Oh My Back

Renate Mangold, 57, spent long hours sitting at her office desk, her back often aching in protest. Pain would come in waves, then subside. She learned to ignore it.

Then, in 2010, after she’d been bopping around the dance floor at her niece’s wedding, the backaches started to linger longer. When she whizzed off on a business trip later that year, pains shooting through her lower back punctuated her timetable of meetings. She ignored them and carried on.

At last, it was time for a weekend at a spa – the perfect place, it seemed, for this book editor to get the pampering her back sorely needed. On Sunday night she snuggled under the covers, relaxed and happy. And woke the next morning in such agony, she couldn’t get up again.

“[My partner] helped me out of bed, helped me to dress myself, and called the doctor,” recalls Renate.

She visited her orthopaedic specialist who gave her the bad news: a herniated (slipped) spinal disc was causing her back problem. And it could no longer be ignored.

Why Do We Get Back Pain?

People have always had backaches, but our modern lifestyles, especially work that involves sitting and staring at computer screens all day, add to the abuse that age and injury can do to the vertebrae, muscles and discs.

“We’re usually slouchy,” says Dr Kristopher Karvelas, a physical rehabilitation specialist at the Spine Center at Wake Forest Baptist Medical Center in North Carolina. “Poor posture can lead to stresses on the spine that, with time, cause pain.”

Estimates vary, but hardly anyone escapes having at least one backache – about half of us will suffer in any given year. And, as Renate learned, ongoing back problems are often “discogenic”, meaning they involve the spinal discs.

“Discogenic pain is the main cause of back pain in people aged 30 to 60 years old,” says Professor Maarten van Kleef, head of the Pain Management Department of the Maastricht University Medical Centre in The Netherlands.

MRI Can Mislead

Discs are little cushion-like cartilage structures that pad the spaces between the interlocking bones (vertebrae) of your spine. Comprising a tough exterior and a softer, gel-like interior, your discs act as shock absorbers for the demands you make on your spine as you walk, sit, run, lift.

Eventually, that stress can cause the outer layer of one or more of the discs to crack, allowing the inner gel-like substance to leak. That pain you feel from a slipped disc might not come from the crack itself. Instead, it might be because the part of the disc that’s pushing out is pressing on a nerve. At times, leaking material causes inflammation in surrounding tissue, which can also cause pain. In addition to back and leg pain, nerve impingement often causes numbness and tingling in the legs, and may even cause bladder and bowel dysfunction.

Since a slipped disc can be seen on CAT or MRI scans, you might assume that diagnosis is a straightforward matter. But that’s not really so, say the experts Reader’s Digest spoke with.

Dr Charles Argoff, neurologist and the director of the Comprehensive Pain Center at the Albany Medical Center, New York, explains why. Although he has no back pain, “There’s a 50 per cent likelihood that if you did an MRI of my lower back, I’d have a herniated disc.” He points to a 1994 study that found that half those over the age of 30 given MRIs had herniated discs. But they weren’t necessarily the ones who reported aching backs.

“We have to be very careful not to over-interpret the MRI or CAT scan findings,” says Argoff. Not all herniated discs cause symptoms; and not all backaches are caused by herniated discs.

Other factors – from a simple muscle pull to serious ailments such as a spinal infection, kidney stones, bone spurs, tumours or illness involving one of the major organs – might be causing back distress. So physicians typically won’t rely solely on imaging; most also conduct a thorough physical exam to rule out other possible causes.

However, if the pain occurs in the middle of the back rather than the right or left side, or if pain increases when you come back up from bending forward, “That might be an indication that the person has discogenic low back pain,” says van Kleef.

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