Your back pain questions have been answered.

Last week, I invited people to submit questions about back and sciatica problems (Ask the expert: back pain). Here are some of the questions and answers. Malton Schexneider, PT, MMSc is a clinical specialist in orthopaedic physical therapy and is author of Back Pain Relief Secrets and Healthy Back Essentials.

Question 1:

Hello, I will start with I am a nurse and had L-3 L-4 L-5 and S-1 all cleaned up about 2 years ago. Great results for the most part but occasionally I get that all too familiar nerve pain that starts at the right midline right above L-4 and goes down right butt cheek and into hip. I know it is probably inflammation around that area. I am very active and like I said pleased with surgery. What exercises/stretching would help that area and help keep that pain at bay. I know once a back patient always a back patient but when that burning pain comes on?.I take anti-inflammatories and walk/jog/elliptical 3-4 times a day. I need to start stretching again- that is where I need the help. Help me please? Thanks in advance!
Kendra

Answer: Thanks for your question. Although you have had surgery, I do not agree with the “once a back pain patient always a back pain patient”. The good news is that most of the problems you are experiencing can be alleviated with a few simple activities.

First, let’s address the sciatica issue. While it would be easy to blame the surgical procedure for the periodic onset of your symptoms, chances are your symptoms are the result of irritation to a small muscle that runs from the sacrum to the hip joint. This muscle is called the piriformis and, when tight, can create irritation of the sciatic nerve which courses over the muscle. An effective means of stretching this muscle is reviewed in this video: http://eraseyourbackpain.com/sciatica/sciatica-leg-pain-exercises-for-sciatica/. Let me know how this works out for you.

Secondly, let’s talk about why these symptoms, come on periodically. In most cases, back pain and related sciatica pain are the result of specific muscle imbalances. These imbalances involve weakness in specific muscle groups and tightness in the muscle groups that oppose the weak ones. To effectively treat these conditions, you must first determine the type of imbalance you’re dealing with followed by specific therapeutic intervention to address the specified imbalance. Here’s a short video I did on the four types of muscle imbalances found in people dealing with back pain: http://eraseyourbackpain.com/welcome. The key to recovery is identifying the correct the imbalance and then applying an appropriate treatment sequence to address the imbalance.

I hope this helps.

Question 2:

Hi, I have 4 herniated discs? the bottom four with affects on my sciatic nerve and numbness in my legs and feet. I had a course of physical therapy for awhile. Now, every once and awhile I get bouts of stiffness and muscle spasms. How do I improve my quality of life? surgery? more physical therapy?

Answer: The key to a better quality of life lies in your ability to effectively manage your problem. This process begins with education.

While it’s easy to blame a herniated disc on one’s back pain, the reality is that up to 85% of the asymptomatic population is walking around with a herniated disc(s). In order for the disc to become significant, you must first correlate the results of the clinical exam with the diagnostic imaging exam. In most cases there is no correlation.

Once a cause and effect relationship has been established (or not), the next step is to introduce the appropriate intervention. For the purposes of our discussion here, I’m going to assume that there are no corroborating factors linking your imaging studies to the clinical examination. That being the case, your condition is very likely related to muscle imbalances.

Once a specific muscle imbalance(s) is/are identified, an appropriate therapeutic exercise sequence is initiated to correct the imbalance which, in the majority of cases, will result in a decline in one’s symptoms. Typically, the over-the-counter exercises given by many physicians and therapists do little more than frustrate patients due to their lack of long-term effectiveness. A better approach is a targeted sequence of exercises designed to correct the underlying imbalance.

So to answer your question (finally), determine the source of your problem and then treat it with the best intervention. Following this advice, surgery is an option reserved for less than 10% of people suffering with back pain. Chiropractic and physical therapy intervention, while temporarily effective, will usually not address any underlying muscle imbalances (obviously, there are exceptions) and will focus more on symptom management.

Bottom line: if you can determine what’s wrong and you have the tools to fix the problem, you can treat yourself, in many cases, more effectively than seeking medical attention. In the process, you’ll save thousands of dollars and many, many, many hours of your valuable time.

I hope this helps.

Question 3

I have cervical degenerative disc disease, which exacerbates my chronic migraines. Can you suggest the best ways to sleep in order to avoid worsening the pain I already experience? What kind of pillows and how many? Are there special types of pillows or other tools you would recommend? What sleep positions are best?

