You Are Not Alone: The Back Pain Epidemic
If you suffer from back pain, you are not alone. The widespread failure by doctors to recognize muscles as the primary source of back pain is helping to fuel an epidemic. Back pain is now the most common disability in the United States. Every year twelve million Americans make new-patient visits to physicians for back pain and a reported one hundred million visits to chiropractors. At the current rate, eight out of ten Americans will experience back pain sometime during their lives.
In addition to the human suffering, medical costs are soaring. The cost of back pain, together with related neck pain, came to $86 billion in 2005, the most recent year for which figures were available. That was an increase of $34 billion from 1997. More amazingly, 25 percent of patients reported being significantly impaired, compared with 20 percent eight years earlier. Spending on back pain now equals the amount spent on cancer and is largely the result of failed surgeries, various nerve block procedures, and the cost of pain medications. We are spending more and getting worse results.
Back pain is not only a challenge to civilians, it is one of the major reasons for loss of combat personnel in the army. Disease and nonbattle injuries have always caused more casualties than battle-related injuries. Currently, low back pain is the most common disabling complaint among soldiers in combat, and it is more likely to result in a soldier never returning to active duty than any other diagnosis, except psychiatric. Recent studies have shown that of soldiers disabled by back pain, only 2 percent returned to duty with their unit.
Why have you and millions like you been caught in this epidemic? The reasons are both obvious and subtle. The luxuries of modern society, not only in the United States but also in all advanced countries, just about guarantee that you will suffer back pain because you are (1) under-exercised and (2) subjected to stress.
Muscles are strong and limber only when exercised properly. Lack of exercise makes them weak, short, and stiff, all of which help cause back pain, neck pain, and other muscle pain. The fact that 63 percent of Americans are over-weight is one indication that the majority of the population does not exercise sufficiently. Another is the multitude of labor-saving devices and conveniences that reduce our physical activity – cars, snowblowers, lawn tractors, vacuum cleaners, dishwashers, to name a few – not to mention computers and television, which seduce us into activity.
About 30 percent of the population participates in exercise of some kind: tennis, swimming, jogging, lifting weights, and so on. This reduces the risk of developing back pain but is not guarantee against it. After all, professional athletes, from tennis stars to major league baseball players, are often afflicted with back pain. In their case, lack of exercise is not the issue, but rather improper stretching or insufficient warm-ups and cooldowns, in addition to injuries.
Compounding the problem is stress, which occurs in two forms: external and internal. External stress can come from frustration you may feel sitting in a traffic jam or being subjected to an automated telephone menu. It may be brought on by irritating noises – a neighbor’s loud music, jackhammers tearing up the street – or perhaps by your anger at rude service in the supermarket. Internal stress comes largely from anxiety. Ordinary worries about any number of concerns in daily life – jobs, rent, mortgage payments, grades, health, sex – can bring it on
In 1915, Dr. Walter B. Cannon of Harvard Medical School, who made up significant contributions to medicine, was the first to use the engineering term “stress” in an emotional context. He found that when an animal is threatened or irritated, it releases the hormone adrenaline (also known as epinephrine) into the bloodstream, causing a rise in respiration, heart rate, blood pressure, and blood sugar, and increases muscle tension. The animal then fights or flees, discharging the energy that came from its preparation to ward off the threat. When the challenge is over, its body returns to normal.
Although we humans are animals, we do not respond the way that other animals do. Society demands that we bear with our external and internal stress. We don’t have the opportunity to fight or take flight to relieve our tension. As the stress builds day after day, it increases the tension on our already under-exercised, weak, short, stiff muscles. I will talk more about stress and its effect on pain in Chapter 7.
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