FAQ Category: General Spine

Walking is still the most popular activity because it doesn’t cost anything and can be done at your own pace. Make sure you wear comfortable shoes that are not worn out or uneven on the bottom. Try to increase your walking time each day.

The second most commonly recommended activity is swimming. You may want to find a swimming program for people with injuries or disabilities to get you started.

You’re still at a higher risk for back pain than if you had never used estrogen replacement therapy (ERT). However, your risk is less since you’re no longer on ERT.

A recent study looked at back problems in 7,209 white women over age 65. Women who used ERT were generally healthier than those who had never used estrogen. But 53 percent of women currently using ERT reported back pain, as opposed to 43 percent of those who had never used ERT. Women who had used ERT sometime in the past fell between these two groups, with 49 percent reporting back pain.

Researchers think estrogen may have a loosening effect on the spine, which can lead to back pain. The fact that current users of ERT have more back problems than past users suggests that estrogen’s effects on the spine may be short-lived. Talk with your doctor about your risk for back pain and any extra steps you can take to protect your back.

Even if you’re in good health, estrogen replacement still puts you at a slightly higher risk for back problems.

A recent study looked at back problems in 7,209 white women over age 65. Women on ERT were generally healthier than those who had never used estrogen. They also had fewer vertebral fractures. Nevertheless, 53 percent of women on ERT reported back pain in the previous year, as opposed to 43 percent of those who had never used ERT. Twelve percent of women using ERT said their back pain made daily activities difficult. This was true for only nine percent of women who had never used estrogen.

The link between estrogen replacement and back pain was independent of women’s age, weight, pregnancy, arthritis, or diabetes. It also had nothing to do with smoking or exercise habits.

Your doctor or physical therapist can suggest ways to keep your back healthy while you’re on ERT.

With external fixation, doctors implant a device on the outside of the body with screws placed through the spinal column to stabilize the spine. This is done with patients asleep from anesthesia. Patients wear the device for a few weeks, following special care instructions. Then the device is removed.

External fixation was introduced in the 70s to heal broken bones in the spine. Later, it was found to reduce back pain by holding the spine in place. In a recent study, 60 percent of patients had less low back pain while they wore this kind of device.

Not necessarily. A recent study suggests that external fixation–a way of fixing the spine from the outside with special screws placed in the spinal column–doesn’t predict whether patients will get relief from surgery. Only about half of the patients who had pain relief from the external device went on to benefit from surgery. About a third stayed the same after surgery. A few even got worse.

These results led one doctor to conclude that external fixation should not be used to predict whether patients will feel better after spinal fusion. External fixation is a fairly invasive procedure. It sometimes leads to complications. Talk to your doctor about his experience with external fixation. If you still have questions, get a second opinion.

Studies have shown that depression and anxiety are strongly linked to many medical conditions, including back pain. Treating depression with medication seems to have a positive effect on back pain. Your “depression” may not be a change in mood, but rather a reaction of your nervous system to your injury.

After an injury, the nervous system can start to respond too quickly or strongly. This leads to chemical changes that increase pain and alter the ability to enter deep sleep. This can set up a cycle of more pain, less function, and less sleep.

Anti-depressants help in such cases. Sometimes sleep medication is also advised. Follow your doctor’s advice on this, and give the medication plenty of time to work. Adjusting the dose can take six to eight weeks for a good result.

When carried out properly, telephone surveys can give health care providers, insurance companies, and researchers important information. Usually the questions are about what you think or believe and how you respond to certain problems. Knowing how the public thinks and what their reactions might be to injuries or diseases can help researchers do their work.

For example, the Workers’ Compensation group in Australia wanted to encourage the general public to keep active and return to work quickly after back injury. Based on information from previous studies, we know this response to back pain is more successful than rest and inactivity. The research group interviewed thousands of people over the telephone before launching a large public education plan about back pain. Then they called all the same people back and asked them the same questions. By studying the responses, researchers could see that their education program had worked to change the attitudes of the people surveyed and their doctors.

If you have any doubts about a group that calls you, ask for the group’s name, location, and a number where you can call them back. This can help assure you that the group is legitimate. A good, quality study will have ways to keep the information you give confidential. You may want to ask how the group got your name and number, and if they will be giving this information to other groups.

Studies show that some people are at greater risk for back pain if there are back problems in the immediate family. Unfortunately, there is no way to tell who will have these problems. It has been shown that people with back injuries who remain physically active and avoid long periods of rest and inactivity after episodes of back pain have better outcomes than those who don’t.

Learning how to lift safely and strengthening the back muscles can help prevent injuries. A physical therapist could show your whole family good back techniques and exercises. This may be a very good investment in your children’s back health.

This chicken-or-the-egg question has puzzled researchers for years. Patients with low back pain typically have more pain with physical activity. Studies suggest that they also score lower on measures of mental health. Which comes first in determining their physical performance? Do depression and anxiety cause pain in physical activity? Or does pain in physical activity create depression and anxiety?

Researchers recently looked at the performance of low back pain patients on a treadmill. How long could patients walk? And what made them stop? Half of the patients stopped walking because of pain. Though patients with poor mental health were more likely than others to stop walking because of pain, mental health actually didn’t influence the number of minutes patients walked. Pain was more important to patients’ physical performance. This suggests that poor mental health may be a result of having pain in physical activity, rather than a cause.

