Back pain is very common ailment, however, it can have a major physical and psychological impact on a person's well being. There can be many contributing factors to back pain including poor posture and excessive weight.
If you suffer from back pain, you know how it can limit your enjoyment of daily activities.
Listen in as Dennis Cramer, MD discusses low back pain and what you can do if you suffer from this painful condition.
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Do You Suffer from Lower Back Pain? You're Not Alone!
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Learn more about Dr. Cramer
Dennis Cramer, MD
Dr. Steven Cramer comes to us from our very own Riverside County, having grown up in Norco. After obtaining his bachelor's degree from U.C.L.A., he completed his neurological surgery residency at Arrowhead Regional Medical Center in San Bernardino, CA. He continued his education at the University of Cincinnati-Mayfield Clinic & Spine Institute where he completed a Complex Spine Orthopedic & Neurosurgery Fellowship, learning the most up to date skills for the treatment of adult and pediatric spinal pathology. In 2008, Dr. Cramer joined the Haider Spine Center. He also volunteers with the Children's Spine Foundation, allowing him to actively help underprivileged children who suffer from spinal ailments. He gained vast experience in evaluating and treating pediatric spinal issues while working at Cincinnati Children's Hospital in Ohio. In addition to his clinical experience, Dr. Cramer's fellowship research project was selected for the international American Association of Neurological Surgeons/Congress of Neurological Surgeons Mayfield Clinic Science Award of 2008, presented in Orlando, FL. He became the first osteopathic surgeon to receive the award. When not at work , Dr. Cramer enjoys spending time with his family and gardening.Learn more about Dr. Cramer
Transcription:
Do You Suffer from Lower Back Pain? You're Not Alone!
orthMelanie Cole (Host): Low back pain is one of the most common reasons people visit their doctors every year. My guest today is Dr. Dennis Cramer. He is a neurosurgeon and a member of the medical staff at Corona Regional Medical Center. Welcome to the show, Dr. Cramer. Low back pain is one of the main reasons people stay out of work. What are some of the causes for low back pain?
Dr. Denis Cramer (Guest): I'll tell you that one of the most common causes is just age related wear and tear. Someone goes out, does some exercising or just bends over to lift something up and they feel a strain in their low back and, by and large, most of the time that resolves within a few hours. But, sometimes it could take a little longer and, unfortunately, there are those times that it doesn’t go away and that's the time where they are sent to a spine surgeon or neurosurgeon, such as myself.
Melanie: So, can people, if they start to feel those pains in their low back in the morning, what can they do for themselves before they would visit a doctor to try and stretch it out a little to get rid of some of that pain?
Dr. Cramer: No, you said exactly what I was thinking. First thing I would do is stretching in the morning. Just gradual standing and flexing over and getting your hands as far down to the ground as you can to the floor and some slow twisting of the spine. That's where I would start. Most of the back pains can be managed without any prescribed medications. So, I am talking use of Tylenol or some type of NSAID, such as Advil or Ibuprofen and maybe even some rest. I am not saying strict, laying in a bed or laying on a couch but probably holding off on going or doing any of your exercises such as at the gym or a long walk. I would probably wait a few days until the pain subsides.
Melanie: Do you like ice or heat for a sore back?
Dr. Cramer: I don't think there is any data that says one is better than the other and, in my patients, I tell them to use ice and if that doesn’t work, I'll tell them to put heat on their back and, many times, I tell them to alternate. I found through my experience that what works well for one group of individuals works a lot different for others. And so, if it does work, if ice works for a certain patient, I'll tell him to keep doing that and, if not, then try something different but, like I said, I don’t think there is any one type of treatment that you can use for everybody. It has to be tailored.
Melanie: We hear the word stenosis a lot, the sort of catch all term for kinds of all back pain. What is stenosis? What kinds of conditions do you see in the back that would require seeing a doctor?
Dr. Cramer: Well, I'll tell you, you are right. Stenosis is a phrase or medical terminology phrase that is frequently thrown out there. You see it a lot on MRI reports so forth and primary care doctors like to talk about it. But, basically, stenosis is when the canal or the spinal frame where the nerves exit the canal become pinched, meaning from a disc herniation or you get a lot of arthritis that is starting to block the exiting of the nerves and, in that way, and that’s actually called “stenosis”. Now, it’s the degree of stenosis that people eventually refer to a surgeon for and, depending on that degree, someone may need to have that operated on to open up and relieve the compressed nerve.
