Where do bone grafts come from?

Surgeons use two main types of bone graft–autograft and allograft. Autograft comes from the patient’s own body. Allograft is transplanted material from another person (a donor).

My back started hurting last week. What exercises should I avoid?

Avoid doing anything that makes the pain worse or carries the risk of re-injuring your back. What exercises are safe to do depends on the activity and on what exactly is wrong with your back. Your best bet is to start slowly and gradually begin doing your usual activities. If you normally do intense exercise or sports that involve twisting your back, like golf, you need to wait until your back is better. Walking and swimming are probably the best exercises for rehabilitating your back. They keep you from putting too much stress on your body, yet they get your entire body moving.


Talk with your doctor and physical therapist about how to get started on a program of exercise to help you get back to full function.


I have so much back pain. How do I get through my day?

When you are fighting pain, it is tempting to just give up and lay in bed all day. However, that will make things worse in the long run. It is important to keep doing as many of your daily tasks as possible, even if you need to do them a bit differently. Take frequent breaks. Reorganize your day to include periods of rest, and rest in comfortable positions that take the strain off your body. While you are resting, use ice or heat to soothe sore areas. Pay attention to your posture and your body alignment while you move. Using healthy alignment and standing and sitting up straight can help you get things done with less pain.


If you can’t manage to continue doing certain things, talk to your doctor, physical therapist, or occupational therapist. They can give you suggestions about special ways or devices that can help you accomplish your tasks, and the information you give them will help them tailor an exercise or rehabilitation program that can better meet your goals.


I feel like my low back pain is going to last forever. When will it go away?

It’s hard to tell. Sometimes low back pain goes away quickly, and other times it sticks around for months. In people suffering their first bout with low back pain, it often goes away completely within two months, even without treatment. But for some people low back pain becomes a chronic, recurring problem.


There is no way to predict which group you will fall into. The best bet is to get medical attention for your pain. Your doctor can recommend ways to manage your pain, and suggest ways to help you avoid problems in the future. Even if your pain doesn’t go away completely, there are many strategies for controlling it so that it doesn’t control you.


My back hurts when I lay down, and I can’t get any sleep. Would a special mattress help me?

Maybe. Firm mattresses are usually the best choice for people with back pain. Very soft mattresses or waterbeds don’t give the spine enough support. But there are some ways that may help you get the support you need without buying a new mattress.


To support your lower back, you can lie on your side and put a small pillow or rolled up towel just above your waist and a pillow between your knees. If you lie on your back, put a small pillow under your knees. To support your neck, you can try rolling a bath towel and sliding it in the pillowcase, on top of the pillow. This roll supports your neck when you lie on your back or side. (You can also find many neck cushions, neck rolls, and pillows in stores that are made to support your neck.) If you lie on your stomach, situate your pillow so that your neck isn’t craned all the way to one side. Don’t use foam pillows; they tend to be too firm and push against your head, keeping your neck muscles from resting. Feather or softer fill pillows will be more comfortable.


Some of my co-workers use back support belts when they lift at work. Should I use one?

Probably not. Back support belts can provide muscle support, but they can also make you more likely to overdo it. Long-term use of back support belts can also cause the muscles of the abdomen and lower back to weaken, making back problems more likely.


Medical research has shown that back support belts can help men when they catch an unexpected load that comes directly from the front. However, the benefit was small, and women did not receive the same benefits from the belt. In the same study, support belts actually hurt people who caught unexpected loads from the side. The belts kept key muscles from responding appropriately.


Back support belts may be appropriate for some people who have had back injuries.  However, a support belt should only be used for short periods.  It should be removed often to do a program of exercise to improve abdominal muscle strength.

I’m using a back support belt for my intense low back pain. It helps so much. Why can’t I wear it all the time?

That’s not a good idea. A support belt can improve your posture and limit your movements, which can help calm pain. It can create abdominal pressure, easing the pressure around painful discs in the lower back. But if your wear the brace all the time, the muscles of your abdomen and lower back start to rely on it. Eventually they atrophy–they get weaker and smaller. This will just make your problem worse.


So follow your doctor’s or therapist’s guidelines about when and how much to use your brace. Take it off to do stretches and other exercises. And once your pain starts to go away, you should use your brace less.  



 


I have low back pain. If I just use a brace, will it go away?

A brace all by itself will not heal your back. Supportive braces can help, especially if you have severe pain. However, long-term use of a brace can lead to a weakening of muscles around the spine. This can make your problem worse.


You may need the support of a brace, but don’t wear it for long periods of time. Take it off to do gentle stretches and exercises prescribed to you by a doctor or therapist. They can also suggest ways to control your pain, including cold and heat treatments and medications. All these therapies together can help heal your back. Don’t depend on just one method of treatment.

My back is really hurting. Should I just stay in bed?

No. Bed rest is rarely prescribed and even then should only be used for very short periods, usually two days at most.  Too much bed rest can actually make your problem worse, as your muscles and joints get weaker and stiffer. The key is to help you get back to doing normal activities as early as possible.  Also, gentle exercises can actually help your pain go away. You need to work with a doctor or physical therapist to come up with a plan to help you gain confidence with exercise, movement, and activity.

My lower back hurts. Should I go to work?

If you can manage your pain, and if you can do your job without causing more pain, it’s probably OK to work. If your pain is severe, and if your job makes it worse, then you may need to a short time off. 


When your lower back pain interferes with your job, you need to see a doctor. Your doctor will be able to help you manage your pain. Your doctor can also give you guidelines on how to do your job so that you don’t further injure your back. Your doctor may also put limits on the amount of time you should spend sitting, standing, or walking, and may restrict you from tasks such as lifting or carrying heavy items. You may also need to work with a physical therapist to help you control your pain and strengthen your back. The key is to get you back to your normal activities as early as possible, including work.


