Your Lower Back, and You


Discussion Topic

Return to Forum List
Post a Reply
Messages 41 - 52 of total 52 in this topic << First  |  < Previous  |  Show All  |  Next >  |  Last >>

May 12, 2013 - 01:10pm PT

Back pain breakthrough could eliminate need for major operations

Discovery could transform treatment of chronic lower back pain and save health services millions of pounds

Ian Sample, science correspondent, Tuesday 7 May 2013 04.30 EDT

When patients have no other options, surgeons can fuse damaged vertebrae, or transplant artificial discs into their spines, but both of these operations might largely be replaced with courses of antibiotics. Photograph: Christopher Furlong/Getty Images

The figures make for grim reading. When all costs are considered, the NHS spends more than 1bn each year on back pain. More than half goes on hospital costs. But 140m covers GP consultations, with even more spent on physiotherapy sessions. On any given day, 1% of the national workforce is on leave with a back problem.

Most people recover from acute back pain within six weeks but for a fair portion, around 8%, the problem becomes long-term. In the past, doctors prescribed bed rest for back pain. They now accept that only makes the pain worse, and instead recommend physical exercise, or at least staying active.

In more than 80% of cases, there is no clear cause of back pain. But to the long list of factors, from lifting and posture, to stress and anxiety, scientists in Denmark have now added bacteria.

Microbes should not be lurking in the spine, but Hanne Albert and her team at the University of Southern Denmark found a common bug called Propionibacterium acnes inside the slipped discs of patients who had operations for the problem. The bacteria normally live without oxygen, in hair follicles, or at the bottom of crevices in teeth, but brushing teeth can sweep them into the bloodstream.

The bacteria should pose no threat as they circulate around the body, but when a person has a slipped disc, the body grows fresh blood vessels that reach into the soft disc to repair the tissue. This gives the bacteria a route in, where they can thrive, scientists believe. As the bacteria grow, they cause inflammation around the disc, and release propionic acid, which irritates nerves, and may even cause the painful microfractures seen in vertebrae around the disc.

The Danish researchers found that a long course of common antibiotics, lasting three months, killed off the bacteria, and alleviated pain in most patients who took part in their trial. All had been in pain for more than six months and showed signs of vertebrae damage in MRI scans. They took six to eight weeks to feel better.

The drugs must be taken for so long because the blood supply to spinal discs is very poor. Once the disc is free from infection, the inflammation dies down, and the vertebrae begin to heal.

The discovery could transform the treatment of chronic lower back pain and save health services millions of pounds by doing away with unnecessary operations. When patients have no other options, surgeons can fuse damaged vertebrae, or transplant artificial discs into their spines, but both of these operations might largely be replaced with courses of antibiotics.

The treatment is controversial because greater use of the drugs can lead to more antibiotic resistance, already a major problem in hospitals around the world. The scientists have joined forces with a small team of experts to make educational material and guidelines for doctors and surgeons, to help them target the right patients.
Bruce Morris

Social climber
Belmont, California
May 12, 2013 - 03:23pm PT
A big question this "discovery" brings up: Why in the heck are the rates for chronic back pain so high in the developed world and virtually non-existent in undeveloped countries? Also, the ratios of chronic pain vary considerably from one developed country to another: 1 in 3 in the US, 1 in 4 in Europe, and 1 in 5 in Australia. A native-born Kenyan almost never has a so-called "bad back". However, if you transplant an American or a European or a Japanese to Nairobi, they will have lower back problems at the same rate as in their point of origin. How is this so, if a bacteria is solely responsible for lower-back complaints? There just have to be some psycho-social variables that have to be factored in to the different rates of infection from country to country and culture to culture. You'll notice too in the article that the bacteria only seems to account for back pain in 20-40%. What about all the other cases of lower back pain? What's causing it in the other 60-80% that don't have the bacteria in their systems?

And how about CTS, RSI, TMJ and frozen shoulder? Are there different bacteria associated with these conditions? It's interesting in this context to observe the history of stomach ulcers, which used to be blamed solely on stress. That is, until a bacteria was discovered in the stomachs of some (but no all) people with ulcers. Now there are drugs that target that bacteria and the rates of stomach ulcers have gone down considerably. Ulcers are no longer what is called a "preferred symptom" that develops under psychological stress. Now there are new "preferred" symptoms like back pain, knee pain, and more recently the foot. Of course, almost no one has classical hysterical symptoms like the ones that Charcot and Freud observed anymore either. I would suggest that the recently discovered bacteria can start growing in the soft tissues of patients who have been under a great deal of psychological stress, either external or self-imposed due to personality traits. So, despite out mechanist, dualist bias, it's still a bit premature to exclude psychological causes as reasons for the development of lower-back pain.

Social climber
the Wastelands
May 12, 2013 - 04:19pm PT
A big question this "discovery" brings up: Why in the heck are the rates for chronic back pain so high in the developed world and virtually non-existent in undeveloped countries?

good question

my guess is because the data behind the question may be seriously challenged?

people in third word (undeveloped) countries simply live, suffer, and die

record keeping is virtually nonexistent and there really is no medical care to speak of

outside of that, I suppose one could also put forth that people in the third world are much more physically active, constantly trying to secure food and shelter and as such move more blood and oxygen through their cardiovascular systems, promoting an overall less abusive

nah, on second thought I will go with live, suffer without reporting, and die

Trad climber
Topic Author's Reply - May 13, 2013 - 04:19pm PT
Bruce: I suspect that one of the big reasons there are differences between the US and other in lesser developed countries is that while we may have jobs that require lots of motion and exercise, we also have (generally speaking) the luxury of hanging out after work and being couch potatoes. Most of those in lesser developed countries don't have that luxury at all, and are regularly in motion. In addition, they don't pack on the pounds the way more and more USAmericans do. Pretty broad brush strokes, I know, but my hunch is that there's something to that.

