Slipped discs. Pinched nerves. Bone spurs. Sciatica. Muscle strains. Aches and pains.
We put our backs and necks through a lot every day. That can add up to a lot of wear and tear over the years. The agony of back and neck pain can keep you from the people and activities you love.
The good news, according to The Christ Hospital Physical Medicine and Rehabilitation physician
Jennifer Chung, MD, and spine surgeons
Jared Crasto, MD, and
Ryan Seal, MD, is that there is hope and many options for reducing or eliminating pain.
1. You Are Not Alone.
One in three people will experience neck pain at least once a year. Low back pain is second only to respiratory illness as the main reason to visit a doctor, with 80% of adults complaining of meaningful low back pain at some point in their life.
“Many of us live with neck pain and back pain, including degenerative disc disease, and if we can make a few changes in our lifestyle and activity levels, the pain may dissipate and there is no further intervention that is required," adds Dr. Chung.
2. There is Hope.
“90% of low back pain will resolve within one year of symptom onset," says Dr. Crasto. “Sometimes this depends on the source (of the pain), but certain treatments can also expedite resolution, and that's where we come in."
Dr. Seal encourages patients to focus on their symptoms. as opposed to the actual diagnosis itself or their imaging findings. “Imaging defines the condition and really diagnoses it. That's important because it lets us know the problem exists and where it is, but at the end of the day, symptoms are the most important thing. And that's what really guides our treatment."
“There are always treatments we can provide to help you feel better, even if your pain is not debilitating," says Dr. Chung.
3. Effective Non-Surgical Treatments are Available.
Luckily, there are many non-surgical options to address back and neck pain. Relief for acute back or neck pain can often be found through home treatments such as applying cold or heat, topical ointments and non-narcotic medications. Manual release therapies such as massage, cupping, or foam rollers, trigger release therapies, cervical collars or lumbar pillows can also be helpful. Many people find relief using TENS (transcutaneous electrical nerve stimulation) units, devices that send small electrical currents to targeted body parts.
These therapies can be very effective, but Dr. Chung recommends that you talk to your physician first. “The correct diagnosis is the most important first step to get you feeling better," says Dr. Chung. “Treatments will not work if you are not treating the right issue or using the correct modality."
“We start with physical therapy and different activity modifications - like weight loss, for example," continues Dr. Chung, “and then ultimately decide if injections, acupuncture or other non-surgical treatments can help with mechanical and structural spine pain."
Your doctor and physical therapist can also guide you on the correct use of home treatments. For example, Dr. Chung recommends that people not use braces for too long. “When using braces, your body can quickly become dependent on them, resulting in muscular weakness and deconditioning. Generally, my rule of thumb is to limit brace wearing to no more than three to four hours per day."
Interventional Non-Surgical Treatments
When home therapies aren't enough, there are still many non-surgical options. One of the most common interventional treatments are epidural steroid or cortisone injections. “If you have mostly sciatica type pain down the leg or radiating into the arm, that is when epidural steroid injections are most indicated," says Dr. Chung.
Facet mediated or arthritis pain can be treated with ablation therapy, where an electrical current is sent to the medial branch nerves in the facet joints that have become pain generators, continues Dr. Chung. “The electrical current basically deadens those nerves. They do unfortunately grow back, but the pain relief could last anywhere from 6 to 12 months, sometimes even longer."
Other options include nerve stimulators. “The spinal cord stimulator produces an electrical current to block pain signals from the spine to the brain, resulting in pain relief," explains Dr. Chung. “One newer treatment is a peripheral nerve stimulator and that's more for axial neck and low back pain. A small electrode - almost the size of a needle- is placed under the skin near the spine to block pain signals."
Many people ask about regenerative medicine options, such as platelet-rich plasma (PRP) stem cell, or prolotherapy, says Dr. Chung. “The goal of these treatments is to regenerate and heal damaged tissue. PRP and stem cells are taken from your body: PRP from your own blood and stem cells from bone marrow."
The downside of PRP and stem cell therapy is the out-of-pocket cost – without insurance coverage- and these treatments may not necessarily work for every patient. “I am always really candid with my patients that there is no guarantee with outcomes," continues Dr. Chung. “But if you want to avoid surgery at all costs, and it is something that you can afford, we can refer you to our partners in the community who perform these procedures in the spine."
4. Surgical options are available, too.
If you have symptoms that have failed to respond to the appropriate non-surgical measures, it may be time to consider surgical options. “There are certain conditions that are at risk of progression," says Dr. Crasto, “and if they do progress, they could cause nerve or spinal cord damage. These are conditions where the spine is unstable due to severe degeneration, deformity, trauma, or another process degenerating the bone, such as a cancer or infection."
