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Orthopedic Care

Frequently Asked Questions

Regarding Back Pain
Regarding Spine Imaging
Regarding Spine Treatments
Regarding Activity With a Back Problem

 

Regarding Back Pain

I was told I have degenerative disc disease.  Should I be concerned?

Spine ConsultThe term “degenerative disc disease” may sound frightening and the word “disease” can be misleading.  The term actually describes a natural process of aging.  As we grow older, the discs that act as cushions or shock absorbers between the bones in the spine become dry and begin to break down.  Disc degeneration happens to everyone.  Fortunately the human body is often able to adapt on its own to the condition.  In many cases, degeneration has no symptoms and the condition does not cause pain.  Although the changes it causes in the spine are often subtle, they can be seen on an MRI or CT Scan.  The rate of breakdown – or degeneration – is determined primarily by genetics and family history, as well as by aging.  The earlier in life symptoms appear, the more likely it is that the condition is inherited.  Exposure to activities that place repetitive stress on the spine can also play a part in the degenerative process.  No matter what your age, your body is likely to adapt to degenerative changes in your spine, particularly if you stay as active as possible. 

What causes disc herniations?

The discs cushioning the bones in the spine naturally weaken with age.  The process, called “disc degeneration,” can result in is disc herniation.  A herniated disc is a condition where a disc in the spine has weakened enough to allow its soft, central portion (or “nucleus”) to bulge out past the disc’s outer wall and into the spinal canal.  Chemicals released from inside the disc can then cause inflammation and back pain that may or may not extend into the leg.  Contrary to popular belief, a herniated disc is very rarely the result of a single incident of heavy lifting or physical exertion.  In fact, most people are unable to pinpoint a specific event that may have caused the onset of their back pain.  It often is something as minor as lifting a light object, changing position, coughing, or sneezing that precedes the initial symptoms and pain.  Because disc degeneration is the result of the aging process and genetics, which are things we cannot control, it can be difficult to prevent a herniated disc.   Fortunately, studies have shown that the problem – as well as the pain it may cause – usually resolves on its own with time and conservative treatment.  Surgery is rarely necessary.  If you are experiencing symptoms from a herniated disc, your doctor will be able to help you manage your pain and symptoms as your body heals itself.  Keeping a positive attitude along the way can be very helpful as well. 

Can anything be done to prevent disc degeneration or disc herniations?

Many people who experience back pain are actually feeling the symptoms of disc degeneration and the natural “settling” on their spine and discs.  Unfortunately, there is very little that can be done to prevent the process.  However, the good news is that the human body is quite resilient and will usually adapt to degenerative changes in the spine, including herniated discs.  Although there is some evidence that maintaining a healthy lifestyle may offer a small measure of protection, even people who are extremely fit and exercise on a regular basis may end up with a herniated disc.  The condition usually subsides with time for the vast majority of people.  Of course, someone who is in good physical condition may find it a bit easier to bounce back faster and fully recover.  For the small percentage of people who continue to suffer with no improvement, surgery may be needed.  After a thorough evaluation of your specific situation, your doctor will work with you to find the best approach for you.

 

Regarding Spine Imaging

When is it useful to perform an X-ray, MRI or CT scan of the spine?

X-rays, MRIs and CT scans may not be necessary for the effective treatment of back pain.  In fact, diagnostic imaging procedures are not routinely performed in the early stages of many spine-related issues or isolated Spine Imaginglow back pain, because most people recover from these conditions within a few weeks.  However, imaging procedures are part of the diagnostic process when a patient has been significantly injured or if a person is experiencing certain symptoms that warrant further testing of the spine.  Diagnostic imaging is also called for in cases where there are signs of a progressive neurological issue or a reason to suspect a serious condition like cancer.  Diagnostic imaging may also be warranted when back and leg pain is severe and unrelenting or lasts more than four to six weeks.  Your doctor will know if diagnostic imaging is necessary in your specific situation.  

What are the risks of doing imaging studies for my back condition?

There are enormous benefits to having imaging studies performed when they are deemed necessary, but it is important to understand that there also are reasons to avoid these procedures if they are not needed.  Many back issues are determined by genetics or may be the result of the normal aging process, and imaging studies are not required to establish a treatment plan.  Unless there is a clear indication that further information is needed to diagnosis and treat a spine-related issue, there usually is no reason to put a patient through an imaging procedure.  Repeated and frequent scans can cause health problems, as well as unnecessary exposure to radiation.   There are even instances when MRIs and other study findings may actually steer clinicians in the wrong direction by uncovering a change in the spine that may have nothing at all to do with the patient’s current symptoms or pain.  Many people are living with changes in their spine that cause no problems at all. In these cases, too much information may end up causing needless concern and may even lead to overtreatment and potentially risky invasive procedures.  After evaluating your specific situation, your doctor will decide whether diagnostic imaging is warranted.

