What you need to know to eliminate, reduce and prevent back pain.

Most of us will experience serious back pain at some point in our lives. The New England Journal of Medicine puts the numbers at eight out of ten Americans, with 31 million people in pain at any given time. The good news is that most people recover from serious back pain -- studies say 90 percent will get better, most within seven weeks. But what can we do to reduce, eliminate, or prevent back pain? Below are five secrets to help you get or remain pain free.

Trace the pain to its source.
That tight, throbbing knot in your upper back? It might not have anything to do with lifting a heavy box or playing too much golf. The source of the pain might be somewhere else entirely. Like your feet.
"It's just like the foundation of the home -- if the foundation is bad, the roof will cave in," says Leslie Giese, president of the Oregon chapter of the American Massage Therapy Association.
High heels, shoes without enough arch support, or physical problems like flat feet or high arches all can contribute to back pain. For example, patients with exaggerated arches often experience pain throughout the body, including the back, because their feet don't absorb shock well, says Mark Wolpa, a podiatrist in Berkeley, California.

Also, a surprising number of people have legs of slightly different lengths. Wolpa says about 80 percent of his patients show signs of "limb length discrepancy," some caused by uneven bone length and others due to long-term positioning problems, where muscles have developed unevenly, shortening one side of the body. This uneven stance throws the whole body off balance, causing one part to compensate for another, often resulting in pain.

Another possible source of back pain is nerve damage. Ask your doctor for a special kind of test called an EMG before discussing something as serious as back surgery. But if a doctor rules out specific disc, nerve, or malformation issues, it might be time to visit an alternative medical practitioner.

Massage therapists, chiropractors, and acupuncturists are known to take a more holistic approach to treating pain, which can involve asking questions about multiple aspects of your life, from nutrition to emotions. Check your health insurance plan to see if these treatments are covered, even partially. Giese says massage therapists take the time to trace the pain to its source, something she says traditional doctors don't always do. "Sometimes with allopathic medicine, they go straight to the symptom," Giese says. At the very least, alternative practitioners can give you ideas to discuss with your doctor, allowing you to make the most of those precious minutes on the exam table.

What you can do:

• Experiment with acupuncture or chiropractic care. If your first experience isn't positive, try a different practitioner with another focus. Some chiropractors use gentle techniques; others perform spinal adjustments forcefully -- you'll need to figure out which works best for you. Same with acupuncture -- some practitioners supplement treatment with herbs, while others focus on certain specialties, such as women's health. Ask for recommendations from your primary care doctor as well as friends and others. If the same name keeps popping up, it's more likely you'll have a positive experience with that practitioner.
• Find a massage therapist skilled in therapeutic body work. Personal recommendations are always best, so ask friends or coworkers for names. Neighborhood or regional e-mail groups or websites such as Yelp.com can help narrow down choices. When calling around or using a search engine, look for massage therapists with experience in therapeutic or medical massage. Avoid most spas, where practitioners tend to focus on a soothing experience rather than on relieving a specific ailment.

Listen to your emotions.
Emotions can be key players in the pain game. Joe Smith, a certified athletic trainer who works alongside physicians in an orthopedic clinic at the University of California, San Francisco, says he encourages clients with severe pain to name the place in their body where they hold their stress. Then he asks them to talk about what's bothering them emotionally.

This technique came in handy recently when a friend called him up with sharp pains in his neck. After a short conversation, Smith learned that his friend had an important professional event coming up that was causing him serious anxiety. "Labeling emotional or psychological difficulties and putting a physical form to them can be helpful to patients," he says. "Sometimes that's enough for people to identify why they're having this pain." For Smith's friend, this process of naming turned out to relieve some of his pain.

Numerous medical studies document the close ties between chronic pain, especially back pain, and a sufferer's psychological state. In 2007 the journal Health Psychology published an analysis of 22 medical studies of back pain and found that using psychological interventions, such as biofeedback and cognitive behavioral therapies, to treat chronic back pain was wildly successful -- much more so than traditional medical approaches. This study backs up what many health practitioners witness daily.

Renee Bonjolo, a licensed massage therapist and owner of Body Central in Rhinebeck, New York, sees a clear link between what people are going through psychologically and how their bodies feel. "It comes down to deep emotional issues," she says. Often these emotions involve guilt and anxiety, especially with clients who are juggling work while caring for a parent, spouse, or child. Just acknowledging what they do on a daily basis can be enough to bring her clients to tears, she says, and she's noticed that the process of releasing tension and recognizing emotions relieves some of her clients' physical pain.

Attitude can also help, says podiatrist Wolpa. He's noticed patients who don't believe their pain will go away will often have difficulty completing treatment, creating a self-fulfilling prophesy. "Emotions have a lot to do with one's well-being," he says.
What you can do:

• UCSF athletic trainer Joe Smith says finding a few minutes in a busy day to relax and do some breathing exercises can reduce stress, which reduces pain.
• Say out loud the place where you are hurting, Smith recommends. Then name your reasons for stress. Do this alone or with a friend.
• Other experts recommend therapy, support groups, or a comforting health practitioner to visit regularly as ways to reduce stress and address underlying psychological issues that can contribute to or inhibit recovery from pain.

