FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[TOO MUCH BED REST CAN MAKE LOW BACK PAIN WORSE]

Question: I've recently had a lot of back pain. My doctor just told me to take ibuprofen and to do some exercises. Shouldn't he take X-rays? When my mother had a similar back problem years ago she was put to bed rest for two weeks. Why didn't my doctor recommend this for me?

Answer: Back pain is a common complaint that troubles 80 percent of adults some time during their life. Your mother and I belong to this popular club, so you're welcome to join us, too!

There are many conditions that can cause back pain in adults. Fortunately, the most common ones involve disorders of the muscles, the bones, and/or the way they work (or don't work) together. The reason these are fortunate is that they are not associated with serious or life-threatening conditions but rather with things like muscle injury, ligament sprains, arthritis and a condition that osteopathic physicians call "somatic dysfunction." In these disorders a careful history of the symptoms and a physical examination are usually all that is necessary to establish the diagnosis.

Since the 1930s X-rays have been routinely used to help evaluate complaints of back pain. Deformity of the shape or location of bones is shown with these plain X-ray films. Therefore, broken bones and tumors are often seen. In recent years, sophisticated imaging using MRI or CT scanning have become available. These newer imaging tools are much more sensitive at showing abnormalities in the low back - not only of the bones but also of the adjacent muscles, ligaments, nerves and intervertebral disks. These types of soft tissue are not clearly shown by plain X-rays.

X-rays, MRI and CT scans often show some abnormality of the low-back structures. At one time almost anyone with such a positive X-ray finding would be advised to have surgery. Now, however, we know that almost all of these abnormalities are the result of degenerative conditions associated with age or injury and are very seldom the cause of back pain.

About one percent of back pain is caused by potentially serious conditions such as osteoporosis, infection of the spine or nervous system, tumors, abdominal aortic aneurysm or kidney problems. The history of pain and other associated symptoms alerts the doctor to order plain X-rays or other imaging studies. In the majority of back pain sufferers, like you, X-rays don't clarify the diagnosis or improve the treatment; they only increase the cost of health care.

Experience has shown that days of bed rest prolong the disability of musculoskeletal back pain, not shorten it. Most people with acute back pain benefit from a day or two of rest, but not strict bed rest. Gentle exercise to stretch and tone the sore back muscles and exercises for the abdominal muscles promote a quicker recovery. Heat or cold can also help. The vigor of the exercises is increased as the discomfort decreases. Pain medicine, such as the ibuprofen you are taking, is often adequate but occasionally stronger ones are needed for the first few days.

Manipulative treatment can also be quite beneficial in reducing discomfort and getting people back to a normal life. If your back discomfort isn't improving in a few weeks, you may want to consider seeing a physician who can perform this type of therapy. Some allopathic physicians (M.D.s) and all osteopathic physicians (D.O.s) are trained in these manual medicine techniques. The treatments provided by physical therapists and chiropractors can also be helpful.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.