Aching Back

This article was reproduced from the Backpacker Magazine web site (Body Language: August 1999).

Oh, My Achin'...

What better way to get a backache than to strap 40 pounds to your spine? Here's how to avoid trouble.
By T. Edward Nickens

During college-yes, this is a tale of woeful stupidity-I backpacked with a wiry fellow who impressed me mightily with his Rambo-style manner of applying pack to back. With a fully loaded pack resting at his feet, straps facing away from him, he'd reach over the frame top, slip his hands through the shoulder harness and, with a guttural cry, wrench the thing over his head so it backflipped into position and crash-landed onto his shoulders. Whattaguy.

My attempts to emulate that move have, no doubt, contributed to my membership in the club of occasional back pain sufferers-up to 80 percent of Americans, depending on how you parse the statistics. Given its complexity (24 vertebrae, two dozen cartilaginous discs, and that indispensable spinal cord snaking through the middle of it), the human back seems overly prone to mishap and abuse. Still, we pile on tents, water, clothing, stoves, and another 10 pounds of ultralight gadgetry, hump it hither and yon, and wonder why we can't touch our toes without wincing.

The good news, according to Charles V. Burton, M.D., neurosurgeon and senior medical director of the Institute for Low Back and Neck Care in Minneapolis, is that there is nothing inherently dangerous about bearing extra weight on your back. "People have been doing it for thousands of years," Dr. Burton says. "We know the human body can handle it."

Question is, can your body handle it? The most common structural deficiencies in the human back, scolioses and disk anomalies, are frequently handed down from generation to generation, says Dr. Burton. But there are ways to build a strong back before you hit the trail, as well as trailside tactics to lessen the chance of backcountry injury. The first thing to understand is just what you're doing to your spinal column when you treat your body like a mule.

Backpacking puts extra stress on your back. The first is compression, the result of adding one-third of your body weight (surely you know better than to tote more than that!) to the stacked vertebrae that make up your spine. Under pressure, the vertebral disks-think of a jelly-filled doughnut-are required to absorb even greater shock, and any current irregularities in cartilage or bone alignment are prone to announce themselves with a jolt of pain. With added weight piled on shoulders and hips, the spine relies to a greater degree on surrounding muscle tissues-abdominal muscles and the parespinal muscles that attach to vertebrae-to shore up the load and keep it centered and in balance.

Backpackers risk a sore back because these muscles are required, if only temporarily, to stabilize a much larger load than they are accustomed to. According to Peter Slabaugh, M.D., an Oakland, California, orthopaedic surgeon and spokesperson for the American Academy of Orthopaedic Surgeons, a sore back commonly stems from a buildup of lactic acid in muscle tissue, "just like what happens to your legs when you run a long race." This muscle fatigue can also be paired with microtrauma to muscle cells as they work overtime to keep your overloaded torso centered. The resulting inflammation gives you an aching, tender back.

Or your back could suffer a traumatic injury. You pull a muscle while struggling to shoulder your pack. You arch back to take a big swig of water and superload one side of a vertebral disk, causing the far side to bulge, or "herniate," and pinch a nerve. Even if you make it to camp safely, there's all that water pumping and tent-erecting. In other words, lots of bending and stooping and leaning forward.

Unfortunately, the only warning sign of impending back trouble is pain itself. When that happens, there are ways to lesson your grief:

Unload. Rest and relaxation go a long way toward easing your pain. "Discipline yourself to give your back a break before you have a problem," Dr. Slabaugh advises. Hike in spurts, with frequent breaks. Remove your pack and walk around for 15 minutes or so. If your back still hurts, lie down to unload the muscles. Continue hiking when your heart rate falls below 100 beats per minute.

Listen to your body. Pain localized in the back area generally indicates overworked tissues. But searing pain shooting down your leg, or numbness in feet or toes, is proof of a far more serious condition. Even gently stretching out such an injured back can accentuate the problem, says Wayne Westcott, Ph.D., a strength-training consultant for the Y.M.C.A. and the National Youth Sports Safety Foundation. You might need to drop your pack and retreat, or send a buddy to get help.

Take a pill. Anti-inflammatory drugs can help prevent and alleviate minor back pain. If you're prone to backaches, Dr. Slabaugh suggests taking 600 milligrams of ibuprofen three times a day during strenuous activity. To remedy a sore back, Dr. Burton has a backpacker's prescription. "Aspirin or ibuprofen and an ice-cold mountain stream make for a good initial treatment," he says. That's great for a steamy August afternoon, but if the weather is a bit nippy, try applying a soaked T-shirt to the area. Twenty minutes should help keep inflammation at bay. (Do not, stresses Dr. Westcott, put heat on back pain.)

Preventing the ache

To head off back problems, you need a year-round program.

Tighten up. A strong back is less likely to go south on you, and luckily the lower back muscles "respond more quickly than any other major muscle group to strength-training exercises," says Dr. Westcott. Even if your big trip is only a month-and-a-half away, there's plenty of time. According to Dr. Westcott, you can achieve "a major increase in strength" in six weeks. (Don't forget that excess pounds on your gut also stress your back.)

Lie face down and raise your chest off the floor about 30 to 40 degrees. Concentrate on keeping your hips and feet in contact with the floor; you may need to use your arms to assist you. That's it. One set of 10 repetitions, two or three times per week, should get you in trail shape. If you suffer from chronic back pain, check with a doctor before performing this or any exercise.

Loosen up. Gentle back stretches keep your spinal column flexible and can soothe minor spasms. Dr. Westcott's simple prescription for stretches can be done at camp, on the trail, or in the trailhead parking lot.

Lie on your back, and bring both knees up to your chest. Gently, but firmly, pull the knees until you feel your back muscles stretching. Hold for 5 seconds, and repeat up to 10 times. Stretch back muscles before and after hiking, and even during lunch and water breaks.

Pack back-smart. A properly loaded pack and well-adjusted suspension system are critical to blunting back stress. "Anything that shifts the load to the pelvis," counsels Dr. Burton, "is a good thing." Pack heavy objects close to the pack frame, and balance the load laterally to keep weight centered over your spine. And no he-man, clean-and-jerk histrionics when lifting the pack. "Use your legs and bend at the knees," says Dr. Westcott. Even better is to set your pack on a rock or log, then meet it halfway. (See Know-How, May.)

Downhill danger zone. Tough downhill trails are particularly troublesome for backs, according to Dr. Westcott. The braking action of the quadriceps muscles drives compression upward through the legs and lower back, where it meets the downward pressure of a full pack. The lumbar region takes a beating. "It's easy to let gravity take over and find yourself pounding downhill," Dr. Westcott says. "But that only compounds the pressure on your back and increases the incidences of the tiny traumas that result in sore muscles and back pain. Slow down and stay as erect as possible."

Sleep it off. Sleep is critical to repairing overtaxed muscles, if it's done right. Back experts nearly unanimously discourage back pain sufferers from sleeping on their stomachs or backs. Instead, sleep on your side, says Dr. Westcott, in "a moderately curled, but not fetal, position." That removes the stress and pressure of gravity on the lower back's natural curve and allows muscles to relax. Do your back an extra favor, adds Dr. Burton, and always use a firm foam sleeping pad.