Back Pain - Part II

Last week, we discussed some of the causes of back pain and things that can increase your risk of developing back pain.  This week let’s focus more on how back pain is diagnosed and treated as well as what you can do to help prevent it from happening to you.

 If you have back pain, what will your doctor do to determine the cause?

Your doctor will likely do the following:

• Ask a lot of questions about the pain that you are having, such as the location, if it radiates to other places, if it is associated with weakness or numbness, and other associated symptoms.

• Examine your back, do a good neurologic exam, including checking your reflexes, and assess your ability to sit, stand, walk, lift your legs, etc.

Depending on what your doctor finds on the history and exam, you might need other tests, such as:

• X-ray - Can show spine alignment, whether you have arthritis, or broken bones in the spine.

• MRI or CT scan - Can show bones as well as soft tissues, such as herniated discs, tendons, and nerves.

• Blood tests - Can show signs of infection or other things that might cause back pain.

• Nerve tests - An EMG test measures the electrical impulses produced by nerves and how your muscles respond. This can show evidence of pressure on a nerve from a herniated disc.

How is back pain treated?

It may surprise you to know that most back pain gets better within 2-4 weeks with simple home treatment. Here are the recommended home treatments:

• Over-the-counter pain relievers - Such as Tylenol, Advil, or Aleve.

• Ice packs or heat packs - Used intermittently for short periods of time.

• Continue your activities as much as you can - Bed rest is NOT recommended. Avoid heavy lifting. Try light activities such as walking. Advance your activities slowly as you tolerate them.

What if this home treatment does not work after a month?

If you are not improving, you should see your doctor for further tests or for additional treatment, which might include:

• Prescription anti-inflammatory medications

• Muscle relaxers

• Physical therapy - Focusing on exercises that improve flexibility and strength in your back and abdominal muscles as well as improving posture and lifting techniques.

• Antidepressant medications - Some antidepressant medications improve pain, even in patients who do not have depression.

If you continue to have pain, you may be referred to a spine surgeon or pain management doctor for further testing or treatment.

Can you prevent back pain from developing?

You are likely to avoid initial development of back pain or prevent recurrence of back pain by improving your physical condition and learning and practicing proper body mechanics. Here are the things that you can do to keep your back healthy and strong:

• Aerobic exercise - Do low-impact aerobic exercise regularly, such as walking or swimming, which can increase your strength and endurance.

• Core exercises - Exercise that strengthens your core (abdominal and back muscles) is very protective of your back. A strong core acts like a natural back brace or corset.

• Flexibility exercises - Stretches and other exercises to promote flexibility help protect your back from injury.

• Quit smoking - Back pain is one of many reasons that you should quit smoking!

• Maintain a healthy weight - Being overweight puts a strain on the muscles of your back. If you are overweight, losing weight can prevent or improve back pain.

• Maintain good posture - Good posture reduces the stress on back muscles. This is important when standing or sitting. Don’t slouch. Maintain a neutral pelvis. Choose a chair with good lower back support, armrests, and a swivel base. Change positions frequently, about every 30 minutes.

• Use good lifting techniques - When possible, avoid heavy lifting, especially if you are not used to heavy lifting. Use your leg muscles to do most of the work when lifting. Keep your back straight while lifting, no twisting. Hold the weight close to your body. Share the lifting with another person whenever possible.

Here is a link to some back exercises that you can do to help keep your back healthy and strong:

Slide show: Back exercises in 15 minutes a day - Mayo Clinic

If you have any questions about back pain, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Back Pain

Back pain is one of the most common reasons people see a doctor and is a leading cause of disability around the world.  It can range from a muscle ache to a stabbing, shooting, or burning pain.  It can radiate out to the side or down your legs.  It can be mild or can be quite severe and debilitating.  Let's talk more about back pain, including things that you can do to help prevent it from happening to you.

What causes back pain?

There are several things that can cause back pain.  Here are the most common:

• Strain or sprain of a muscle or ligament - This can happen from repeated heavy lifting or from a sudden movement in an awkward position without any lifting. Strain/sprain injuries are more common, if you're in poor physical condition, but can happen to anyone.
• Arthritis - Wear and tear arthritic changes can affect the spine.  This can lead to bone spurs or other changes that can narrow the spinal canal or cause pressure on a nerve.
• Disc problems - The discs in the spine are sort of like gel pads between the bones of your spine (vertebrae).  The soft inside acts as a cushion or shock absorber, and the fibrous casing holds the discs and the vertebrae in proper alignment.  If the soft material inside the disc bulges or ruptures out of the fibrous casing, this can sometimes cause pressure on a nerve or the spinal cord. 

If the fibrous case is damaged, it can cause one vertebral bone to slip out of line a bit.

Osteoporosis - If your bones lose calcium, they become porous and weaker.  In the spine, this can lead to a type of fracture where the vertebral bone collapses on itself, which is very painful.

