Tag Archives: back pain

Back pain – the downside of being upright

In any group of people, asking about back pain will produce nods and frowns. About 80 percent of adults experience low back pain at some point in their life, and it’s the most common cause of job-related disability, a leading contributor to missed work days. About 20 percent of people affected by acute low back pain develop chronic pain.

Back pain is often associated with general degeneration of the spine due to normal wear and tear with aging. The discs begin to lose fluid and flexibility, which decrease their ability to cushion the spine. The likelihood of back pain also increases among people who are not physically fit. An increasing amount of research points to a hereditary component, identified by DNA analysis of families with widespread back pain. Jobs that require heavy lifting, pushing, or pulling have a higher incidence of back pain. At the opposite end of the physical demand spectrum, a desk job may also contribute to back pain, as the sitting position increases the pressure within the lumbar discs. Finally, there is clear evidence that smoking leads to premature degeneration of the lumbar discs, with an increased likelihood of back pain.

Fortunately, surgery is rarely indicated, and there are a multitude of useful nonsurgical treatments, including the application of heat and/or cold and massage. Recommendation for bed rest should be limited, as those who avoid bed rest are more likely to improve faster. Other common treatment methods include over-the-counter medications, physical therapy, and spinal manipulation. More involved but less frequent options can include spinal injections provided in a pain clinic.

Once chronic back pain has developed, the emphasis should be on maximizing symptom management. For those with a desk job, standing and walking frequently during the work day can be very helpful. Ergonomically designed furniture, such as standing desks and lumbar support chairs, may help to reduce symptoms, with particular attention to the most appropriate height for the work surface.

The benefits of a regular exercise program as the most effective tool for management of chronic back pain have been clearly demonstrated. The most important factor is to identify an individual program that works best, and then remain committed to it. This can include walking, swimming, cycling, yoga, low-impact aerobics, and many other regimens.

Affliction of back pain has been noted throughout human history. With our upright posture, the spine bears significant stress regardless of our level of activity. The future of spine care will be best focused on improved means of preventing the degenerative changes that lead to back pain, as well as identification of the most effective and consistent means of diminishing its impact.

TIMOTHY MILLEA, M.D. has practiced as an orthopedic spine surgeon in the Quad Cities area of Iowa and Illinois since 1992. He is an active member of the Catholic Medical Association and serves on the board of directors, as well as being CMA’s state representative for Iowa, and president of the St. Thomas Aquinas Guild of the Quad Cities.

Back pain and the realities of surgical recovery

Statistics show that 80% of us will have at least one episode of low back pain during our lifetime. This is especially important when you consider these factors will increase your risk: obesity, smoking, age, female, physically strenuous work, sedentary work, stress, job dissatisfaction, anxiety or depression.

healthnetThere are four main regions of the back: Neck: seven cervical vertebrae (C1-C7), Upper back: 12 thoracic vertebrae (T1- T12), Lower back: five lumbar vertebrae (L1-L5), and Base of spine: sacrum, coccyx (S1- S4). Low back pain is most commonly found in the L4, L5 and S1 areas. However, most people (>85%) have “nonspecific low back pain,” which means there isn’t a specific disease or abnormality in the spine clearly causing the pain.

Causes of low back pain include: degenerative disc disease (wear and tear causing breakdown of spinal discs or loss of fluid in the discs), facet joint arthropathy (arthritis in joints connecting the vertebrae to one another), spondylolisthesis (one of the vertebrae of lower spine slips forward), herniated disc (outer covering of disc is torn, soft inner tissue extrudes), lumbar spinal stenosis (open space inside the vertebrae is narrowed), and spinal compression fractures.

Symptoms include: radiculopathy (nerve root becomes irritated, causing radiating pain, numbness, etc.), sciatica (one of the five branches of the sciatic nerve becomes irritated), neurogenic claudication (pain runs down the back to buttocks, thighs and lower legs, often on both sides and may cause weakness and limping).

Diagnosis: Imaging studies including X-rays, MRI, CT scan. It’s interesting to note that a patient may have an abnormality on imaging and actually experience no symptoms.

Treatment: Remaining active helps to relieve muscle spasms and prevents loss of muscle strength. Also helpful: heat, pain meds, exercise to increase back flexibility and strengthen core muscles, physical therapy, chiropractic manipulation, acupuncture, massage, trigger point injections into the soft tissues of back or epidural injections, traction, ultrasound, electrical nerve stimulation, low level laser therapy.

Surgery is only recommended if more conservative treatments fail. Options include spinal fusion (fusing two or more vertebral bodies together), lumbar disc replacement (may help preserve normal range of motion), discectomy (removes part of/entire disc to relieve pressure on the nerve roots), open discectomy (standard surgical incision), micro discectomy (smaller incision to remove of disc fragment).

Spinal fusion recovery. Pain should decrease gradually. Usually the worst is over by four weeks. However, some patients have pain for three to six months after surgery. Avoid bending, twisting or lifting anything over 10-15 lbs. If a back brace is recommended, wear it for six weeks to three months after surgery. Driving may be allowed after four to six weeks. Outpatient physical therapy may be started at six weeks.