 

Regarding Spine Treatments

What can I expect from treatment with epidural steroid injection for my herniated disc?

An epidural steroid injection is most commonly used to relieve pain by reducing inflammation.  The injection delivers both a local anesthetic numbing agent and a long-lasting steroid medication to the area of spine where swelling may be pushing on nerves and causing pain.  The anesthetic may provide temporary pain relief for the first few hours following the procedure, but pain may return for a few days to a couple weeks until the steroid medication has a chance to take effect.  In many cases, epidural steroid injections provide a substantial short-term benefit, often shortening the time patients experience the most severe pain associated with a herniated disc.  However, injections do not work for everyone.  There are cases where epidural steroid injections provide no relief at all and others where pain actually increases following an injection.

Even without an injection, most back or leg pain is likely to improve slowly over time.  In fact, approximately three to six months following the onset of pain, patients who have received injections and those who have not often report very similar pain levels.  Because several months can feel like a very long time to wait for relief, many patients are quite willing to accept the relatively small risks associated with a spine injection in order to feel better sooner.  For those who wish to avoid an injection and find they are able to tolerate the pain (with or without medication), there is usually no necessity to undergo the procedure.

What can I expect from treatment with facet joint steroid injection for my back pain? 

Facet injections deliver medications into the joints along the spine to reduce inflammation and pain.  The injection includes both a local anesthetic numbing agent and a long-lasting steroid medication.  The anesthetic may provide temporary pain relief for the first few hours following the procedure, but pain may then return for a few days to a couple weeks until the steroid medication has a chance to take effect.  Patients with arthritic facet joints that cause chronic back or neck pain with movement are usually good candidates for facet injections and will often experience at least temporary pain relief.  How long the benefit will last is hard to predict.  While the steroid itself remains in the joint for about a month, the effect can last longer.  The joint may not become painful or inflamed again for quite some time.   

I was told that I may need several injections for my back problem. When is that necessary?

In some cases, there can be a benefit to having more than one injection spaced over several months.  However, the most significant pain relief is often achieved with the first injection.  When the injection is for a disc herniation, the level of relief achieved with each subsequent injection tends to be less and less dramatic, while the risk of minor complications (such as spinal headache or bleeding) remains the same for each procedure.  Your doctor will evaluate your response to your first injection.  If you experience a substantial reduction in pain, additional injections may not be warranted. On the other hand, if the first injection has no positive effect at all, there also may be no need to repeat the procedure.  A second procedure may be considered if severe pain returns or if pain continues to interfere with your ability to perform everyday activities.  More than one injection may be performed for diagnostic reasons as well.  Injections in different areas of the spine to treat separate issues may help your doctor determine the specific problem in your back that is the main source of your pain. 

How soon should I exercise for my spine and/or arm/leg pain? 

Every person is unique.  Your doctor will assess your particular situation to determine how exercise will fit into your recovery.  Initially, your doctor may recommend activities like walking or home stretching, as well as the use of ice or heat to reduce muscle spasm.  He or she will let you know if the time is right for you to take part in a physical therapy guided exercise program.  Early on, your physical therapy regime may include electrical stimulation, massage and therapeutic ultrasound to provide some short term soothing benefits.  These therapies are not known to hasten recovery for patients with spinal pain.  Many people benefit most from the assistance of a licensed physical therapist and exercise progression once their pain begins to lessen.  As pain improves, it becomes easier to treat any restrictions in motion or muscle weakness through an exercise program aimed at increasing flexibility, building strength and gradually resuming activities. 

Would decompression therapy or traction help my low back and leg pain?  

Ever since humans stood upright on two legs, the spine has had to bear the body’s weight during all kinds of daily activities.  It is no surprise that many of us experience spine-related back pain.  The intended goal of decompression and traction therapies is to ease back pain by stretching the spine and taking pressure off the discs and vertebrae.  While it is true that a person with back or leg pain may experience a temporary reduction of symptoms when suspended upside down or decompressed in a traction device, there is no conclusive evidence that this type of treatment hastens recovery from spine or disc problems.  No data exists to substantiate the claims of the often misleading advertisements you may see promoting the effectiveness of decompression therapies.  If you have a disc irritation, tear or herniation, listen to your doctor.  He or she will help you find the right path to the best outcome. 

Why are the physical therapists having me bend and lift with my sore back in the PT program?  

A strong, flexible back is normally a more comfortable back. Once the worst of your pain has lessened, spine rehabilitation can help strengthen your weak, stiff back muscles.  You will be guided through the process of lifting progressively heavier and heavier weights little by little over time, which will decrease the likelihood of back strain.  With an intensive, progressive back strengthening program, most people are able to increase their back strength by more than 50 percent.  In fact, patients often end up stronger than they were before their pain issue.  A progressive exercise program can help patients gain confidence as they gradually resume their favorite recreational activities, like golf, tennis, running, and gardening.  A strong, flexible back is a more comfortable and functional back.   

