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For Patients
Frequently Asked Questions By Patients
- If I have a herniated disc, won't I need surgery?
- I've talked to surgeons, therapists, chiropractors, and family
members with bad backs. Everyone tells me something different. Who's
right and who's wrong?
- I just had a lumbar laminectomy a month ago. Is it safe
for me to engage in rehab?
- How is working on my back going to make the tingling in
my foot go away?
- The other doctor told me that all I would have to do is
lose weight and my back pain would go away. What do you think?
- Can stress cause pain?
- I've tried everything. Do you really think you can help
me?
- I know my back can't be weak because I work out all the
time.
- I've been working out on the Nautilus and Eagle low back
machines for months at my health club. How could my back possibly
be weak?
- How does a back or neck get weak?
- All I've ever had to do before was rest and my pain went
away. Why do I have to exercise now?
-
Lately I see a lot of ads promoting super traction devices with space age
sounding names like DRX-9000 and Vax-D. Do these treatments actually
work?
-
If I have a herniated disc, won't I need surgery?
 A herniated disc is not a catastrophe. Annoying, certainly,
but a condition with a favorable natural history.
Many people feel that this is a serious injury that
always
needs an operation. In fact, over 90% of people who
herniate a disc go on to uneventful recoveries without
surgery and do quite well. A famous study done in
1983 compared patients with surgically treated herniated
discs with similar patients
treated non-operatively (Reference 1).
The study found that at the 5 and 10 year point there
was no difference in the
results between those treated surgically and those
treated conservatively. The American Academy of Orthopedic
Surgeons considers a herniated disc to be a 12 week
syndrome and recommends at least 3-6 months of conservative
care prior to surgery. Click HERE to
see how PNBC treats disc herniations.
- I've
talked to surgeons, therapists, chiropractors,
and family members with bad backs. Everyone tells me
something different. Who's right and who's wrong?
 Back pain is rather unique. There is very little consensus
about the proper treatment for chronic
problems.
If you break your ankle it doesn't matter much where you are treated. You are
likely to get the same advice regardless. Not so with back pain. Every provider
seems to have a different spin. The chiropractor says you are out of alignment
and need manipulation. The surgeon says you have a degenerative disc and may
need surgery. The therapist recommends stretching and ultrasound. The pain
clinic physician suggests injections.
Someone once said "When you're a hammer, the whole world is a tack." He/she
must have been talking about back pain.
The dirty little secret is this:
most of the time we "professionals" cannot
be certain about the cause of back pain. According to
experts, we can only determine the precise cause of
back pain about 15% of the time (e.g.,a disc herniation pushing on a nerve causing leg pain). But we all have
opinions and most providers are not shy about sharing
them. Some
day the mystery of back pain will be solved but for now
we often have to live with some uncertainty (see reference "What Causes Low Back Pain").
At
PNBC we view the issue a bit differently. We make sure
you don't have a catastrophic condition (tumor,
infection, new fracture, gastric ulcer mimicking back
pain, etc.) but then we ask a different question. What
can be done to improve your pain and function, regardless
of the underlying condition? Our studies have shown (see
outcome data) that aggressive reconditioning is effective
for many different spinal conditions. We therefore concentrate
on strengthening your weak link so you can get back on
the road to healthy activity.
To see what the New England
Journal of Medicine says about this topic click
here.
- I
just had a lumbar laminectomy a month ago. Is it safe
for me to engage in rehab?
Post-surgical patients are well served by rehab but
must be careful not to disrupt the surgical repair.
For a simple laminectomy/discectomy the soft tissues
are usually well healed and able to withstand maximum
work-outs after 8 weeks. Until that point patients
are placed in our sub-maximal program. Proper exercise
during the post operative period, while the soft tissues
are still healing, can influence the way in which the
collagen is laid down. Collagen tends to line up along
the lines of force and if the force is applied in a
controlled manner the collagen that is laid down is
more biomechanically sound. Usually, a strong back
will help to protect against recurrent problems after
your surgery.
- How is working on my back going to make
the tingling in my foot go away?
 Extremity pain associated with a back injury is either
radicular (due to a "pinched nerve") or referred.
Radicular symptoms are those that are associated with
neurologic deficits (e.g., weakness, sensory disturbance,
loss of reflex) and usually involve a sharp band of
pain radiating all the way down to the foot or arm
(for neck problems). Usually only one leg or one arm
will be involved.
Referred pain can be caused by injuries to
ligaments or disc fibers and tends to be patchy and
vague or
aching. Most of the time it will not be associated
with any neurologic deficit. It may involve both legs
or both arms and oftentimes will only go down to the
knee or the elbow. To better understand the concept
of referred pain consider a patient experiencing a
heart attack. These patients will often feel severe
pain in their left arm or jaw; but there is nothing
wrong with the arm or jaw; the problem is in the heart.