Melanie: What kinds of tests would you order if somebody suffers from chronic low back pain?
Dr. Cramer: Well, as a spine surgeon, we typically like to divide pain into basically into two different categories. Number one is just pure, straight back pain and the second type is back pain which effects the exiting nerves in the lumbar spine and results in pain in the legs and we often refer to that as “sciatica”. If someone has straight back pain, we start off by getting some x-rays of the lumbar spine. And, a lot of the times, I’ll have the patient lean forward and lean back and get an x-ray to see if there is any abnormal movement of the bones in the spine because that itself--abnormal movement itself--can result in the pain. Once the x-rays are done and we prescribe treatment based on that--it might be a short course of physical therapy. If they're still having issues or having sciatica like symptoms then probably the next test I would order is an MRI scan. MRI scans are really good for looking at soft tissue and when I say soft tissue, what I am looking for are the discs itself. I am looking to look at the nerve roots in the spinal cord itself as well as the amount of ligamentum and nerve pinching. Because those kinds of things, the soft tissue structures, you can't really see on x-rays. X-rays are more to look at spinal alignment and to look for fractures or any other type of a boney pathology.
Melanie: When we are looking at some treatments for low back pain, people hear about epidurals, they hear about steroid injections, either orally or injected. Tell us, when do those come up?
Dr. Cramer: Well, I typically order quite a few epidural steroid injections. They are mostly indicated for people that have sharp shooting pains into the legs, also known sciatica or the other word that is kind of interchangeable with that is radiculopathy. Basically, radiculopathy means that there is pressure on the nerves and is sending pain down the leg. Since there is a lot of inflammation around the nerve itself, we'll go ahead and take a needle, put the needle right where the nerve is being pinched, right where it’s been inflamed, and inject a small amount of steroid medication. As people may know or may not know, a steroid is a very powerful anti-inflammatory medication. It reduces the amount of swelling and irritation around the nerve itself. So, most of the time a patient will experience a significant reduction in the amount of pain after an epidural steroid injection. Now the thing is that you can only have so many injections because it’s a steroid, so you don’t want to keep going and getting injection after injection because of the drawbacks and side effects of steroids. Sometimes, some steroid injections don’t last as long as we want them to. Steroid injections are typically only indicated for someone with a more acute or sub-acute pain, meaning someone might have sciatica, but if it’s been over three or four or six months, a steroid injection might not provide enough long-term treatment than more than for a few days or a few weeks. So, you have to weigh the risks and benefits and pros and cons of epidurals.
Melanie: What can they do prevention-wise? While it may not be possible to prevent low back pain, are there some life style modifications you'd like to recommend to help with that sort of pain?
Dr. Cramer: Well, yes, there are. And, we talked about one of those. I think that stretching is very important and to do stretching, even if you don’t have pain, I think that helps. But, I think one of the biggest risk factors for low back pain and degenerate changes are smokers. So, when I have a patient that comes in, the number one thing I'll tell them is that, “You've got to stop smoking” because not only is it very important for someone's overall health, but studies have shown how smokers have very bad backs. And what I mean by that is, as we get older we get degeneration and bone spurs and arthritis in our joints in the back and that's just a normal process of age-related wear and tear, but smokers seem to have accelerated degenerate changes. That's what we try to stay away from. So, that's the number one thing about people that smoke that really is hard on the spine itself. Another treatment to help prevent is the type of activities you do. If you are doing a lot of activates where you are twisting your spine such as a sport, particularly in golfers, it’s really hard on the joints and the back and many times when I see these long standing golfers that come in and their backs show severe degeneration. So, I just try to counsel them on the need to be very careful with the type of activities they do.
Melanie: What about proper lifting techniques?
Dr. Cramer: Yes. I go over that with my patients about the way to lift and more to bend the knees and kind of bend the pelvis so much, not so much hump over and bend over your back when you are lifting a heavy objects because when you are in a bent over or forward bent position and you try to lift a heavy object, that puts an immense load on the pressure in our joints and in our discs in the lumbar spine and repetitively doing that over a long period can cause some serious damage and a reason why patients are finally referred to their family doctor or their family doctor refers them to their local neurosurgeon for evaluation.
Melanie: In just the last few minutes, Dr. Cramer, what should people with low back pain think about when seeking care?
Dr. Cramer: I think the first thing that they should seek is that they need to find a doctor that if you are comfortable with, that is going to treat them in a very logical, methodical way and starting from A and then finishing at Z, just go step by step.
