Self Management Tips For Chronic Back Pain

July 1, 2020 / Thomas Cohn, MD

Chronic back pain is one of the most common conditions that affects Americans over the age of 40. Because it is so common, many people often try to push through the pain and keep on living their daily life. While this is admirable, it may not be your best move, and it can actually lead to worse pain. However, if you are proactive and deliberate in how you care for your spine, you can help treat these types of pain and get back to a pain-free way of living. We share those tips in today’s blog.

Managing Back Pain On Your Own

There’s no perfect playbook for managing chronic back pain on your own, but here are some helpful tips to start you off on the right foot.

Get A Diagnosis – Now, this may go against your idea of managing your back pain “on your own,” but getting a diagnosis can play a key role in helping you self-manage your pain. If you don’t know what you’re dealing with, it can be hard to follow the right self-care management techniques. The vast majority of spine specialists will recommend conservative care before moving towards surgical intervention, so one appointment can lead to a comprehensive conservative care plan. Knowing what you’re dealing with and how to best treat your pain leads to higher treatment success rates.

Exercise – This may seem like it goes against conventional wisdom, but exercise or physical therapy can help strengthen weakened spinal areas and resolve inflammation that could be leading to pain. Your first instinct may be to rest, but after 24-48 hours, controlled activity often proves more helpful than extended rest. Again, this depends on your root cause of pain, which speaks to the importance of getting a clear diagnosis.

Don’t Over Rely On Painkillers – Painkillers and anti-inflammatory medications can help manage pain, but they don’t always target the underlying cause of discomfort. Simply relying on rest and painkillers to fix the issue will often leave you unsatisfied and still in pain. Use these medications to pursue more active treatments if pain is making things like therapy or exercise unbearable.

Don’t Overdo It – Your spine is with you for the long haul, so be sure to prioritize your long term health over your short term physical desires. Athletes, for example, are notorious for trying to rush back from injury before they are truly ready. The same can be said for many older adults who work manual labor. Listen to your body and realize that missing a game or a couple days of work is worth it to help it heal instead of overstressing it while it’s injured. Manage these issues before they snowball because you tried to power through them.

Food And Water – A healthy diet can also go a long way in helping provide back pain relief. A diet rich in key vitamins and nutrients can help strengthen your spine, and staying hydrated will ensure healthy blood flow to key spine structures. A good diet can also help you maintain a healthy weight, which will limit excess stress and strain on your spine.

Mind Your Mental Health – Finally chronic pain back can be just as much of a mental battle as it is physical, so don’t ignore your mental health. Make sure you are doing things that benefit your mental health, like exercising, reading, socializing and getting a good night’s sleep!

For help managing your chronic spine pain, reach out to Dr. Cohn’s office today!

Preventing Back Pain During Summer Projects

May 23, 2019 / Thomas Cohn, MD

Memorial Day and the unofficial start of summer is almost here, and that means many Minnesotans will soon be outside doing yard work and other physical activities. Staying active in the summer can help us cross items off our to-do list, but it can also lead to an uptick of back injuries. Below, we share some tips for helping to prevent back injuries during spring and summer projects.

Protecting Your Back This Summer

Here are some tips to keep in mind to help protect your back and prevent spine injuries during the warm summer months.

1. Bending and Twisting With Yard Work – The summer time means it’s yard work season, and that can take a physical toll on your body. Use tandem lifts when moving heavy equipment, use knee pads if you’re going to be on the ground planting the garden or pulling weeds, and don’t be afraid to break up the yard work over the course of a couple days. Overstressing your back is one of the easiest ways to injure it.

2. Ladder and Height Safety – If you need to get up on a ladder to clean the gutters, make sure the ladder is stabilized properly or you have someone to secure it. Every year we see patients who have hurt their spines because of a fall from a height, so be smart about getting up on the ladder this summer. For even greater heights, use safety harnesses.

3. Hydrate – Spinal muscle injuries and spasms are more likely to occur if you are dehydrated, so if you’re going to be working out in the sun for a while, be sure that you bring water and stay hydrated.

4. Stretch – Before diving into any projects, even if it’s just mowing the lawn or trimming the hedges, take a couple minutes to stretch. Stretching will help your spinal muscles prepare for the physical activity that lies ahead, which can help prevent sprains and strains.

5. Rest – Rome wasn’t built in a day, and you shouldn’t expect to get all of your home projects done in a day. Take your time and listen to your body. If something starts to hurt, take a break. If it continues to hurt, set up a consultation with a spine specialist.

6. Stop Small Pains – Finally, don’t try to push through pain in order to get your project done. It’s better to see a pain specialist and treat your bulging disc instead of trying to push through the pain and suffering a full blown disc herniation. Stop lesser injuries before they snowball by proactively treating them.

For more tips on how to protect your back this summer, or to talk with a pain specialist about discomfort you’re having, reach out to Dr. Cohn’s office today.

Is Low Back Pain Inherited?

March 5, 2018 / Thomas Cohn, MD

A 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.

Facet Joint Pain of the Low Back – Symptoms and Treatment

July 22, 2013June 24, 2014 / Thomas Cohn, MD

Low back pain can have many causes. Structures in the lumbar region include:

Muscles
Bones
Joints
Discs
Nerves
Pelvic organs

Sensory feedback from these structures can be similar. As a result, determining the cause of low back pain often becomes more complex since multiple areas can produce sensory signals that are perceived the same way. Furthermore, there are often multiple structures contributing to the pain perceptions we have and it may be necessary to treat multiple pain generators to control symptoms.

The facet joints in the spine are small joints the size of our finger joints that articulate on both sides of the spine, posteriorly, between vertebral bodies at every level. They have significant mobility and carry the full body weight. Bending backwards closes the joint, while bending forward tends to open the joint. Since they have the same size and mobility as the finger joints, we can see the same wear and tear type changes in the hands, and assume fairly accurately that the same changes will be present in the low back facet joints.

Symptoms of Facet Joint Pain

The symptoms related to facet joint pain are similar to pain from other joints:

Stiffness after sitting or lying in one position
Pain often with extension of the spine backwards

Pain from facets is often just along the spine and does not radiate significantly into the legs. Often, the lumbar muscles are very tight, trying to prevent excessive spine movement. Severely degenerated facets have significant bony overgrowth, and then can narrow the exit of spinal nerves and cause radiating pain into the leg.

The diagnosis of facet pain is made by:

Patient history
Physical exam
Radiologic imaging
Nerve blocks to the joints

The typical history of facet joint problems is pain along the spine without significant radiation. X-rays and CT scans often show facet problems in detail, but pain can be present even with normal radiologic studies. Diagnostic medial branch blocks are the most reliable tool to establish the etiology of pain from facet joints, and two nerves provide the sensory feedback from each joint.

Treatment

Treatment of facet joint pain must be multifaceted to be successful. Basic level management includes stretching and core strengthening of the lumbar region, with using good body mechanics. Nonsteroidal anti-inflammatory drugs like naproxen and aspirin often are very helpful. More advanced physical therapy including a TENs unit for electrical stimulation and traction of spine is sometimes helpful in addition to the above. For persistent symptoms, facet joint steroid injections and medial branch blocks with radiofrequency denervation of the joint can be extremely beneficial.