Aching Back!

Anatomy of the Spine ®
Exams and Treatments ®
Prevention and Protection ®
Additional Resources ®
According to recent research from the National Institutes of Health, nearly 40 million workers in the U.S. suffer from chronic low back pain. Organizations such as the Cleveland Clinic report that 80% of adults will have a bout of back pain at some point in their lives. In 2015, back pain accounted for almost 264 million lost work days, according to the United States Bone and Joint Initiative. Is it any wonder that back pain is one of most often cited health issues and one of the most searched-for health conditions on the internet?
In our new Back Pain Toolkit we will explore what causes back pain and how to fix it. Let’s start with the hows and whys of back pain and function.
The Back Pain Toolkit • ©2021 Ebix. All rights reserved.
A Word About Back Pain
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Almost everyone has back pain at some time in their life. Often, the exact cause of the pain is unknown.
A single event may not have caused your pain. You may have been doing many activities, such as lifting the wrong way, for a long time. Then suddenly, one simple movement, such as reaching for something or bending from your waist, leads to pain.
Many people with chronic back pain have arthritis. Or they may have extra wear and tear of the spine, which may be due to:
• Heavy use from work or sports.
• Injuries or fractures. • Surgery.
You may have had a herniated disk, where part of the spinal disk pushes onto nearby nerves. Normally, the disks provide space and cushion in your spine. If these disks dry out and become thinner and more brittle, you can lose movement in the spine over time.
If the spaces between the spinal nerves and spinal cord become narrowed, this can lead to spinal stenosis. These problems are called degenerative joint or spine disease.
Other possible causes of chronic low back pain include:
• Curvature of the spine, such as scoliosis or kyphosis. • Medical problems, such as fibromyalgia or rheumatoid arthritis. • Piriformis syndrome, a pain disorder involving a muscle in the buttocks called the
piriformis muscle.
A Word About Back Pain Back Pain, explained.
Follow this checklist for safe lifting.
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other condition.”
— Centers for Disease Control and Prevention, National Center for Injury Prevention and Control
Back Pain, continued Back Pain, explained.
You are at greater risk for low back pain if you:
• Are older than age 30.
• Are overweight or obese.
• Feel stressed or depressed.
• Have a job that includes heavy lifting, bending and twisting or involves whole body vibration, such as truck driving or using a sandblaster.
• Smoke. If you smoke, quit. Smokers are twice as likely to have back pain as nonsmokers. Smoking reduces the amount of oxygen-rich blood available for maintaining spinal health.
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Some good news: You can relieve the vast majority of back pain issues with exercises and actions that you control as opposed to circumstances beyond your control. Many of the most common back issues have their root in our choices, such as not following proper lifting techniques, having poor posture or not building a strong supportive core through regular exercises. This toolkit gives you the necessary information to take control of your back health.
Note: The content for this toolkit is interactive. As you read through the sections, you will see highlighted links: to additional information and resources. You can click on the vocabulary highlighted in green for more information on those particular topics as well. We recognize that not everyone may have the same level of interest in each topic. Our goal is to provide basic information on each page plus links to additional resources.
The spine is complex. Pain may result from damage or injury to any of its various bones, nerves, muscles, ligaments and other structures.
Vertebrae The spine is a column of small bones, or vertebrae, that support the upper body. The column has three sections:
The cervical (C) vertebrae are the seven spinal bones that support the neck. The thoracic (T) vertebrae are the 12 spinal bones that connect to the rib cage. The lumbar (L) vertebrae are the five lower bones of the spinal column. A lot of the body’s weight and stress falls on the lumbar vertebrae.
Skeletal Spine Below the lumbar region is the sacrum, a shield-shaped bony structure formed by fusion of five sacral (S) vertebrae. The sacrum connects with the pelvis at the sacroiliac joints. At the end of the sacrum are three to four tiny, partially fused coccygeal vertebrae known as the coccyx, or tailbone.
The Disks Vertebrae in the spinal column are separated by small cushions of cartilage known as intervertebral disks. The disks rely on nearby blood vessels to keep them nourished.
