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Pain in the neck: Local doctors, therapists and chiropractors offer tips on preventing back and neck pain

Monday, August 2, 2010

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If you've got an ache in your back or a pain in your neck, don't brush it off as a natural part of aging. At a July 14 seminar at Saint Francis Medical Center, four local experts reviewed proper prevention, care and treatment when it comes to back and neck pain.

STOP THE PAIN IN ITS TRACKS

Dr. Aaron Andrews, chiropractor at Jackson Healing Arts, said the first step is to know how the back and spine work so you can recognize any problems. The body is flexible and adapts easily, but it can only take so much -- that's why easy, everyday moves can set off sudden, severe back pain, he explained. One of the most common problems at Andrews' practice are vertebral subluxations, in which out-of-place vertebrae cause the muscles to tighten and spasm. Subluxations have a number of causes, from car accidents and improper lifting to falls and poor posture. Left untreated, they degenerate, causing more pain and possibly permanent damage.

The first chiropractic visit involves a discussion of symptoms as well as nutrition and weight loss. Many patients find that once they lose a few pounds, their pain goes away without any treatment, said Andrews. Smoking complicates every medical condition, especially back pain, he added.

"You need to get the little problems diagnosed to avoid bigger problems later," said Andrews. "If it's too late, some things can't be fixed. You're never too old to invest in your health."

To prevent back pain, Andrews said exercise, a healthy diet and regular chiropractic care will keep the joints moving and improve stability and range of motion.

"If you keep preventing and maintaining, it will save you time and money," he said.

Todd Wasilewski, physical therapist at Saint Francis, said the most common problems for patients age 50 and up are muscle strains, disc bulges and herniations, and osteoarthritis. While muscular strains usually resolve on their own or with muscle relaxers and rest, the other two conditions likely require more treatment, such as muscle relaxers, physical therapy and perhaps epidural spinal injections or surgery. Regardless of the situation, the goal is to keep the pain from becoming a chronic problem.

"The goal with a lot of these things is to decrease pain," said Wasilewski. "We are conscientious of your symptoms and we want to make the pain better."

According to Wasilewski, smoking and repetitive bending are two of the biggest risk factors for back pain -- the average person bends 3,000 to 5,000 times each day, and even small actions put stress on the back.

"We don't realize the repetitive stress we put on our bodies," said Wasilewski. "When patients exercise regularly, we typically see that it decreases back pain and prevents the onset of back pain."

WHEN THE PROBLEM IS MORE SEVERE

Rhonda Robert, registered nurse in the Pain Management Center at Saint Francis, said injections, like epidural spinal injections or Botox, help treat chronic muscle spasms and back pain. Though the center treats 30 to 40 diagnoses, Robert said lower back pain is one of the most common. Many patients use injections in order to stay active or begin physical therapy without pain.

"A lot of elderly patients do it to maintain their living status and stay at home," Robert added.

It might take hours, days or weeks after the injection to see improvement, and multiple injections may be needed. After three injections, Robert said, the patient may need additional diagnostic tests or could be referred to a neurosurgeon.

"We really don't give up," she said.

Dr. Franklin Hayward, neurosurgeon on staff at Saint Francis, said most doctors don't recommend surgery within the first few weeks of back pain, as they want to give the body time to heal. However, patients with "red flags" like fractures, infection, tumors, major motor weakness or difficulties with urination require treatment immediately.

"What matters is how the pain affects your life and the things you're able to do in life," said Hayward. "In most cases it's a matter of function."

Fortunately, surgeons like Hayward now have access to new, minimally invasive tools and techniques.

"The current trend is toward minimally invasive surgery and motion preservation devices," or artificial discs, said Hayward. "MIS allow faster recovery while minimally affecting normal anatomy. Traditional procedures such as fusions and discectomies can be performed via MIS. Motion preservation devices help maintain motion, thereby putting less stress on adjacent structures."

Like his colleagues, Hayward agreed that it all goes back to the basics when preventing and alleviating back and neck pain.

"Stress can aggravate back pain," said Hayward, noting that this works in reverse, too. "It's like a snowball effect." Smoking is also "notorious" for back pain, as it dries out the discs between vertebrae, he said.


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Advice from you family doctor

For most patients with back and neck pain, the family doctor is their first phone call.

"It's very rare to go your entire life without some sort of twisting, bending or lifting injury, but if the pain interferes with the activities of daily living or changes the way you're doing things, you need to be seen," says Dr. Danette Miller, family practice physician at Plaza Primary Care West of Southeast Missouri Hospital. "The most common back pain is what we call mechanical back pain, which is related to some type of bending, twisting, stretching or lifting injury. It's very acute at the onset and happens suddenly." This pain is sharp and debilitating enough that it causes the patient to call a doctor right away. "The good news is that it's very self-limiting, it doesn't last a long time and it doesn't require major interventions," says Miller. It can usually be treated with stretching, lower back exercises, Tylenol and a heating pad.

"Patients have a lot of success with low back exercises. That's a very easy way to strengthen the lower back muscles and prevent acute injuries in the future," says Miller. "One of the worst things to do for back pain is lay up in bed for a few days in a row. That causes the injury to prolong. The best thing is to stay active. Keep walking and stretching."

Disc degeneration disease is common as people age and place wear and tear on their back, says Miller. Spinal stenosis, the narrowing of the spinal column, is a serious, debilitating injury that requires surgical intervention.

"Watch out for serious numbness, tingling, loss of urinary continence, or inability to walk," warns Miller.

When it comes to preventing back pain in the first place, Miller offers this advice: "The No. 1 key is a healthy diet and weight. Maintain an active lifestyle; continue to walk and stretch and keep the joints mobile. The worst thing you can do is lay up in bed or sit on the couch."

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