Are back problems keeping you from living life to the fullest? If so, you’re not alone. About 80 percent of adults will experience lower back pain at some point in their lives. Back pain typically first strikes between age 30 and 50, and it becomes more common later in life. There are many different triggers for back pain: muscle strains from lifting a heavy object; traumatic injury; spinal disc degeneration; nerve damage.
SOURCE spoke with Huntsville Hospital neurosurgeon Holly Zywicke, MD. She is part of the Spine & Neuro Center, which includes Rhett Murray, MD, Joel Pickett, MD, Cheng Tao, MD, Jason Banks, MD, Derrick Cho, MD, Hayley Campbell, MD and Brent Newell, MD.
At what point should a person consider calling a neurosurgeon?
Neurosurgical consultation should be pursued after non-operative treatment has been maximized including physical therapy, osteopathic or chiropractic manipulation, anti-inflammatory medications, and injections. Additionally, prior to surgical evaluation, X-ray studies should be completed. Sometimes, other studies are necessary to fully understand how changes in the back may be causing pain. In some cases, neurosurgical evaluation may be sought sooner. This is usually when back pain is accompanied by symptoms such as weakness, sensory change/loss, or pain radiating to the leg.
Can certain chronic back problems be effectively treated with physical therapy alone?
Yes. Most back pain is due to multiple factors rather than a single cause. Physical therapy targets many different potential pain generators. Maintaining an active lifestyle, keeping a healthy weight and not smoking are some of the best ways to prevent and improve back pain.
If physical therapy isn’t working, are there other non-surgical alternatives that you might recommend?
Osteopathic or chiropractic manipulation, injections, acupuncture, and biofeedback therapy are alternative ways of treating back pain. Regular low-impact exercise including Pilates and yoga are also recommended. Pain management can also be beneficial, but long-term narcotic pain medication use should be avoided. Narcotics provide poor back pain relief and can have very significant side effects.
When does spine surgery become the best course of action and how effective is back surgery at giving a person long-term relief?
Although surgery is performed on the back, the majority of spine surgeries actually have a much greater chance of improving leg symptoms rather than back pain. How well surgery can improve back pain depends on the cause of the pain. With the right leg symptoms and right X-ray findings, there is a 90 percent or greater chance of relieving leg symptoms including pain, weakness and sensory loss. Under perfect circumstances, it is usually a 60 percent chance of improving back pain to a person’s satisfaction. Back pain that is most responsive to surgery is mechanical pain. Mechanical pain is generally worse with standing and walking yet better with sitting or lying down. Constant and non-radiating (i.e. pain that stays in one place) back pain does not respond well to surgery. There are exceptions to this, of course, but back pain generally is less well treated with surgery than leg troubles. If the right back pain is surgically treated, however, relief can be long standing.
What are the most common types of back and spinal injuries you encounter at Spine & Neuro?
The most common back troubles include muscle strains and lumbar stenosis. Muscle strain is usually sudden pain due to overuse or other injury such as heavy lifting or twisting. This can be very intense pain, and many people are convinced something that hurts that badly cannot be just muscle. The back muscles, however, are very strong so when injured the pain is severe. Depending on age and the extent of the injury, it can take up to a year for the pain to completely go away. Lumbar stenosis results, most commonly, from degenerative changes. Degenerative changes can also be called aging or arthritic changes. This causes narrowing of the spaces where nerves run. It generally causes leg pain, weakness, and sensory change. Lumbar stenosis can also be experienced as back pain, but this is less common.
Exercises to strengthen lower back
Lie on your side. Bend top leg, and straighten bottom leg. Cross arms across chest, and slowly rotate back until a stretch is felt in lower back. Holds for 20 seconds, repeat five times.
Single Knee to Chest
While lying on your back grab knee with both hands, and pull knee to chest until a stretch is felt in the lower back and buttocks. Hold for 20 seconds, repeat five times.
Lower Trunk Rotation
Lie on your back and rotate both knees to one side while keeping shoulders flat. Hold for 20 seconds, rotate knees to opposite side and repeat. Repeat five times.
While lying flat on your back with legs outstretched, tighten and squeeze buttocks together. Hold for five seconds, repeat 10-30 times.
Lie on your back and cross the involved leg over knee. Grasp knee with both hands and pull to opposite shoulder. Hold for 20 seconds, repeat five times.
Lying on back, hold behind the knee with both hands. Extend leg toward ceiling. Progress to leaving opposite leg straight. Hold for 20 seconds, repeat five times.
While seated in chair, straighten one leg and place on small stool. Keeping back straight, slowly bend forward at the waist. Hold for 20 seconds, repeat five times.
Using step or calf wedge, keep knee straight and stretch calf muscle. Can be performed one leg at a time if needed. Hold for 20 seconds, repeat five times.