Each disk is 80% water and contains two structures:
1. Nucleus pulposus — a central jelly-like substance inside each disk.
2. Annulus — a tough, fibrous ring that surrounds the nucleus pulposus.
Anatomy of the Spine The structure and function of the back.
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“Take care of your body.
It’s the only place you have to live.”
— Jim Rohn
Anatomy, continued Structure and function.
Processes Each vertebra in the spine has a number of bony projections called processes. The spinous and transverse processes attach to the muscles in the back and act like little levers, allowing the spine to twist or bend. The processes form the joints between the vertebrae, meeting together and interlocking at the zygapophysial joints (more commonly known as facet joints or z-joints).
Spinal Cord The spinal cord is the central trunk of nerves that connect the brain with the rest of the body. Each nerve root passes from the spinal column to other parts of the body through small openings, bound on one side by the disk and on the other by the facets. When the spinal cord reaches the lumbar region, it splits into multiple bundled strands of nerve roots called the cauda equina (meaning horsetail in Latin).
Back Muscles Our back muscles work together to support the trunk and hold the body upright. They allow the trunk to move, twist and bend in multiple directions. We use them all the time, not only to lift objects but also to lift ourselves.
The muscles of the back are categorized into three groups:
1. Intrinsic or deep muscles that fuse with the vertebral column.
2. Superficial muscles which help with shoulder and neck movements.
3. Intermediate muscles which help with the movement of the thoracic cage.
Only the intrinsic muscles are considered true back muscles.
Function of the Back These muscles work together to support our upper body and provide for strength and movement. A healthy pain-free back is central to good physical functioning. Without a healthy back we can’t easily move, lift, stretch, push, pull or even sit without pain.
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your backache.
As we mentioned in the beginning, just about everyone will have a bout of back pain at some point in their lives. Most of the time it is acute pain which means it comes on suddenly and lasts only a short while. Unfortunately for some, back pain can be chronic which means it is reoccurring. Below is a closer look at the symptoms and common causes of each.
Low back pain — acute You may feel pain, experience back stiffness and decreased movement of the lower back, as well as difficulty standing straight.
Acute back pain can last for a few days or a few weeks.
Symptoms You may have a tingling or burning sensation, a dull achy feeling or sharp pain if you hurt your back. The pain may be mild or so severe that you are unable to move.
Depending on the cause of your back pain, you may also have pain in your leg, hip or the bottom of your foot. You may also have weakness in your legs and feet.
Causes Most people experience at least one backache. Although this pain or discomfort can happen anywhere in your back, the most common area is your lower back because it supports most of your body’s weight.
Low back pain is the No. 2 reason why Americans see their health care provider. It is second only to colds and flu.
First you will usually feel back pain just after you lift a heavy object, move suddenly, sit in one position for a long time, or have an injury or accident.
Acute low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. The pain may result from muscle spasms or a strain or tear in the muscles and ligaments.
Symptoms and Causes of Back Pain Types of back pain and what causes it.
Read more about stress and back pain.
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Symptoms and Causes, continued Symptoms and causes.
Causes of sudden low back pain include:
• Compression fractures to the spine from osteoporosis.
• Cancer involving the spine. • Fracture of the spinal cord. • Muscle spasm (very tense
muscles). • Ruptured or herniated disk. • Sciatica. • Spinal stenosis (narrowing of the spinal canal). • Spine curvatures (scoliosis or kyphosis), which may be
inherited and seen in children or teens. • Strain or tears to the muscles or ligaments supporting
the back.
Low back pain may also be due to:
• Kidney infection or kidney stones. • An abdominal aortic aneurysm that is leaking. • Arthritis conditions, such as osteoarthritis,
psoriatic arthritis and rheumatoid arthritis. • Infection of the spine (osteomyelitis,
diskitis, abscess). • Problems related to pregnancy. • Medical conditions that affect the
female reproductive organs, including endometriosis, ovarian cysts, ovarian cancer or uterine fibroids.
• Pain around the back of your pelvis or sacroiliac (SI) joint.
