There's an old joke that goes: "You know you've reached middle-age when your back goes out more than you do." In actuality, lower back pain is a common problem that afflicts people of all ages and from all walks of life. The most recent statistics show that lower back pain disables as many as 1 million persons in the United States annually.

  Lower back pain will cause about 50 percent of ill Americans to miss at least one week of work during their lifetimes. "Next to the common cold, back injuries are the leading cause of worker absenteeism," notes Dr Scott Van Oosten, D.C., of the Lakewood Chiropractic Clinic. "Back pain is a huge industrial cost in this country."

  Last year, more than $80 billion was spent on the treatment of lower back problems, making it the most expensive healthcare cost in America.

  While Dr. Van Oosten says that the majority of his patients are in their early 30s to their 50s, their occupations range from factory laborers to corporate executives. ''Many of our patients are laborers who have experienced lifting or carrying injuries" he says.  "But we're seeing a growing number of people who have desk jobs.  Many sedentary office workers are experiencing problems in their lower backs and cervical areas due to sitting in front of a computer all day."

  Add to that the typical rash of "weekend warrior" back injuries caused by excessive sports activity or even gardening, and practitioners such as Dr. Van Oosten are assured of full waiting rooms for years to come.

  So what causes lower back pain?

  Barring a serious condition such as a ruptured disk, scoliosis or a traumatic injury, Dr. Van Oosten explains that the main causes of lower back pain are stress, poor posture, and lack of exercise. All of these factors can have a detrimental effect on the curvature of the spine.  Without proper curvature, the risk of lower back injury increases.

  The spine is an intricate structure: It's sturdy enough to house and protect the spinal cord, yet it's flexible enough to permit movement in all directions. The elastic intervertebral discs, which serve as shock absorbers between the vertebrae, allow spinal mobility while maintaining a high degree of stability.  These discs are susceptible to injury when they're subjected high compressive forces or put into compromising position.

  When in a "neutral" position, your spine has a natural S-shaped curve, and the discs can withstand tremendous amounts of force. Any deviation from neutral alignment can cause disc compression, which may lead to excessive compression on side of the disc and/or extreme bulging on the opposite side.

  "In many cases, being sedentary can lead to poor postural weakness," Dr. Van Oosten says. "Muscles should support the spine, but most people don't exercise and they become deconditioned.  Along with lack of exercise, poor diet and excess weight can exacerbate the postural problems."

  If you have a slouching posture, says Dr. Van Oosten , you put pressure on areas that are not designed for the weight. Muscles tighten in trying to compensate for poor posture.  Over a period of time, this can produce uneven wear and tear on the joint."

Reduce the risk 

Lower back pain is subject to a wide range of treatment. Therapies include heat packs, massage, chiropractic manipulation, steroidal injections, and orthopedic surgery. While the American medical community has a definite prevailing stance about treatment of lower back injuries, Dr. Van Oosten says we need a greater focus on prevention.

  Explaining that the key to prevention is spinal fitness, he says, "To reduce your risk of back injury, it's important to keep your spine in neutral alignment, especially when exercising.  It's essential to keep your abdominal muscles and lower back in good condition. By maintaining torso fitness, it will be easier to support your spine and keep it aligned."

  Always strive for neutral alignment, whether sitting or standing. In general, standing neutral alignment is achieved when the head, neck, shoulder joint, hip joint, knee joint and ankle joint form a straight, vertical line when viewed from the side. The key to neutral alignment starts with the head: If your head drops, your neck bends, often followed by rounding of the shoulders, ultimately leading to rounding of the back and slouching.

  Specific muscle exercises can help strengthen the back and prevent the injuries suffered by millions of Americans. To shore up deconditioned backs, focus on the lumbar extensors and the abdominal muscles. Weak abs allows the belly to sag, creating a greater load on the lower back, forcing it to hold up the mass in front of it. Strengthening the abs promotes a more upright positioning of the spine.

  Exercising to increase the strength of the lumbar extensors will help improve posture and significantly decrease the incidence of back pain. Strong lower back muscles and strong abdominals work together in maintaining a pain-free healthy back.

Dr. Van Oosten advises these two basic back strengthening exercises:

  Opposite arm and leg raises: Start on all fours, resting on hands and knees. You should look straight down, neither tucked nor looking up. From this position, simultaneously raise and straighten your right arm and left leg until they are parallel to the ground (or as close to parallel us you can) without going past the parallel position.  Hold for two seconds and come back slowly to the starting position.  Repeal with left arm and right leg. Start with 10 repetitions on each side and build up to repetitions.

  Basic Trunk Extension: Lie facedown flat on the floor leaving your arms at your side.  Slowly raise your chest off the floor as high as you comfortably can. Hold for two seconds and come back to the floor slowly. Gradually increase until you can do 20 repetitions easily. Try to keep your feet on the ground - either by placing them under a couch or by having a partner hold them down.

Stretches for golfers

Because of the vigorous rotation and side-to-side bending involved in the golf swing, the lower back is a prime area of injury for golfers.  To help prevent injuries, it's important to maintain a good range of motion and build flexibility.  Here are a few stretches to promote greater mobility in joints and in muscles.  Before you do these stretches, spend a few moments walking to raise your body temperature - cold muscles aren't as receptive to stretching as warm muscles.

  Forward bend: Gently bend forward at the waist until you're able to grasp your ankles, bending your knees as necessary. Let your neck and arms relax as you bend forward slowly from the hips. Holding your ankles, straighten your knees until you feel a comfortable stretch in the backs of your legs. Hold 10 to 15 seconds, then slowly stand, bending your knees as you straighten your trunk. ("Gently" and "slowly" are the key words for this stretch.)

  Trunk rotation: Standing with your back to a tree or golf cart rotate your upper body to the right so you can grab hold with both hands without moving your feet.  Look over your left shoulder as you stretch. Increase the tension by pulling yourself around a little farther with your hands.  Hold for 10 to 15 seconds, then repeat to the other side.

  Side bend: Stand with your feet shoulder-width apart and raise your right arm above your head. While keeping your slightly flexed, lean to your left and move your left hand down the outside of your thigh to just above your knee. You should feel a comfortable stretch along the right side of your trunk.  Hold for 10 to 15 seconds, then repeat on the other side.

  Neck rotation: Turn your head to the right, looking as far over your shoulder as possible. Take your left hand and gently push against the left side of your face.  Hold for 10 to 15 seconds, then switch sides.

  Shoulder stretch: Reach across your body and grasp the back of your right elbow with your left hand. Pull that arm across your body and under your chin as far as you can and hold.  Repeat with the other arm.

Sitting lessons

For those of us who spend our workday at a desk, posture problems can be an occupational hazard. Slouching and Ieaning can place unbalanced stress on the entire spine. Dr. Van 0osten has this advice for desk jockeys: "A chair should assist you in maintaining good posture and supporting your spine.