Back pain

Is Low Back Pain Inherited?

/ Thomas Cohn, MD

back pain inheritedA frequent question I receive from patients is whether low back pain is just your fate and if it’s inherited. This is an especially hard question to answer, but genetics may influence the fact that you develop problems with your back. There are many conditions that may cause low back pain, and some of them are linked to your genes and thus could be inherited.

Back pain that may have genetic causes include scoliosis, inflammatory arthritis, osteoporosis, spondylolisthesis, obesity and possibly even lumbar degenerative disc disease. Back pain in younger people tends to be more related to traumatic causes such as force exhibited on discs, joints and muscle sprains. In older adults, the lists of causes of back pain are often associated with lifestyle issues as well as genetic causes.

Inheriting Back Pain

There are certain causes we know that have definite genetic causes and have direct links to back problems. One of the most common is scoliosis. About 3 percent of the population has scoliosis, and in most cases it is usually a minimal curvature without any significant impact on the back mechanics, and therefore it does not cause pain. Most scoliosis is considered idiopathic, and that implies that we have no idea why it is present, but there is a family association of roughly 30 percent and thus there is likely some sort of genetic component. Another five percent of scoliosis is associated with a variety of neurologic and musculoskeletal disorders, like Marfan’s syndrome or muscular dystrophy, and these diseases are definitely related to genetic causes. A lot of these latter diseases are associated with significant curvatures of the spine and the structural abnormalities are painful.

Another category of genetic causes of back pain are related to certain inflammatory disease that are linked to arthritis. These are disease like rheumatoid arthritis, lupus, psoriasis, and ankylosing spondyloarthritis. All of those problems can cause a variety of structural changes to the spine, especially to the joints as well as to the discs and bones. These conditions can lead to structural and motion changes, whic could cause spinal narrowing and nerve irritation. The combination of physical changes in the spine often results in pain.

Degenerative Disc Disease and Osteoporosis

Research out of Kings College in London in 2012 identified a gene known as PARK2 that occurred in some 65-80% of those people whom have lumbar degenerative disc disease. As everyone ages, the discs do degenerate by losing hydration and shrinking in height. This may lead to some changes in movement patterns in the spine, and also lead to bony changes in joints and discs. Sometimes these changes can cause narrowing where the spinal cord is and where the nerves exit the spine. In some people these changes are painful, and in many they are not since the body can adapt to many things, especially if the change is very slow.  

One common but often not recognized disorder that more commonly affects women is osteoporosis, which is commonly inherited. Thinning of the bones oftentimes occurs in the spine, which may cause the vertebral bodies to fracture and collapse downward. Sometimes these fractures are painful, and many times they are not, but the overall changes to the spine may lead to motion changes, muscle changes, and spinal narrowing, which may cause pain.

The overall answer to the question of whether your low back pain is due to genetics and is inherited is maybe. There are many things that can contribute to back pain and some of the most common issues are lifestyle related. A lack of exercise and obesity may be one of the most serious problems in our modern society. Many of us sit at desks all day long, eat too much food, and spend the evening in front of the television. Changing factors that one can control like the amount and type of exercise is often one of the most important strategies to treat back problems. One can not often change the inherited factors, but one often can change their impact by controlling your environment and lifestyle.

A Doctor Who Understands Your Pain

/ Thomas Cohn, MD

spine pain cohnI have been known to preach a little about the work it takes to control pain. It is not about taking a pill or just going to therapy and it will all be better. I often offer advice and I rarely cut people a lot of slack. I also do not like opioid medications, but that is for obvious reasons related to effectiveness and addiction. But most people wonder if I actually understand pain. The answer is yes, I deal with my own issues daily, but my patients are not paying to listen to me complain. The reality is I had to learn what works for me to manage my issues.

My Pain Story

My story started in medical school. Keeping in shape was important just to have the energy to spend countless hours in class and studying. At one point, a housemate convinced me to try weightlifting. The second time I tried I had the weights in the wrong position, lost my balance, and took out my back. I probably herniated a disc in my lower back, but there were no scans available then. I did therapy and over months it became manageable most of the time, not slowing me down if I was generally careful and not doing stupid things.

In my mid forties, 20 years later, my back started to become more noticeable. I had regular low back pain, and it started to frequently radiate down the leg. I gave up on running since that set it off, and just tried to keep in reasonable shape. This worked until I was in my late forties, and then finally I had a MRI scan that showed a significant slippage at the bottom of the spine, a disc that was pretty much shot and a lot of narrowing where the nerves exit the spine. The radiologist that read the scan had only one question for me, and that when was I thinking about having surgery. Surgery had not crossed my mind since my issue was pain. I decided to follow the advice I had given others; If there was no weakness and no loss of bowel or bladder control, surgery was not the answer.  

