Sit-ups may be bad for low back pain, but being overweight does not cause a slipped disk, and it does not seem to matter what kind of shoes you wear. These facts are among the many interesting results of the ongoing investigation about causes and treatment of low back pain syndromes.

Afflicting 80 percent of the American population at some point in their lives, costing billions of dollars in days lost from work and medical bills and procedures, low back pain is a major epidemic in modern society. Although only 4 percent of those with acute attacks will go on to develop chronic pain, the cost for disability, compensation costs and the psychological toll is staggering.

Research over the past decade has dispelled old theories and myths and, although this condition is far from being well understood, a variety of helpful facts and tools have emerged.

First, low back pain is not only one disease or condition. As doctors proficient in specific diagnosis emerge, treatments are likely to be more specific and therefore more effective.

The most disabling, and the condition best popularized, is that of the "slipped disk". This condition is sometimes called "sciatica" because of its propensity to irritate nerve fibers along the course of the sciatica nerve in the back of the thigh. When severe, this condition may cause pins and needles, numbness or actual muscular weakness in the leg.

A "discogenic history" is the best clue to presence of a herniated disk as the cause of lower back pain. This history is so specific that many patients can be helped by telephone if they live an inconvenient distance from the office. Pain is characteristically worse with sitting. Standing is actually more comfortable. Pain is increased with sneezing, coughing, straining, laughing or bending forward. In milder cases, the patient may experience stiffness or a "twinge" of pain when they stand up after sitting for a long time or getting in or out of a car.

X-rays and electrical studies can lend support to the diagnosis by eliminating other possibilities and confirming pinching of the nerve. Yet by far, the history (and confirmation by careful examination) remain the clinician’s best tools. Recently, MRI (Magnetic Resonance Imaging) has begun to emerge as a non X-ray imaging technique to clearly visualize the disk, spinal cord and nerve roots as they exist. This holds great promise, along with CAT scans, as a test to better define the exact source of pain.

Most patients with a slipped disk can be treated at home. On occasion, the patient should be hospitalized where there are medical complications or when the patient cannot get sufficient care at home.

Being obese and wearing high-heel shoes are not risk factors for back pain. In numerous investigative studies, risk factors that are established include prolonged driving, a sedentary occupation with prolonged sitting, a high number of pregnancies and poor overall physical fitness. Other probable factors include chronic cough, tallness, sports involving twisting (like baseball and tennis), and trauma involving heavy lifting or sudden severe impact.

Patients who rest in bed have been known to return to work earlier than those who stay on their feet. This is because the disk has to be "unloaded" of its body weight in order to "seal back up". Recently, anti-inflammatory medications, similar to aspirin, have been shown to shorten the degree and duration of low back discomfort.

Drs. Donald and Howard Liss are diplomates of the American Board of Physical Medicine and Rehabilitation. Dr. Donald Liss is chief, Department of Physical Medicine at Meadowlands Hospital Medical Center.

As Elder Med America participating physicians, they are able to answer any questions you might have on this topic. Write or call Drs. Donald and Howard Liss, 15 Engle Street, Suite 205, Englewood, New Jersey 07631, (201) 567-2277.