Got Back Pain?
Look Beyond Surgery
Going under the knife, no matter how routine an operation, always presents a range of serious risks. For this reason, the correct way to view surgery – from both a medical professional’s and patient’s perspective – must be to only proceed if it is absolutely necessary. With back surgery comes additional layers of risk: nerve root damage, bowel and/or bladder incontinence or even paralysis. Let me be unequivocal: if your surgery is being carried out by a qualified and experienced team of surgeons the chance of any of the above happening to you is extremely unlikely; and yet, the risk remains a palpable reality. As a doctor, it is my duty to make patients aware of this risk and, consequently, the alternatives to back surgery. What is more, if you are considering back surgery because of a pain issue, it might not even be the most expedient treatment for you as it will not always alleviate or mitigate pain. Unless your back issue is neurological or an instance of instability of the spine, surgery simply is not your best course of treatment. How horrible would it be to deal with the pre-surgery preparation, surviving the risk of surgery and enduring post-surgery recovery only to realize that it was all for very little or maybe even nothing at all? It would be a nightmare, which I am sure you would be keen to avoid. If you suffer from muscular or myofascial pain, lumbar facet arthropathy or lumbar disc herniation, amongst other back pain issues, your best bet is to treat your back pain without surgery. There are a number of non-surgical solutions and often patients use more than one to treat their back pain. At this point I would like to discuss what the best options are and if you have any questions, be sure to send me a Tweet or to reach out to me on Facebook or LinkedIn.
Regardless of the cause of the back pain, physical therapy is almost always the first place to turn for treatment. The goal of your treatment will be to reduce back pain, increase function and to teach you a maintenance program to continuously strengthen your back and increase its flexibility to help prevent future issues. But it is not only physical therapy you should be after, but the right kind of therapy. If, for instance, you are dealing with pain caused by a compression fracture, it is essential that your physical therapist design a therapy program that sees your spine either in a natural or partially extended position as bending forward will cause increased pressure on the vertebral bodies and will risk further damage to the compressed fracture or even injury to a new level. Alternatively if you suffer from spinal stenosis you will want your therapist to design for you a flection bending forward program to give space to the nerves to relieve the stenosis, but which also avoids back extensions that can worsen the condition by pinching nerves. Treating back pain with physical therapy is not a case of ‘one size fits all’: your therapist must know the cause of your pain and they must be qualified to design the right treatment for you.
Thanks to recent medical innovations – of which I am personally proud to have played a part – there is a lot we can do for back pain without every having to put a patient on the operating table. I am talking about ultrasound guided injections. Through this amazing technology we can insert a needled directly into the affected part of the spinal chord with absolute precision thanks to the ‘inside the body’ viewing capabilities ultrasound provides. Through this innovation we can deliver a pain-relieving steroid injection directly into the spine’s epidural space (lumbar epidural injection) or through the cervical epidural space (cervical epidural injection). Often two or more injections are administered between 1 and 4 week intervals for lasting pain relief. Another highly effective injection treatment for those who suffer from arthritis in the spine is facet joint steroid injection. For those for whom these treatments do not deliver the required pain relief, we offer neuromodulation. This revolutionary treatment involves implanting a spinal cord stimulation device near the spinal chord that sends mild electrical pulses to disrupt or alter the signals being sent to your brain that cause you to feel pain. All these non-surgical treatments work wonderfully, particularly when combined with physical therapy.
This miraculous treatment comes to us courtesy of ancient Chinese medicine and involves inserting fine needles into so-called ‘acupuncture points’ to restore Qi (pronounced chee) to promote convalescence, mitigate pain and prevent sickness. For those who view Eastern or complementary or alternative medicine (CAM) dubiously, I should reassure you that it often complements Western medicine wonderfully and is reported to work very well on its own, too. There is copious research that backs up acupuncture’s medical effectiveness, but where we lack research-based proof, it is often a case of the research not having yet been performed. Besides which, patients often swear by it. I have personally witnessed its effectiveness, particularly in dealing with muscle spasms. My only word of caution is that it may not be helpful for a deeper spinal pathology.
Yoga and Pilates
In so far as it is good to be healthy, fit and flexible, I could not recommend pursuing yoga and pilates enough, regardless of whether or not you have back pain. If you do suffer from back pain, you should absolutely take up either or – better yet – both. Both activities are super for pre-emptively preventing back pain or mitigating it as they improve core strength and flexibility. However, you must be advised that they are forms of exercise and not treatments; furthermore, if you suffer from back pain you must discuss with your physician the recommended intensity level as overdoing it can result in further spine injury.
Osteopathic Manipulative Treatment
As a qualified Doctor of Osteopathic Medicine I would be remiss if I did not pitch a specialty of ours called Osteopathic Manipulation Treatment (OMT), which should be at the top of any list of non-surgical back pain treatments. A key to osteopathic medicine is the view that tightness in your muscles and nerves can lead to other pain and/or health issues. To combat it we use our hands to gently manipulate your tissue and joints to correct any problems and restrictions in your range of motion. Do not worry – it does not hurt a bit. All you will feel is a combination of light pressure, resistance and stretching.
While surgery absolutely has its time and place, for back pain it is not necessarily the go-to treatment. What is more, surgery goes hand-in-hand with a range of risks – however remote – which should be avoided unless it is absolutely necessary. All the non-surgical back pain treatments I have recommended work particularly well in conjunction with one another and if you suffer from chronic back pain, it is best that you do your own research based on my suggestions. Of course, if you have any questions or would like to speak to me directly either reach out to me on Facebook, Twitter or LinkedIn or get in touch with me for an appointment on my website.