Melanie: And, why should they come to Corona Regional Medical Center for their care?
Dr. Cramer: Well, I think the physicians at Corona do exactly that. They start off with behavioral techniques that we talked about, proper stretching, proper lifestyle changes. If that doesn’t work, the next step would, we see if the patient is a candidate for epidurals or for physical therapy or chiropractic manipulation and if that doesn’t work there's still ongoing pain and pathology, then that’s when you start doing x-rays and imaging studies such as an MRI scan and possibly the nerve studies. By that time, if they have been down that trail and they are still not getting better, then many times the primary care physician will go ahead and send them to myself or for evaluation.
Melanie: Thank you so much for being with us today. You are listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to coronaregional.com. Physicians are independent practitioners who are not employees or agents of Corona Regional Medical Center. The hospital shall not liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Do You Suffer from Lower Back Pain? You're Not Alone!
orthMelanie Cole (Host): Low back pain is one of the most common reasons people visit their doctors every year. My guest today is Dr. Dennis Cramer. He is a neurosurgeon and a member of the medical staff at Corona Regional Medical Center. Welcome to the show, Dr. Cramer. Low back pain is one of the main reasons people stay out of work. What are some of the causes for low back pain?
Dr. Denis Cramer (Guest): I'll tell you that one of the most common causes is just age related wear and tear. Someone goes out, does some exercising or just bends over to lift something up and they feel a strain in their low back and, by and large, most of the time that resolves within a few hours. But, sometimes it could take a little longer and, unfortunately, there are those times that it doesn’t go away and that's the time where they are sent to a spine surgeon or neurosurgeon, such as myself.
Melanie: So, can people, if they start to feel those pains in their low back in the morning, what can they do for themselves before they would visit a doctor to try and stretch it out a little to get rid of some of that pain?
Dr. Cramer: No, you said exactly what I was thinking. First thing I would do is stretching in the morning. Just gradual standing and flexing over and getting your hands as far down to the ground as you can to the floor and some slow twisting of the spine. That's where I would start. Most of the back pains can be managed without any prescribed medications. So, I am talking use of Tylenol or some type of NSAID, such as Advil or Ibuprofen and maybe even some rest. I am not saying strict, laying in a bed or laying on a couch but probably holding off on going or doing any of your exercises such as at the gym or a long walk. I would probably wait a few days until the pain subsides.
Melanie: Do you like ice or heat for a sore back?
Dr. Cramer: I don't think there is any data that says one is better than the other and, in my patients, I tell them to use ice and if that doesn’t work, I'll tell them to put heat on their back and, many times, I tell them to alternate. I found through my experience that what works well for one group of individuals works a lot different for others. And so, if it does work, if ice works for a certain patient, I'll tell him to keep doing that and, if not, then try something different but, like I said, I don’t think there is any one type of treatment that you can use for everybody. It has to be tailored.
Melanie: We hear the word stenosis a lot, the sort of catch all term for kinds of all back pain. What is stenosis? What kinds of conditions do you see in the back that would require seeing a doctor?
Dr. Cramer: Well, I'll tell you, you are right. Stenosis is a phrase or medical terminology phrase that is frequently thrown out there. You see it a lot on MRI reports so forth and primary care doctors like to talk about it. But, basically, stenosis is when the canal or the spinal frame where the nerves exit the canal become pinched, meaning from a disc herniation or you get a lot of arthritis that is starting to block the exiting of the nerves and, in that way, and that’s actually called “stenosis”. Now, it’s the degree of stenosis that people eventually refer to a surgeon for and, depending on that degree, someone may need to have that operated on to open up and relieve the compressed nerve.
Melanie: What kinds of tests would you order if somebody suffers from chronic low back pain?
Dr. Cramer: Well, as a spine surgeon, we typically like to divide pain into basically into two different categories. Number one is just pure, straight back pain and the second type is back pain which effects the exiting nerves in the lumbar spine and results in pain in the legs and we often refer to that as “sciatica”. If someone has straight back pain, we start off by getting some x-rays of the lumbar spine. And, a lot of the times, I’ll have the patient lean forward and lean back and get an x-ray to see if there is any abnormal movement of the bones in the spine because that itself--abnormal movement itself--can result in the pain. Once the x-rays are done and we prescribe treatment based on that--it might be a short course of physical therapy. If they're still having issues or having sciatica like symptoms then probably the next test I would order is an MRI scan. MRI scans are really good for looking at soft tissue and when I say soft tissue, what I am looking for are the discs itself. I am looking to look at the nerve roots in the spinal cord itself as well as the amount of ligamentum and nerve pinching. Because those kinds of things, the soft tissue structures, you can't really see on x-rays. X-rays are more to look at spinal alignment and to look for fractures or any other type of a boney pathology.