Certainly, this kind of question is best answered on a case-by-case basis. For many patients with low back pain, both physical and emotional issues must be addressed to get the best results from treatment.

A recent study measured mental health and physical performance (walking) in patients with chronic low back pain. Patients who had poor mental health reported the same amount of pain before and after the walking tests as other patients. They also walked the same amount of time.

Patients who scored low on mental health were more likely than others to stop walking because of pain. But pain–not mental health–was the main factor that stopped patients from walking. This suggests that depression and anxiety may come from (rather than cause) poor physical performance in patients with low back pain.

Optimal treatment for patients with low back pain addresses all of these issues, mental and physical, to get the best results.

It could be a combination of both. A group of researchers recently set out to determine whether physical pain or emotional well-being was more important to the physical performance of patients with chronic low back pain. These researchers suspected that mental health might play a bigger role than previously thought.

But in testing patients with low back pain on a treadmill, the researchers found that pain stopped patients from walking more than poor mental health. From these results, it looks like poor mental health may be a result of the pain patients experience with physical activity, rather than a cause.

If movement causes pain, it’s natural that your husband would want to avoid it. Talk with your husband and his doctor about your concerns. The doctor may be able to suggest a program to improve your husband’s activity levels with less pain. This may improve your husband’s mood as well.

Several studies have looked for possible predictors of back injury among college athletes. One group of researchers looked at age, type of sport (contact versus noncontact), gender (male versus female), and economic background. There were no differences in rates of back injury based on these variables. The most important risk factor for back injury in both men and women was a previous back injury in the last five years.

Dissatisfaction with work is indeed a known risk factor for back injury in the general adult population. A second, equally important factor is previous or current back injury. Repeated studies of college athletes show an injury rate of seven per 100 participants. Like the population at large, athletes are at greater risk for back injury if they’ve had a back injury in the last five years.
 
Dissatisfaction with the coaching staff or other team players does not seem to be connected to back injury. At both the college and professional levels, athletes are highly motivated. They have financial reasons to stay healthy and keep a positive mental outlook.

A new study of 679 college athletes found that athletes who have a history of back injury have a three to six times greater risk of another injury compared to athletes without previous back injuries. For this reason, you should speak to someone on the coaching or athletic staff. Do this at the beginning of the training season. A specific training program with exercises to “retune” the muscles of your back may be very helpful in preventing further injuries.

Unfortunately, no. There are a lot of variables before, during, and after spine surgery that influence its success. Even when the surgery succeeds in fusing the vertebrae together, some patients still don’t get pain relief.

The good news is that you have numbers on your side. More patients have good results than not. Talk with your doctor about the results he or she expects from surgery, given your condition. Your doctor may be able to advise you about steps you can take before and after surgery to maximize results.

These two professional disciplines used to be very distinct. Orthopedic surgeons did procedures that had to do with the bones of the spine, such as fusion. Neurosurgeons dealt more with conditions of the nerves that required surgeries like laminectomy.

Now there is a lot of overlap in both training and treatment. Neurosurgeons undergo training for cranial (brain) conditions in addition to the training they receive for problems of the spine. A neurosurgeon who intends to specialize in spine care will do training similar to an orthopedist who chooses to specialize in spine surgery.

Be sure to ask any questions that relate to your situation. Ask about the risks of having surgery and the chances of success. Compare these to what could happen if you don’t go ahead with surgery. Find out what impact the surgery might have on your symptoms. You may want to get more details about how the surgery is done. You should also get an idea about what to expect after surgery.

Patients with ankylosing spondylitis (AS) are often prescribed nonsteroidal anti-inflammatory drugs (NSAIDs). These medications have a tendency to irritate the gastrointestinal (GI) system and make peptic ulcers worse. They can also increase the risk for GI bleeding. These concerns should be discussed with your doctor. 

Other medical conditions commonly associated with AS include ulcerative colitis and Chron’s disease. Again, these should be discussed with your family doctor. Your orthopedic doctor usually doesn’t treat these conditions.

The tissues in the back actually need some tension in order to support and stabilize the spine. This tension provides a stiffness that protects your vertebrae as you move. If the tissues become lax, the vertebrae lose stability, making them prone to injury.

Researchers have shown that keeping the spine bent forward for long periods causes a loss of tension in these tissues, which makes the spine loose and unstable. In this case, a lack of tension can actually set the stage for back injury.

To allow these tissues to recover during the workday, use good body postures and take frequent rest breaks.

Probably more than you think. Picture the back muscles as rubber bands. When you bend forward, you stretch them out. It takes time for the muscles to recover their strength afterward. Without adequate recovery, they’re not able to properly support the vertebrae in the spine. This makes the spine loose and unstable, setting the stage for back injury.

A recent study looked at back muscle recovery after just 20 minutes of uninterrupted bending. Researchers found that even seven hours of rest weren’t enough to return the back muscles to 100 percent. After seven hours, the muscles had only reached 79 percent of their normal elasticity. (Most of this recovery happened within the first ten minutes of rest.) Researchers suspect that 24 hours may be needed for muscles to recover fully after keeping the spine bent forward for long periods.

You may not have 24 hours to rest between bending movements. Still, it’s important to take precautions. Talk with a doctor or physical therapist about specific things you can do to protect your low back.