Back pain is one of the most common and difficult occupational health problems and is a common reason for absence from work.
Although back pain may be painful and uncomfortable, it is not usually serious and is more common among adults between 35 and 55 years old.
Occupational health provider, Dr. Jeff Meyer here to talk about low back pain.
Low Back Pain: Is It On Your Last Nerve?
Featured Speaker:
Learn more about Dr. Jeff Meyer
Jeff Meyer, MD, MPH,- Occupational Medicine/Internal Medicine
Dr. Jeff Meyer is a board-certified occupational medicine and internal medicine physician at Allina Health Coon Rapids Clinic. His professional interests include pilot exams, low back pain and spine consults; Dr. Meyer is also an air medical examiner for the Federal Aviation Administration.Learn more about Dr. Jeff Meyer
Transcription:
Low Back Pain: Is It On Your Last Nerve?
Melanie Cole (Host): Back pain is one of the most common and difficult occupational health problems and is a very common reason for absence from work. My guest today is Dr. Jeff Meyer. He's a board certified occupational medicine and internal medicine physician at Allina Health Coon Rapids Clinic. Welcome to the show, Dr. Meyer. How much of a problem is back pain? What is it doing to this country in terms of absenteeism from work and keeping people from living the quality of life they'd like to live?
Dr. Jeff Meyer (Guest): Low back pain is a significant problem. It's a very common medical complaint. Surveys of the U.S. population show that at least 80-90% of the United States population has had at least once significant episode of low back pain. Among medical providers, it is the fifth most common reason for office visits in the United States. But, what is important to realize is that most episodes of low back pain resolved with time if the person stays active; if they stay up and moving and walking. It's very important to be up and walking and moving in order for your low back pain to heal.
Melanie: Are there certain risk factors to having low back pain? I know what you're saying when you say how many people will have had back pain in their lives and you can't appreciate the pain unless it's actually happened to you before. Are there certain things that would predispose somebody to having back problems?
Dr. Meyer: In my experience and when we are testing back strength of patients, weakness of back muscles is one of the most common causes of prolonged back pain. Weakness of the muscles around the core of your trunk, around your back and your abdomen, is a very important risk factor. Now, when they do surveys, smokers have a lot more back pain than non-smokers but that has not been proven to be a cause and effect. You can't say that smoking causes back pain but smokers do have more back.
Melanie: What's the link between obesity and back pain?
Dr. Meyer: You will read often that obesity is a risk factor for low back pain but when you really look at the research, many scientific studies have looked at obesity and low back pain and have not shown that obesity causes low back pain. There was one big study where severely obese patients weighing many hundreds of pounds had bariatric surgery. These are obese patients with low back pain. They lost hundreds of pounds but their low back pain did not improve. So, I want my patients who are obese to lose weight to lower the risk for diabetes, for heart disease, high blood pressure, cancer stroke but there isn't a guarantee that it will lessen their back pain.
Melanie: When you see certain people at jobs and they're wearing back braces, are there certain jobs that are more likely to cause back problems? What causes those sorts of things?
Dr. Meyer: Well, actually, people often think that if they have a job with heavy lifting they will have more low back pain than if they have a sitting job but that isn't necessarily true. There was one study of Swedish farmers--owners of their own farms--who did very heavy lifting and pulling at their work. They also spent hours sitting on a vibrating tractor. These Swedish researchers followed these farmers for many, many years, and they compared them to a group of comparison subjects who did seated jobs, and they found, actually, that the farmers had less neck and low back pain than the comparison subjects who spent all day sitting at an office. So, it's important for the health of your back that you stay active and moving.
Melanie: So, when we're talking about back pain as a general term, how do you determine what is the cause whether it's a bulging disc or stenosis or just osteoarthritis setting in? How do you evaluate back pain and determine what the cause is?
Dr. Meyer: Well, you often get the most information from talking with your patient and doing a physical exam. One of the most frustrating things about low back pain is that 90% of the time, you can't be sure what exact issue or what exact structure in the back is causing a person's low back pain. It is very frustrating. The tissues in the low back that have pain fibers include the muscles, the ligaments on the back of the spine called the “ligamentum flavum”, the facet joints and the outermost part of the disk, which is a tough ligament like structure called the “annulus fibrosis”. The inner part of the disc which is like gelatin has no pain fibres.
