ROUTINE ALIGNMENT PREVENTIVE EXERCISES, IMPROVED POSTURE CAN STAY PAINFUL BACK DAMAGE.

Byline: Mariko Thompson Staff Writer

WE SLUMP in the car on the way to work. We slouch in front of the computer. We don't exercise. Is it any wonder that our poor backs ache?

Next to the common cold, lower-back pain is the second-most-common reason Americans under age 45 cite for missing work. Four out of every five Americans will suffer a bad bout of lower-back pain at some point in their lives, according to the American Academy of Orthopaedic Surgeons.

Often, the culprits are poor posture and weak core muscles in the abdomen and back. The lower back allows the body to twist, turn and bend. Without proper alignment and conditioning, something as minor as bending over to pick up a piece of paper on the ground can trigger back pain, said Cheryl Resnick, assistant professor of clinical physical therapy at the USC Keck School of Medicine.

``It's unfortunate, but Americans do a lot of sitting,'' Resnick said. ``You become tight. Unless you have an active exercise program, you spend your whole day in a flexed position.''

For the majority of people, the soreness or pain will be little more than a nuisance, clearing up within a month. About 10 percent require intervention, starting with biomechanics, exercises or medication and then moving to more serious treatments if needed, said Dr. Brett Rosenberg, an orthopedic surgeon with Orthopedic Consultants in Agoura and Encino.

``As we age, we decondition ourselves,'' Rosenberg said. ``On top of that there's the question of whether humans have evolved so that our low backs can withstand the test of time. We have to do everything in our power to keep ourselves conditioned to counteract this effect.''

At Kaiser Permanente in Woodland Hills, physical therapist Justin Hamilton will start with strengthening and stretching exercises and look at posture issues. How does the person sit at work? Is the car seat adjusted properly? How does he sleep? Many people are so accustomed to slouching that they don't know how to sit straight anymore. Hamilton will sit next to his clients and move them into the proper position.

``We teach the ideal posture,'' Hamilton said. ``We teach them the neutral position, ears over shoulders, shoulders lined up over pelvis. We want a 90 degree bend in the knees.''

Good posture doesn't get a break at home either. People who like to sprawl on the couch with their feet up aren't doing their backs any favors.

``You need to get your feet on the floor and adjust the pillows so that you sit more erect,'' Resnick said. ``You also need to find a way to support your arms.''

Alignment also can be thrown off by two everyday items, wallets and purses. Men often leave their wallets in the back pocket, which causes them to sit unevenly. Women tote overladen purses on one shoulder.

``For chiropractors, it's not just about aligning the spine but educating people on what went wrong,'' said chiropractor Ron Marinaro of the Pain Relief Center in Studio City. ``There's a reason your body is hurting.''

Even people with good posture run the risk of back injury if they sit for long periods of time. Back experts say it's important to move around every half hour. Take a walk around the office. Shrug your shoulders by raising them toward your ears and down again. Squeeze the shoulder blades together by placing your hands behind your head with the elbows out. Do isometric exercises in the car by contracting and holding your abdominal muscles for the length of a red light.

If first-line treatments of exercise, ergonomics and medication don't solve the problem, orthopedic surgeons will do an MRI. As people get older, the discs that cushion the vertebrae can dry out and protrude into the spinal canal.

``If you did an MRI on everyone over age 40, about 60 percent would show some evidence of protrusion,'' Rosenberg said. ``Few are symptomatic. That's why we don't rush to get an MRI. We try to treat conservatively.''

Sometimes the herniated disc presses on nerve roots, causing a sharp, shooting pain in one leg, a condition known as sciatica. Other signs of a herniated disc include numbness, weakness or tingling in one leg, and a burning pain centered in the back, according to the American Academy of Orthopaedic Surgeons. Emergency situations that may require immediate surgery include loss of bladder or bowel control, severe numbness in the groin area, or inability to walk, Rosenberg said.

Options for herniated disks include epidural injections or surgery. Though back surgery today is far less invasive, Rosenberg calls it a worst- case scenario. In general, only patients who suffer from leg pain make strong surgical candidates, he said.

Ten years ago, Steven Feder had lower-back surgery to relieve pain from a herniated disc. A writer and director, Feder spends a lot of time in front of the computer. He didn't change his habits after the surgery, and soon another disc started to degenerate.

Rather than go through another surgery, the 44-year-old Studio City resident turned to Marinaro at the Pain Relief Center. He started getting weekly chiropractic adjustments and massage therapy. He bought an ergonomically correct chair for his office and takes breaks every half hour to stretch and walk across the room. After the surgery, Feder had a tough time jogging. Now he runs 20 miles a week.

``It makes a world of difference,'' Feder said. ``Ten years later, I'm more active than ever before.''

Back orders

The American Academy of Orthopaedic Surgeons suggests some of the following exercises to keep the back muscles strong and flexible. For more information, visit orthoinfo.aaos.org and click on the icon for spine.

Wall slides: Stand with your back against a wall with feet shoulder-width apart. Slide into a crouch with the knees bent at a 90-degree angle. Count to five and slide back up the wall. Repeat five times.

Leg raises, back and hip: Lie on your stomach. Tighten the muscles in one leg and raise it from the floor. Hold your leg up for a count of 10, then return it to the floor. Do the same with the other leg. Repeat five times with each leg.

Leg raises, stomach and hip: Lie on your back with your arms at your side. Lift one leg off the floor. Hold the leg up for a count of 10, then return it to the floor. Do the same with the other leg. Repeat five times with each leg.

Partial sit-up: Lie on your back with knees bent and feet flat on the floor. Slowly raise your head and shoulders off the floor and reach with both hands toward your knees. Count to 10. Repeat five times.

Back leg swing: Stand behind a chair with your hands on the back of the chair. Lift one leg back and up while keeping the knee straight. Return slowly. Raise the other leg and return. Repeat five times with each leg.

Back stretch: Lie on your back with knees bent and feet flat on the floor. Raise your knees toward your chest. Place both hands under your knees and gently pull your knees close to your chest. Do not raise your head. Do not straighten your legs as you return your feet to the floor. Repeat five times, several times a day.

Back bend: Stand with your feet slightly apart. Place your hands in the small of your back. Keep your knees straight. Bend backward at the waist as far as possible and hold the position for one or two seconds.

CAPTION(S):

2 photos, 2 boxes

Photo:

(1 -- cover -- color) your aching back

Although most of us will experience this pain, there are ways to ease the suffering

(2) Ron Marinaro of Studio City's Pain Relief Center adjusts the neck of Steven Feder, a writer and director who has already had back surgery and is intent on avoiding another operation.

Michael Owen Baker/Staff Photographer

Box:

(1) Back orders (see text)

(2) EXAMINING THE LOWER BACK

SOURCE: Family Practice notebook.