderness, and protect against pain and damage from activity or exercise. Vasodilation improves oxygen supply, nutrient delivery, and wash-out of waste materials. Although L-carnitine (an amino-acid rich compound) has been used for this purpose, as an isolated substance, it can cause imbalance when used in large or long-term amounts. Vitamin B complex (often found with carnitine in whole foods) and foods rich in minerals like potassium, calcium, magnesium, and others, can naturally help relax blood vessel walls, allowing better blood flow.
Minerals such as calcium, magnesium, manganese, copper, zinc, potassium, selenium, boron, sulfur, and iron all play significant roles in the health, strength, integrity, flexibility, relaxation and contraction, enzyme support, and repair capacity of bone, muscle, ligament, tendon, cartilage, and nerve tissues. Calcium and magnesium are intimately involved with muscle function, and reduce the tendency to cramp or spasm. Many Americans are deficient in magnesium, which can result in painful spasms of muscles. Pain medications use up more magnesium and increase the possibility of future muscle spasms! Magnesium helps activate alkaline phosphatase, an enzyme involved in forming calcium crystals in bone and converting vitamin D into its active form. Calcium, magnesium, and potassium help strengthen muscles and bones for good posture. Manganese is required for collagen formation and is a cofactor for an enzyme required for sulfate uptake. Manganese deficiency is linked with a decrease in cellular ‘cement' (glycosaminoglycans) in intervertebral discs and with a lack of tone in ligaments and tendons as well as abnormalities in bone and cartilage formation. Sulfur can relieve pain and swelling. It is needed to make glycosaminoglycans and collagen (a protein substance). Collagen binds muscle cells together, provides movement in joints, and maintains the shape of intervertebral discs. A degenerated disc may have only half the sulfate of a normal disc. Deficiency can contribute to stretched or flabby ligaments which cause abnormal tension on muscles, resulting in spasms and pain. Several amino acids such as cysteine, methionine, and cystine are good sources of sulfur. Copper-dependent enzymes are needed in bone for cross-linking collagen. Zinc-dependent enzymes are needed for cell proliferation during healing. Zinc stimulates protein synthesis in bone. In zinc deficiency, there is delayed closure of wounds and the collagen produced has reduced tensile strength. Copper, manganese, and zinc play significant roles in forming superoxide dismutase, an enzyme that protects cells and serves in the inflammatory process.
Vitamin C complex (which includes copper), vitamin D complex, essential fatty acids, and quality protein are helpful to back and tissue health and healing. Flavonoids (associated with C complex) can aid in stepping up the inflammatory response towards repair and stabilizing collagen structures for mending. These include bioflavonoids, proanthocyanidins, quercetin, catechin, and anthocyanidins.
Vitamin C complex is a key to creating collagen. Collagen is particularly crucial for tendons and bursa sacs (a baglike pouch in joints that contain liquids for lubrication). Ligaments, tendons, cartilage, muscles, and bones all require vitamin C complex for proper healing. Isolated ascorbic acid (the fake vitamin C) does not work like the food complex. Capillaries deliver nutrients and other repair substances to injured areas and eliminate waste. With injury, healthy capillaries protect against bruising, hemorrhage, edema, and excessive inflammation. Capillary-wall strength and reduced permeability (‘leakiness') is improved by better collagen synthesis. Rutin (a bioflavonoid) is especially effective in strengthening capillaries. Vitamin E complex, vitamin A complex, and carotenes assist inflammation and repair of micro-injuries to tissues. Vitamins C and E complexes help prevent a decline in muscle function and may also prevent or reduce muscle damage. Coenzyme Q-10 can help improve muscle strength when there is nerve involvement. Injury usually causes a dramatic loss of skeletal muscle protein due to increased protein breakdown. Quality food protein is necessary for damage repair and preservation of muscle mass.
