Low-Back Pain Can Be a Pain in the Butt--Literally

Not only will 80–90 percent of the population have issues with low-back pain sometime during their adulthood but, in addition, back pain is one of the most common symptoms inducing people to visit a physician and is involved in almost a fourth of all occupational injuries and illnesses. In 2001, back injuries resulted in the highest percentage of short-term disability of all nonfatal illness and injury cases. In sum, back pain, especially low-back pain, is a big problem—for workers, employers, and insurance companies alike.

Part of the problem is that back pain can be difficult to diagnose, and physicians often overlook or misdiagnose trigger point pain (that is, localized areas of muscle soreness that refer pain to elsewhere in the body). This diagnostic difficulty can lead to treatments that don’t accurately address the problem, such as painkillers, which don’t necessarily rectify the problem but simply dull the pain. It is also worth mentioning that surgical rates for low-back pain are twice as high in the United States as in most other developed countries.

Often, to give a commonly occurring example, clients who are experiencing low-back pain actually have an issue with trigger points in the gluteal muscles, the piriformis muscle (which lies deep to the glutes), or even muscles as far away as the calf (the soleus muscle, to be exact). The piriformis, in particular, seems to be a major culprit when it comes to low-back pain. In my own practice, when I release knots in the piriformis muscle, I have had clients say they can feel the tension in their lower backs dissolve immediately. I even had one client say he felt his whole back realign when the tight spot in his piriformis let go.

Because low-back pain relief can be so close at hand—literally—it only makes sense to visit a knowledgeable massage therapist before trying something more invasive or simply palliative but not curative (such as pharmacologic “solutions”). And research is mounting to support this course of action. In one study, massage recipients reported less pain, depression, and anxiety, as well as improved sleep, and they showed improved trunk flexion. Stress hormones associated with chronic low-back pain were also reduced. A more recent study found similar results, with benefits lasting up to six months. And numerous other studies have shown massage to be helpful in relieving back pain.

Although reduction of stress hormones may come into play, in terms of how massage works to relieve low-back pain, as found in the one study, other researchers aren’t sure why massage seems to work. It may be that massage stimulates the muscle tissue locally or that it causes a response from the central nervous system. They also hypothesize that the reasons for improvement could be as simple as being in a relaxing environment or being cared for by a sympathetic therapist.

In any case, I agree with the chief author of the most recent study, who was quoted as saying, “If you’ve tried other things and you’re not getting adequate relief, then massage is a reasonable thing to try.” I would go one step further, though, and suggest that perhaps massage should be one of the first things you try.

Sources

Bagduk, Nikolai. 2004. “Management of Chronic Low Back Pain.” Medical Journal of Australia, vol. 180.

Bakalar, Nicholas. 2011. “Stubborn Back Pain? Try Massage.” New York Times, July 4 (http://well.blogs.nytimes.com/2011/07/04/embargo-july-4-5pm-for-back-pain-try-massage/?scp=1&sq=%22low%20back%20pain%22&st=cse).

Cherkin, Daniel C., et al. 2011. “A Comparison of the Effects of Two Types of Massage and Usual Care on Chronic Low Back Pain: A Randomized, Controlled Trial.” Annals of Internal Medicine 155:1–9.

Deyo, Richard A. 1983. “Conservative therapy for low back pain: Distinguishing Useful from Useless Therapy.” Journal of the American Medical Association 250:1057–62.

Deyo, Richard A., et al. 1996. “Low Back Pain: A Primary Care Challenge.” Spine 21:2826–32.

Hernandez-Reif, Maria, et al. 2001. “Lower Back Pain Is Reduced and Range of Motion Increased after Massage Therapy.” International Journal of Neuroscience 106:131–45.

Papadopoulos, E. C., and S. N. Kahn. 2004. “Piriformis Syndrome and Low Back Pain: A New Classification and Review of the Literature” Orthopedic Clinics of North America 2004 35:65–71.

Simons, D. G., and J. G. Travell. 1983. “Myofascial origins of low back pain. 3. Pelvic and lower extremity muscles. Postgraduate Medicine 73:99–105, 108.

U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention. 2004. Worker Health Chartbook 2004. Publication no. 2004-146. Cincinnati, OH: U.S. DHHS, PHS, CDCP, National Institute for Occupational Safety and Health. Fig. 1-38.

Cruisin', on a Sunday Afternoon

Not since I was a kid have I had the leisure to ride a bike simply for the fun of it. I bike to work. I bike to run errands. I bike to dinner parties. I enjoy all of those excursions, but there are almost always time constraints or, at least, substantial distances to cover. Consequently, I've been riding bikes that can go, baby, go! Skinny tires, multiple gears.

But in Michigan, on vacation, time is a little more free form and we're not in much of a rush for anything. So I decided to try my gal's cruiser. I love the look of cruisers, but they've never been especially practical for my purposes. On vacation, though, with lots of leisure, there was nothing to hold me back, so I hopped on Kathy's cruiser. And unlike when I'm riding in the city, with cars and people and other bikers everywhere, I didn't even worry that I didn't have on a helmet or that I was riding with flipflops. What a freeing experience!