Answer: I just did an interview with WebMD on this very subject so your timing is impeccable.

Here’s the deal: if you sleep on your back or your side, use a pillow to fill in the space between your neck and mattress. Most people will tend to have their shoulders on the pillow which negates the effectiveness of the pillow altogether. What I teach my patients to do is to make sure their shoulders make contact with the mattress and not the pillow. The key is to maintain alignment of the neck and the rest of the spine. If you tend to sleep on your belly, I recommend no pillow. Using a pillow while sleeping on your belly tends to “jack the neck joints backwards” and he has, perhaps, the single biggest reason for waking up with a “crick and the neck”.

As for the type of pillow to use, my recommendation is actually a water pillow made by MediFlo. The pillow sells for about $60 and is the pillow my patients have overwhelmingly chosen over pillows costing four times as much. The advantage of this pillow is that it provides the ultimate support for the neck, allowing the muscles to relax completely. Bottom line: a much better night’s sleep. The disadvantage of the pillow is that it’s heavy (it weighs about 10 pounds), making it a lethal weapon – so no pillow fights.

Hope that answers your question.

Question 4

I have two questions but they’re both related to travel and back pain, so I hope that’s ok. I am also a nurse like Kendra and I hurt my back many years ago. I haven’t had any surgery or anything but I did have a spinal injection about 25 years ago. It didn’t help that much and I remember that my blood pressure plummeted; the doctor had to wait a long time before I could slowly be sat up in an upright position. So, I’m afraid to do that again.

My problem now is when I drive long distances, be it as a passenger or the driver, I end up having pain in my lower back and right hip. Actually, I develop this pain more often as a passenger than as a driver.

I recently did a 6.5 hour drive. I stopped at every single rest stop along the way, so the longest I drove without stretching was about 50 minutes. I would walk around for a bit, stretch and then move on. Yet I was still quite achy when I got to my destination.

Now, I’m scheduled to fly – a 3 hour flight, non stop – and I’m afraid that the pain will kick in, especially since I did the long drive so recently. What can someone do in that situation?

My second question is what does someone with a sore back to do when they are traveling and staying in different accommodations? We have no control over our beds and I’m always concerned about how my back will react to the mattress.

Thank you for answering my questions.

Answer: If your work requires you to frequently travel, you may be concerned about how to handle your stiff or sore back on the road. And if you’re like many travelers, you may be dreading the ride, sleeping in a strange bed and getting out of your usual exercise routine.

To avoid discomfort on your trip, you can take several precautions to avoid the unwelcome travel companion of a painful back. For example, when traveling in a plane, car, or train for long periods of time, place a rolled towel or small pillow in the curve of your lower back. This will help you maintain better posture, which is critical to maintaining normal curves in your back.

While we often hear parents reminding children to “hold your head up,” pull your shoulders back,” and “don’t slump,” it’s important for older citizens to also take the advice to heart. As we become older, poor posture is often a source of pain. But if we maintain good posture, we can benefit from keeping the normal curves of the spine in the cervical (neck), thoracic (mid-back), and lumbar (low-back) regions of the body. Life-long slouching can lead to slumping postures later in life, often characterized by an upper back hump.

When sleeping in an unusual place such as a hotel or cramped guest room, smart travelers can take simple steps to offset their back pain. For example, politely ask for some extra pillows at the front desk to make your rest more comfortable. If you need to substitute for an extra pillow, try a rolled up blanket or towel to cushion your body in the bed. When resting on your side, place a pillow between your legs and a small rolled towel at your neck. If you sleep on your back, place a small pillow beneath your knees. And remember, avoid using a pillow if you sleep on your belly.

The best remedy to avoid long term back pain is to stay active. People with a low level of activity, often suffer from backaches as a result of staying in slouched positions for a long period of time. When slouching, your upper back is rolled forward and the muscles in the front of your neck, chest and shoulders relax and become tight in a shortened position. This leads to stretching and weakening of the muscles across the back of the neck and shoulders. If you remain inactive, this problem escalates, leaving you more susceptible to strains or sprains as the muscle becomes progressively weaker.