Melanie: Wow! So, people don't even always realize in the movements and the things that they do. Do you send people for an MRI or do xrays show what you need to find out? What do people have to do to figure out what the cause of their back problems are?
Dr. Meyer: In certain situations, MRI scans can be very helpful and they are indicating if a patient has sciatica, which is nerve pain traveling down the back of a leg to the foot or if this patient has had back pain with sciatica that has not gotten better with time, with staying active, and with walking or with physical therapy or with chiropractic manipulation. But, if there's no pain traveling down the back of the leg to the foot; if there's no sciatica, then lumbar MRI scans actually don't tell me much because it is really common to find abnormalities on lumbar MRI scans of people who have no low back pain. There was one study of volunteers--they were pretty young. Their average age was 35 years--and they had no back pain. Among these 35-year-old average volunteers, 40% had disc protrusions and 18% had disc extrusions, yet they had no low back pain. Now, patients will often say, “My back pain is from a disc bulge” but disc bulges are a normal finding on MRI of the spine. Everyone has disc bulge on MRI scans. The disc is a gel pack shock absorber and it's meant to bulge. So, this is really frustrating but you can have a patient with excruciating low back pain from a muscle strain and they can have a disc protrusion or a disc extrusion on their MRI that is not causing their low back pain. If you would take a patient like that and you do a lumbar fusion, where you remove their disc and replace it with bone and metal hardware, their low back pain will not get better because that disc herniation, or that disc protrusion, or disc extrusion was not causing their back pain. It was what we call an asymptomatic finding. So again, MRI scans can be extremely helpful if a patient has sciatica, pain radiating down the back of leg to the foot and they have numbness in their foot in the distribution of the lumbar spinal nerve. If they then have an MRI scan that shows a disc protrusion or a disc extrusion pushing on the nerve that correlates with numbness in that part of the foot, then you know that that is the cause of their sciatica.
Melanie: So, Dr. Meyer, people are back and forth about bracing your back, about ice and about heat. What sort of a man are you? Are you an ice man? A heat man? What do you do when people first experience this back pain? We don't have a lot of time but I'd love to get to treatments and things people can do, and those exercises to keep your core strong.
Dr. Meyer: Sure. Heat or ice can be helpful for the back. When you sprain a joint, you always ice it but when it's a muscle strain, you can do either heat or ice. Ice does not feel good for me when I have a back strain. As far as back braces, they have not been shown to be helpful or to prevent a back strain. One of the most important treatments for low back pain is to stay active in moving and avoid prolonged bed rest. Prolonged bed rest has been shown in studies to be harmful. Over the counter medications like Ibuprofen, Naproxen or Tylenol could be helpful. Walking is very helpful. Physical therapy and chiropractic manipulation can be beneficial. I have found that programs to increase the strength of the back muscles are very effective treatment for low back pain. Now, for someone who has had recurrent episodes of back pain or really prolonged episodes of low back pain where standard physical therapy hasn't helped, there is a computerized strengthening program called The MedX that has been invented and it's very effective for treating prolonged low back pain. They have The MedX at many different location. They have it at the Courage Kenny Spine Rehabilitation Institute; at PNBC; at the Institute of Athletic Medicine; at Twin City Orthopaedics; at PDR and the Hudson Physicians in Huston, Wisconsin, have it. There are several other locations. It's very helpful.
Melanie: Dr. Meyer, when is surgery what has to be done? People go for back surgery all the time. Is it really necessary? Give us your advice about back surgery.
Dr. Meyer: Sometimes lumbar surgery is necessary. If a patient has a disc herniation pressing on a nerve and that patient develops weakness in their leg or if their low back pain and sciatica do not go away with other treatment, but it's important to remember that disc herniations do get absorbed by the body over time and disc herniations often heal without surgery. There was a study in Norway on patients with a disc herniation pressing on a spinal nerve causing sciatica where you knew that the disc was the cause of their pain and in these patients, The MedX intensive strengthening program was as effective as the lumber fusion.
Melanie: So, in just the last minute or two, Dr. Meyer, give your best advice for something that is so painful and so common, that so many people have for their back pain. Give your best advice for possibly preventing it in the first place.