A Jury of My Gears?

Jury duty is not only a civic responsibility: it's an honor and a privilege. Sometimes, though--much like having a job--it gets in the way of things. Like exercise.

Recently, I received notification that I was supposed to report to jury duty in Maywood, IL. Jury duty doesn't start that early in the morning, but counting in travel time and all, I was pretty sure I'd end up forgoing my exercise that day because I can no longer get up before dawn.

But then I had the bright idea to see whether it was bikable. And it was! So I biked from my house in Chicago, through Oak Park and River Forest and on into Maywood. I'm pretty sure I've never even been through the latter communities by car, so it was a lot of fun seeing completely new things.

And I'm fairly certain I was the only one who biked to jury duty that day.

Intersection of Terror!

I can see the previews for the movie version now: don't go into the intersection! Cars turning from the wrong lane--enter at your own risk.

Yeah, as movies go, that one would stink. But despite my hyperbole, it is a scary intersection: Ashland/Armitage/Elston. And so my letter to Transportation Commissioner Gabe Kaplan....

August 6, 2011

Gabe Klein, Commissioner

Department of Transportation

City Hall

121 N. LaSalle Street

Chicago, IL 60602

Dear Commissioner Klein,

First, I want to thank you for all your advocacy on behalf of cyclists and pedestrians. As a regular bicycle commuter, I know the perils—and pleasures—of cycling on Chicago streets, and I very much appreciate all you’ve done to make such travel a little easier for Chicago’s citizens.

Now I’d like to direct your attention to an intersection that plagues me on a daily basis, that at Armitage, Elston, and Ashland. Going southbound on Elston on my bike, travel through that intersection goes without a hitch, but when I am going northbound, it gets a little dicey at the juncture between Ashland and Elston. Even when I am in the center lane, indicating, I would think, my intention to stay on Elston, cars routinely cut in front of me to turn right onto Ashland. Sometimes it is more treacherous than others, depending on how closely they cut me off.

What I’d like to propose is that the lanes on Elston south of Armitage be painted to indicate that those who intend to travel north on Ashland be in the right-hand lane and those traveling north on Elston be in the center lane; the far left lane is already marked for left turn onto Armitage. North of Armitage, I suggest that one of the two lanes that continue to Elston be turned into a bike lane. Ideally, I’d love a protected bike lane, but at this point I’d take anything that helped give bicyclists a clear right of way! Since this may be hard to understand in the abstract, I’ve created some drawings to illustrate what I mean.

Current Intersection

Proposed Intersection

In the picture at right [above here, in the blog], I’ve used purple to show what I think should be painted onto the road.

If you have any questions about my concerns or suggestions, I hope you will feel free to contact me. I know everything can’t be attended to at once, but I hope this is a matter that you can investigate and resolve quickly.

Sincerely,

Brave Heart, Chicken Liver

Beginning with Pipi Longstocking and on up through Amelia Earhart, I have always loved the idea of adventure. However, after probably age 9 or 10, my own brave heart gave way to my chicken liver and I have contented myself primarily with reading about adventure, whether fiction (as with Patience and Sarah and a hundred other books whose titles are just now escaping me) or nonfiction and biography. I've especially loved reading about brave, adventurous women, but sometimes, especially when there are shared interests involved, the derring-do of men has attracted my attention, as with The Lost Cyclist, by David Herlihy.

I had started reading this book months ago, but then had to return it to the library. When the LGRAB contest came up (see at right), it seemed like a splendid time to resume reading that book. The Lost Cyclist chronicles the round-the-world bicycle ride of Thomas Allen and William Sachtleben and the attempt by Frank Lenz to accomplish that same feat in the opposite direction about a year or two later, in 1892-93, under the auspices a periodical called Outing.

I'm not going to do a "book report," as my lovely spouse Kathleen keeps calling it, but I do want to mention a couple of the things that particularly struck me. Lenz's racism--referring, for example, to the Chinese people he hired to help him as "coolies"--was really jarring. But in the main, the accounts of his junket were fascinating. For instance, he had to use rail beds for travel (owing to the general impassability of roads), which required him, on at least one occasion, to hang from a railroad overpass, his bike in the other hand, when a train surprised him.

I also loved that Lenz was swarmed in every town and city, so rare were bicycles in those days--though not so rare that there were bicycle clubs in most large cities, including female members. I can relate to the excitement he generated--when I'm on the bakfiets (cargo bike). Seldom do I venture out on the cargo bike without getting shouts of "nice bike!" and without getting stared at.

And I couldn't help putting myself in Lenz's place as he traveled through Japan and China without speaking a word of those countries' languages. While it's true that I went to St. Petersburg, Russia, without knowing a word of Russian, I went there as part of a writing seminar and was therefore hardly on my own. I can't imagine how frightening it must have been for him, all on his own, especially back then when foreign countries were truly foreign to most people.

I would say "spoiler alert" if it weren't for the fact that the title Lost Cyclist pretty much clues the reader in at the start that all does not go well for Lenz. I will read on now with trepidation, wishing my good thoughts could alter his fate.