Imagine yourself perched on the examining table in your doctor’s office, your back hurting so much you can barely move. You have had the pain only a few weeks, but already you cannot remember what it is like to feel normal.  Seventy to eighty percent of Americans experience back problems at some time in their lives, and the pain is often so devastating that they are willing to do almost anything to make it go away. 

With your back to the wall with pain, surgery may sound like a tempting solution, and nearly 300,000 Americans each year choose to go under the knife–often to discover later that they should have explored other options first.  No matter how much suffering your back is causing, surgery is almost never a good early option. In 90 percent of cases, the pain goes away on its own within a few weeks, even with no treatment.  When the pain persists or comes back, it is probably necessary to see a doctor. And treatment often leads to frustration for both doctor and patient.

When it comes to surgery, however, even doctors admit they are sometimes too optimistic. In one study, physicians recommending surgery predicted “a great deal of improvement” for 79 percent of their patients and “moderate improvement” for another 20 percent. A year later, 39 percent of these patients said the surgery had not helped them.

Muscle or Nerve?

About 80 percent of back problems involve muscle strains. You overdid it shoveling snow the day before or you twisted a muscle when you bent over awkwardly to pick up a crying child.  The muscles in your back are shorter than those in your arms and legs and are more likely to tighten up and spasm. The best prevention is to exercise regularly and maintain strong, flexible muscles, particularly in your back and abdomen.

Once the pain hits, the natural urge is to go to bed and stay there until it stops. In fact, doctors now know that returning to normal activities as soon as possible are the best course of action. A study published 20 years ago in the New England Journal of Medicine concluded that for most back pain, rest should be limited to two days at most. Gentle movements, stretching, ice, heat and anti-inflammatory meds are good conservative measures to follow while waiting for the pain to go away.  Even if you have overworked your back muscles with digging, shoveling, lifting or even heavy exercise, some short-term rest might be called for, but do not overdo it. That will only weaken your muscles and make them more susceptible to injury and pain.

Another common cause of back pain is a herniated or bulging disc. Wedged between each bone or vertebra of the spine, discs have a gel-like center that absorbs shock with each movement of the body.  A heavy strain or fall can cause one or more of these discs to bulge or even to rupture, and the gel-like material sticking out can press against nerves that branch out from the spinal column. Disc problems become increasingly common with advancing age, as the discs degenerate and lose some of their elasticity.  A disc that is just sticking out never needs surgery, but there is a common belief that a herniated disc does. That is not necessarily the case.  A herniated disc can indeed be the cause of severe pain that lingers or recurs. But the pain might also begin with a muscle strain or some other cause. Even if a herniated disc can be seen on an MRI scan, that is no proof that the disc is causing the pain. Similar disc defects are often seen on scans of individuals with no back pain at all.

Special exercises can not only relieve pain but also help suck the center of the disc back into place. These exercises and other treatment options should be tried before any decision regarding surgery is made.

Instability of the joints in the lower back–sometimes caused by an injury to ligaments or muscles–can also bring about nerve-related pain. Curvatures of the spine such as scoliosis or kyphosis can be the source of back problems. And sometimes aging or arthritis can cause narrowing of the canal through which nerves pass, causing shooting pain down the legs at certain times.  One sign of a nerve problem is pain radiating down into a leg or arm. Any such pain, numbness or tingling is reason to see a spine specialist quickly–within two to three days. Generally, surgery is considered only when a nerve is pinched to the point that it is putting in danger normal function.

Surgical procedures that can be performed include removing the gel-like substance to relieve pressure on the nerve, removing the entire disc and fusing the adjoining vertebrae together surgically and replacing the damaged disc with an artificial one.  Theoretically, surgery may sound like a good solution and techniques and materials have improved in recent years. According to one study, 80 percent of patients who had surgery for a herniated disc showed some improvement. Other studies have shown, however, that as many as 40 percent of back surgery patients have persistent pain. Several studies have shown no benefit or only a slight edge for surgery over intensive rehabilitation in easing low back pain.

Three symptoms of nerve involvement are serious enough to warrant seeking immediate medical attention, if possible by a spine specialist: