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Frequently Asked Questions

 

What is back pain?

Back pain affects 80% of Americans at some time in their lives. It comes in many forms, from lower back pain, middle back pain, or upper back pain to low back pain with sciatica. Common back pain causes include nerve and muscular problems, degenerative disc disease, and arthritis. Many people find relief from symptoms of back pain with pain medication or pain killers. Back pain symptoms can range in intensity from mild to severe.

What is the difference between acute and chronic pain?

Acute pain occurs suddenly, such as after an accident or injury. The one major misconception about acute pain is that it will often resolve on its own; therefore, people tend to do nothing which slows the recovery process and can even lead to chronic pain. If the back pain is addressed and treated during the acute phase, research shows that you have a quicker recovery process. To be classified as acute, pain should last no longer than 6 weeks. Acute pain is the most common type of back pain.

Chronic pain, on the other hand, may come on either quickly or slowly, but it lingers over a long period of time. In general, pain that lasts more than 3 months is considered chronic.

What causes back pain?

Back pain is often caused by overuse, strain, or injury. For instance, people often hurt their backs playing sports or working in the yard, being jolted in a car accident, or lifting something too heavy.

Aging plays a part too. Your bones and muscles tend to lose strength as you age, which increases your risk of injury. The spongy discs between the bones of the spine (vertebrae) may suffer from wear and tear and no longer provide enough cushion between the bones. A disc that bulges or breaks open (herniated disc) can press on nerves, causing back pain.

In some people, back pain is the result of arthritis, broken vertebrae (compression fractures) caused by bone loss (osteoporosis), illness, or a spine problem you were born with.

Often doctors don't really know what causes back pain. Dr. Dennis C. Turk is a professor of anesthesiology and pain research at the University of Washington and a past President of the American Pain Society. He states that the exact cause of back pain is never found in approximately 85% of patients.

How is back pain treated?

There are many treatments for back pain that vary from their level of invasiveness to their effectiveness. There are many practitioners that treat back pain, including physicians, physical therapists, massage therapists, chiropractors, acupunctures, and more. There are also many devices, creams, lotions, pills, and so-called miracle solutions available.

Though the treatments are vast and often difficult to sort through, there are a few things to keep in mind when looking at your treatment options. Please see “How can I tell if my back pain treatment is a “quack”? below.

How can I tell if my back pain treatment is a “quack”?

When you look for a treatment option for your back pain, you need to find one that the creator is teaching/doing on a daily basis. Also, find out past outcomes in measurable standards. For example, what percentages of the people that have used a system, or treatment option, have had success in eliminating their pain? Additionally, since not all back pain is from the same cause, make sure that the program or treatment can be individualized to you. Also, we know that some of the so called treatments available out there can actually do more harm than good, so we encourage you to put each one through the “Quack Test©” prior to trying it. The Quack Test©…if it looks like a duck, quacks like a duck, it is a quack!

 

Does the treatment address the cause of back pain rather than just the symptom of pain?

If the treatment addresses the cause of back pain, does it treat the cause of the cause when it is resolved? (For example, if your back pain is caused by a bulging disc, and your treatment helps reduce the bulging disc, does it then help you to understand what caused the problem in the first place and how to fix it so that the bulging disc doesn’t get worse for the same reasons it came about in the first place?)

Does your treatment teach you how maintain a neutral spine (proper posture) while doing daily activities?

Does your treatment teach you a comprehensive flexibility, strengthening, and core stability routine to decrease unnecessary stresses on your spine?

Does your treatment option educate you in lifestyle changes to prevent your pain from reoccurring?

If you answered no to any one of these questions, keep searching…chances are the current treatment you’re receiving is not going to be successful in eliminating your pain and preventing it from reoccurring!

When, if ever, will the pain in my back go away and will ever get back to “normal”?

These are common questions. Unfortunately, this cycle can go unbroken for one very specific reason. Most treatment options available only treat the symptoms of back pain. They are not specific to the individual needs of a patient, nor are they typically comprehensive. Back pain can be caused from a multitude of different things so the approach of a treatment option has to take that notion into account.

The good news is that you can return to a normal, pain free lifestyle. Research shows that the most effective way to treat back pain and prevent it from returning is through a comprehensive, preventative approach. The best approach in treating back pain is one that combines education on the anatomy of the back, information as to what causes back injuries, instruction in proper movement patterns/postures, and stretches and exercises to help prevent back pain in the future. This is what many people think of as “Back School.”

I've had back pain on and off for years. Why does it keep coming back?
The most likely reason you have had recurring back pain over a period of time is because your previous options have been probably been geared more toward alleviating the back pain itself and not treating the underlying cause.

Research shows that the most effective way to treat back pain and prevent it from returning is through a comprehensive, preventative approach. The best approach in treating back pain is one that combines education on the anatomy of the back, information as to what causes back injuries, instruction in proper movement patterns/postures, and stretches and exercises to help prevent back pain in the future. This is what many people think of as “Back School.”

I just injured my back, but it doesn't hurt enough to go into the doctor. Should I take it easy for a few weeks and see if it gets better on its own?

Though bed rest is not as widespread of a treatment anymore, I still find a small percentage of people that come to physical therapy after having tried bed rest for several days, thinking their pain would go away. Research clearly shows that not only does bed rest not “fix” back pain; it can actually make it worse. It can also leave an individual with decreased range of motion, flexibility, and muscle tone, which are all vital for the elimination of back pain. Research also shows that those who stay active during episodes of back pain do better than those who stay more sedentary.

Another key reason that bed rest is ineffective is that it does not do anything to change what caused the pain in the first place. It simply attempts to provide temporary relief for the symptoms themselves. Unfortunately, I have seen the effects of bed rest on those who subscribe to this treatment option. In fact, many are worse off in their mobility once they do get up and start moving than had they stayed more active throughout recovery.

I would highly recommendation that you are proactive in seeking treatment during this acute phase. Don’t make the mistake of thinking you pain will simply go away with rest or time.

When should I see a doctor for my back pain?

Certainly you know your body better than anyone so, it is recommended you use sound judgment in making this decision. Overall, as a guide, you should see a doctor if you have numbness or tingling, if your pain is severe and doesn’t improve, or if you have pain after a fall or an injury. It is also important to see your doctor if you have pain along with any of the following problems: trouble urinating; weakness, pain, or numbness in your legs; fever; or loss of normal bowel or bladder function. Such symptoms could signal a serious problem that requires treatment soon.

Which type of doctor should I see?

Many different types of doctors treat back pain, from family physicians to doctors who specialize in disorders of the nerves and musculoskeletal system. In most cases, it is best to see your primary care physician first. In many cases, he or she can treat the problem. In other cases, your doctor may refer you to an appropriate specialist.

What questions should I ask my doctor?

When you're having back pain, going to the doctor can be intimidating. You might feel rushed and forget to ask some important questions about your back pain. It's always a good idea to know what to ask beforehand and to take notes during your doctor visit. Some of the questions below about back pain and its treatment may be worth asking. Print out this page and take it with you to your next appointment.

1. What's causing my back pain?
2. What treatment options should I consider for my back pain?
3. Are there any other symptoms I should be aware of that could indicate a more serious condition?
4. Are there activities I should temporarily or permanently avoid to ease back pain or keep it from returning?
5. Could my daily activities or my work station be causing or increasing my back pain?
6. Are there alternative therapies that I should consider?
7. How long will it take before I notice results, and have less back pain?
8. What can I do to prevent back pain from persisting or returning?

Will I need surgery for my back pain?

Depending on what is causing your back pain, you may need spine surgery. However, just 5% of patients with back pain actually require surgery. Before recommending surgery, your doctor will most likely have you try other more conservative treatment options, such as physical therapy or medication. Keep in mind that spinal surgery is an aggressive and invasive treatment approach so most doctors will recommend starting with the conservative treatments first.

What types of surgery are used for back pain?

There are many types of surgery used for back pain because there are many causes of back pain. If you do require surgery, your surgeon will recommend a surgery that's best for your pain. Some common surgeries used for back pain are:

Discectomy: The surgeon will remove part of the intervertebral disc, which could be pressing on your spinal cord or other nerves and causing pain. Sometimes, the surgeon will need to perform a spinal fusion at the same time as the discectomy. The fusion aims to permanently stabilize that area of your spine, but not everyone who has a discectomy will need a fusion.

Foraminotomy: A surgeon uses a foraminotomy to make more room for your nerves that may have gotten compressed and are now causing you back pain. In this procedure, the surgeon will remove a part of the foramen (the area where the nerve roots exit the spinal canal) to increase the size of the opening for the nerve pathway.