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QuikRisk™ Assessment:
Back Pain — Are You at Risk? Several factors can trigger back pain, including habits, lifestyle and health conditions. Assess your risk:
1. Are you overweight or obese? YES (10) | NO (0)
2. For women: Are you pregnant? YES (10) | NO (0)
3. Do you smoke? YES (10) | NO (0)
4. Do you have poor posture? YES (10) | NO (0)
5. Have you had back injuries or back surgery? OFTEN (10) | SOMETIMES (5) | RARELY (0)
6. Are you generally sedentary (little or no regular exercise)? YES (10) | NO (0)
7. Do you often need to lift heavy objects? OFTEN (10) | SOMETIMES (5) | RARELY (0)
8. Do you feel depressed? OFTEN (10) | SOMETIMES (5) | RARELY (0)
9. Do you sit for long periods of time? OFTEN (10) | SOMETIMES (5) | RARELY (0)
10. How often do you feel stressed? OFTEN (10) | SOMETIMES (5) | RARELY (0)
Add up your total here: How did you do? 100-60 high risk | 55-25 medium risk | 20 low risk
Exams and Tests You health care provider will ask about your back pain, including how often it happens and how severe it is.
Your provider will try to determine the cause of your back pain and whether it is likely to quickly improve with simple measures, such as ice, mild painkillers, physical therapy and proper exercises. Most of the time, back pain will lessen using these methods.
During the physical exam, your provider will try to locate the pain and figure out how it affects your movement.
Most people with back pain improve or recover within four to six weeks. Your provider may not order any tests during the first visit unless you have certain symptoms.
Tests that might be ordered include:
• X-ray. • CT scan of the lower spine. • MRI of the lower spine.
Treatment To get better quickly, take these measures when you first feel pain:
Ask your provider about how active you should be the first couple of days you have pain. This will help relieve your symptoms and reduce any swelling in the area of the pain.
Apply heat or ice to the painful area. One good method is to use ice for the first 48 to 72 hours, and then use heat.
Take over-the-counter (OTC) pain relievers, such as ibuprofen or acetaminophen. Follow package instructions on how much to take. Do not take more than the recommended amount. Always consult your provider before taking any OTC medications.
Exams and Treatments Methods to alleviate existing back pain.
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Exams and Treatment, continued Alleviating back pain.
While sleeping, try lying in a fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.
A common misbelief about back pain is that you need to rest and avoid activity for a long time. In fact, bed rest is not recommended. If you have no sign of a serious cause for your back pain (e.g., loss of bowel or bladder control, weakness, weight loss, or fever), then you should stay as active as possible. Get your provider’s okay first.
You may want to reduce your activity only for the first couple of days. Then, slowly start your usual activities after that. Do not perform activities that involve heavy lifting or twisting of your back for the first six weeks after the pain begins. After two to three weeks, you should gradually start exercising again.
Begin with light aerobic activity, such as walking, riding a stationary bicycle, and swimming. These activities can improve blood flow to your back and promote healing. They also strengthen muscles in your stomach and back.
You may benefit from physical therapy. Your health care provider will determine whether you need to see a physical therapist and can refer you to one. The physical therapist will first target reducing your pain, and then the therapist will teach you ways to prevent getting back pain again.
Stretching and strengthening exercises are important, but starting these exercises too soon after an injury can make your pain worse. A physical therapist can tell you when to begin stretching and strengthening exercises and how to do them.
If your pain lasts longer than one month, your primary provider may send you to see either an orthopedist (bone specialist) or a neurologist (nerve specialist).
If your pain has not improved after use of medicines, physical therapy and other treatments, your health care provider may recommend an epidural injection.
You may also see:
• A massage therapist. • An acupuncturist.
Sometimes, a few visits to these specialists will help back pain.
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Watch this video on how to brace your abdominals.
Now that we have laid the foundation on how the back works, causes of back pain and some common treatments for when back pain arises, let’s focus on what we can do to prevent back problems. In this section we will share some of the most studied and proven exercises for preventing back pain and strengthening the back.
Exercise Activities, such as stretching, strengthening and walking are critical for a healthy back.
Professor Stuart McGill, Ph.D., one of the most influential researchers on the fundamentals of back health, has studied the causes and treatment of back pain for more than 30 years.