Why doesn't the patient have pain in the heart? What
happens is complex but essentially the pain signals
get mixed up and the brain interpets the signals as
arm or jaw pain even though the problem is the heart.
A similar pattern can occur with the spine but the
referral pattern for the low back is into the buttock
and into the legs and the referral pattern for the
neck is into the trapezius muscles and into the arms.
The
key point is this: even though your leg or arm may
be painful, the problem is in the back or neck.
Therefore the treatment must be directed at the source.
When the source improves, the extremity pain also usually
improves. One of our published studies (Reference
5)
showed that the majority of patients with leg symptoms
showed significant improvement after they improved
the fitness level of their spine.
- The other doctor
told me that all I would have to do is lose weight
and my back pain would go away. What
do you think?
It's true that extra weight puts more pressure on
a back and is associated with more low back pain.
But
the truth of the matter is that 95% of people that
try to lose weight are unable to do so long term.
Therefore, if a doctor's primary method of treating
back pain in overweight patients is to recommend dieting,
he will fail 95% of the time. Even people who are overweight
can improve their back pain significantly by engaging
in active rehab. If they can lose weight also, so
much the better.
- Can stress cause pain?
Yes. Stress seems to be related to
both back and neck pain, especially pain in the upper
back and
neck area. When a person is under stress the upper
back
and neck muscles will contract involuntarily. It's as if these muscles
are lifting weights all day long and eventually they
wear out and become painful.
Learning to relax helps to avoid this problem as does exercise.
- I've tried
everything. Do you really think you can help me?
Assuming
surgery has already been ruled out, people at this
stage basically have three options:
- Decrease activity to try to eliminate all
things in their lives that cause pain;
- Increase their function to the point where they can
do the things that they want, even in the face of
pain; or
-
Do some combination of one
and two.
Obviously the first choice is a poor one. Giving up everything that makes life enjoyable is not something that should be contemplated lightly. The best choice is number two. If you can increase your function to the point where you can do everything you want, this is a pretty good outcome. Even if you continue to have pain, as long as you can do what you want, you're better off. If the second option doesn't work, then the next best option is some combination of the first two. It's better to only eliminate a few things than to become completely inactive. In our experience, the people that become inactive are the people who do poorly.
- I know my back can't be weak because I work out
all the time.
A person can be strong everywhere else in the body
but still have a weak back. In effect, the back becomes
the weak link in the chain. We have seen this over
and over in people who appear to be extremely well
conditioned but who have very weak backs. This is
a common scenario in athletes who exercise continually.
- I've been working out on the Nautilus and Eagle low
back machines for months at my health club. How could
my back possibly be weak?
 The Nautilus and Eagle "low back machines" are
really pelvic extensor machines. The muscles that
push up the weight stack are actually the hamstring
and
the gluteus muscles. If you watch people from the
side while they are working out on those machines,
the spine
really does not move much at all. Almost all of the
motion is the pelvis rocking back and forth on the
hip joints. Therefore, the lumbar muscles get very
little, if any, workout. A controlled study
done at the University of Florida (Reference
2) showed that
people who worked out on either the Eagle or
the
Nautilus "low
back machine" for 12 weeks actually gained no
strength at all in their lumbar extensor muscles,
although their hamstring and gluteus muscles did
improve significantly.
- How does a back or neck get
weak?
That's easy to explain. Whenever a person injures
his or her back they tend to take it easy. Because
of the
pain they begin to utilize other body parts to substitute
for their back/neck, and therefore the back/neck does
not get used much. This happens involuntarily. When
the muscles are not used they atrophy and lose strength
and become deconditioned. In addition, if
the back and neck are not continually moved they become
stiff. It is well known that joints that are not moved
will deteriorate. Think of a leg in a cast. When the
cast is taken off, the leg is usually shrunken and
weak and the knee is very stiff. This deterioration
comes from disuse. The same thing happens with the
back and neck. With each new episode the spine loses
a bit more strength and the cycle repeats itself.
- All
I've ever had to do before was rest and my pain went
away. Why do I have to exercise now?
Pain will often diminish when people rest. The problem
is that you can't rest forever and often the pain will
simply return when you try to return to normal activities.
Most people we see have what we call " activity
related pain". The more they try to do, the more
pain they have. Reconditioning is by far the best type
of treatment for these types of complaints. Moreover,
there are costs associated with rest. Muscles atrophy,
blood flow is diminished, and joints deteriorate.
The goal must be to try to diminish pain while preventing
these adverse effects and that can be done through
proper rehab.
12. Lately I see a lot of ads promoting super traction devices with space age
sounding names like DRX-9000 and Vax-D. Do these treatments actually
work?
According to the scientific studies, the answer is no. Which is why none of the major insurance companies pay for it. If you are interested in what the real science is behind these devices click here.
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© 2007 Physicians
Neck & Back Clinics
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