Don’t ignore that pain in your neck or back. Early diagnosis and treatment may reduce your need for surgery.
Dr. Ian A. Madom discusses cervical and lumbar spine disorders and how they are treated.
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Back, Neck, Cervical and Lumbar Pain
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Learn more about Ian A Madom, MD
Ian A. Madom, MD
Ian A. Madom, MD cares for a wide variety of conditions related to the cervical, thoracic and lumbar spine. Typically that includes pain that starts in the neck and back, but spreads to the arms and legs. He offers a wide range of options for patients that include non-operative and operative approaches to treat their pain.Learn more about Ian A Madom, MD
Transcription:
Bill Klaproth (Host): Many people live with chronic back and neck pain which creates a major impact on their quality of life every day. Here to talk with us about back, neck, cervical and lumbar pain is Dr. Ian Madom and orthopedic spine specialist at South County Health. Dr. Madom thanks for your time. So, what is the most common cause of acute back or neck pain?
Ian A. Madom, MD, MBA (Guest): Well, thank you for having me. The most common causes are muscle injury. The data that’s out there available, shows that it’s a pretty common condition for people to experience at some point in their lifetime, upwards of 80-85% of people will have some type of back injury that is incapacitating for a day or two at some point in their life. And most of the time, these issues relate back to muscle injury. Now there may be some underlying conditions that people have, but the root cause a lot of times are muscular injuries that may have to do with just a muscle pull or strain but may also have to do with the patient’s posture and their alignment issues and possibly even how much or a lack of core strength that they have.
Bill: So, since most of us will experience back or neck pain over our lifetime; at what point should we see the doctor?
Dr. Madom: I think that’s a great question. A lot of times, people should just take a step back and get some rest. Typically, a short period of rest and that should not exceed more than a day of kind of getting your feet up and maybe even less than that. But getting some rest, getting some ice to the area, maybe some anti-inflammatories although even some of the literature has questioned the use of anti-inflammatories but as a general rule of thumb, an anti-inflammatory and some rest can help and trying to take it easy for a day and then starting to mobilize. If things continue to be a problem after a good five to seven days, where somebody is still having significant back pain they should probably contact their primary care provider to discuss the issue with them and maybe be evaluated. Some additional medications may be offered at that point like a muscle relaxant to get people out of their acute phase of pain. Certainly, somebody like myself really only comes into the picture if the pain that the patient is experiencing is so severe that they are completely incapacitated for multiple days, they can’t mobilize but more typically it’s when people start to develop pain that shoots down into their leg coming from their back or shoots into their arms coming from their neck.
Bill: Okay, so let’s stick with that then. For those people that have that shooting pain or are incapacitated; what are the treatment options available? How do you work with patients to figure out a treatment plan?
Dr. Madom: So, I mean we – in our office, we evaluate everybody individually first by sitting down with them and getting a detailed history of what happened to them. Typically, x-rays are involved. Oftentimes people think that they need an MRI right away. They typically do not. Because an MRI supports the diagnosis that I sit and listen to talking to somebody and doing a physical exam to develop that diagnosis. The MRI is not often the thing that we need to get right off the bat. There are exceptions to that, but the vast majority of the time, we don’t need an MRI right away. We get an x-ray. We do an exam and then we sit down with people and talk about some options. Sometimes that might be a short period of steroids which are really strong anti-inflammatory, and these aren’t the kind of steroids that you hear about that sports players take. These are oral steroids that we use for a variety of conditions to reduce inflammation sometimes for people’s respiratory issues, their lung issues to even something like poison ivy. We use them for somebody who may have an early injury where that pain is shooting into their arm and leg and can be fairly severe. So, we will do that and then once we get that to calm down, start some physical therapy as an outpatient, probably the week later and have somebody work with the therapist for a few weeks and if that doesn’t work; by the time we see them back, we do have other options like medications to control nerve pain or potentially setting somebody up for a steroid injection that can reduce pain in an area. But at that point, before we start to talk about anything invasive like an injection or potentially even surgery down the road; we would get an MRI.