Dr. Meyer: The most important way to prevent back pain is to keep your back muscles strong, to stay active. I think, in summary, the most important parts to remember about back pain is that most episodes of low back pain do resolve if a person stays active and out of bed. Over the counter medications can help. Physical therapy and chiropractic manipulation can help. MRI scans are usually not indicated early on when somebody has back pain and they often don't tell me what is actually causing a person back pain. And, The MedX intensive strengthening program can be very effective.
Melanie: Thank you so much, Dr. Meyer. It is great information. You're listening to The WELLCast with Allina Health. For more information, you can go to AllinaHealth.org. That's AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
Low Back Pain: Is It On Your Last Nerve?
Melanie Cole (Host): Back pain is one of the most common and difficult occupational health problems and is a very common reason for absence from work. My guest today is Dr. Jeff Meyer. He's a board certified occupational medicine and internal medicine physician at Allina Health Coon Rapids Clinic. Welcome to the show, Dr. Meyer. How much of a problem is back pain? What is it doing to this country in terms of absenteeism from work and keeping people from living the quality of life they'd like to live?
Dr. Jeff Meyer (Guest): Low back pain is a significant problem. It's a very common medical complaint. Surveys of the U.S. population show that at least 80-90% of the United States population has had at least once significant episode of low back pain. Among medical providers, it is the fifth most common reason for office visits in the United States. But, what is important to realize is that most episodes of low back pain resolved with time if the person stays active; if they stay up and moving and walking. It's very important to be up and walking and moving in order for your low back pain to heal.
Melanie: Are there certain risk factors to having low back pain? I know what you're saying when you say how many people will have had back pain in their lives and you can't appreciate the pain unless it's actually happened to you before. Are there certain things that would predispose somebody to having back problems?
Dr. Meyer: In my experience and when we are testing back strength of patients, weakness of back muscles is one of the most common causes of prolonged back pain. Weakness of the muscles around the core of your trunk, around your back and your abdomen, is a very important risk factor. Now, when they do surveys, smokers have a lot more back pain than non-smokers but that has not been proven to be a cause and effect. You can't say that smoking causes back pain but smokers do have more back.
Melanie: What's the link between obesity and back pain?
Dr. Meyer: You will read often that obesity is a risk factor for low back pain but when you really look at the research, many scientific studies have looked at obesity and low back pain and have not shown that obesity causes low back pain. There was one big study where severely obese patients weighing many hundreds of pounds had bariatric surgery. These are obese patients with low back pain. They lost hundreds of pounds but their low back pain did not improve. So, I want my patients who are obese to lose weight to lower the risk for diabetes, for heart disease, high blood pressure, cancer stroke but there isn't a guarantee that it will lessen their back pain.
Melanie: When you see certain people at jobs and they're wearing back braces, are there certain jobs that are more likely to cause back problems? What causes those sorts of things?
Dr. Meyer: Well, actually, people often think that if they have a job with heavy lifting they will have more low back pain than if they have a sitting job but that isn't necessarily true. There was one study of Swedish farmers--owners of their own farms--who did very heavy lifting and pulling at their work. They also spent hours sitting on a vibrating tractor. These Swedish researchers followed these farmers for many, many years, and they compared them to a group of comparison subjects who did seated jobs, and they found, actually, that the farmers had less neck and low back pain than the comparison subjects who spent all day sitting at an office. So, it's important for the health of your back that you stay active and moving.
Melanie: So, when we're talking about back pain as a general term, how do you determine what is the cause whether it's a bulging disc or stenosis or just osteoarthritis setting in? How do you evaluate back pain and determine what the cause is?
Dr. Meyer: Well, you often get the most information from talking with your patient and doing a physical exam. One of the most frustrating things about low back pain is that 90% of the time, you can't be sure what exact issue or what exact structure in the back is causing a person's low back pain. It is very frustrating. The tissues in the low back that have pain fibers include the muscles, the ligaments on the back of the spine called the “ligamentum flavum”, the facet joints and the outermost part of the disk, which is a tough ligament like structure called the “annulus fibrosis”. The inner part of the disc which is like gelatin has no pain fibres.
Melanie: Wow! So, people don't even always realize in the movements and the things that they do. Do you send people for an MRI or do xrays show what you need to find out? What do people have to do to figure out what the cause of their back problems are?
