Back and joint pain in women over 50

Jan 29, 2010 at 3:56 p.m. ET

Back and joint pain are an all too common and increasingly debilitating medical condition in the US. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a staggering eight out of 10 Americans will suffer from back pain at some point in their lives, and experts say a growing 83 million people suffer from chronic pain. Women over 50 years old are at particular risk of back and joint pain, particularly those who are sedentary or overweight. The easy solution for pain, of course, is anti-inflammatories and pain pills, but the long term solution is fixing the root of the problem. Physical therapist Mitchell Yass, author of Overpower Pain: The Strength Training Program That Stops Pain Without Drugs Or Surgery, gives us the dish on the causes of back and joint pain and the best way to get rid of pain for good.

Senior woman with back pain

A passion for preventing back and joint pain

Mitchell Yass, PT, founder of PT2 Physical Therapy and Personal Training in Long Island, New York, has spent his career teaching thousands of clients the cause of and medication- and surgery-free solution for chronic back and joint pain. By prescribing physical rehabilitation programs that include strength training and stretching, Yass helps clients achieve the skeletal realignment and muscular balance necessary to prevent and resolve back and joint pain for people of any age.

Causes of back and joint pain

SheKnows: What are the most common causes of back and joint pain in women 50 plus?

Mitchell Yass: The most common cause of back pain and joint pain in women 50 plus is the same cause as any other age group or gender: muscle weakness or imbalance. Even if pain is experienced in a joint, the cause is due to a misalignment of the joint surfaces caused by a muscle weakness and/or imbalance. This creates abnormal joint surface rubbing, which causes irritation and pain.

Pain is not a necessary part of aging

SheKnows: Research indicates 80 percent of people experience back pain, and many people believe it is just a part of the aging process. What is your opinion?

Mitchell Yass: At the lower back, the most common cause is a muscle imbalance between the front thigh and back thigh muscles. This causes people to severely arch their back. The lower back muscles become severely shortened in this position and susceptible to straining and going into spasm. There is a tremendous amount of bad information that states that pain in older individuals is due to aging or, in women, due to osteoporosis. This couldn't be farther from the truth.

Studies have shown that loss of bone and muscle and increased fat deposits are not a part of aging but a part of a lifestyle change associated with the older population. If you can accept that the cause of most pain is muscle weakness and/or imbalance, then the extension of this is that since loss of muscle mass and weakness is not part of aging, then pain associated with muscle weakness is not part of aging.

How to prevent back pain before it starts

SheKnows: How can back and joint pain be prevented in the first place?

Mitchell Yass: I have a general principle that can explain what causes pain and other symptoms. Strength = Function. What this means is that when people want to perform a functional activity, ultimately, it is muscle that allows them to perform the task. If they do not have enough muscle, there will be a break down in the mechanism that attempted to perform the activity. This can present as pain, swelling, an altered sensation, weakness or lack of function. The problem with the medical establishment is that they focus on the symptom. They try to determine how they can mask the symptom through treatments like cortisone shots, epidural nerve blocks or medications. Once a symptom is created, the first question is to determine what caused the symptom. I am sure if they asked this question, it would be identified that the cause was weakness associated with performing an activity. For people who are somewhat deconditioned, activities that create symptoms can be as benign as climbing stairs or walking for a short distance.

The key to preventing back and joint pain: Prevention of pain can be accomplished by utilizing strength training to achieve proper strength, flexibility and balance of all musculature. This will allow functional activities to be performed without creating a symptom.

Conventional back and joint pain treatments

SheKnows: What are the most common or conventional treatments for back and joint pain?

Mitchell Yass: The most conventional treatments for back and joint pain are medication or other masking protocols such as cortisone shots. The extent to which medication is being used is very concerning. The medications typically prescribed include addictive narcotics such as Vicodin or Oxycodone. These drugs fall into a category that chemically is the same as heroin. Other drugs that are used include Cymbalta and Neurontin. Cymbalta is an anti-depressant and Neurontin is a anti-seizure medication. None of these drugs attempts to address the cause of pain so the time frame for taking these drugs appears to be unlimited.

There are other conservative forms of treatment such as physical therapy, chiropractic and acupuncture. Again most of these treatments are considered palliative, meaning that they attempt to diminish the symptom without attempting to treat the cause. When all of these methods fail, surgery is the final option.

Unfortunately, surgery is performed because no other form of treatment worked and not because the clinical indications showed that the cause of pain could be resolved through surgery. Surgeries that fail at resolving neck and back pain are even termed "failed back surgery syndrome," coined by those performing the surgeries to explain the continued or increased pain experienced after the surgery.

Chronic pain is a chronic healthcare problem

SheKnows: What is the success rate of conventional treatments?

