Cheryl Senter for The New York Times
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Health Guides: Nonspecific Back Pain | Low Back Pain - Chronic
But back pain is notoriously difficult, and expensive, to remedy.
“The treatments are varied, and we don’t have great science showing what
works best for particular patients,” said Brook I. Martin, an
instructor of orthopedic surgery at Dartmouth Medical School. “There are
questions about the safety and efficacy of a surprising number of
therapies, including some types of surgery.”
Those with back pain inevitably end up with higher overall medical costs
than those without, studies suggest. Dr. Martin has found that patients
with back pain spend about $7,000 annually on health care, while people
without back pain spend just $4,000 a year. (Insurers will pay the
majority of these costs, but patients often bear some of these expenses
in the form of insurance co-payments and deductibles.) These estimates don’t include costs for lost work days or diminished productivity.
Some back problems, of course, can’t be avoided. Over time, spinal
vertebrae naturally degenerate and spinal facets become inflamed,
causing stress and discomfort.
“The majority of back pain is the result of muscle and ligament strain
or weakness, and can often be prevented by developing core strength and
proper posture,” said Dr. Daniel Mazanec, associate director of the
Center for Spine Health at the Cleveland Clinic.
Maintaining good posture not only helps you look better (there’s a
reason inept people are called slouches), it improves muscle tone, makes
breathing easier and is one of the best ways to stave off back and neck pain, not to mention the dreaded dowager’s hump of old age.
“Posture is the key,” said Mary Ann Wilmarth, chief of physical therapy
at Harvard University Health Services. “If your spine is not balanced,
you will inevitably have problems in your back, your neck, your
shoulders and even your joints.”
Sitting a little straighter now? Good. Here’s some advice that will help
you make it a daily habit and stave off expensive back problems to
boot.
THE D.I.Y. APPROACH First, try correcting your
slouching habits on your own. Stand up and lift your chin slightly;
align your ears over your shoulders and your shoulders over your hips.
Place your hands on your hips and pitch forward about two inches.
There should be a slight inward curve in your lower back, an outward
curve in your upper back, and another inward curve at your neck.
Maintain this posture and sit down.
When you are sitting or driving for long periods of time, place a
cushion or rolled-up towel between the curve of your lower spine and the
back of your seat. Supporting your lower back will maintain the natural
curve of your spine; when the back is supported, the shoulders more
naturally fall into place, said Dr. Wilmarth.
Maintaining good posture requires abdominal and back strength. “It’s not
enough to just sit up straight if your core muscles are weak,” said Dr.
Praveen Mummaneni, a spine surgeon at the University of California, San
Francisco. Consider taking a Pilates class,
which focuses on developing one’s core — the muscles and connective
tissues that hold the spine in place — or hire a physical therapist to
create a personalized exercise plan.
A CUBICLE CURE If you sit at a desk all day, ask your
human resources department if they have an ergonomics expert on staff
(some large companies do) who can assess your work area. An ergonomist
can make sure your chair, desk and keyboard are at the optimal height
and can adjust your sitting posture.
If no expert is on hand, make adjustments yourself. The center of your
computer screen should be at eye level, and the desk height should allow
your forearms to rest comfortably at a 90-degree angle. Work with your
feet flat on the floor and your back against the chair.
Whether you work in an office or at home, get up and stretch every 30 to
60 minutes. Sitting for long periods puts pressure on discs and
fatigues muscles. And most workers spend the majority of their days sitting down. A recent study published in The European Heart Journal found that Americans are sedentary for an average of 8.5 hours a day.
“Stretching helps break bad patterns and allows your muscles to return to neutral,” said Dr. Wilmarth.
Stand up and place your hands on your lower back, as if you were sliding
them into your back pockets. Gently push your hips forward and slightly
arch your back. Sit back down and circle your shoulders backward, with
your chin tucked, about 10 times.
Not likely to remember? Set your phone or computer alarm to remind you to stand up and stretch each hour. An iPhone app called Alarmed has a feature that allows you to create regular reminders throughout the day.
AN EXERCISE PLAN Habits are hard to break. A physical
therapist can show you how to align your spine and provide you with
exercises to both strengthen your core and loosen up stiff neck, back,
arm and leg muscles (tight hamstrings can contribute to back pain).
The American Physical Therapy Association’s Web site (www.moveforwardpt.com) offers a simple tool that lets you search for physical therapists by ZIP code and specialty.
Most insurers cover physical therapy, although some may insist that you
get a referral from a physician before they will authorize a visit.
If you decide to go out of network or to bypass your insurer, you’ll pay
$150 to $250 for an initial assessment. Follow-up visits will be $50 or
so less. Most experts say you can address basic posture issues in just
one to three sessions.
A CLASS IN POISE If you want a more systematic,
long-term approach to posture change, consider the Alexander technique, a
method that teaches you how recognize and release habitual tension that
interferes with good posture.
Not all doctors in the United States are familiar with the technique,
but recent research suggests that it can help with lower back pain as
well as posture. A study published in The British Medical Journal found that lessons in the technique helped patients with chronic back pain. A 2011 study
published in Human Movement Science concluded that the Alexander
technique increased the responsiveness of muscles and reduced stiffness
in patients with lower back pain.
Try one session to see if it’s for you. If so, consider committing to 10
lessons. Individual lessons cost $60 to $125, depending on the
teacher’s experience. Insurers will not reimburse you; group lessons may
be more affordable. To find a teacher, go to the Web site of the American Society for the Alexander Technique. Still slouching? A study published in The European Journal of Social Psychology found that subjects who were told to sit up straight with good posture gave themselves higher ratings and had more self-confidence on a given task than those who were told to slouch.
Moral: Sitting pretty yields immediate, not just long-term, benefits.
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