McGill designed a treatment intervention known as the Big Three — the McGill curl-up, the side bridge and the bird dog — to build endurance in the muscles of the core and low back that help stabilize the spine.
But First, the Brace* Before you attempt McGill’s Big Three exercises, you must learn how to properly engage the targeted muscles: your abdominal obliques. McGill refers to this as abdominal bracing or stiffening the core to stabilize the spine. [WATCH VIDEO. ]
1. Lie on your back on a firm surface. 2. Bend your knees and place your feet on the floor. 3. Place your hands on your hips, with your fingertips in front of your front hip bones. 4. Gently press into both sides of your abdomen with your fingertips. 5. Tighten your abs as if you are pulling your belly button toward your spine. You
should feel the muscles under your fingertips tighten.
Once you have mastered the abdominal brace, incorporate it into daily activities — particularly when lifting — to help protect your back.
How to Do Them To improve the effectiveness of the Big Three exercises and reduce the risk of injury, proper form is crucial. These core stabilization exercises are performed with the low back in a neutral, slightly arched, position to preserve the natural lordosis curve of the lumbar spine. Even the crunch, which in theory would involve some spinal flexion, is performed with the arch of the low back supported.
Prevention and Protection Protect back wellness.
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*Low Back Exercises: Stuart McGill’s Big Three. Lorne Oplerby, The American Council on Exercise. Accessed August 23, 2018.
Read more about proper lifting.
Prevention and Protection, continued Exercises to strengthen the back.
MOVE 1: McGill Curl-Up At first glance, the McGill curl-up might appear similar to an abdominal crunch. However, lordosis of the lumbar spine is maintained with McGill’s exercise. [WATCH VIDEO. ]
1. Lie on your back on a firm surface. 2. Bend one knee and place your foot on the ground. Keep the opposite leg straight. 3. Reach your arms behind you and position your hands underneath your low back.
This will help preserve your arch during this exercise. 4. Lift your head, shoulder and upper back off the floor, as a unit. Try not to move each
area individually. 5. Hold this position for 10 seconds, then slowly lower back down.
Aim for 10 repetitions of this exercise, performing five with one knee bent, then the rest with the other knee bent.
MOVE 2: Side Bridge The side bridge works the erector spinae, latissimus dorsi and multifidus muscles in your back; external and internal obliques in your abdomen; and your glutes, as well as, your deltoid and pectoralis major muscles in your chest and shoulders. [WATCH VIDEO. ]
1. Lie on your side on a firm surface. Place your forearm on the ground, under your shoulder.
2. Reach across your chest with the other hand and place it on the opposite shoulder. This will help stabilize your trunk.
3. With your legs stacked on top of each other, bend your knees to 90 degrees. 4. Push down through your forearm and bottom knee to raise your body off the
ground. You should be in a straight line from your head to your knees. 5. Work up to holding this position for 10 seconds on each side.
When this exercise is no longer challenging, stagger your legs slightly and straighten your knees. Press down through your forearm and feet to lift up into the side bridge.
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MOVE 3: Bird Dog The bird dog exercise is performed in a quadraped position, on your hands and knees. Keep your abs tight throughout this exercise; do not allow your belly to drop toward the ground. [WATCH VIDEO. ]
During this exercise, the core muscles are engaged isometrically, meaning they don’t actually move. They stabilize your midsection while you move your arms and legs.
1. In the quadruped, keep your neck straight by looking at the ground between your hands.
2. Lift your right arm straight out in front of you until it is parallel to the floor. 3. At the same time, squeeze your glutes and lift your left leg straight out behind you
until it is parallel to the floor. 4. Keeping your right arm, torso and left leg in a straight line, hold this position for
10 seconds. Do not allow your hips to rotate; your pelvis should remain parallel to the ground throughout this exercise.
5. Slowly lower back down and repeat on the opposite arm and leg.
If this exercise seems too difficult, or you can’t keep your back straight, begin by lifting just your arm, then just your leg, until you are strong enough to move them simultaneously.
Lift Smart Think before you lift. Never lift anything heavier than you can manage alone. Ask for help if the load is too heavy.
Bend at your knees, not your waist. Go down as low as you can by bending at your knees while keeping your back straight.