Trad climber
Topic Author's Reply - May 13, 2013 - 04:20pm PT
ksolem: I just went through that Pilates video, and that was actually pretty cool! Thanks for that.

Trad climber
Monrovia, California
Jun 7, 2013 - 04:08pm PT
Been looking into local Pilates offerings. A bit spendy, but doable. For those of you who do Pilates (I have no experience with them), is it best done in a "studio" with a drill instructor, or is a DVD sufficient?

The DVDs out there are pretty variable. Alisa Wyatt has some good ones. Peter Fiasca's Complete Classical Pilates series provides an excellent demonstration/documentation of the work, but offers little instruction.

There is no real substitute for working with a good teacher. One good way to do it without having to sell all your gear is to take a few privates to get a foundation, and then do weekly group classes, with a private thrown in once in a while. Create a regular home practice using what you learn from your teachers. Make sure your teacher knows this is your plan when you start.

A lot of good studios require this (some amount of privates before joining a group) and often you'll get a lower rate on the privates if you commit to a series of group sessions up front. Any good studio will let you come in and observe a class so you can see if you like the idea before you commit. Buying a series of 10 classes at a time should substantially reduce the rate.

In the places where I have worked, the class sizes are limited officially to four but they'll let in a fifth if the teacher okays it. Unless you are very experienced at Pilates, a class of more than five is a waste. Occasionally I attend workshops where a master teacher will lead a large group, but this is different as everyone's technique is already well formed.


Trad climber
Topic Author's Reply - Jun 7, 2013 - 06:19pm PT
Thanks, Ksolem. I've been doing some of the stuff your initial link demonstrated, and it's easier now that I've been doing a couple of them a bit more.

I know the real hardmen and women are into this:, but I know that's a bit ambitious for me at this point in the game.

I've appreciated all the suggestions, and the PMs! Thanks, folks!

Jun 7, 2013 - 06:27pm PT
I'm sure that the lower back has a mind of it's own

Trad climber
Jun 7, 2013 - 06:35pm PT
Genetics play a pretty significant role in many conditions that cause lower back pain.

Trad climber
Monrovia, California
Jun 7, 2013 - 07:08pm PT
The spinal cord proper, as a distinct anatomical unit, ends somewhere around L1-2, as it divides into a large array of nerves forming the Cauda Equina (Horses Tail.) These nerves, among them the notorious sciatic nerve, find their way out of the lumbar vertebrae and sacrum through a series of Foramen (holes or openings) in the skeletal structures.

The specific layout of the Cauda Equina, the routing of these various strands of nerves as they reach out to the rectal and genital areas, and down the legs, varies in different individuals.

So, yes it can be said that the lower back has a mind of it's own, and there is certainly a genetic role in lower back issues as well.

Actually the idea that other parts of our nervous system than just the brain are involved in our feelings and emotions, our movement and what we call "muscle memory," is an exciting area of study in neurology today. I have been kind of buddies with the neurologists who have been studying my own somewhat unusual situation, and in conversations with them it has become clear to me that the brain is no longer thought to be exclusively in control of our bodies, nor is it the exclusive repository of memories or emotions. It appears we are more like a network, than a machine controlled by a cpu.

Trad climber
Millbrae, CA
Jun 7, 2013 - 07:15pm PT
My lower back was horrible in my late 30s and early 40s. Constant pain and sciatica. Now it's quite good - not perfect but very functional and I'm mostly pain free.

Here are what I think were the key changes:

Leaving a job where I had to commute for 2 hours a day and then sit all day. I probably don't sit in a regular chair for more than 2 - 3 hours a day now.

Stretch my hamstrings and hip flexors every day, religiously.

Ice my low back every night after a day that included exercise (ice works for me as well as nsaids).

See a chiropractor about once a month. I used to be a skeptic about chiropractic - before I had ever tried it, but it makes a big difference for me.

Good luck! Phyl

Trad climber
Monrovia, California
Jun 7, 2013 - 10:04pm PT
I mentioned up-thread that i was putting in a standing workstation. So now it's up and running, and it's great!

Credit: Ksolem

Yeah I know all you finish carpenters out there will raise an eyebrow to the cheap closet world furniture. And I still have some wiring to properly dress, pictures to hang (they'll distract you from the furniture,) and I'll find a nicer way to get the monitors at the right level than a couple old drawers upside down.

It sure is nice to be on my feet, rid of the chair. I was slightly concerned at first, but now I have logged enough hours standing here to know it's right for me.

And the Gel-Pro floor mat rules.

edit: The counter-top is 38" off the floor.
Messages 41 - 52 of total 52 in this topic << First  |  < Previous  |  Show All  |  Next >  |  Last >>
Return to Forum List
Post a Reply
Our Guidebooks
Check 'em out!
SuperTopo Guidebooks

Try a free sample topo!

SuperTopo on the Web

Recent Route Beta
Recent Gear Reviews