Bill: So, tell me about the advancements that have been made in spine care over the past few years and what can we expect to see in the future?
Dr. Madom: I think the biggest advancements that we have made in my opinion, is really the way that we counsel patients and that doesn’t seem very high tech. It doesn’t seem very fancy. But spine surgery, if you talk to a lot of friends and family, people will say never have spine surgery and that comes from a history of surgery being done for a variety of conditions not all of which respond to surgery. We have learned a lot especially over the past 25 years who is the best candidate for surgery. Who can we really help? And the biggest advancements that I think that we have made is having strong clinical data that’s reported, peer reviewed in the medical research that says these are the people that we can help with surgery. These are the people we are much less likely to help and give people information so that they can make a good decision for themselves. Now, once we reach a decision to have surgery, there is a variety of things that have helped us do better surgery and surgery that reduces the amount of time that people may be in the hospital. We have even moved many procedures to an outpatient procedure. Recovery times and that really includes pain control so far as to say that we are trying to even reduce the amount that we rely on opioid medications similar to my colleagues at Orthopedic center who are doing opioid sparing type of surgery using multiple other types of medications to limit the number of narcotics that people need after surgery. We are starting the same thing for the spine service line itself and help.
Bill: So, it sounds like it’s a constant evolution. And I want to ask you, you mentioned the never have surgery perception. Is that a common misconception about spine health and what are some of the others?
Dr. Madom: Yeah, I think that one of the biggest misconceptions about spine health is that spine surgery can fix all types of back pain. There is a very small subset of patients that come in who have primarily back pain, that I’m going to actually have a conversation about surgery with them. It’s pretty rare that I can sit down with somebody and say I can fix your back pain. The things that surgery is very effective at addressing is treating leg pain, sciatica or treating arm pain that is coming from a pinched nerve in their back or their neck respectively. Fixing the actual back pain is a much more difficult process because there are so many different things that contribute to back pain whereas taking pressure off of a nerve is very reliable at getting grid of the pain in people’s necks and backs. Now, we still don’t jump to surgery right away. There are a ton of options out there that we absolutely both discuss and encourage before considering surgical treatment because the vast majority of people who have that arm and neck pain, still don’t go on to surgery because they respond to these other treatments like therapy, like a short course of either steroids or medications that manage their nerve pain until the therapy starts working and the pain subsides. So, it’s a misconception that back pain is a surgical problem that can be fixed with a surgical solution is probably one of the biggest misconceptions. That I work with patients all the time to say the thing that I want you to really focus on as far as trying to fix is leg or neck pain and if that is not your major problem, them I’m probably not the guy to give you the solution that you need. And it’s all about having a conversation with people. And I think that people are savvy and pretty smart and if you just give them a little bit of information and present it the right way, try not to speak too much doctor speak and present it in a way that people can understand; people can make good decisions for themselves.
Bill: Well that makes sense. And it sounds like most neck and back issues can be resolved or managed through medication and physical therapy and if you could just quickly wrap it up for us Dr. Madom. What can we do to prevent spine issues?
Dr. Madom: I think that one of the – so one thing is to realize that neck and back pain is kind of part of who we are as human beings. I worked with a surgeon from Canada once at a course we were teaching a medical course on spine conditions and he said we in the medical profession have turned something that is parted of the normal human condition into a disease process. Neck and back pain is part of our lives an dhow we manage it and think about managing it is more important than how we “fix it.” The way that we can try to prevent these things is having good overall healthy lifestyles. No smoking. Because smoking increases your chances of having chronic neck or back pain. Maintaining a good weight and good diet because those things will affect your overall health, but then having good core strength and that’s not just doing a bunch of abdominal exercises. Core strength is about your balance and your posture and how you move your body. Doing things – I certainly am a proponent of things like yoga, Pilates, but you don’t have to go spend tons of money at classes on, you can find these things on the internet very readily. And being attentive to your body. So, when something is wrong, and not letting it go too far down the road before addressing it and that doesn’t necessarily have to be with your medical doctor. There are lots of providers out there that can provide you solutions for your spine health.
