Many practitioners immediately associate back pain, particularly in the lumbar spine area, with muscle injuries due to overexertion. A brief patient interview regarding physical activity usually confirms this diagnosis, as almost everyone is guilty of overexertion, whether it be a sudden spike in activity or consistent, though lower-intensity, overuse over a long period of time.

In many cases, such an approach is entirely proper, as muscle injuries do cause most types of back pain. In these instances, a recovery plan that includes a lower back brace or some other similar device usually both addresses the physical abnormalities and creates a placebo effect.

That diagnosis and treatment plan may be appropriate in other situations as well, because compression certainly supports the area while creating the aforementioned placebo effect. However, new research suggests that this approach may be incomplete.


Nucleus pulposis, the substance that makes up most of the tissue inside each spinal disk, is mostly water. Everyday exertion, gravity, and other such forces squeeze out much of this gelatinous substance on an ongoing basis. Overnight, and during other periods of prolonged inactivity, the nucleus pulposis regenerates. Patients can visibly see evidence of this dehydration/rehydration cycle for themselves, because many people are up to one-half inch shorter when they retire for the night than when they rise in the morning.

Under ideal circumstances, the outer portion of each disk should absorb approximately 25 percent of the spine’s weight load, and the nucleus pulposis should bear about 75 percent. But if the inner part of the disk does not fully regenerate due to dehydration, the majority of the weight load shifts to the outer portion of the disk, creating risk of injury.

So, regular hydration may be a key to preventing back injuries. Furthermore, the movement associated with light exercise and regular physical activity expedites the above-described process, reducing the risk of injury even further.

The eight-serving-a-day rule for hydration is not always accurate. A better approach is one serving of water, juice, or other clear liquid, non-sugared, non-carbonated, non-caffeinated beverage for every twenty pounds of body weight.


Alcohol Consumption

In the 1980s, researchers first theorized that there may be a link between back pain and alcohol consumption, and this idea has been confirmed through additional research, and countless observations, over the ensuing decades.

While the causation is almost irrefutable, the process behind this causation is still debated among experts and practitioners. Some of the more common theories include: 

  • Since alcohol is a muscle relaxant, the abdominal muscles may not fully support the lumbar spine during periods of consumption, creating additional pressure in this area that does not dissipate until the effects of the alcohol wear off altogether.

  • Alcohol is also a depressant that slows the circulatory and nervous systems, thus restricting blood flow in the back and denying essential nutrients to the tissues therein.

  • Alcohol consumption reduces production of certain anti-diuretic hormones, thus increasing the risk of dehydration. In fact, the “hangover” headache is usually related to dehydration.

  • Chronic alcohol use is sometimes associated with depression, a state that worsens certain back and neck conditions.

Decreasing alcohol consumption, or at least increasing water consumption in the immediate aftermath, can reduce some of these symptoms and strengthen the patient’s lumbar spine area, thus avoiding back pain.

As a practical matter, practitioners should consider modifying the patient interview mentioned earlier. Instead of simply looking for evidence of overexertion, doctors should also inquire about other personal habits, specifically water and alcohol consumption. Many times, if the patient is properly informed about the risks associated with these behaviors, the patient may voluntarily undergo behavioral modifications, obviating the need for more aggressive physical treatments.

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