Conservative management was my goal. I had a couple of lumbar epidurals that brought down the worst pain and I did a few physical therapy sessions and they gave me a ton of exercises. The exercises were repetitive, and they seemed to be focused on the same muscles, doing all of them took about 40 minutes and they were boring. As the pain improved, I gave up on the program. Within 18 months the pain was again bad and I had another epidural, but I thought I needed to condense the exercise program. I narrowed it down to a set of core exercises that were all different parts of my core muscles, and I added a stretching regimen. Core work was about 10-20 minutes depending on what I did, and stretching was only about 5-10 minutes at the most.

My kids were hockey players, and my daughter had scoliosis and had exercises and a balance board. When I tried the balance stuff, I was terrible and it proved to me I needed to work more on core. I also felt since I was getting old, general strengthening would be a good thing to add to my workouts to reduce muscle loss. Lastly, I needed to also throw in general aerobic conditioning to maintain cardiac health.

Finding What Works For Me

The workout for the last few years has been pretty consistent. I start every day pretty early to get it done. After I climb out of bed, I stretch for a couple of minutes, and my dog gets a belly rub while I loosen up my back. After that comes core work that includes planks on a balance board, sit-ups, leg lifts and upper body/core with rubber tubing. I use a universal gym machine for additional strengthening and a roman chair device for abdominal work and pull-ups. Cardiac/aerobic workouts rotate between an elliptical, bike and rowing machine doing intervals. The rowing machine is the most recent addition. It supposedly works 85 percent of all your muscles, and it really seems to loosen things up and get the body moving well without stressing things out. During the summer I get outdoors and bicycle. Since I have a big dog, she gets twice a day walks daily year around.

As with everyone, as we get older, we all start to gain weight. I like to eat, and often enjoy snacking on junk food. Eventually my wife convinced me that I needed to change my habits. I had to stop eating as much carbohydrates, eat more vegetables and protein, and get rid of sugary drinks and snacks. I am no where near the weight I was in college, but I think I probably have more upper body muscle and some extra gut, but I have lost a few pounds.

For most people with back pain, sleep is a huge problem. Like many, I never feel well rested. I used to be a stomach sleeper, but with my back, extension is the worst position and that is absolutely out.  Side or back sleeping is feasible. Multiple pillows are my best friends keeping my knees bent while on the back, between the legs while on the side, and adjusted under my neck to keep that in a neutral position. A good memory foam pad adds to the comfort level to help relieve pressure points. I am not a deep sleeper, and after four hours stiffness often wakes me up. Instead of fighting it, I get up and stretch for just a few seconds, and then go back to bed and I can sleep for several more hours. For me, sleeping over 7.5 hours just hurts my back, so I get moving after that amount of time. To fall asleep, I do not do work right before bed, I do some reading and try to clear my mind of anything serious.

Like everyone else who has back pain, I have to take care of my back. It is not easy to do, but it is a priority to stay healthy.  It would probably help me if I could figure out how to get more sleep at night since some experts say this is good for general health. Maybe I should try to meditate, but this would also take time, and I am not yet into that either. I may spend to much time exercising, but a large part of it is walking my dog, and someone has to do it. Eating a more healthy diet has reduced my weight slightly. To lose more weight, another major change and reduction in calorie intake would be necessary and no fun. Life is a matter of balancing multiple options. If you have pain, one of the best treatment options is a comprehensive exercise program. There will never be a magic solution for pain, it will always require lifestyle choices.

Connecting The Medical Dots

/ Thomas Cohn, MD

Medicine today has become fractured. Primary care does basic analysis of a problem and basic care of that problem, while specialists have become such experts that they often can not see past their own rabbit hole. Few doctors are willing to look at the whole picture, analyze the patient as a person and all the problems presented. When someone takes the time and connects the dots, something special happens, and a path to the future can be found. For many patients, finding the doctor that has the experience to listen, to ask the right questions and to find the source of the problem can take years.

One Patient’s Dots Become Connected

Being a patient can be very frustrating. The other day I had a new patient with back pain, which is a pretty normal complaint for a referral. The patient was referred from an orthopedic spine surgeon who felt the patient was not a candidate for surgery. She was in her mid-30’s and had neck and upper back pain. She also has had longstanding scoliosis, a prominent curvature of the spine, and she had been to a number of previous providers for the problems and wants answers and a solution.

