An estimated eight out of ten people in the United States will injure their back at some point during their lives. Few of these problems will require extended treatment, but back problems are invariably painful.

Managing and relieving back pain is not a simple process. The experience of pain is subjective; it cannot be measured from the outside. Health providers who treat back pain find it challenging to obtain the objective or measurable signs that verify and diagnose a patient's painful back symptoms.

Additionally, everyone's experience of pain is different. Pain descriptors encompass numerous adjectives - dull, sharp, throbbing, pulsating, stabbing and shock-like, just to name a few.

People experience and describe pain so differently partly due to its varied and complex origins. In fact, pain originates from numerous places in the body, such as muscles, bones, nerves, organs or blood vessels.

Pain is also described as acute or chronic. The word "acute" derives from the Latin word for needles and is usually described as a severe, sharp sensation. The initial stage of an injury is called the acute phase.

The word "chronic", on the other hand, originated from the Greek word for time. Chronic pain is pain that persists after a length of time, often months to years. Many back injuries tend to become chronic, especially when not treated properly during the acute phase. Chronic pain is often experienced as a dull ache or constant nagging irritant.

Acute and chronic pain sensations also travel different nervous system pathways inside the body. When you injure muscles or ligaments in your back, nerve endings called pain receptors pick up the pain impulses and transmit them to the spinal cord. From here, the pain message ascends to the brain. This process takes place at varying rates of speed depending on the size of the nerve fiber involved.

Acute pain tends to travel on faster, larger diameter fibers, while chronic pain prefers smaller, slower pain fibers. Experts suggest that chronic pain affects the brain's limbic system, which is associated with emotional states. Anyone who has ever had a long-term painful injury knows that negative or distressing emotions may accompany or perpetuate the initial injury.

The best way to treat chronic back pain syndromes is to prevent them. Although proficient early treatment does not always prevent an acute injury from turning into a chronic problem, it is a good insurance policy. Early treatment is especially important with injuries to the soft tissues (muscles, tendons and ligaments) to prevent them from becoming weaker, less elastic and more pain-sensitive.

One of the best ways to treat both acute and chronic soft tissue injuries is a hands-on approach that works to repair the injured tissues. Some examples are joint and soft tissue manipulation and mobilization, typically performed by a doctor of chiropractic or osteopath. Other good options are massage and physical therapy. A formal rehabilitation program at a health club or therapy clinic may also help to strengthen weakened and damaged muscles, especially the core stabilizers of the back.

A Holistic View Points Toward Skeletal Muscles

It is often stated in conventional literature that the cause of lower back pain cannot be precisely identified. This perspective derives from a mechanistic, non-integrated view of the body which has been our legacy since the scientific revolution. When the body is viewed as a collection of isolated parts rather than an elegant, integrated whole, the cause of lower back pain becomes a bewildering puzzle.

However, a holistic view of the body can begin to sort out the confusion. By evaluating the relationship between the body's overall structure in gravity and it's function in movement, the causes of lower back pain begin to reveal themselves.

A holistic perspective guides us to one of the most overlooked sources, not only of lower back pain, but chronic pain in general. That source is skeletal muscles.

As Drs. Janet Travell and David Simons made explicitly clear in their exhaustive 2-volume work, Myofascial Pain and Dysfunction: The Trigger Point Manual, a vast proportion of chronic pain in the body is not due to problems with damaged nerves, disrupted bursae, and degenerative joints, but dysfunction in the soft tissue, especially skeletal muscles.

The cause of lower back pain can be broken down into five primary problems which interconnect with one another. The following breakdown is adapted from the St. John Neuromuscular Therapy training, a method of postural analysis and clinical massage therapy focused on musculoskeletal alignment and treating compensatory muscular patterns.

Five Primary Problems

1) Ischemia (pronounced: Iz skeem ee ah)

The first cause of lower back pain is ischemia. "Ischemia" means lack of blood. Without adequate blood to provide nutrients and oxygen, soft tissues such as muscles, tendons, ligaments, and fascia build up lactic and other toxins and become painful. Ischemia occurs when muscles are chronically contracted over a period of time. The most prevalent cause of lower back pain, by far, is muscular strain and spasm due to ischemia.<

2) Trigger Points

The second cause of lower back pain is trigger points. A trigger point is an area of the soft tissue which, after chronic contraction and reduced blood flow, becomes an area of high neurological activity. For example, fibers in an ischemic muscle (a muscle with low blood) can become an active trigger point in response to biochemical changes in the tissue. Active trigger points cause referred sensation to other parts of the body. That sensation can be pain, tingling, numbness, thermal sensations (hot or cold), weakness, a general achy quality, or the feeling that "it just doesn't feel right." For example, you might have a trigger point in a muscle of your lower back which refers sensation down into your buttocks, or even down the leg. This is NOT same thing as the referred pain caused by nerve compression and nerve entrapment which will be covered next.

