FWD:New York Times:What You Can Do About That Aching Back

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From: byrd45 (Original Message) Sent: 10/4/2005 5:56 PM
Personal Health
<NYT_HEADLINE type=" " version="1.0">What You Can Do About That Aching Back </NYT_HEADLINE>
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<NYT_BYLINE type=" " version="1.0">
By JANE E. BRODY
</NYT_BYLINE>
Published: October 4, 2005
<NYT_TEXT>
The spine can join the knees as an example of the limits of evolution. We just were not meant to stand upright for more than 50 years. Still, most of us now do, and we pay with progressive degeneration of these vital support structures.

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Stuart Bradford

More Columns: Personal Health

Forum: Fitness and Nutrition

Arthritis - the wear-and-tear kind - is by far the most common cause of a potentially debilitating disorder called spinal stenosis, a narrowing of the passageways for spinal nerves. The problem is most common in people over 50, though the young are sometimes affected through injury or a birth defect.

Not everyone with spinal stenosis has symptoms, but 250,000 to 500,000 Americans do, and with age as the leading risk factor, the number afflicted is expected to grow significantly as the population ages.

The Spinal Anatomy

The spine is an incredibly complex structure of bone and cartilage that must provide both stability for an upright posture and flexibility to allow bending in four directions. The spine also houses all the nerves that enable the brain to tell the rest of the body what to do.

The spine is a column of 26 bones, 24 of them vertebrae - 7 in the neck (cervical), 12 in the upper back (thoracic) and 5 in the lower back (lumbar). The other two are the fused vertebrae that form the sacrum in the hip region and the coccyx at the base of the spine.

Vertebrae are linked by facet joints that stabilize the spine and, at the same time, allow it to bend. Ligaments keep the vertebrae in place during movement, and fibrous disks with jellylike centers provide cushioning between them.

Now for the crux of the problem: The spinal cord, a long bundle of nerves from the base of the brain to the second lumbar vertebra, passes through a bony channel called the spinal canal.

On its way, two spinal nerves - one to the left side of the body and the other to the right - emerge between the vertebrae, and another bundle of nerves, the cauda equina, extends from the end of the spinal cord.

If the channel for the spinal cord and its many extensions becomes narrowed, pressure on the nerves can cause pain, cramping, tingling or numbness in the area served by the nerve.

When arthritis wears out the cartilage that cushions the ends of bones, the body may produce bone spurs in an effort to repair the damage. If these spurs form on the facet joints, they reduce the spaces through which the spinal cord travels and the nerves exit.

Arthritis is also associated with deterioration of the spinal disks, which flatten, become brittle and may develop tiny rips that allow the jellylike substance to leak and press on the nerves. The ligaments, too, degenerate with age, becoming stiff and thick, shortening the spine, narrowing the canal and sometimes compressing nerves.

Other causes of spinal stenosis are tumors, trauma, Paget's disease of the bone, and a genetic disorder called achondroplasia.

Signs, Symptoms and Treatment

Common symptoms of spinal stenosis include pain or cramping in the legs, especially when standing for long periods or when walking; radiating pain in the back and hip (sciatica) that typically starts in the buttocks and gets worse when sitting; shoulder and neck pain, headaches or loss of balance resulting in frequent falls or clumsiness when the cervical nerves are affected; and loss of bowel or bladder control when the cauda equina is involved.

Spinal stenosis is a progressive disorder, so you can assume it will gradually worsen. But even as it progresses, symptoms may come and go. Most people with symptoms do not seek medical treatment, attributing their discomfort to the inevitable consequences of age.

But experts say that any pain or stiffness that limits mobility (and is not a result of overexertion or unusual exercise) is not normal and should be medically evaluated.

Certain symptoms, like sudden difficulty controlling bowels or bladder, warrant immediate attention. Likewise, if numbness develops in an extremity, it the is at greater risk of injury, muscle atrophy and permanent loss of sensation.

Various diagnostic tests are used to check for spinal stenosis or other problems that cause similar symptoms. Among them are spinal X-rays, CT scans, a CT myelogram, a bone scan and, best of all, an M.R.I. The M.R.I., which usually requires precertification from your medical insurer, produces cross-sectional images that can reveal disk and ligament damage, tumors, bone spurs, fractures and spinal stenosis.

A variety of treatments are available, but doctors usually suggest nonsurgical remedies, which do not correct problems but can relieve symptoms and reduce the frequency of recurrence.

Drug remedies include over-the-counter or prescription painkillers like acetaminophen (Tylenol and the like) and nonsteroidal anti-inflammatory drugs (Nsaids) like aspirin, ibuprofen, Celebrex or Mobic. If symptoms are severe enough to warrant it, the doctor may inject a corticosteroid into the spinal fluid to suppress inflammation and relieve sciatic pain.

For the very elderly or those with exceptionally weak abdominal muscles or stenosis in more than one part of the spine, the doctor may recommend a back brace or corset.

Physical therapy can help relieve symptoms and reduce recurrences. The therapist can help patients increase strength, endurance and flexibility (regular, proper stretching is a critical component of pain relief), teach you how to relieve symptoms when they occur and improve the stability of your spine.

Because nerve compression causes symptoms, learning how to open the spinal spaces often brings temporary relief.

Increase flexion of your spine by bending forward a little when walking or by lying on your back or side with your knees raised. Moderate, regular exercise is also helpful, especially riding a bicycle with your back slightly flexed.

Sometimes surgery is needed to decompress pinched nerves, although this too is no guarantee of complete or permanent relief.

Surgery can only correct existing problems, not prevent new ones. Various operations are used, including laminectomy, to remove the back part of the bone over the spinal canal and vertebral fusion.

Prevention Strategies

Although no one can prevent age-related changes indefinitely, delaying them is possible. One method is regular exercise, combining activities that promote endurance, strength and flexibility. Strength training to increase the muscle power of your arms, legs and abdomen can take stress off your back.

Regular stretching (after muscles have warmed up a bit) helps to reduce stiffness and wear-and-tear injuries.

Also helpful is to maintain a normal body weight since being overweight, especially in the abdomen, places added stress on the back.

Experts at the Mayo Clinic advise using good body mechanics. Choose seats that support your lower back or place something in its small area to maintain its normal curve; keep knees level with hips when driving; push rather than pull heavy objects; avoid lifting overhead; and lift by bending the knees; and sleep on a firm mattress with a pillow that keeps your neck at a normal angle.

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Email: personalhealth@nytimes.com.