Why Does His Lower Back Hurt?

If you have back pain, chances are you may be leading a sedentary life, weigh more than you should, and have a stressful job. Research indicates that a history of smoking, hypertension, and coronary artery disease are all risk factors for atherosclerosis, or blocking of the arteries—a condition closely associated with the development of low back pain.

At some point, nearly everyone experiences back pain significant enough to interfere with work, recreation, and daily routine.

More than $50 billion is spent annually in this country due to low back pain, which is also a major cause of job-related disability and missed days of work.  For men, the problem is often occupationally related. Factory workers, furniture movers, and health care workers who lift people are especially affected. "But even a small amount of weight—if lifted improperly—can be damaging," explains K. Rao Poduri, MD. "The key to protecting your back is the knee. It's important to always remember to bend your knees while lifting."

You can see the difference for yourself by dropping a small object on the floor in front of you. "Bend at the waist to retrieve it keeping your legs straight; then repeat the movement with your knees bent. You will feel the difference," says the back specialist who notices back abuse at airports every time she travels. "Lifting, pulling, and pushing heavy suitcases can be very damaging to the back."

Carrying excessive weight around the waistline—think beer belly—is another factor. "Having a big belly puts a lot of stress on the discs in the back. If your abdominal muscles aren't strong, your back suffers," she adds. A poor mattress is most likely to blame for back soreness in the morning. "Sleeping on a mattress that is too soft causes the back to sag." Losing weight and switching to a firm mattress will bring immediate relief.

Becoming active is also essential for getting over back pain. Poduri says her patients received excellent results with physical therapy and she also recommends Tai Chi—an ancient form of gentle, physical exercise that incorporates rhythmic movement and breathing. Tai Chi is generally safe, requires no special equipment, and can be done in a group or alone in the privacy of your home. Another reason the specialist is a fan of Tai Chi: "Having experienced an episode of acute back pain predisposes the affected individual to a reported recurrence rate of 30 to 60 percent," Poduri explains. "Tai Chi has been shown to be effective in preventing a recurrence of low[er] back pain and is wonderful for improving back muscle strength. Yoga, too, can be beneficial but must be done with extreme care to avoid further injury."

If your job is sedentary, Poduri recommends getting up and walking and stretching at least once every two hours. "If you work across the hall from people, don't send them emails to communicate, get up, and walk to them," she says.  It's also vital that the workplaces provide ergonomically correct workspaces. "In truth, the height of the desk and position of the chair are different for each person. Ideally, each office area should be customized for the person using it."

Although there are several exercises that can be done to increase back flexibility and help stretch the spine, Poduri recommends one in particular:

  • Lie on your back with your knees bent and your feet flat on the floor.
  • Squeeze a pillow horizontally between your knees and rest your arms beside you (palms flat to the floor).
  • Continue squeezing the pillow as you lift your buttocks off the floor until your hips are in the neutral position.
  • Press into the floor with your arms if necessary. Weight should be primarily in feet and shoulders.
  • Hold for five seconds before returning to the starting position.
  • Repeat several times.

Poduri suggests having back pain evaluated by a physician before attempting a regular exercise regime, especially if you haven't been active in the past. In the meantime, ice and heat (the use of cold and hot compresses) can reduce pain and give temporary relief. Heat can help relax muscles and increase blood flow to the sore area. Cold can be effective immediately following trauma to the back. According to Poduri back surgery is rarely necessary. "Except in cases where a person has neurological deficit such as the sudden onset of back pain with weakness of the legs or bowel and bladder impairment."


National Institute of Neurological Disorders and Stroke

Interview with K. Rao Poduri, MD
Chair of Physical Medicine and Rehabilitation at the University of Rochester Medical Center