 


Do doctors use lasers for spine surgery?

Yes. At this point, laser surgery for the spine is used primarily for disc problems. Lasers are not widely used now, but they appear to leave less scarring after spine surgery. A procedure called thermodiskoplasty uses lasers to shrink collagen and fibrocartilage to change the shape of the disc.

I know it’s important to bend my knees when I lift heavy things. But I’ve had surgery on both of my knees, and they really hurt when they bend too far. How can I protect my knees and my back when I lift?

That can be difficult. It would be best to lift heavy items from waist level so you don’t have to bend your knees. If you have to lift heavy items from the ground, try to bend your knees only as far as they can go without hurting. Then lower your body by bending at the hips and keeping your hips back. Your low back should be arched in slightly. Grab the item without rounding your back. Without holding your breath, tense your abdominal muscles and lift. Straighten up from your hips. The idea is that your hip muscles will take most of the load, rather than your knees or low back. 

I am going to have surgery for a bulging disc. My doctor wants to do a procedure called IDET. What is IDET?

Interdiscal electrothermal therapy (IDET) is a fairly new type of procedure used for outpatient disc surgery. The surgeon uses X-rays to guide a special needle into the disc. A catheter is then put through the needle into the disc, and the needle is heated over 30 minutes. The heat makes the disc material shrink, which reduces the bulge or closes off the torn part of the disc. After surgery, patients are usually monitored for 90 minutes and then sent home. Sometimes doctors have their patients do a rehabilitation program afterwards.


Because it is a new treatment, long-term results are not known. But IDET has been shown to have good short-term benefits. IDET is most effective when the disc is definitely the painful tissue. Pain from other spinal joints or nerves aren’t helped by IDET surgery.


Some people say I should use heat for my pain, and others say ice. Which is best?

They both have their place in treating and inflammation. Ice or other cold treatments are usually used in the early stages of an injury. Cold applied to the injured area makes the blood vessels get narrower (vasoconstrict), limiting the swelling of the initial period of healing. Cold treatments should be applied for about 15 minutes, three to four times a day for the first two or three days after the injury.


In some cases, heat is helpful two or three days after the injury. Heat makes the blood vessels get larger (vasodilate). This brings more blood to the area, infusing it with nutrients and oxygen to help healing and flushing away chemicals that have built up in the injured tissue. True heat, such as moist hot packs, heating pads, or warm showers or baths, are better than creams that just make the skin feel hot. Heat treatments should usually be held on the injured area for 15 to 20 minutes, three to four times a day. Be careful not to burn yourself by routinely checking your skin for extra redness. 


My young daughter wants to compete in gymnastics. Will it hurt her low back?

Intense athletic training and competition can hurt children’s spines. This is especially true in gymnastics. Pay attention to how much time she spends training. A recent study suggests that adolescents who spend long hours doing gymnastics are at risk for developing too much bend in the curves of their spines. This was most true in adolescents who trained hard more than 400 hours per year. 


I keep reading about using glucosamine for arthritis. Will it help me?

No one knows for sure at this point. Glucosamine has been tested for knee osteoarthritis, with good results in easing pain. However, these tests only looked at knee osteoarthritis, and the studies only followed patients for up to two months. Glucosamine’s long-term effects, effects on different joints, and effects on different diseases are unknown.


Glucosamine does look promising. Some doctors have decided that glucosamine is worth a try, even if it isn’t fully tested yet. Talk to your doctor if you are interested in trying glucosamine.
 



 


Will my doctor prescribe medication for my pain?

Yes. Doctors have many medications they can prescribe for pain and inflammation. Your doctor may prescribe only one of these medications or several.


*Nonsteroidal anti-inflammatory drugs (also called NSAIDs) effectively relieve muscle pain and inflammation. Ibuprofen is an over-the-counter type of NSAID. A doctor must prescribe some types of NSAIDs.
*COX-2 inhibitors help relieve inflammation like other familiar NSAIDs, but they aren’t as hard on the stomach and intestines.
*Non-narcotic analgesics attack the pain at the point of injury. (“Analgesics” means “pain relievers.”) Tylenol and aspirin are examples of over-the-counter analgesics.
*Muscles relaxants can sometimes help ease the pain from muscle spasm.
*Narcotic pain medications are sometimes used in cases of severe pain. These medications numb the central nervous system and are highly addictive if they’re overused, so doctors prescribe them sparingly.
*Anti-depressants can help with the emotional stress and emotional fatigue that comes from suffering chronic pain. 


Medications cannot stop degeneration, but they can help control your symptoms so you can move and exercise easier. Work with your doctor to find what works best for you.



 


I drive a forklift, and my neck is really getting sore from always turning my neck to see behind me. What can I do to keep my neck pain from getting worse?

Warm up before you start work by doing some gentle neck, back, and shoulder stretches. Sit with good upright posture while you drive. Keep your chest up and shoulders back. Try to avoid straining your neck when you turn to see behind you. As much as possible, turn your shoulders with your head, so that you aren’t just craning your neck. Assess whether rearview mirrors on the forklift could help you see behind you without having to turn your head as often.


Take frequent breaks as you work. Do some gentle stretching or walk around a bit. During your breaks or after work, try using a cold pack on the sore area. This can help control the pain. 


 If your neck pain continues, see a doctor. Your doctor can help control the pain, and he may be able to help you come up with exercises to help strengthen your neck muscles and improve your posture.


What is an EMG test?

EMG stands for electromyogram. EMGs are used to test the function of nerve pathways to the muscles. Tiny electrodes are inserted into the muscles. If nerve pathways are injured or damaged, the EMG will show abnormal signals. EMGs can be used to test muscles and nerves in many different parts of the body.