At three to six months’ post-surgery, exercise is the central component of the recovery process. Focus should be on strengthening your back and core muscles for support. Complete recovery may take up to eight months. Bone continues to evolve for 12-18 months.

SUSAN LOCKE, MD is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

Back in business: John Hunt values Healthnetwork’s assistance

John Hunt has always valued Legatus’ relationship with Healthnetwork Foundation, but when his severe back pain incapacitated him late last year, Legatus’ executive director realized that value firsthand.

Pat Ridolfi, Healthnetwork

Pat Ridolfi

On Christmas Eve, Hunt experienced a severe attack of back pain which traveled from his lower back and radiated down his right leg. He spent two hours on the floor, unable to move until his son found him and helped him into a chair.

Doctors subsequently diagnosed him with retrolisthesis of L1 and 2. Hunt had been going to a chiropractor on a maintenance basis for manipulation for a number of years, but he knew this episode was different. He realized his situation would require more than manipulation because simple movements like standing too long or bending over to pick something up proved to be too difficult.

Hunt called Healthnetwork and was immediately referred to the Rehabilitation Institute of Chicago (RIC), the No. 1-ranked rehabilitation hospital in the U.S. Even better, Hunt and his wife Kathie were in Chicago at the time, so travel was not an issue.

Pat, a Healthnetwork medical coordinator, secured Hunt’s first appointment the next day. When he arrived, Hunt was greeted at the elevator by Matthew Ginsberg, global patient services business process manager, who went through the necessary paperwork so he could get started.

Hunt saw Dr. Alexander Sheng, who was able to identify the crux of the problem. He ordered the appropriate scans of Hunt’s back and diagnosed the problem immediately. Hunt was then introduced to Davalyn Partain, who began his physical therapy program that day.

John Hunt, Legatus’ executive director, and his wife Kathie are founding members of Legatus’ Chicago Chapter

John Hunt, Legatus’ executive director, and his wife Kathie are founding members of Legatus’ Chicago Chapter

Over the next two weeks Hunt had a series of follow-up visits to RIC and received exercise assignments between visits. His short-term goal, to fulfill his responsibilities at the Annual Legatus Summit by Jan. 28, was accomplished.

“My experience with Healthnetwork reaffirmed my belief that Legatus’ affiliation with this organization is a valuable Legatus member benefit that should be called upon whenever a family health crisis arises,” Hunt said.

Hunt said that what impressed him the most was the manner in which he was received at RIC and how diligently and professionally they helped him achieve his short- and long-term goals. Hunt said his rehabilitation continues to go well, and he is grateful for Healthnetwork’s assistance.

PAT RIDOLFI is a medical coordinator at Healthnetwork Foundation.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

When is back pain an emergency?

SUSAN LOCKE helps readers understand when low back pain is and isn’t an emergency . . .

health

Most cases of low back pain don’t require urgent care, but patients should seek a doctor immediately if they experience low back pain as a result of severe trauma, or if low back pain is accompanied by any of the following four situations.

1. Progressive leg weakness and/or loss of bladder or bowel control. These symptoms may be “cauda equina” syndrome where there is severe compression of the nerves in the lower spine. Left untreated, cauda equina syndrome can result in permanent paralysis, loss of sensation in the areas below the lumbar spine and loss of bladder/bowel control.

2. Unexplained weight loss, loss of appetite, pain and neurological problems. These symptoms may be indicative of a spinal tumor.

3. Severe, continuous abdominal and lower back pain. This could be symptoms of an abdominal aortic aneurysm.

4. Sustained fever and increased pain. These symptoms are consistent with spinal infection (osteomyelitis).

A diagnosis will typically classify the patient’s condition as one of three types of pain. Patients can experience one type, and based on the progression of their condition, may experience another.

• Low back pain, the most common type of back pain, is confined to the lower back only and does not travel into the buttocks or legs. The pain may be sharp or dull and may be severe enough to limit everyday activities. Pain may worsen with certain activities (such as sports) or physical positions (such as sitting for long periods) and is relieved by rest. Most low back pain is acute (short-lived and heals within six to 12 weeks).

• Sciatica is the second most common type of pain caused by a lower back problem. Caused by conditions that compress the nerve roots of the sciatic nerve, the pain is more severe in the leg than in the back. Symptoms are pain, numbness and/or weakness in the lower back and on only on one side of the lower body, affecting the buttock, leg, foot, or the entire length of the leg.

• Low back pain with referred pain that radiates to the groin, buttock and upper thigh, but rarely below the knee. Patients describe the pain as dull and achy with varying intensities. Low back pain with referred pain is similar to axial pain and is managed with similar treatments.

Treatment for lower back pain depends upon the patient’s history and the type and severity of pain. The vast majority of lower back pain cases get better within six weeks without surgery, and lower back pain exercises are almost always part of a treatment plan.

If pain persists or worsens, more involved diagnostic and surgical procedures may be recommended. Rest for a few days to allow injured tissue and nerve roots to begin to heal. Heat and ice packs help relieve most types of low back pain by reducing inflammation. Over-the-counter medications and prescription medications are available to help reduce symptoms of lower back pain.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org