I usually work with a scribe. When I started my visit with the woman with scoliosis, she was fascinated. Within in a couple minutes and a few choice questions, my scribe saw a light in my brain go on and the discovery of the unifying diagnosis that no one in the past had a clue about. The patient had scoliosis, but had been double jointed, had shoulder and knee joint issues, had heartburn, and cardiac problems. She also had siblings that were double jointed. The unifying theme was a genetic-based connective tissue disorder, probably a form of Ehlers Danlos syndrome or Marfan’s disease. This will need to be confirmed by further testing and probably genetic testing.

Finding a diagnosis that connects the dots changes the whole picture of a problem. It no longer is a set of random of events causing pain. Now there is a reason and a pathway to follow to manage the problems. There is also knowledge about the course of the disease and a way to anticipate future medical issues.

Unfortunately, most patients never can connect the dots. Primary care physicians often do not have the time to address more than one problem at a visit. Specialists are only interested in their small corner of the world. My world often consists of looking at odd medical issues. Many times helping a patient means having to analyze the past, ask a few questions, closely listen to what a patient says, and bringing together the story to develop a pathway to the future.

The best patient care is provided by those providers who can see the big picture. Medicine has been fractured by the pressures to see as many patients as possible if providing primary care, or staying in your specialty only for others. Seeing the big picture and connecting the dots is a lost art. Changing lives for a patient means being able to go beyond the ordinary and really trying to answer the all their questions to uncover a long-term solution.

Desk Workers Have High Rates of Lower Back Pain

/ Thomas Cohn, MD

Desk Back Pain MinneapolisA three-month study that examined back problems of sedentary and active workers found that desk workers were more likely to end up in the doctor’s office with back pain.

The study examined employment data from 1,300 people who said they deal with spine-related pain. Researchers said that desk workers outnumbered field workers by a rate of 4 to 1. Additionally, one in four participants with a desk job had more than  one spine-related problem, like neck and back pain, or shoulder pain and finger numbness.

“Our data shows that half the patients with sedentary jobs had lower back pain,” said Dr. Garima Anandani of Qi Spine, the clinic that conducted the survey.

Growing Epidemic

According to the World Health Organization’s Global Burden of Diseases study, which was conducted in 2010, lower back pain caused by a person’s job is a growing problem. Lower back pain was the leading cause of absenteeism from work in 2010.

“People sit on chairs for 10 to 12 hours,” said Dr. Anandani. “Moreover, they tilt their heads to cradle a phone while typing. These factors affect the biomechanics of the body.”

Dr. Anandani said the best way to combat back pain during your time at the office is to focus on your posture. Some tips to keep in mind while working your desk job include:

  • Stand up for five minute every 30 minutes
  • Keep your back straight, don’t hunch over your computer
  • Consider a stand up desk
  • Keep your head positioned over your spine, not out in front of you
  • Consider a headset for phone calls, so your neck isn’t torqued to the side when you’re on a call
  • Exercise each day when you get home from the office.

If pain persists and exercise and anti-inflammatory medications aren’t working, consider visiting a back specialist. They’ll be able to diagnose the underlying problem and help chart a course of recovery.

3 Exercises To Help Alleviate Back Pain

/ Thomas Cohn, MD

Back Stretches St. Paul PainOutside of the common cold, more Americans head to their local clinic with problematic back pain than for any other health condition. In fact, back pain affects between 80 and 90 percent of people at some point in their lives.

The issue with back pain is that we do so much to make the condition worse. We sit on our butts too often. We have poor posture. We’re always hunched over on our phones. All of these things can contribute to back problems, but the good news is we can fight back. One of the best ways to combat back pain is through regular exercise and strength training. Here’s a quick look at three exercises you can preform to help prevent and counter back pain.

Blast Away Back Pain

Here are three exercises you can do in the comfort of your home to help prevent back pain.

1. Supermans – For this exercise, you’ll start by lying on your stomach with your arms positioned directly in front of you. When you’re ready, lift your arms and your legs off the ground as if you are flying through the air like Superman. Hold the position for 5-10 seconds, then relax. Repeat this process until you’ve completed 10-20 Superman exercises. This is helpful for people suffering from low back pain.

2. Knee Hugs – Once you’re done with Supermans, roll over on your back for the next exercise. For this one, lie on your back with both your legs straight ahead of you. Bring one knee up to your chest and hug it for 10 seconds. You’ll naturally notice that the small of your back will be pressed into the floor. This will help strengthen your back muscles and keep it loose. Repeat the exercise five times with each leg.

3. Bridges – For the last exercise, remain lying on the ground on your back. Instead of placing your feet straight forward, bend your knees and position your feet flat on the ground near your buttock. When ready, thrust your pelvis forward, creating a diagonally straight line from your knees down to your shoulder blades. Hold this position for 10 seconds, then bring your butt back to the ground. Repeat this exercise 5-10 times. When done correctly, you’ll feel this exercise strengthening and loosening your upper back.