Does everyone with arthritis of the spine or disc problems have back pain?

No.  In fact, almost everyone develops some degenerative disc disease (DDD) and some arthritic changes in the spine as they get older.  These changes can be seen on imaging studies, such as X-rays or MRIs, even in people who have absolutely no symptoms related to their back.  It is considered a normal part of aging.  Researchers are still trying to understand why some people have back pain and some don't, even with the very same changes of their spine on imaging tests.  There are a number or things that may influence this pain.

Is there a link between smoking and back pain?

Cigarette smoking is an important risk factor for degenerative disc disease (DDD) of the spine.  Smokers are more likely to develop DDD, develop DDD earlier than those who do not smoke, and they are often more symptomatic as well.  Here are some of the reasons for this:

• Nicotine deprives disc cells of vital nutrients they need to stay healthy.
• Smoking increases the level of carbon monoxide in the blood. This also inhibits the ability of the disc to absorb needed nutrients from the blood.
• Smoking causes the discs to become prematurely dehydrated, which makes them less pliable and more susceptible to damage.
• Smoking leads to decreased blood flow to the spine, limiting its ability to heal injuries.
• Smoking increases the overall risk of chronic pain in any location in the body, especially in the spine.
• Smoking leads to increased risk of coughing over time. This abrupt motion, that is sometimes awkward motion, increases the pressure on the discs, and increases the risk of muscle strain.
• People who smoke are typically, on average, less physically active than people who don't smoke, which increases your risk of back pain.

What other factors increase your risk for developing back pain?

Back pain can happen to anyone, even children.  Here are some things that can increase your risk of developing back pain:

• Age - Back pain is more common as you get older, especially over age 40.
• Weak core muscles – Even people who are physically active sometimes don’t do enough to keep the muscles of their back and abdomen strong. The spine relies on the core muscles to help keep it healthy.
• Being overweight or obese - Extra weight puts more stress on your back.
• Inflammatory arthritis - Including rheumatoid, psoriatic, and others, can damage the spine.
• Improper lifting - Using your back instead of your legs, for instance.
• Cancer - Some cancers can spread to the spine.  Some cancer treatments can lead to bone loss in the spine (osteoporosis).
• Psychological conditions - People prone to depression and anxiety appear to have a greater risk of back pain.  Researchers are still trying to understand this connection.

Next week, we will talk more about back pain, including things that you can do to help prevent it from happening to you.

If you have any questions about back pain, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

COVID-19 Update July 2022

COVID cases are on the rise again, as are hospitalizations and deaths.  Let's talk about what you need to know.

What is responsible for the current rise in COVID-19 cases?

The latest subvariant of the omicron COVID variant is called BA.5.  It is responsible for 65% of all new COVID infections in the US right now.

Why is BA.5 more concerning than other variants?

• This subvariant is more contagious than the original omicron variant and more contagious than other subvariants that we have seen in the past.
• It is incredibly good at evading our body's immune mechanisms.
• It is infecting people who have had a COVID infection just 3 months ago.
• It is infecting people who have been vaccinated and boosted.
• It is causing more severe disease than some of the other recent variants of the COVID virus, particularly in those individuals who have not been vaccinated and boosted.

Since 7/4/22, 400-525 Americans have died every day from COVID-19 infections, 3,323 COVID deaths in the past week.  This is increased from 200-400 Americans dying every day for the time period between 5/15/22 to 7/3/22.

Is there any good news about BA.5?

There is one bit of good news.  People who have been vaccinated and boosted who are infected by the BA.5 subvariant are usually not getting severely ill.

What can you do to protect yourself?

The best way to protect yourself is to be vaccinated and boosted.

If you are over 50, you should have had a second booster.  If you have not had a booster in the last 6 months, you need to get that as soon as you can. 

For those under 50, the FDA is considering whether a second booster should be given.  They should make that decision soon.

You should also consider wearing a mask in indoor spaces, especially in areas that are crowded, until the case counts start to come down again.

What new vaccines should you know about?

Novavax - The FDA has just authorized the Novavax COVID-19 vaccine and the CDC is expected to formally recommend it within the next few days.  It is a more traditional vaccine.  It works by giving the immune system a small piece of the virus grown in the lab to stimulate the immune response.  Several traditional childhood vaccines have used this technology for years.  This vaccine has been shown to be highly effective in protecting against moderate-to-severe disease.

Omicron variant vaccines - Pfizer, Moderna, and Novavax have all been working on COVID vaccines that target the Omicron variant, some even focused on the BA.4 and BA.5 subvariants.  These vaccines are expected to be available this fall.  These would be considered "boosters" that would give a broader protection, based on the more recent variants, while still boosting your overall protection against COVID-19.

For all the latest information about COVID vaccines, use this link.

Vaccines for COVID-19 | CDC

If you have any questions about COVID-19, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor