Backache

SHAPE UP . . . OR BE CARRIED OUT

By Buck Tilton

Here's one theory, proposed by me, with absolutely no basis in historical fact: prehistoric humans walked around stooped over because they were perpetually throwing out their backs lifting big heavy things like rocks and mastodons.

Being something of a throwback myself, so to speak, I've done my imitation of an early hominid many times, the last only recently, tossing my pack up to my shoulder while balancing on backcountry skis. I spent two days staring painfully at my feet. When your back goes out of whack, by too much strain on the muscles, this is how you know: It feels like a hot vice clamp with large teeth is being applied to your lower back by someone with extremely large arms who doesn't like you. The Call of the Wild becomes the Moan of the Careless.

ANATOMY

With feet the foundation, the back constitutes the structural support for those who still maintain spinal integrity. The human spine, a marvelously intricate column of 33 bones (vertebrae) woven together with ligaments and muscles, gives strength yet flexibility to the body. By restricting motion to within definite bounds, the bones provide protection for the delicate spinal cord, the super-highway of nerves running down the center of the vertebrae.

The top seven bones of the spine work with the muscles of the neck to carry the head. These cervical vertebrae are the smallest and most flexible in the spinal column. Twelve thoracic vertebrae have ribs attached to them which gird the chest cavity and lend extra strength to the mid-back. Since the bottom two thoracic vertebrae are attached to ribs that float freely in front -- the first ten ribs attach to the sternum in front -- the low thoracic spine provides a lot of rotational freedom.

But the lower back, with five lumbar vertebrae, the largest components of the spine, bears the greatest load with the least flexibility and, consequently, gets the most votes as Area Most Likely To Hurt.

Below the lumbar spine, a lump of bones called the sacrum holds the pelvis in place. Finally, the function-less little coccyx reminds us, perhaps, that we once extended farther in that direction. The five fused bones of the sacrum, and four of the coccyx, gives the total of 33.

TREATMENT

It takes surprisingly little strain on your back, if the angle is right, to tear muscles. About 5.5 million people in the US every year miss work due to back strain. The resulting agony can be debilitating. It will probably be several days before the pain goes entirely away, but almost everyone can make themselves functional in a couple of days by following a recognized routine.

1. Rest. Very important. Rest on your side, or on your back with thick padding underneath your knees.

2. Apply heat: a warm compress, a hot water bottle, a hot bath (if you can figure out how to pull it off in the woods). A few people react better to an application of cold to the lower back, but use of heat is indicated for most of us.

3. Get someone to massage your lower back muscles.

4. Take drugs that relax muscles. (Consult your physician.)

A doctor friend of mine, who insists on remaining anonymous, suggests moderate doses of alcohol can have a beneficial effect. Alcohol, he says, blunts pain, increases circulation, and is less addictive that some prescription muscle relaxants (e.g. Valium).

If the pain doesn't go away, or if pain, tingling, numbness or paralysis begins to creep down your legs, it's time to forget the outdoors for a while and find a physician.

PRE-TRIP PREVENTION

Prevention, as always, is the best treatment for back pain. "Not surprisingly, most people who injure themselves . . . ," writes Casey Terribilini, a doctor of chiropractic in the San Francisco Bay area (Journal of Emergency Medical Services, May, 1993), " . . . do so by doing too much too soon or by not working out regularly." Exercise often and moderately: brisk walking, swimming, jogging, biking, paddling. And shed extra body weight. There will be enough of a strain on your back without packing fat around your waist.

"Exercises that increase flexibility and strengthen the trunk (abdomen) and hips," continues Dr. Terribilini, "also help maintain a healthy back." Here are five daily exercises you can do to buy insurance against back injury:

1. Start flat on your back and use your hands to pull one knee to your chest. Hold the knee-to-chest position for about 10 seconds. Repeat for the other knee. Do 10 repetitions for each leg.

2. While still lying down, bend your knees and do abdominal crunches. A crunch raises your head, shoulders and arms off the floor toward your bent knees. Crunches should not raise your lower back off the floor, which would put too much pressure on your back and decrease the benefit to your abs. Hold each crunch for several seconds. How many? Till your abdominal muscles burn. Your goal: To eventually be able to do 3 or 4 sets of 25-30 crunches.

3. Roll onto your stomach and get into a pre-pushup position, hands on the floor just above your shoulders. Now arch backward, but keep your pelvis on the floor. Hold for about 10 seconds. Repeat 10 times.

4. In the same face-down position, extend your arms overhead along the floor. Raise one arm and the opposite about six inches off the floor and hold for about 10 seconds. Alternate sides. Keep repeating until you feel a little burning fatigue in the muscles being used.

5. Roll over and sit up with your legs straight out in front of you. Stretch your hamstrings by keeping your legs on the floor, knees slightly flexed, and reaching gently for your toes. Do not bounce. Hold maximum stretch for 10-15 seconds and repeat several times.

These exercises can be performed, slowly and gently, after a back injury to help get your muscles working again, if doing them does not increase your pain.

DURING-TRIP PREVENTION

1. Loosen up before lifting anything heavy such as that big ol' fat pack, especially in the morning.

2. Keep your back straight and use your legs, not just back and arms alone, to lift the load.

3. Get the load well balanced before stepping out.

4. Option: Have someone help you lift the load and get it balanced.

5. Take frequent rest breaks with the load off your back.

6. Reverse the lifting procedure when you drop the load.