Face the object you are about to lift. Hold the load as close to your body as you can.
Lift with your legs, core (abdomen) and shoulders. Straighten up slowly using the strong muscles of your hips and legs. Balance the weight.
Move carefully. Keep your back straight, and don’t turn it sideways while carrying. Lift and unload slowly.
Use tools and lifting machines whenever possible.
Prevention and Protection Protect back wellness, continued.
Watch this video on how to do the bird dog.
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Prevention and Protection, continued Home ergonomics.
Home Office Ergonomics for First-Timers You’re now working from home, and chances are, if you don’t have a dedicated home office, you’re set up at the dining table or sitting on the sofa with a laptop. And, as you may be discovering, these makeshift offices are not the best for your body — maybe you have a twinge in your neck, lower back pain or even sore wrists. Proper office ergonomics can help alleviate this discomfort and keep you productive.
Here is a short guide:
Choose a chair that supports your spine and adjust the height so that your feet rest flat on the floor. If you don’t have an adjustable office chair, use a footrest (a stack of books will do) so that your thighs are parallel to the floor. Use a lumbar or back pillow to support your spine and relieve pressure.
Place your monitor directly in front of you at eye level (consider investing in a separate computer monitor to help alleviate neck strain if you use a laptop full time). Adjust placement if you wear prescription eyeglasses
Place your keyboard or laptop within easy reach, keeping your wrists straight, upper arms close to your body and forearms parallel to the floor. Tip: If you plan to use a tablet or laptop for longer durations, use a tablet stand or laptop riser to avoid neck strain, and use a separate keyboard and mouse to keep wrists straight.
Employ other tools to help you stay comfortable such as an ergonomic mouse and hands-free headphones if you’re on the phone a lot.
Consider using a voice-to-text app or dictation software if your job requires constant typing.
Adjust the display brightness properly so you aren’t straining to see your screen. Consider using 20/20/20: Every 20 minutes look at something 20 feet away for 20 seconds while flexing your hands.
Use brighter task lighting for paperwork and lower lighting for computer work.
Take microbreaks for at least one to two minutes every half hour to walk or stretch. Tip: Set a timer to remind yourself.
Learn more at OSHA.gov.
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Standing Desks: Are They for You? A few years ago, the benefits of using a standing desk got a lot of attention. While these desks may work for some, ergonomic experts say that it’s all about using them correctly. Sure, sitting all day can cause stiffness, muscle pain and weakness, but so can standing all day — just in different areas. Your best bet, whether you sit or stand at a desk, is to change positions often (sit, stand or walk) and take frequent breaks to keep muscles strong and limber.
Let’s take a quick look back (excuse the pun). If you have or have had back pain you are not alone. Most of us will have at least a short bout of back pain at some point. While there are many
potential causes and treatments for back pain, many of the most common are within your control. How we choose to exercise, stretch or maintain a good body weight all contribute to a healthy back.
Below is a short summary checklist for keeping a healthy back:
3 Know your risk factors. Identify what puts your back at risk and work to minimize those risks.
3 Practice prevention. Preventive self-care includes doing exercises such as the Big Three and using proper lifting techniques.
3 Learn effective treatments for self-care. There is a lot you can do to manage back pain if it occurs. The right amount of rest followed by the right exercise is a good place to start.
3 Don’t take your back for granted. Make all the above recommendations a regular part of your self-care.
In Conclusion Resources and additional solutions.
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Resources At a Glance Below is a list of additional resources for your healthy back program:
What’s Causing Your Backache? 3 Things Your Back Loves Is Stress Behind Your Backache? Back Care at Work Lifting DOs and DON’Ts Checklist for Safe Lifting QuikChecklist™: Are You Protecting Your Back?
Lifting Lessons 4 Tips for a Healthy Back
QuikRisk™ Assessment: Back Pain — Are You at Risk?
Home Office Ergonomics for First-Timers Lift Smart
EXERCISE VIDEOS:
Abdominal Bracing McGill Move 1: McGill Curl-Up McGill Move 2: Side Bridge McGill Move 3: Bird Dog

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Aching Back!