Bill: Well, I’m going to go do my Downward Dog and my Forward Fold yoga positions right after this interview Dr. Madom. Thank you and thank you for your time today and talking with us about back, neck, cervical and lumbar issues. For more information please visit www.southcountyhealth.org, that’s www.southcountyhealth.org. This is South County Health Talks from South County Health. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Many people live with chronic back and neck pain which creates a major impact on their quality of life every day. Here to talk with us about back, neck, cervical and lumbar pain is Dr. Ian Madom and orthopedic spine specialist at South County Health. Dr. Madom thanks for your time. So, what is the most common cause of acute back or neck pain?
Ian A. Madom, MD, MBA (Guest): Well, thank you for having me. The most common causes are muscle injury. The data that’s out there available, shows that it’s a pretty common condition for people to experience at some point in their lifetime, upwards of 80-85% of people will have some type of back injury that is incapacitating for a day or two at some point in their life. And most of the time, these issues relate back to muscle injury. Now there may be some underlying conditions that people have, but the root cause a lot of times are muscular injuries that may have to do with just a muscle pull or strain but may also have to do with the patient’s posture and their alignment issues and possibly even how much or a lack of core strength that they have.
Bill: So, since most of us will experience back or neck pain over our lifetime; at what point should we see the doctor?
Dr. Madom: I think that’s a great question. A lot of times, people should just take a step back and get some rest. Typically, a short period of rest and that should not exceed more than a day of kind of getting your feet up and maybe even less than that. But getting some rest, getting some ice to the area, maybe some anti-inflammatories although even some of the literature has questioned the use of anti-inflammatories but as a general rule of thumb, an anti-inflammatory and some rest can help and trying to take it easy for a day and then starting to mobilize. If things continue to be a problem after a good five to seven days, where somebody is still having significant back pain they should probably contact their primary care provider to discuss the issue with them and maybe be evaluated. Some additional medications may be offered at that point like a muscle relaxant to get people out of their acute phase of pain. Certainly, somebody like myself really only comes into the picture if the pain that the patient is experiencing is so severe that they are completely incapacitated for multiple days, they can’t mobilize but more typically it’s when people start to develop pain that shoots down into their leg coming from their back or shoots into their arms coming from their neck.
Bill: Okay, so let’s stick with that then. For those people that have that shooting pain or are incapacitated; what are the treatment options available? How do you work with patients to figure out a treatment plan?
Dr. Madom: So, I mean we – in our office, we evaluate everybody individually first by sitting down with them and getting a detailed history of what happened to them. Typically, x-rays are involved. Oftentimes people think that they need an MRI right away. They typically do not. Because an MRI supports the diagnosis that I sit and listen to talking to somebody and doing a physical exam to develop that diagnosis. The MRI is not often the thing that we need to get right off the bat. There are exceptions to that, but the vast majority of the time, we don’t need an MRI right away. We get an x-ray. We do an exam and then we sit down with people and talk about some options. Sometimes that might be a short period of steroids which are really strong anti-inflammatory, and these aren’t the kind of steroids that you hear about that sports players take. These are oral steroids that we use for a variety of conditions to reduce inflammation sometimes for people’s respiratory issues, their lung issues to even something like poison ivy. We use them for somebody who may have an early injury where that pain is shooting into their arm and leg and can be fairly severe. So, we will do that and then once we get that to calm down, start some physical therapy as an outpatient, probably the week later and have somebody work with the therapist for a few weeks and if that doesn’t work; by the time we see them back, we do have other options like medications to control nerve pain or potentially setting somebody up for a steroid injection that can reduce pain in an area. But at that point, before we start to talk about anything invasive like an injection or potentially even surgery down the road; we would get an MRI.
Bill: So, tell me about the advancements that have been made in spine care over the past few years and what can we expect to see in the future?
