Most people—about 80 percent, according to the National Institutes of Health—will experience back pain at least once in their lives. The lower back (lumbar spine) is the most common site of soreness. And it’s an equal opportunity pain—affecting both men and women equally. It can occur suddenly, due to accident or injury. Or it can be a slowly brewing storm, taking years to develop. Age can be a risk factor, due to changes in bones, tissues and muscles of the spine. But, whether you’re young or old, a bulging (herniated) disc, a common form of disc degeneration disease, is often blamed as the culprit, but just because an intervertebral disc is bulging does not necessarily mean it’s causing pain.
“As common as back pain is, it’s an elusive problem,” explains orthopaedic spine surgeon A.N. Shamie, MD, Professor & Chief, Orthopaedic Spine Surgery UCLA School of Medicine. “Wear and tear is ubiquitous on imaging, but imaging is not the holy grail. You have to treat the patient, not the MRI.”
What Back Pain Research Tells Us
Indeed, studies have shown that disc herniation is common in people who don’t have any pain symptoms. In one study, researchers performed MRIs on people who never had low back pain. Of those who were over age 60, about 57 percent of the scans revealed abnormalities (36 percent with herniated discs, and 21 percent with spinal stenosis). And yet, there was no pain reported by the study subjects.
This is not to say that disc degeneration disease has nothing to do with back pain. But finding the actual source of pain is a challenge because the spine is, after all, the central meeting point of nerves, an intricate array of bones, and the home to the spinal cord. Though a typically strong and flexible assembly, the spinal column is constructed of many parts. The possibilities for malfunctions (and hence pain) are varied and numerous. Finding the cause of back pain is often a matter of exclusion, says Dr. Shamie, meaning that if it’s not the disc, it may be a joint or nerves. One method of identifying the source of pain is to inject a pain-reliving medication into the suspected joint and if that pain is relieved, the culprit may have been found.
Intervertebral Disc Degeneration
The spinal column, also known as your backbone, is a flexible structure consisting of vertebral bones that are linked by muscles, ligaments, and fluid-filled rubbery discs. These discs connect and cushion the bones, acting like shock absorbers as we walk, twist, side bend, and perform other physical movements. With age, the discs can start to dry out, making them less shock absorbent and less stabilizing of the vertebrae above and below. Trauma (e.g., vehicle collisions, sports injuries, falls) can also injure discs.
As discs degenerate and lose height, the surrounding bony structures can change positions. This can lead to greater joint compression, which can also cause a disc to bulge. Either of those situations—joint compression or bulging disc—can pinch a nerve, causing pain.
Reducing Disc Degeneration Disease
“The disc is like a car tire: The heavier the car, the more quickly the tire will wear out,” explains Dr. Shamie. “It’s the same with intervertebral discs. Maintaining a healthy body weight, or losing weight if you’re overweight, can reduce pressure on the discs. Also, lifting objects with proper body mechanics can reduce wear and tear.”
In contrast, poor posture, such as when driving, working at the computer or being seated for a long period of time, can all be destructive to discs and joints. Dr. Shamie recommends lumbar support while sitting for long periods to maintain a proper arch in the lower back, as that can relieve the load on the discs. Without the arch, there’s more force and more wear on the lower back discs and joints.
Ergonomics is an applied science that deals with designing and arranging objects and environments to make them align better to the human body. Ergonomic principles can be applied to computer work stations, chairs, as well as how you use your body, such as when lifting heavy objects or opening doors.
Treating Back Pain
There is a lot of research around re-hydrating discs with solutions and bioactive materials, and according to Dr. Shamie, some animal studies have shown promise, but none of these treatments have been shown to be clinically viable. “There has been a lot of press about using PRP (platelet-rich plasma) and stem cells, but no data show that these injections will rehydrate the disc,” he says. “I caution patients about doing this because putting a needle in a disc can damage it and its contents.”
Most of the time back pain will resolve on its own with simple at-home treatments such as anti-inflammatory pain relievers, and heat and ice treatments. Soaking in a hot tub with Epsom salts can also be helpful. These salts contain magnesium, which is a natural muscle relaxant. Some gentle stretches, massage or an easy yoga class might bring relief.
If back pain persists for more than a few weeks or gets worse over time, see your doctor. Though many people may fear surgery, it may be the right choice in some circumstances. “Surgery can reduce pain and suffering and improve life,” says Dr. Shamie. He advises consulting with specialists, getting referrals, and obtaining a second opinion. He cautions against big promises and quick-fix laser clinics that guarantee outcomes on the internet and on television and radio commercials. Also, beware of surgeons who use an MRI as the sole rationale for surgery. “Most patients with back pain get better on their own in a few months,” he says.
Exercise to Prevent Back Pain
Back pain is more common among people who are not physically fit. Weak back and abdominal muscles cannot properly support the spine. “Weekend warriors”—people who go out and exercise a lot after being inactive all week—are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Low-impact aerobic exercise is especially beneficial for maintaining the integrity of intervertebral discs. If you haven’t exercised in a while, start with just a few minutes of easy walking or swimming. A physical therapist can help you develop a custom plan and ensure you’re doing exercises correctly.