Strengthen key muscles.
We've all seen incredibly fit men and women in their 60s, 70s, and beyond striding through the mall or the park with the gait of someone half their age. Despite what you might think, they're not freaks of nature. They've made choices to keep their bodies moving, even as the birthdays add up. "People can live fairly pain free, outside of injury or disease, if they continue to move like they did when they were younger," says massage therapist Bonjolo. "Those aches and pains -- it's generally due to lack of exercise."

This lack of exercise and movement leads to decreased flexibility, which often leads right back to less movement, creating a vicious cycle. "In the end, pain is the ultimate motivator," says John McKenzie, a physical therapist with Heartland Rehabilitation Services in New Jersey. Back pain is second only to the cold or flu as the most common reason people seek a doctor's advice. And what advice do doctors hand out time and time again? Get more exercise. "People don't want to hear it," says Bonjolo. "But it's easier to exercise than it is to be in pain."

McKenzie says that by finding one or two simple exercises, sufferers can build up the core muscles their bodies need to support their daily movements and increase their flexibility. If pain is severe or the result of injury, it's important to consult a doctor who will likely recommend working with a physical or occupational therapist to develop an exercise plan. Those intent on preventing pain can follow a self-directed exercise course, though an initial consultation with an experienced athletic trainer or physical therapist can insure that you're doing the exercises properly.

McKenzie tells his patients, many of whom come to him with serious back injuries or chronic neck or back pain, "I want you to be healthy and move as a younger person would for many, many years to come."

What you can do:

• Certified personal trainer Scott Catanzaro, with Indiana University, recommends you write down one simple goal -- like taking a walk once a week -- and put the piece of paper in a visible place. "Writing it down for yourself makes you more accountable," he says.
• Tell someone about your exercise goals, however small, and encourage them to ask you about your progress regularly. Working with a physical or occupational therapist provides built-in support, but if you're exercising independently, a friend or family member can provide encouragement.

Vary your daily routine.
As soon as we sit down at our desks in kindergarten, we begin molding our bodies to curve forward. Many of us continue to sit at a desk for decades. We perform repetitive tasks and take too few breaks. All these factors lead to an epidemic of poor posture, says physical therapist McKenzie. "Many people are surprised at how far they are from what would be considered a normal posture," he says.

Healthy posture means a standing person's ear, shoulder, hip, and ankle all line up. Frequently a patient who comes to McKenzie with neck or back pain learns that his head juts too far forward. McKenzie works with clients to reduce the tightness in the chest muscles and strengthen the back muscles to help get the patient back in line. He asks clients to sit on an exercise ball during therapy sessions because he finds it helps folks acclimate to proper posture. Simply lying flat on the floor, facing upward, is a basic exercise in reversing the forward slump many of McKenzie's patients experience.

To prevent pain from becoming chronic, McKenzie recommends trying to vary your routine as much as possible: Get up every ten minutes, shake out the arms and legs, pull the shoulders back, and do a few simple stretches. We used to chop wood, climb hills, twist, and turn throughout our day, he points out. "We just don't do that any more."

What you can do:

• Set an egg timer or computer reminder for every 10 or 15 minutes. When the alarm goes off, stand up and stretch for one minute.
• Every morning, practice standing and sitting with good posture, aligning the ear, shoulder, hip, and ankle. Then revisit this stance throughout the day. Use sticky notes throughout your home or office to remind yourself.

Change everyday actions.
"As we age, there are a certain amount of degenerative changes," McKenzie says, using arthritis as one example. "But you can still have many issues going on and be able to control your pain and live a normal life." When we pay attention to the little things we do every day that put pressure on our bodies, we can take steps to correct bad habits.

During his 34 years of treating patients, McKenzie says he's noticed the everyday acts that he believes bring clients through his door stooping in pain. "If a woman comes in and puts her pocketbook on the floor, I'll say, 'Why don't you put it on a chair,' or 'Hey, we've got hooks over there, why don't you hang it up?'" A lifetime of bending over in awkward positions to lift a heavy bag can mean unnecessary back strain, he says.

The same goes for driving, sleeping, and simply picking something up. He recommends supporting the lower back with a rolled up towel or specially designed wedge while driving to avoid slumping over. Sleeping with a body pillow, where the knees straddle the pillow, helps keep the spine in a neutral position. And when picking something up off the floor, McKenzie advises holding on to a table to distribute some body weight onto the arm instead of only the legs and back. Making these small changes pays off in the end. "All that stuff really adds up," he says.

What you can do:

• Lighten your load. If you carry a purse or other bag every day, take out the nonessentials to reduce back strain.
• Focus on one daily activity at a time. Experts say breaking a habit can take three or four weeks of consistent focus. When emptying the dishwasher, for example, try different ways to move your body to minimize overextension or awkward positions. Then once this becomes a habit, apply those same strategies to doing the laundry or taking out the trash.

Article Resource: Care.com.
(Copyright © 2010 Caring.com. All rights reserved. This article is provided for informational purposes only and is not intended to be, or to serve as a substitute for, professional medical advice, examination, diagnosis or treatment. Caring.com does not provide medical advice; diagnosis or treatment; or legal, financial, or other professional services advice and disclaims any liability for the decisions you make based on this information. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.)