So even though you’re traveling, don’t forget your exercise routine. A physical fitness program including safe back exercises is one of your best defenses against back pain. The program should include exercises which focus on flexibility, strengthening and endurance. For example, modified sit-ups and low back stretches offer good alternatives as well as water exercises like swimming or aqua aerobics. Remember, with an exercise routine already started, you don’t want to take a step back while traveling.

If your back becomes aggravated on the trip, over-the-counter medication may provide temporary relief from the pain. Keep your knees elevated if lying down is uncomfortable. Light massages, warm baths, or ice may also provide short-term relief. Resting your back is important, but practicing good posture and exercising can contribute to a healthy and pain-free back.

Question 5

What, if anything, can I do when my back pain flares up and is an acute phase? I can go weeks without back pain and then one unexpected movement will send “electric” shocks across my back and sometimes down the sciatic nerve.

I’ll have a constant dull ache but these shocks of pain depending on movement or position. For example, I was doing fine until yesterday morning when I bent over (incorrectly, I admit) to pick something up. The sudden familiar jolt of pain shot through my lower back. It has since gone (it is very quick) but I’m now in that fragile stage where any movement may bring it on. Is there anything I can do when this happens.

Thanks,
Marijke

Answer:

Marijke,

I know exactly what you’re talking about; happens to me every now and then – pain out of absolute no where.

Here’s what’s happening.

The muscles of our back are divided into superficial and deep layers. The superficial layer is generally responsible for maintaining postural control while the deeper layer provides dynamic stability to the spine. Dynamic stability means that as we move, the deep spinal stabilizing muscles contract in a coordinated fashion to allow the desired movement to occur. In other words, they control the movement.

However, after the age of 25, these muscles are highly susceptible to atrophy, meaning they weaken and shrink in size. Consequently, the endurance capability of these muscles is sometimes cut in half creating a state of potential rapid fatigue. What this means to people who experience chronic recurrent back pain (like yourself) is that you can be going along just fine and one day bend over to pick a Kleenex off the floor and a “lightening bolt” of pain sends you to your knees. A day or so later, you’re fine again.

What’s up with that?

Obviously picking up a Kleenex didn’t cause your back to hurt. What happened was that those deep muscles were teetering on the brink of fatigue and at that very moment “gave up”, creating a state of dynamic instability resulting in the secondary restraint systems (ligaments and postural muscles) to kick in to protect the spine from serious damage. Once the deep muscles have had a chance to recover, everything’s good again until the next time the deep muscles fatigue.

This up and down cycle can go on for years and is responsible for some of the accelerated degenerative changes we see in the spine – herniated disc, stenosis, arthritic changes. Fortunately, this process can be stopped with the right program of exercise that targets these deep muscles and corrects the associated muscle imbalances, which are specific tight and weak patterns of muscular dysfunction. And this is what my Erase Your Back Pain program accomplishes – identifying the underlying imbalances and prescribing the appropriate corrective exercise to counter the imbalance. Once the imbalance has been corrected, then the re-stabilizing program can be effectively administered.

To read more about my program or just find out more on various topics related to back pain, go to my blog at http://EraseYourBackPain.com.

Images: iStock

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Technorati Tags: chronic pain blog,pain blog,living with back pain,living with chronic pain,back pain,back pain expert,Malton Schexneider,orthopedic physical therapy,health back,surgery for back pain,sciatica,sciatica pain,herniated discs,chiropractics,physical therapy,cervical degenerative disc disease,chronic migraines,traveling with a sore back,back exercises,acute back pain

 

Your back pain questions have been answered.

Last week, I invited people to submit questions about back and sciatica problems (Ask the expert: back pain). Here are some of the questions and answers. Malton Schexneider, PT, MMSc is a clinical specialist in orthopaedic physical therapy and is author of Back Pain Relief Secrets and Healthy Back Essentials.

Question 1:

Hello, I will start with I am a nurse and had L-3 L-4 L-5 and S-1 all cleaned up about 2 years ago.

Click here to read more.

~~~~~~~~

Image: iStock

Technorati Tags: chronic pain blog,pain blog,living with back pain,living with chronic pain,back pain,back pain expert,Malton Schexneider,orthopedic physical therapy,health back,surgery for back pain,sciatica,sciatica pain,herniated discs,chiropractics,physical therapy,cervical degenerative disc disease,chronic migraines,traveling with a sore back,back exercises,acute back pain