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April 28, 1991|ANNE C. ROARK | Roark is a Times staff writer specializing in medicine and science.

You don't know how or where it began. Perhaps you simply sat too long. Or you bent over too quickly or stretched too far. But now the pain of a bad back has taken over your whole life.

Like a security alarm that can't be shut off, the discomfort of an ailing back can be merely annoying, but all too often it is blinding and debilitating in its intensity. And it can happen to anyone at any time.

Back ailments are among the most frequent health problems, second only to the common cold. Four of five adult Americans suffer from back pain sometime in their lives. About 1% of the population--2.5 million individuals--are totally and permanently disabled by chronic back problems. And the incidence of back pain, what the National Institutes of Health recently called "a crippling ailment of staggering dimensions," appears to be increasing faster than any other form of bodily injury.

As alarming as the frequency of back complaints is the mystery that surrounds them. Despite an arsenal of new tools, only about 17% of cases can be accurately and fully diagnosed, according to recent epidemiological studies.

Yet there is good news for many of the 8 million Americans who will be stricken with back pain this year and the nearly 80 million already afflicted. Thanks to new insights into the mechanics and biochemistry of the spine and radical rethinking about how to treat back pain, the majority of back problems can be brought under control and in some cases--with the right diet, proper exercises and new work and leisure habits--can be prevented.

"There is no cure for back pain," cautions Michael Schlink, founder of Schlink & Associates, a physical-therapy group in West Los Angeles that specializes in back pain and other orthopedic ailments. There is, he says, "control and prevention. More than almost any other area of medicine, it is up to the patient to do the controlling and the preventing."

Back-pain sufferers, Schlink says, cannot passively submit to doctors or therapists and hope to find a permanent remedy for their back problems. Nor can they rely on often-prescribed pills--anti-inflammatory drugs and pain relievers--to offer anything more than temporary relief.

"This is one area of medicine," he says, "where a patient cannot be a patient."

What that means to the sufferer is exercise to strengthen all parts of the body: stretching leg, neck and pelvis muscles and learning to stabilize and control the trunk of the body so that the spine always remains in its natural alignment, says Dr. Lionel A. Walpin, former director of physical medicine at Cedars-Sinai Medical Center and now medical director of the Walpin Physical Medicine and Pain Institute in Los Angeles.

Which exercise works best will vary from person to person, depending on body condition and the precise nature of the ailment, Walpin says. But virtually every back patient will benefit from routine stretching and strengthening exercises, along with regular aerobic activity, either swimming or vigorous walking for at least 20 minutes a day.

That assessment, shared by most health-care professionals, is based on long-term epidemiological studies of back patients and recent research on the mechanics of the spine and the biochemistry of discs and other soft tissues that support the back.

Current thinking about what works--and what doesn't--would have been considered medical heresy a decade ago, says Dr. August A. White III, an orthopedic surgeon at Harvard Medical School.

Posture, for example, is now believed to be neither a cause of back pain nor a cure for it. Evidence that the admonition to "stand up straight" does little, if anything, to keep people from having back pain comes in part from a detailed review of "posture pictures" taken as part of fitness programs in women's colleges in the 1950s.

"Posture . . . good nor bad, was not in any way associated with a higher or lower incidence of low-back pain over a 25-year period," White notes in his 1990 book on back pain.

Heat and massage, two of the oldest and most trusted remedies, are now considered by most physicians and physical therapists to offer little more than temporary, palliative relief.

The same is true of bed rest. According to experts, taking to bed for more than a few days during an acute bout of back pain might do more harm than good, causing the muscles that are needed in recovery to atrophy and exacerbating the feelings of helplessness and depression that often accompany back pain.

Back surgery, once considered to be the riskiest but only permanent remedy for back ailments, also has fallen out of favor--even with prominent back surgeons. "Surgery should be the last treatment a patient considers. And even then, the patient should get a second opinion," says Dr. Theodore B. Goldstein, a Beverly Hills orthopedic surgeon who specializes in back surgery.

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