Back pain is one of the biggest reasons we seek medical care, and low back pain is listed as a leading cause of disability worldwide. But there's a lot of misinformation out there, and along with it, a lot of bad treatments.
背部疼痛是我们去见医生的 最主要原因之一, 而腰痛被列为了世界上 导致残疾的主要因素之一。 但是流传着许多 有关的不实信息, 产生了许多欠佳的治疗方式。
(Music)
(音乐)
[Body Stuff with Dr. Jen Gunter]
[珍·冈特(Jen Gunter)医生的 身体秘密(Body Stuff)节目]
So today, I want to bring up five things you should know about back pain.
那么今天,我想分享 关于背痛你该知道的五件事。
One: Back pain isn't just limited to the spine. Our back is made of bones called vertebrae that run from your neck to your tailbone. These vertebrae form the spinal column, which houses the spinal cord. Each vertebrae is also connected to the others by ligaments. Between each vertebrae are discs which provide cushion and help absorb and distribute pressure. Within this structure of connections are also joints, muscles, tendons and nerves. But our back isn't held up by just the spine. In fact, a lot of that work is done by our core, which includes our abdominal muscles, low back muscles, hips and glutes and pelvic floor. The muscles in our core take pressure off the rest of the spine. Every day, we put all kinds of pressure on our backs when we walk, stand, carry our groceries, lift boxes, and even when we sit. So it’s not only spinal pressure but torn muscles or slipped discs that could be contributing to back pain. But pain itself is even more complex. Often, it's how pain signals are processed in the nerves, or in the brain that perpetuates the pain. Other factors, like stress and anxiety, can amplify pain. This complexity is why treating back pain can be so frustrating, and why it's enticing to seek out all sorts of medically suspect care.
第一: 背痛不局限于脊柱。 我们的背部由“椎骨” 这类骨头支撑着。 它从你的脖子延伸到尾骨。 椎骨组成了脊柱, 里面是脊髓。 每块椎骨之间由韧带相连。 椎骨间是椎间盘, 起到缓冲, 吸收和分散压力的作用。 在这种相连结构中, 还存在关节、肌肉、肌腱和神经。 但是我们的背部不只由脊柱撑起来。 事实上,这很大程度 依靠着我们的核心肌群, 包括腹部肌肉、 腰部肌肉、臀部肌群和骨盆肌群。 我们的核心肌群分散了 脊柱其余部分的压力。 每天,我们都在给背部 施加各种各样的压力, 包括我们走路、站立、 抱着杂货、抬起箱子, 以及静坐的时候。 所以不仅是脊柱的压力, 肌肉撕裂或者 椎间盘突出也会导致背疼。 但是痛感本身更加复杂。 通常来讲,是疼痛信号 经神经或大脑里的处理方式 让疼痛持续良久。 其他因素,如压力和焦虑, 会使疼痛加剧。 这些复杂因素使得 治疗背痛令人崩溃, 也让人们去欣然尝试 各种未被证实的治疗方法。
Which leads me to two: Chiropractic treatment is not backed by science. Going to chiropractors for spinal manipulation is very popular, especially in the United States. But a study that looked at 45 systematic reviews found no evidence supporting chiropractic treatment as effective for any medical condition. I'm not denying that people who visit chiropractors sometimes feel better after a session, but studies suggest that the comfort and relief from being touched is most likely a placebo effect. This is also a reminder that chiropractic treatment can sometimes be dangerous. There are people who have suffered vascular strokes after neck adjustments.
这就要谈到第二点: 脊椎推拿没有任何科学依据。 去脊椎推拿师那儿“整脊”很流行, 尤其是在美国。 但是有一项分析了 45 份全面性综述的研究 发现脊椎推拿没有 对于任何身体病症有效的迹象。 我不否认去做脊椎推拿的人 每次结束后感觉更好, 但是研究表明体肤触碰 带来的安宁和舒缓 很可能是潜在原因。 这里还要提醒, 脊椎推拿有些时候是危险的。 有人在颈部“正骨”之后 出现了脑卒中状况。
Three: Imaging techniques like MRI or X-ray don't always help with diagnosing back pain. For instance, you can be in a lot of pain and get an MRI showing a pristine spine with nothing out of the ordinary. Or you could have no pain whatsoever, and an MRI could turn up abnormalities, like a bulging disc. What’s more, sometimes, when you do have pain, and abnormality on MRI may have nothing to do with it. Additionally, an MRI doesn't always capture what's happening with your muscles or tell us how pain is being processed in the brain. There are instances when imaging helps to rule out a serious problem, especially after trauma or an accident, or if there are red flags, meaning warning signs for cancer or troubling neurological symptoms. But for the majority of people with back pain, imaging has actually been associated with worse patient outcomes and unnecessary surgeries.
第三: 像核磁共振 和 X 光这样的造影技术 有时候无法诊断背痛。 比如,你痛得要死, 但核磁共振显示 你的脊柱没有任何毛病。 或者你根本不痛, 然后核磁共振发现异常, 说你有椎间盘突出。 还有些时候, 你确实感到疼痛, 但是核磁共振找到的 异常毫无关联。 此外,核磁共振不会经常 捕捉到肌肉的状态, 或者显示大脑是如何传达疼痛的。 有案例表明影像确实 可以排除严重问题的可能, 尤其是在受到创伤或事故之后; 或者确定是否有危险预兆, 即癌症信号或者不妙的精神症状。 而对于大多数背痛患者而言, 通常与造影相关的是 更差的治疗效果 和不必要的手术。
Speaking of surgeries, four: Back surgeries can sometimes do more harm than good. Researchers analyzed studies on two types of spine surgery, lumbar spine fusion and lumbar spine decompression. They found that neither of these surgeries was more effective than nonsurgical treatment, which I'll get into in a bit.
说到手术,第四点: 脊背手术有些时候弊大于利。 研究人员分析了 关于两类脊椎手术, 腰椎融合术和腰椎减压术的研究。 他们发现这两类手术都没有 非手术疗法来得有效。 这我会后续展开。
Finally, five: Physical therapy is a really good option for back pain. A well-designed physical therapy program can often be very effective at treating acute and chronic back pain. But it does take work. Good physical therapy involves not just assessments, but also a structured home exercise program, which you need to do regularly. There are also multidisciplinary clinics that can offer multimodal therapy, like medications, physical therapy, and, sometimes, injections.
最后第五点: 物理疗法对背痛来说 是个很不错的选择。 一项精心设计的物理疗法计划 通常会在治疗急性 和慢性背痛上有奇效, 只不过需要下点功夫。 好的物理疗法不仅涵盖评估, 还包括合理安排的 居家锻炼计划; 这你也得定期完成。 市面上也有综合诊所 提供多种形式的治疗, 如药物治疗、物理治疗, 以及注射治疗。
What I'm saying is there isn't always an easy fix for back pain. The solutions take time and sometimes need a multipronged approach. For now, you can show your back some love by staying active and doing exercises that strengthen your muscles, including your core.
我是说背部疼痛 很少会有简单的治法。 治疗需要时间, 有些时候需要多角度配合。 至于现在,关爱 你的背部吧,动起来, 多多锻炼,强健肌肉, 也别忘了核心肌群。