I was told I should always lift with my knees.     

When lifting something light, like piece of paper or a child’s toys, it feels quite natural to bend over with your back.  But when picking up a heavier object, like a box filled with textbooks, it usually feels more natural to bend with your back and your knees.  Lifting something with some bulk requires the use of muscles in both your back and your legs.  There are times, however, when it is impossible to use your knees for lifting and you must depend only upon your back muscles.  Examples include lifting a child out of a crib or reaching deep into the trunk of a car.  Spine rehabilitation focuses on the all too often neglected and weak back muscles.  In most cases, sensitivity and weakness in the back improves as the muscles are used over time.

 

Regarding Activity With a Back Problem

It hurts to sit.  Should I avoid sitting? 

Spine ModelSitting can be quite uncomfortable for people with back and leg pain, but the discomfort should lessen over time.  There is no evidence that sitting is harmful for most people with back pain.  Sitting is not known to cause any further injury, and refraining from sitting will not lead to a speedier recovery.  You may find that a chair with a back support adjusted for your height is more comfortable than a soft, low chair or couch.  You may find it helpful to get up every 30 minutes or so to stretch for a moment or take a short walk.  Some workstations can be temporarily adjusted to allow you to stand if sitting is too painful to tolerate.  Although it is important to listen to your body, there is no need to worry that you are causing further harm to your back if you need to sit down for your job or during your daily activities… even if it hurts. 

My back pain is worse with standing or walking.  Should I walk anyway? 

Walking is the main form of exercise for many of us.  It can be quite discouraging when activities you may have taken for granted, like walking, become painful or difficult.  After evaluating your specific situation, your doctor and/or physical therapist will talk with you about how pain is affecting your life.  Most likely, you will be encouraged to stay as active as possible.  There may be some different forms of exercise and ways of staying fit that you find more tolerable than walking, such as taking a bike ride outdoors or using an indoor exercise bike.  The forward posture used on a bike is often more comfortable for people with certain spine conditions, such as lumbar spinal stenosis.  Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back where nerves pass through to the legs.  Prolonged standing or walking can cause pain or aching down the legs for people with the condition.  Some find they are able to walk further when leaning on a shopping cart.  Others find it helpful to use Nordic walking poles while walking.  Both methods allow for a more forward posture, which opens up the spinal canal and relieves pressure on the nerves.  Walking poles also provide the added bonus of arm exercise.      

Is running bad for the back? 

The motion of running is not really the pounding up and down that you may imagine it to be.  The motion is actually more of a smooth sine wave and trajectory forward over forgiving surfaces.  Add a decent pair of running shoes to the fact that our joints (ankles, knees and pelvis) are able to adjust with each stride and running can be a graceful and effective aerobic exercise.  Because the rate of degeneration of the spine is genetically determined, it does not appear to be influenced by running.  In fact, an interesting study compared the spine MRI findings of long distance runners with people who are sedentary.  Degeneration of the spine was no worse in the long distance runners.  These findings are reassuring for people with typical back pain who enjoy running as a form of exercise. 

I was told by my physical therapist to stop an exercise if it hurts. Is it OK to work out and stretch even if hurts?

Once your doctor and/or physical therapist has a firm understanding of your spine condition and the source of your pain, he or she will be able to figure out just how far you should push yourself during recovery.  They will talk with you about whether the pain you are feeling is “safe” pain or pain that is signaling a problem.  If your pain is considered “safe” and not indicative of harm, you may be encouraged to push through it as you work to restore motion, strength and endurance to your spine.  This could include stretching into the pain and strengthening beyond what you may feel you can do.  A physical therapist with this philosophy can be a valuable coach.  He or she will watch your form very closely, monitoring for proper technique and help you focus your attention on any areas of restriction or weakness.  By zeroing in on goals that are specifically designed around your particular needs, you may discover that your pain will subside as your function improves.  In the beginning, the challenge of exercise on a weak, stiff spine can be difficult, but the results should be quite rewarding if you stick with your program. 

Will I ever be able to (ski, golf, play tennis, or pick up my grandchild) again?

When you have a painful spine issue, you may find yourself avoiding all kinds of things you once enjoyed.  Your doctor will want to know the important things in your life that you have given up because of your spine problem – even the simplest of things like bending down to hug a child.  He or she will want to help you sort through these issues so you can have a greater understanding about what your symptoms mean and what will be possible for you to achieve.  You may need guidance as you slowly, but surely take the steps necessary to resume the most basic activities of daily living.  Whether it is an everyday task like putting on your shoes in the morning or something as challenging as regaining the edge as a competitive triathlete, your doctor wants to help you continue activities that maximize your independence and enrich your life.

    

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