Laminectomy: A procedure for treating spinal stenosis by relieving pressure on the spinal cord. A part of the lamina (a part of the vertebra) is removed or trimmed to widen the spinal canal and create more space for the spinal nerves.

What are the risks associated with back surgery?

Complications that can occur with spinal procedures include infection (1-3%), spinal fluid leak, nerve injury, bleeding, failure to fuse (2-5% per level), implant failure or the need to re-operate, and failure of the pain to improve.

The biggest risk is a lack of pain relief. A recently published extensive review of the literate indicates spinal fusion has an associated satisfactory relief of pain in the 70% range - meaning 30% of patients who undergo a spinal fusion do not receive adequate pain relief. This would be by far the biggest risk.

The risks involved with spine surgery depend upon the specific surgery being performed, the health of the patient involved, and the training and experience of the spine specialist performing the surgery. You can minimize the risks by seeking out surgeons with advanced training and who dedicate their practice to spinal surgery.

I have noticed that my upper back is starting to become rounded in appearance. Why is this, and will my posture continue to get worse?

In the book Muscles: Testing and Function, Kendall, et al convey that the effect of poor posture, as it relates to mild discomfort to complete disability, is directly related to how bad the posture is and for how long it has been that way. (lorence P Kendall, Elizabeth Kendall McCreary, and PR Provance. Muscles: Testing and Function. 4th ed. Baltimore: Williams & Wilkins, 1993.) For many, this isn’t new news but endorses the significance of taking action in addressing poor posture. It also gives us hope that correcting our posture can halt further damage from posture related problems and in fact, alleviate problems caused by poor posture altogether.

Most people think that proper posture is just “standing up straight.” In reality, we have to learn to use proper posture while we are sitting, standing, sleeping, and moving. Our back never rests…even when we sleep. The effects of poor posture are exerted on it 24 hours a day, 365 days a year.

Research has repeatedly shown that the positions we place our back in throughout the day, whether during activity or at rest, we will either benefit our back or create harmful stresses on the muscles, ligaments, discs, nerve tissue, and bone of the back. In addition, studies have shown that the most common causes of back pain, after lifting, include poor posture, exercising improperly, driving for long periods with poor posture, sleeping on a mattress that does not give your back proper support, being in poor physical shape and being overweight. Over the years, sustained poor posture can lead to discomfort and pain, as well as conditions that lead to surgery and/or disability.

You have to remember that poor posture and movement patterns are learned habits. They develop over time, so there is no quick fix to correcting them. Poor posture and improper movement patterns are a physical problem, so it only makes sense that they require a physical solution. There is not a pill, cream, injection, device, or massage technique that can manipulate your muscles back into balance. It takes intelligently applied stretches, exercises, and re-education of your current postures and movement patterns.

The reason I say “intelligently applied” is because many people think they can just Google “posture” on the internet, watch a few videos, and read a few tips and be set. It may seem confusing, but not everyone needs the same recommendations for how to improve their posture. Though there are some generalizations we can make about the general population, the muscle imbalances responsible for one person’s posture may not be the same as another individual.

According to many authorities, for the most part, doctors and other health care providers do what mothers do and remind us to "stand up straight." I’m sure you have heard it before, if not said it yourself! I know I have. Let me assure you there is some great validity to this point, but there are more effective methods of posture correction. Yes, they will take time (typically 1 to 6 months) and specific and targeted training such as what I have utilized in my program through the Functional Movement Technology™. You don’t need fancy equipment and devices or expensive memberships to the latest club or trendiest class.

Sitting or standing in a proper posture may be uncomfortable at first, but remember that it will get easier as you work on it. Eventually, your body will get used to it, and you will not even have to think about it. One day, your postural muscles will be so well conditioned that the body will hold proper posture on its own.

Are there other medical professionals who may be able to help me deal with my chronic back pain?

There are many practitioners that treat back pain, including physicians, physical therapists, massage therapists, chiropractors, acupuncturists, and more. Though many of these professionals treat back pain, make sure the treatment option or professional you choose is not just treating the pain itself. It is important for you to learn:

• What has caused your pain in the first place.
• how to move properly so as not to put extra stress on your back.
• how to retrain your body to move correctly throughout all daily activities.
• a proper exercise and conditioning routine to ensure balance in the muscles that stabilize or exert force on your spine.

No matter which professional you choose to see, make sure the above areas are addressed or your pain will likely return at some point.