Melanie: When we are looking at some treatments for low back pain, people hear about epidurals, they hear about steroid injections, either orally or injected. Tell us, when do those come up?
Dr. Cramer: Well, I typically order quite a few epidural steroid injections. They are mostly indicated for people that have sharp shooting pains into the legs, also known sciatica or the other word that is kind of interchangeable with that is radiculopathy. Basically, radiculopathy means that there is pressure on the nerves and is sending pain down the leg. Since there is a lot of inflammation around the nerve itself, we'll go ahead and take a needle, put the needle right where the nerve is being pinched, right where it’s been inflamed, and inject a small amount of steroid medication. As people may know or may not know, a steroid is a very powerful anti-inflammatory medication. It reduces the amount of swelling and irritation around the nerve itself. So, most of the time a patient will experience a significant reduction in the amount of pain after an epidural steroid injection. Now the thing is that you can only have so many injections because it’s a steroid, so you don’t want to keep going and getting injection after injection because of the drawbacks and side effects of steroids. Sometimes, some steroid injections don’t last as long as we want them to. Steroid injections are typically only indicated for someone with a more acute or sub-acute pain, meaning someone might have sciatica, but if it’s been over three or four or six months, a steroid injection might not provide enough long-term treatment than more than for a few days or a few weeks. So, you have to weigh the risks and benefits and pros and cons of epidurals.
Melanie: What can they do prevention-wise? While it may not be possible to prevent low back pain, are there some life style modifications you'd like to recommend to help with that sort of pain?
Dr. Cramer: Well, yes, there are. And, we talked about one of those. I think that stretching is very important and to do stretching, even if you don’t have pain, I think that helps. But, I think one of the biggest risk factors for low back pain and degenerate changes are smokers. So, when I have a patient that comes in, the number one thing I'll tell them is that, “You've got to stop smoking” because not only is it very important for someone's overall health, but studies have shown how smokers have very bad backs. And what I mean by that is, as we get older we get degeneration and bone spurs and arthritis in our joints in the back and that's just a normal process of age-related wear and tear, but smokers seem to have accelerated degenerate changes. That's what we try to stay away from. So, that's the number one thing about people that smoke that really is hard on the spine itself. Another treatment to help prevent is the type of activities you do. If you are doing a lot of activates where you are twisting your spine such as a sport, particularly in golfers, it’s really hard on the joints and the back and many times when I see these long standing golfers that come in and their backs show severe degeneration. So, I just try to counsel them on the need to be very careful with the type of activities they do.
Melanie: What about proper lifting techniques?
Dr. Cramer: Yes. I go over that with my patients about the way to lift and more to bend the knees and kind of bend the pelvis so much, not so much hump over and bend over your back when you are lifting a heavy objects because when you are in a bent over or forward bent position and you try to lift a heavy object, that puts an immense load on the pressure in our joints and in our discs in the lumbar spine and repetitively doing that over a long period can cause some serious damage and a reason why patients are finally referred to their family doctor or their family doctor refers them to their local neurosurgeon for evaluation.
Melanie: In just the last few minutes, Dr. Cramer, what should people with low back pain think about when seeking care?
Dr. Cramer: I think the first thing that they should seek is that they need to find a doctor that if you are comfortable with, that is going to treat them in a very logical, methodical way and starting from A and then finishing at Z, just go step by step.
Melanie: And, why should they come to Corona Regional Medical Center for their care?
Dr. Cramer: Well, I think the physicians at Corona do exactly that. They start off with behavioral techniques that we talked about, proper stretching, proper lifestyle changes. If that doesn’t work, the next step would, we see if the patient is a candidate for epidurals or for physical therapy or chiropractic manipulation and if that doesn’t work there's still ongoing pain and pathology, then that’s when you start doing x-rays and imaging studies such as an MRI scan and possibly the nerve studies. By that time, if they have been down that trail and they are still not getting better, then many times the primary care physician will go ahead and send them to myself or for evaluation.
Melanie: Thank you so much for being with us today. You are listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to coronaregional.com. Physicians are independent practitioners who are not employees or agents of Corona Regional Medical Center. The hospital shall not liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.