Increased intestinal permeability ("leaky gut syndrome") can be caused by food intolerances or sensitivities. In some folks, there is a connection between "leaky gut" and musculoskeletal discomfort. Eliminating offending foods and supplementing with appropriate food complexes may bring moderate to significant improvement of musculoskeletal problems. "Everything you put into your mouth affects the health of every cell and tissue in your body." Eat natural, real whole foods. Avoid depleted, industrialized nonfoods. Drink plenty of clean water. Limit or avoid stimulants like coffee (see article on caffeine), colas, and cigarettes which can tighten up muscles around the spine. Keep your weight down; excess belly girth can pull at lower back muscles, stress the joints, and cause poor posture, misalignment, and pain. iv
An injured or painful back is often accompanied by the natural process of inflammation. Discomfort may lessen if inflammation is subdued. So inflammation is thought to be "bad," by the medical profession, something they have to stop. If the pain is stilled, so medial thinking goes, the problem is solved, right? Not really. Any good biochemistry book will explain that inflammation is a multi-faceted, intricate immune system response used for any injury or insult to body tissues. The purpose of inflammation is to clear away dead or damaged cells and set the stage for replacement of those cells. Inflammation is the body's major healing process. This incredible task involves many substances and many cells in numerous stages of healing. The affected area is effectively fenced off, needed compounds and worker cells are called in (creating a ‘traffic jam' or congestion); damaged or dead tissue cells are engulfed, broken down, and ushered out; and a repair matrix is laid down. This demolition and reconstruction project is accompanied by temporary inconveniences that signal the progress or stage of work. There may be heat, swelling, and discomfort. As the healing proceeds, these symptoms change and gradually dissipate. Upon completion, not only are the inconveniences gone, but healing has been completed. All of this occurs IF - and this is very important - IF all the needed nutrients have been present in adequate amounts and IF there has been NO interference in any of the stages of the process, especially not using anti-inflammatory drugs.
Ice, for example, may be needed with severe or very painful swelling. But used excessively or for less severe injuries, ice can interfere with inflammation. Anti-inflammatory drugs interfere. Steroid drugs (prednisone, etc.) interfere. Large doses of ascorbic acid (fake ‘vitamin C') interfere. All of these drugs are commonly used by the medical profession for back pain. They ease discomfort by interfering with the natural process the body is using to repair itself. There are times when drugs or ice are needed, but most of the time they are not. Nevertheless, stopping or interfering with inflammation seems to be a treatment goal for the medical profession. This means repair may not be completed. Tissues can remain very susceptible for years to future insult or injury.
That's why one successful treatment for musculoskeletal problems is a medical paradox. It is called prolotherapy. It has been used for everything from severe, constant back pain to loose ligaments, from arthritis, tendonitis, and bursitis to TMJ and whiplash, from acute injury to chronic pain. Also called regeneration injection therapy and non-surgical reconstructive therapy, prolotherapy involves injection of a sugar-based solution (usually dextrose) along with phenol and glycerin into the injured area. Why? To serve as a mild irritant which induces - are you ready? - an inflammatory response. The inflammation induces more blood flow to that area, bringing needed nutrients and natural immune chemicals and cells to help repair, strengthen, and stabilize the tissues. The idea is to trigger the process the body wanted to use in the first place - inflammation. The end result of the inflammation induced by the injections is stronger, tighter, more flexible tissues, reduced or resolved pain, repair, stabilization, tissue regeneration and reconstruction. The idea is to mount a natural healing response.
Isn't there a simpler, safer, and less expensive way? Well, rather than treating back pain with ANTI-INFLAMMATORY therapies - methods that interfere with inflammation and repair processes - why not support this wonderful function from the beginning to attain as much repair as possible? Many complex nutrients in whole foods and herbs support the inflammatory procedure including vitamins A complex, C complex, B complex, E complex, carotenoids, calcium, magnesium, potassium, zinc, iron, many amino acids, essential fatty acids, enzymes, innumerable phytonutrients - in fact, virtually all known and unknown FOOD factors. Setting a course for healing also means avoiding dietary perils that may prevent optimal body function - such as refined sugars (which interfere with white blood cell function), other refined carbohydrates, altered fats, overly-processed and chemically-adulterated nonfoods. Use of wet heat (rather than excessive application of ice) feels better to many sufferers and will not hinder the course of inflammation. v
To sum up, the message for your aching back is to: MOVE IT, SOOTHE IT. KNEAD IT, FEED IT. ADDRESS THE STRESS, ALIGN THE SPINE. SANCTION INFLAMMATION IF YOU CARE FOR REPAIR.
This website has excellent nutritional protocols for pain, especially low back pain which are available in conjunction with the Symptom Survey. Take the Symptom Survey to discover specifically what nutrition you need for your individual health problems. I want to emphasize that the whole-food nutrition I recommend CANNOT be purchased in any retail store: so-called "health food" store, drug store, super market, etc. The whole-food nutrition I recommend will help rebuild your body and help restore your health. Those other products will only give you a pharmaceutical (drug) effect. They will attempt to deal with your symptoms, which is the ONLY thing any drug can do, while leaving the state of your health unchanged.
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Originally published as an issue of Nutrition News and Views, reproduced with permission by the author, Judith A. DeCava, CNC, LNC.