I can't get comfortable in bed. Do I need a special mattress or pillow?

Sleeping with an improper pillow or mattress can have negative consequences on your back and can often exacerbate low back pain. If your pillow and mattress lack the ability to support your back, it reinforces poor sleeping posture causing undo strain on your muscles and poor spinal alignment. Ideally, it is best to find a mattress and pillow that provide the support needed to decrease or eliminate low back pain, while being able to find one that does not force you to sacrifice comfort based on your individual preferences. When comfort and support are provided, you are able to allow your mind and body to rest and rejuvenate, maximizing the quality of your sleep.

For maximum support, try to find a pillow that provides the following characteristics:

It keeps the spine in its natural alignment - A pillow should maintain this curve while you sleep. If the pillow is too high when sleeping on your side or back, it will bend the neck forward or to the side. On the other hand, if your pillow is too low, it will not provide enough support to the neck and the muscles can be strained in this manner as well.

It is comfortable to sleep on - This is largely based on your personal preference. Any type of pillow filling or surface material is acceptable, as long as the first characteristic of spinal alignment is maintained.

Ideally, it can be conformed to your neck - This would be the type of pillow that contours and adjusts to the neck. Many of the new memory foam fillers will allow the pillow to conform to your body and alleviate pressure points while providing support. Ideally, your pillow should measure four to six inches in height.
A good mattress should provide support, while also allowing for the natural curves and alignment of the spine. Proper back support from a mattress also helps prevent muscle soreness in the morning.

Typically, the recommendation is to get a mattress that is medium to firm, primarily because a mattress that is too firm will cause pressure at points such as the shoulders, hips, and knees, which can be uncomfortable. If you currently have a firm mattress and need to soften it up a bit, consider getting a padding to put on top. The padding should be about one and a half to two inches thick.
You need to make sure the mattress you are looking to buy provides adequate support. The mattress’ core, whether it is water, air, coils, or foam, is where the support for your back is located. Once it begins to wear out, you are left without the support that guarantees the proper alignment of your spine. If the core is not sufficient to maintain spinal alignment, the back can become swayed while you sleep and increase the risk of bulging or herniated disks.

To view short videos showing how to determine correct spinal alignment in sleeping, visit:

http://www.youtube.com/watch?v=CSd2WJud5WE
http://www.youtube.com/watch?v=zIMz_OaZPo8

Can my shoes affect my back pain?

As with so many things in life…one size does not fit all! Shoes are certainly no exception to that rule and selecting the “best” one for your foot is critical. Having the wrong shoe can lead to problems such as blisters, plantar fasciitis, Achilles tendonitis, stress fractures, knee and ankle pain, as well as hip and back pain.

When choosing a shoe, whether it is for everyday casual use, running, hiking, cross training or for dressing up, it is essential you make sure that you have a proper fitting shoe.

There are certain things that should be taken into consideration when choosing shoes. Your biomechanics, weight, shape of your foot, and whether or not you are using them for exercise, are all factors that should be considered.

Shoes are divided into three categories: stability, motion control, and cushioned (also referred to as neutral). The shape of your foot will determine which shoe you need.

Before we discuss how to determine your foot shape, let’s first talk about how your foot moves. You will often hear the word pronation used when determining the biomechanics of your foot. Simply put, pronation is the motion the foot has from the heel to the toe as you take a step. Typically, you start the step on the outside of your heel and your foot should roll over the ball of your foot. This motion is referred to as a neutral stride. People who have a normal arch tend to pronate efficiently and are less likely to have biomechanical issues. Sometimes, people have too much pronation (over pronation) which means that your feet flatten out too much during your stance.

In order to determine your foot shape, you can use the “Footprint Test”. Simply wet the entire sole of your bare foot and step onto a dry piece of paper. Trace around the outline with a pen or pencil. The outline will give you an idea of the amount of stability you might need in a shoe.

High Arched Foot

If this is your foot type, a cushioned shoe is the best choice for you, as it will allow your foot to roll as much as it can. You should avoid motion control or stability shoes as they limit the flexibility and normal motion in your foot.

 

Normal Foot

The type of shoe that is suited for this is referred to as a neutral or moderate stability shoe. These shoes provide plenty of cushioning and less arch support.

 

Flat Foot

The best shoe for this foot type is a motion control shoe. These will ensure maximum support in your heel and arch. You should avoid highly cushioned or curved shoes.