Two other conditions indicate it may be time for surgery, says Crasto. “Severe spinal stenosis in the thoracic or lumbar spine, known as Cauda Equina Syndrome, compresses the nerve roots and causes severe lower extremity weakness, loss of bowel or bladder control, and numbness. Severe spinal stenosis in the cervical or thoracic spine, known as Myelopathy, compresses the spinal cord itself. Myelopathy can cause symptoms such as balance or gait dysfunction, loss of fine motor control or hand dexterity, and loss of bowel or bladder control. So, any of these could indicate it's time to consider surgical treatment."
There are three major types of spine surgery, and they can be accomplished in different ways, according to Dr. Crasto. “These include decompression surgery where pressure is taken off the nerves; stabilization or fusion surgery where the bones are fused together to stop the motion at that segment; or correction of a spinal deformity. And these surgeries are not mutually exclusive. Some surgeries will address one, two, or all three of issues at the same time."
Once the pain has subsided, preventive measures such as exercise to strengthen core muscles and improve posture can be very impactful. “One of the most important things to do for low back problems in general is lumbar core strengthening exercises. Keeping a strong core can take tension off the back and disc spaces—even in the setting of a prior spinal surgery where there could be some scarring of the posterior spine musculature," says Dr. Crasto.
Modifying your workstation to reduce strain, losing weight, stopping smoking, and meditation or deep breathing to address stress and anxiety are also helpful.
It may come as a surprise to most people that
smoking is bad for your back. "What smoking does and why we hate it as doctors, is it really impairs blood flow to areas that already don't have great blood flow," explains Dr. Crasto. Deprived of oxygen-rich blood and nutrients, the spine can't heal as quickly when injured. Smokers also have a higher incidence of
degenerative disc disease.
If the thought of quitting smoking seems daunting, The Christ Hospital has many
smoking cessation resources to help.
5. Don't Wait.
“I cannot emphasize enough the importance of getting the right diagnosis. And not waiting too long to be seen by one of us," says Dr. Chung. “People often think their pain is not “bad enough" or that they are wasting our time by coming in for an appointment. And that is never the case. If your pain is affecting your day-to-day activities and your quality of life, we are happy to see you and figure out how we can help you feel better."
Dr. Seals adds, “I think oftentimes people get a little scared of the idea of surgery on their spine. I don't think we ever recommend surgery unless we feel it's dangerous not to do surgery. There are many options for our patients. We educate you on what those options are, so that you can make the best decision for you."
Bonus Q & A with our Physicians
Q: I sit at a desk all day. What suggestions do you have for improving my workstation to prevent back and neck pain?
If you're seated at a desk, a few things can help. One is that your seat height should be set such that the degree at which your knee bends is about 90 to 120 degrees. You should raise your seat height to achieve that or you can put something like a stool underneath your feet.
You should also have some sort of lumbar support on your chair so that you maintain the normal curvature at the small of your back. The top of your monitor should be aligned with your eye level so that you're either looking straight ahead or just down, but you can look with your eyes. We've found that posture like this allows you to work for the longest period of time in a seated position without getting any additional muscle strain.
Something that's also important to follow is that if you're working like that for an eight-hour day, then probably once an hour you should get up and walk around for at least two to three minutes. And you should also give your eyes a break by looking past your computer screen at something off in the distance for at least one to two minutes an hour.
Q: When I garden or am active for more than an hour or two, my lower back starts to ache. Where can I find a site where I can find some basic exercises to help?
I have stretches and handouts in my office – we all do - for patients that I think are easy. But for sciatica pain, if you wanted a Google buzzword, I think it would probably be a McKenzie program. These are exercises designed to improve spinal mobility and posture. It's best to start with a physical therapist who can give you a proper evaluation and instructions.
Dr. Crasto: There is also a free app for your phone that's called Back Doctor. It'll give you guided strength exercises to do each day. And once you pass each exercise, and make sure you're doing it safely, then you can go to the next. I think the best way to do this, though, is through the guidance of a physical therapist, but if you don't have time or you want reading materials, I think the app is good.
Q: Is golf a bad sport for the lower back if one has bulging discs?
Rotational exercises like golf tend to stress the disc spaces. But doing lumbar core strengthening exercises can allow for internal stabilization during golfing that may lessen your symptoms. Also working with a trainer to optimize your form and mechanics would help.
Q: Do you have any advice for continuing chest musculoskeletal pain three years after coronary artery bypass graft? Stress test and X-ray reveal no abnormalities.
Dr. Chung: There are many treatments for this, with focus on the soft tissue involvement. I have effectively treated a lot of post op pain with trigger point injections and dry needling.
Q: Is there a role for good nutrition in these spinal pain issues?
Absolutely. Some anti-inflammatory diets have been helpful for patients. Weight loss can help most patients with spinal issues!
Q: Should I go to my primary care provider to schedule an appointment, or do I call the Joint & Spine Center directly?