3) Nerve Compression and Nerve Entrapment

The third cause of lower back pain is nerve compression and entrapment. Nerve compression is the pressure put on a nerve by a bone or an intervertebral disc. Nerve compression occurs when the spine becomes misaligned for some reason (faulty movement patterns, injury, chronic muscular tightness) and one of the discs between the vertebrae get squeezed on one side so that it bulges out the other side. If the bulging puts pressure on a spinal nerve, then you've got pain! Nerve entrapment is when a nerve is caught or pinched by the soft tissues. For example, the sciatic nerve (the largest nerve in the body) runs down through the buttocks and can become entrapped by the piriformis muscle when that muscle is very tight. This can result in pain down the back of the leg.

4) Structural Imbalance, aka Postural Distortion

The fourth cause of lower back pain is structural imbalance or postural imbalance. In a sense, this issue is the most significant of all. The reason for that lofty status is due to the fact that structural imbalance is often the root problem responsible for ischemia, trigger points, and nerve compression or entrapment.

If the body is distorted off its center line of gravity, compensating muscular patterns can result. To illustrate the point, put your elbow on the table in front of you with your forearm pointed straight up to the ceiling. Now imagine you've got a bowling ball resting in your palm. If your forearm is completely straight up and down, the weight of the bowling ball will be supported by the bones of your forearm. Theoretically, you could hold that bowling ball there indefinitely.

But if you shifted off that center line, even a tiny bit, then the muscles of your arm would have to engage in order to hold up the bowling ball. Even the strongest human in the world wouldn't be able to hold that ball there for long. This is precisely what can happen with your body. If your alignment is off such that your head is not centered over your shoulders over your hips over you feet, then the core muscles of your body must perpetually engage in order to hold your body up!

5) Dysfunctional Biomechanics

The fifth cause of lower back pain is dysfunctional biomechanics. This is often a secondary result of structural imbalance and is evidenced by faulty movement patterns. For example, if you've got nagging lower back pain you might hold your body in a restricted way, walk differently, or reach for things with limited range of movement. It's logical to do that, and not recommended to fight against your body's self-imposed limitations. It's trying to protect you from pain. Until the structural imbalance is addressed, and the pain is relieved, there's wisdom in those limits. However, repetitive movements can become patterned into your nervous system such that, even after structural and muscular problems have been eliminated, you still move in a limited, protective way. This can revive structural and muscular imbalances. That's why even a minimum regime of daily stretches can be vital to full recovery.

If you suffer from severe back pain and fear that surgery may be necessary, or if surgery has been recommended and you question the wisdom of it, you may want to try some non-surgical physical treatments first.

Unless your back pain is due to an infection, malformation of the back, or tumor, some type of physical treatment can probably help it. Let's look at a few of the more popular and effective types of treatment.

Chiropractic Therapy

Chiropractic treatment has been shown to be most effective when applied within 2 months of the onset of back pain. Chiropractors realign the spine, increase the range of motion in back muscles, increase the flexibility of spinal soft tissue, break down scar tissue, and reduce pressure from constricted and misaligned spinal joints, all of which help to relieve pain. Usually treatment takes around 15 minutes 3 times a week at first. Over a few weeks sessions decrease until you are on a maintenance program of once a month or even "come come only if it hurts."

Acupuncture

Studies by the National Institutes of Health show that acupuncture is very effective in treating back pain. According to the theory of acupuncture, energy (known as chi) flows through the body along pathways called meridians. If the flow of chi is interrupted, pain or illness can result.

An acupuncturist uses very thin needles inserted into the skin along the meridians to correct the flow of chi. You may be surprised to learn that acupuncture is rarely described as painful. In fact, many people find it relaxing and even fall asleep during treatment.

Physical Therapy

A good physical therapist will combine passive and active treatments, since exercise is essential to the long term imporvement in back pain.

Active therapy involves the patient's participation. The therapist will determine which exercises are best for a particular condition, and supervise you in those exercises to ensure that you are doing them correctly. They will include:

* stretching

* strength building exercises

* aerobic exercise.

Passive therapy is done on you, usually while you are relaxing, and includes:

* heat or cold therapy

* electrical stimulation

* ultrasound

* massage

* iontophoresis (inserting a drug through intact skin using an electric current).

Other Alternatives to Surgery

In addition to these 3 modalities, many other non-surgical treatments exist for back pain, among them massage, and the use of herbs and natural supplements.