Your Complete Guide to a Healthy Back

Back issues are easier to resolve than you may think

Hallie Levine Sklar

The back is literally your body’s support system, made up of more than 30 bones and hundreds of nerves, muscles, ligaments, and tendons. But all those moving parts mean it’s vulnerable to problems, too.

“Women are particularly susceptible to pain because they lug around extra weight every day, from purses and grocery bags to a kid on their hip,” says Heidi Prather, D.O., chief of physical medicine and rehabilitation at Washington University School of Medicine in St. Louis.

Plus, many of us have gained weight and lost the time to exercise over the years, weakening our back muscles. Is it any wonder that almost five million women each year see doctors due to low back pain?

Luckily, back issues are easier to resolve than you may think. Use this guide to pinpoint what’s causing yours, so you get the right treatment, fast—and prevent future flare-ups.

Culprit #1:  Muscle strains

The lowdown.  Muscle strains are actually small tears in, or the stretching out of, muscle fibers. They’re also the top reason for back pain.

What it feels like.  A stiffness or soreness that worsens with activity (including small movements, like bending over to pick something up).

The cause.  Any repetitive or jolting movement — —or even just sitting. “Women who sit at work hunched over for hours put stress on their backs,” says Jeffrey Goldstein, M.D., director of the spine service at the New York University Langone Medical Center. “If they also don’t exercise regularly, they lose strength in their back and their core—the muscles which help support their spine. So when they do ramp up their activity, they may pull one or several back muscles.”

Another surprising trigger: “Tight hamstrings can exacerbate a strain by putting stress on the low back,” explains Renée Garrison, a physical therapist at the Medical University of South Carolina.

The Rx.  Every waking hour for the first 24 hours, then every few hours for the next 24: Ice the strain for 15 minutes to reduce swelling. (Heat will only increase inflammation.)

Every two hours (at least): “Stretch and move gently,” says Jennifer Solomon, M.D., a physiatrist at the Hospital for Special Surgery in New York City. “Lying down may cause the muscles to tighten up even more,” i.e., go into a spasm.

Every four to six hours: Try an over-the-counter anti-inflammatory like ibuprofen—take according to package directions.

After 48 hours: If pain doesn’t improve, call your primary care physician to rule out a more serious condition.

Culprit #2:  Bulging or herniated disks

The lowdown.  When the disks in your spine start to degenerate over time, as they are wont to do, they can bulge out or herniate (meaning they’re ruptured), sometimes compressing the nerves around them.

What it feels like.  You may not feel them at all. “Not all herniated disks cause symptoms,” explains Prather. But if part of the disk protrudes out into the spinal canal, near or touching a nerve, that can bring on back pain that may also radiate down your leg.

The cause.  Your body’s normal wear and tear. “Women may report mild back pain in their 20s and 30s, but as they get older and the disks dry out and degenerate further, they can experience more persistent discomfort,” says Jessica Shellock, M.D., an orthopedic spine surgeon at the Texas Back Institute.

The Rx.  In most cases, pain resolves after 8 to 12 weeks following treatment with OTC or prescription anti-inflammatories and physical therapy. If pain is severe, a cortisone injection, which reduces swelling around the nerve, may help.

Beware a doctor who tells you the first and only solution is to go under the knife: “Less than 10 percent of my patients require surgery,” says Raj Rao, M.D., vice chairman of the department of orthopedic surgery at the Medical College of Wisconsin.

Culprit #3:  Normal aging

The lowdown.  You already know that your disks may dry out and you’re more vulnerable to muscle strains as you age. In addition, Rao says, over time you may begin to notice early signs of spinal osteoarthritis. That’s when the protective cartilage and joints in your spinal column start to wear down with age, causing bone to grind against bone. (Often affected are the facet joints— those hook-shaped structures that run up and down the back of the spine.) This may lead to the bone bulging out and putting pressure on surrounding nerves.

What it feels like.  Spinal osteoarthritis causes serious stiffness accompanied by pain in your lower back that may go down into your butt and upper thighs, as well as up into your shoulders and neck, especially in the early morning after waking up, or when you’re bending backwards.

The Rx. It’s absolutely crucial to do exercises that will strengthen your back muscles and core now, and to stay active and flexible overall, to give your spine as much support as possible.

If you’ve got even 10 pounds to lose, try to take it off now: “Any extra weight will just put additional strain on worn-out disks and joints,” says Shellock.

You may also require physical therapy, medications, and, in very rare cases, surgery to address problematic disks. If you have pain related to osteoarthritis, injections of both anesthetics and a steroid anti-inflammatory right into the joint can help ease it.

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