Dr. Meyer: In certain situations, MRI scans can be very helpful and they are indicating if a patient has sciatica, which is nerve pain traveling down the back of a leg to the foot or if this patient has had back pain with sciatica that has not gotten better with time, with staying active, and with walking or with physical therapy or with chiropractic manipulation. But, if there's no pain traveling down the back of the leg to the foot; if there's no sciatica, then lumbar MRI scans actually don't tell me much because it is really common to find abnormalities on lumbar MRI scans of people who have no low back pain. There was one study of volunteers--they were pretty young. Their average age was 35 years--and they had no back pain. Among these 35-year-old average volunteers, 40% had disc protrusions and 18% had disc extrusions, yet they had no low back pain. Now, patients will often say, “My back pain is from a disc bulge” but disc bulges are a normal finding on MRI of the spine. Everyone has disc bulge on MRI scans. The disc is a gel pack shock absorber and it's meant to bulge. So, this is really frustrating but you can have a patient with excruciating low back pain from a muscle strain and they can have a disc protrusion or a disc extrusion on their MRI that is not causing their low back pain. If you would take a patient like that and you do a lumbar fusion, where you remove their disc and replace it with bone and metal hardware, their low back pain will not get better because that disc herniation, or that disc protrusion, or disc extrusion was not causing their back pain. It was what we call an asymptomatic finding. So again, MRI scans can be extremely helpful if a patient has sciatica, pain radiating down the back of leg to the foot and they have numbness in their foot in the distribution of the lumbar spinal nerve. If they then have an MRI scan that shows a disc protrusion or a disc extrusion pushing on the nerve that correlates with numbness in that part of the foot, then you know that that is the cause of their sciatica.
Melanie: So, Dr. Meyer, people are back and forth about bracing your back, about ice and about heat. What sort of a man are you? Are you an ice man? A heat man? What do you do when people first experience this back pain? We don't have a lot of time but I'd love to get to treatments and things people can do, and those exercises to keep your core strong.
Dr. Meyer: Sure. Heat or ice can be helpful for the back. When you sprain a joint, you always ice it but when it's a muscle strain, you can do either heat or ice. Ice does not feel good for me when I have a back strain. As far as back braces, they have not been shown to be helpful or to prevent a back strain. One of the most important treatments for low back pain is to stay active in moving and avoid prolonged bed rest. Prolonged bed rest has been shown in studies to be harmful. Over the counter medications like Ibuprofen, Naproxen or Tylenol could be helpful. Walking is very helpful. Physical therapy and chiropractic manipulation can be beneficial. I have found that programs to increase the strength of the back muscles are very effective treatment for low back pain. Now, for someone who has had recurrent episodes of back pain or really prolonged episodes of low back pain where standard physical therapy hasn't helped, there is a computerized strengthening program called The MedX that has been invented and it's very effective for treating prolonged low back pain. They have The MedX at many different location. They have it at the Courage Kenny Spine Rehabilitation Institute; at PNBC; at the Institute of Athletic Medicine; at Twin City Orthopaedics; at PDR and the Hudson Physicians in Huston, Wisconsin, have it. There are several other locations. It's very helpful.
Melanie: Dr. Meyer, when is surgery what has to be done? People go for back surgery all the time. Is it really necessary? Give us your advice about back surgery.
Dr. Meyer: Sometimes lumbar surgery is necessary. If a patient has a disc herniation pressing on a nerve and that patient develops weakness in their leg or if their low back pain and sciatica do not go away with other treatment, but it's important to remember that disc herniations do get absorbed by the body over time and disc herniations often heal without surgery. There was a study in Norway on patients with a disc herniation pressing on a spinal nerve causing sciatica where you knew that the disc was the cause of their pain and in these patients, The MedX intensive strengthening program was as effective as the lumber fusion.
Melanie: So, in just the last minute or two, Dr. Meyer, give your best advice for something that is so painful and so common, that so many people have for their back pain. Give your best advice for possibly preventing it in the first place.
Dr. Meyer: The most important way to prevent back pain is to keep your back muscles strong, to stay active. I think, in summary, the most important parts to remember about back pain is that most episodes of low back pain do resolve if a person stays active and out of bed. Over the counter medications can help. Physical therapy and chiropractic manipulation can help. MRI scans are usually not indicated early on when somebody has back pain and they often don't tell me what is actually causing a person back pain. And, The MedX intensive strengthening program can be very effective.
Melanie: Thank you so much, Dr. Meyer. It is great information. You're listening to The WELLCast with Allina Health. For more information, you can go to AllinaHealth.org. That's AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.