Dr. Madom: I think the biggest advancements that we have made in my opinion, is really the way that we counsel patients and that doesn’t seem very high tech. It doesn’t seem very fancy. But spine surgery, if you talk to a lot of friends and family, people will say never have spine surgery and that comes from a history of surgery being done for a variety of conditions not all of which respond to surgery. We have learned a lot especially over the past 25 years who is the best candidate for surgery. Who can we really help? And the biggest advancements that I think that we have made is having strong clinical data that’s reported, peer reviewed in the medical research that says these are the people that we can help with surgery. These are the people we are much less likely to help and give people information so that they can make a good decision for themselves. Now, once we reach a decision to have surgery, there is a variety of things that have helped us do better surgery and surgery that reduces the amount of time that people may be in the hospital. We have even moved many procedures to an outpatient procedure. Recovery times and that really includes pain control so far as to say that we are trying to even reduce the amount that we rely on opioid medications similar to my colleagues at Orthopedic center who are doing opioid sparing type of surgery using multiple other types of medications to limit the number of narcotics that people need after surgery. We are starting the same thing for the spine service line itself and help.
Bill: So, it sounds like it’s a constant evolution. And I want to ask you, you mentioned the never have surgery perception. Is that a common misconception about spine health and what are some of the others?
Dr. Madom: Yeah, I think that one of the biggest misconceptions about spine health is that spine surgery can fix all types of back pain. There is a very small subset of patients that come in who have primarily back pain, that I’m going to actually have a conversation about surgery with them. It’s pretty rare that I can sit down with somebody and say I can fix your back pain. The things that surgery is very effective at addressing is treating leg pain, sciatica or treating arm pain that is coming from a pinched nerve in their back or their neck respectively. Fixing the actual back pain is a much more difficult process because there are so many different things that contribute to back pain whereas taking pressure off of a nerve is very reliable at getting grid of the pain in people’s necks and backs. Now, we still don’t jump to surgery right away. There are a ton of options out there that we absolutely both discuss and encourage before considering surgical treatment because the vast majority of people who have that arm and neck pain, still don’t go on to surgery because they respond to these other treatments like therapy, like a short course of either steroids or medications that manage their nerve pain until the therapy starts working and the pain subsides. So, it’s a misconception that back pain is a surgical problem that can be fixed with a surgical solution is probably one of the biggest misconceptions. That I work with patients all the time to say the thing that I want you to really focus on as far as trying to fix is leg or neck pain and if that is not your major problem, them I’m probably not the guy to give you the solution that you need. And it’s all about having a conversation with people. And I think that people are savvy and pretty smart and if you just give them a little bit of information and present it the right way, try not to speak too much doctor speak and present it in a way that people can understand; people can make good decisions for themselves.
Bill: Well that makes sense. And it sounds like most neck and back issues can be resolved or managed through medication and physical therapy and if you could just quickly wrap it up for us Dr. Madom. What can we do to prevent spine issues?
Dr. Madom: I think that one of the – so one thing is to realize that neck and back pain is kind of part of who we are as human beings. I worked with a surgeon from Canada once at a course we were teaching a medical course on spine conditions and he said we in the medical profession have turned something that is parted of the normal human condition into a disease process. Neck and back pain is part of our lives an dhow we manage it and think about managing it is more important than how we “fix it.” The way that we can try to prevent these things is having good overall healthy lifestyles. No smoking. Because smoking increases your chances of having chronic neck or back pain. Maintaining a good weight and good diet because those things will affect your overall health, but then having good core strength and that’s not just doing a bunch of abdominal exercises. Core strength is about your balance and your posture and how you move your body. Doing things – I certainly am a proponent of things like yoga, Pilates, but you don’t have to go spend tons of money at classes on, you can find these things on the internet very readily. And being attentive to your body. So, when something is wrong, and not letting it go too far down the road before addressing it and that doesn’t necessarily have to be with your medical doctor. There are lots of providers out there that can provide you solutions for your spine health.
Bill: Well, I’m going to go do my Downward Dog and my Forward Fold yoga positions right after this interview Dr. Madom. Thank you and thank you for your time today and talking with us about back, neck, cervical and lumbar issues. For more information please visit www.southcountyhealth.org, that’s www.southcountyhealth.org. This is South County Health Talks from South County Health. I’m Bill Klaproth. Thanks for listening.