Mitchell Yass: Look at some of the statistics regarding the medical establishment's success in resolving pain. At least 83 million people are estimated to have chronic pain. This number is supposed to go to 150 million in the next 10 years. Up to 30 billion dollars a year is spent just on pain killers. Five to 10 years ago there was no such thing as a pain management clinic; I would suggest it is the fasting growing business in healthcare. The number of MRIs requested has grown exponentially in the past five to 10 years. It is estimated that back pain alone costs the economy 100 billion dollars! These are not statistics indicating success, such as the fall in cases of open heart surgeries due to stents or angioplasties or the drop in cases of colon cancer or prostate cancer due to the advent of the PSA test or the colonoscopy. There is no question that in the area of pain, the medical establishment is failing miserably and Americans are suffering.

Diagnostic problems

SheKnows: How does your approach to back and joint pain differ?

Mitchell Yass: I designed my method of diagnosing and treating pain after I found that the education I was given did not prepare me to be able to identify the cause of pain and treat it effectively. It was through an analytical evaluation of pain that led me to realize that the cause of most pain is not the result of variations to the structures of tissues but an alteration of the forces that are applied to tissues.

These forces are in the form of muscle pulls that can vary when not sustained in a strengthened, flexible and balanced manner. My method has now been validated by many studies showing that the structural elements being treated as the cause of pain such as herniated discs, arthritis, stenosis and meniscal tears can be found in as many people with absolutely no pain as those with pain. The conclusion of these studies is that there is very little correlation between MRI and x-ray findings and pain.

Risks of conventional back and joint pain treatments

SheKnows: Given that most people are treated with conventional methods, what are the risks associated with medications and surgery?

Mitchell Yass: Taking addictive, narcotic medication can have terrible risks. Addiction is a very serious possibility. It is so common that I have seen commercials for programs to help resolve addiction to pain medication. The almost comical part of the situation is that the physicians performing the detox programs are the very physicians who created the addiction. Other medications have other severe risks and side effects.

Having surgery is always risky. In the case of pain, having surgery seems to have an even greater risk. It is estimated that almost 50 percent of all neck and back surgeries end up with the patient having the same level of pain or worse. These are not percentages that indicate that the cause of pain is properly understood. The balance of the treatments available is not necessarily a risk to your health. The risk is in the fact that they don't attempt to address the cause of pain so there is a severely increased risk that your pain will continue and you will have to suffer for a longer period of time.

Exercise offers long term healing

SheKnows: What are the advantages of strength training and flexibility training in treating or preventing back and joint pain?

Mitchell Yass: Most pain is due to lack of strength, which limits an individual from performing functional activities without creating symptoms; the advantage to strength training and flexibility training is that you can prevent most pain.

What is also very important to understand is that strength training can prevent arthritis from developing and reverse systemic disease processes associated with cardiovascular disease, osteoporosis, obesity, type 2 diabetes and other chronic illnesses. Strength training is recommended by the Center for Disease Control and Prevention, the American Heart Association and the American College of Sports Medicine. Not only can strength training resolve or prevent the onset of pain, it has a value to maximizing the function of the body.

Be your own best advocate

SheKnows: What is your advice to women who are experiencing back and joint pain -- what can they do to best ensure they get successful, long-term relief?

Mitchell Yass: Do not fall into the standard method of going to a medical practitioner who simply takes some diagnostic tests and establishes the cause of your pain through the tests alone. A clinical evaluation is the only method of determining the cause of pain. There must be an attempt to correlate a specific symptom with a specific cause. I can promise you that 10 women with pain at 10 different locations in their legs can be given the same diagnosis of the same herniated disc once an MRI finds the same disc herniated. The fact that their symptoms are completely different (which would certainly suggest different causes) will be completely ignored if the MRI finding is the only method for establishing cause.

Attempt to make sense of your symptoms:

  • If the pain is at the lower back or gluteal region not directly on the spine, I would suggest that the tissue causing your pain is muscular.
  • If pain is at a joint, don't accept that an x-ray or MRI was taken and that you have arthritis causing your pain. The determining factor of whether arthritis is causing pain at a joint is based on specific clinical tests not diagnostic tests.
  • Don't take medication for pain as a treatment protocol. Cortisone shots are a ridiculous response to pain at a joint. These simply mask the symptoms and, in my experience, the pain returns fairly quickly.
  • Don't accept any one who tells you the key to resolving your pain is stopping any activity that incites your pain. For example, buying a new bed or a pillow or sleeping on a recliner are all suggestions that will never address the cause of pain.
  • Establish the cause and resolve it with a qualified professional.

The best thing I can offer as advice is to search out a medical practitioner who can not only explain what tissue is causing the pain signal you are experiencing but how he or she knows that it is not coming from other tissues in the same area.

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