What Every Woman Needs To Know About Back Pain

My wedding was a few weeks away, and I was determined to burn some serious last-minute calories in Spinning class. I felt great until the next morning, when any movement that required me to use my back (even routine things like brushing my teeth) caused lightning bolts of pain to shoot down my left leg. I knew this wasn't run-of-the-mill workout soreness. The pain was so severe that my doctor ordered an MRI (magnetic resonance imaging); the scan revealed that a bulging disk in my lower back was pressing on one of my sciatic nerves, the ones that start at the spine and snake down each leg. The physician recommended physical therapy, but because I couldn't begin until after my honeymoon, I downed lots of over-the-counter pain relievers. They got me through the big day and our bicycle trip around France, but over the next year, I ended up trying almost every nonsurgical remedy I thought was safe, only to get worse. At 32, I felt ancient.

It turns out that women often experience back pain, mild or severe, for the first time as young adults, says Daveed Frazier, M.D., a spine-disorders specialist and assistant clinical professor of orthopedic surgery at Columbia University College of Physicians & Surgeons in New York City. And 80 percent of Americans will have an aching back at some point, according to the American Academy of Orthopedic Surgeons in Rosemont, Illinois. I'd had minor pain on and off for years, and if I'd known then what I know now, I'd have taken it more seriously. Happily, most people with back pain can find relief when they know where to look. That's where I come in: In my quest to feel better, which ultimately included eight specialists, 71 physical therapy sessions and surgery, I've learned more than I cared to. So with the help of top back experts, I've come up with six crucial pieces of advice that can help anyone with back pain get back on track. Get ready to put pain behind you.

Take care of yourself first

Even if your back really hurts, pursue at-home treatment for several days, says Jeffrey Goldstein, M.D., a spine surgeon at New York University Hospital for Joint Diseases in New York City. This advice is especially helpful for first-time pain caused by everyday injuries such as lifting something heavy or making an unexpected twisting move. Those aches are often muscle and ligament strains and sprains, which respond well to these do-it-yourself fixes: Take it easy, but don't stay in bed longer than 24 hours; your muscles will only get weaker, says SELF contributing editor Lisa Callahan, M.D., medical director of the Women's Sports Medicine Center at the Hospital for Special Surgery in New York City. Instead, return to gentle activities and light stretching (but no twisting moves) as soon as you can. You can also take a nonsteroidal anti-inflammatory drug such as ibuprofen or naprosyn and use ice to reduce swelling (15 minutes on, 45 minutes off); if cold packs don't seem to help, try applying heat (20 minutes on, 20 minutes off). This simple approach usually cures about 90 percent of cases, Dr. Frazier says. But there are a few instances where do-it-yourself treatment is the wrong approach: Go to the emergency room if your pain is accompanied by high fever, chills or nausea (which may indicate a serious infection); do the same if you have a loss of bladder control or sharp pain in the lower leg (both of which point to severe nerve damage).

Still aching after a week? Seek help

If you're not noticeably better after seven days, there's probably something more going on than a garden-variety strain, and it's worth getting evaluated. General practitioners can and do treat back-pain symptoms effectively, but you may want to see a specialist. If you have shooting pain like sciatica, start with a neurologist. If your pain is more generalized, consider a physiatrist (an M.D. expert in nonsurgical treatment of musculoskeletal problems), an orthopedist (a bone and joint specialist) or a chiropractor. One note about chiros: They do more than spinal manipulation, which a report in the Annals of Internal Medicine found only moderately effective for back pain. Many chiropractors use other techniques, such as exercise and deep-tissue massage to eliminate fibrous adhesions within the muscles. Whomever you choose, try to get recommendations from physical and massage therapists in your area. They tend to see patients after treatment and hear all the stories, the good and the bad.

Exercise can ease pain, even if working out caused the problem in the first place.

The doctor will check for a more severe muscle injury (such as a strain from overexertion), the most probable cause of back pain in young women, Dr. Callahan says, as well as for problems with a disk, the spongy water-filled shock absorber between each vertebra. One of the biggest culprits is hitting the gym (or the track or tennis court)—just as you're supposed to.

"High-impact activity is good for your muscles, bones and heart, but not so good for your joints," like the vertebrae in your spine, Dr. Frazier says. Over time, repeated muscle and ligament problems combined with the stress of activity can begin to damage these natural shock absorbers. (Other back busters include poor posture, wearing high heels, weight gain, pregnancy, even chronic stress.) Plus, as you age, your disks increasingly become drier, making you even more prone to injuries, says Janet Bezner, Ph.D., vice president of the American Physical Therapy Association in Alexandria, Virginia. Another big factor is weak core muscles, which can't properly support the spine to maintain good posture. When a disk is overstressed, it may gradually bulge from between the vertebrae or it may rupture; both can put pressure on a nerve exiting the spine, which can result in leg and back pain. In my case, pedaling hard in that Spinning class wasn't the only thing that triggered the herniated disk; it was likely a combo of years of sports (I rowed competitively), intense workouts several times a week and spending countless hours hunched over my desk.