With Dr. Stephen Leffler

One of the most troubling problems that bowhunters can face is low back pain.  The problem can range from a minor annoyance to a disabling medical condition that   requires surgery.  In the first part of this article we will look at the various causes of back pain, some treatment options.  In the second part of the article we will cover back strengthening exercises and techniques to keep you hunting when your back is hurt.

Back pain is a very common problem.  Approximately 15% of Americans will experience back pain this year.  Many will miss work and leisure activities.  It is estimated that 80% of the population will have at least one episode of back pain in their lifetime.  Bowhunters, with their active lifestyle probably experience even higher rates of back injury and pain.

First, we need a brief anatomy lesson.  Your back is made up of bones called vertebrae with little cushions between each of the bones called discs.  The front part of the bone is very strong and solid.  It gives your spine its strength.  The back part of each bone is hollow and surrounds and protects your spinal cord.  On the side of each bone are small holes, which allow the nerves from you spinal cord to leave the spine and innervate your arms and legs.  The discs are cushions between each spinal bone and provide shock absorption for your spine.  The spine itself does not hold you up.    When standing upright your spine is supported my numerous small muscles which are constantly contracting to hold you upright.  Most of these muscles are very small but the combination of all of them flexing together allows us to stand.  These small muscles get constant use everyday but are easily injured.  When you suddenly perform a new activity such as dragging a deer or back packing, these muscles become strained and you have back pain.  Lifting incorrectly is one of the most common causes of back pain and is easily prevented.  You should always keep your back straight and lift with your thigh muscles.  Your legs are big and strong and can handle the load.  Lifting the weight with your lower back is a sure way to strain the muscles around the spine and cause pain.

Muscular lower back pain is an annoyance but is usually not a serious problem.  Typically you will feel an achy pain in your lower back and be able to identify a recent activity, which was the culprit.  There should be no radiation of the pain into your legs and no numbness or weakness in your extremities.  You should be able to walk although it may be very painful.  You may feel spasms in your back which are the muscles complaining about the recent injury.  If you seek medical care, your doctor will perform a careful neurologic exam to make sure you don’t have a pinched nerve and will probably prescribe some anti inflammatory medications and muscle relaxers.   Usually X-rays are not needed and don’t add much to the diagnosis.   Typically you will be given a series of exercises to do to help strengthen you back and get back to normal activity.  The most important initial activity is walking.  Multiple studies have shown that walking helps patients get over their injury and back to normal activity more quickly.  You may have been told in the past to stay in bed for up to a week and then gradually increase your activity.  Early walking has been shown to be superior to bed rest.  Walking doesn’t mean strenuous activity - just an easy pace, increasing your distance each day.  If walking is extremely painful, it is reasonable to use bed rest for a day or two.  As soon as possible you should begin walking and increase the distance each day.  I normally ask patients not to start the back exercises until they are almost completely pain free. 

I am often asked about using a chiropractor for lower back pain.  For muscle based back pain, many people get excellent relief from spinal manipulation but others don’t.  If a chiropractor helps you great, if not then you will need to use other measures.

If the back pain radiates into your legs you may have a pinched nerve.  The medical term for this is a herniated disc.  In this situation, the disc between your spinal bones has become squished and is pinching the nerve roots as they leave the spinal cord.  The pinched nerve becomes swollen and inflamed and you feel pain in your leg.   Typically you will have numbness or shooting pain into one or both legs.  You may also have weakness and possibly difficulty urinating.  It may be difficult to walk because of leg weakness not pain.  This condition can be much more serious and will occasionally require surgery.  If the nerve is being damaged badly enough a spine surgeon will remove the disc and decompress the nerve.  Luckily most of the time the pinched nerve will resolve without surgery and your symptoms will improve.  In most cases, the inflammation and swelling will resolve in four to six weeks and the nerve function will return to normal.  If you have back pain with any leg symptoms or urinary difficulty you should see your physician.  The doctor will carefully check you symptoms and reflexes and possibly order a CT scan or MRI.  They are both excellent at diagnosing herniated discs.  If you are diagnosed with a pinched nerve your doctor will likely prescribe you some pain medications and possibly steroids.  Some physicians believe that steroids help reduce the swelling around the nerve and quicken resolution of your symptoms. Certain findings on physical exam or overwhelming pain may require rapid surgery to preserve nerve function.   For less severe cases the best initial treatment for a herniated disc is walking!  Strengthening and toning the back muscles seems to take pressure off the disc and nerve root.  Walking is the ideal treatment to strengthen these muscles.  Most people will have excellent relief and return of nerve function in four to six weeks.  Physical therapy can be useful to motivate you but hasn’t been shown to be better than daily walking.   Physical therapy is excellent for conditioning your back to help prevent further injury.

The last type of back pain that we will talk about is more insidious and difficult to treat.  Arthritis of the spine can cause severe back pain and be difficult to treat.  This is often a disease of aging and long-term wear and tear on your back.  Seventy-five pound packs of elk meat and dragging big deer gradually take their toll.  Arthritis comes in different forms but the end result is the same- long term back pain.  This pain is there every day and is not related to an injury.  There are typically no leg symptoms or other neurologic findings.  X-rays will show signs of arthritis.  Many people will need to use medications such as ibuprofen regularly top control the pain.  Except in rare cases surgery will not help.  Chiropractic care may help this form of back pain for some people.  For this type of back pain regular exercise and back strengthening exercises are the key to keeping you out hunting.  Since nothing will cure the arthritis you must do everything possible to keep active and functional.  . 

Hopefully you now have a better idea of what causes your back to hurt and when it is necessary to seek medical care.  In part two of this article we will cover back strengthening exercises and methods to keep you in the woods when back pain strikes during the season.