Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice. 

Joey Wahler (Host): This podcast is for informational purposes only. That is not intended to be used for personal medical advice. It's a common source of discomfort for many. So we're discussing back pain and how it's treated. Our guest, Dr. Dylan Morris, spine surgeon at Skagit Regional Health. This is Be Well with Skagit Regional Health. Thanks for listening. I'm Joey Wahler, Dr. Morris. Hi there. Thanks for joining.

Dr. Dylan Morris: Yeah, thanks for having me.

Joey Wahler (Host): Great to have you with us. So first, just how common is back pain and who does it usually affect most?

Dr. Dylan Morris: Back pain is fairly common. The people that it usually affects most are anywhere from adolescents, early to mid-teens, up to, the octogenarians.

Joey Wahler (Host): And what are the typical causes of it?

Dr. Dylan Morris: Yeah, so there are various causes of back pain. Most common would be, a muscle strain, which occurs after, heavy lifting or a heavy workout. You can also have some inflammation or arthritic-type pain that affects the little joints in your back called your facet joints. And then also you can have stenotic type back pain from all of the nerves being compressed in your back. That's called neurogenic claudication. Most of those people have pain in their back and their butt source when they walk and stand. It gets better when they sit down. Those are the most, three main causes of back pain.

Joey Wahler (Host):  How about upper back pain versus lower back pain, which is more common and which is harder to get rid of?

Dr. Dylan Morris: Lower back pain is more common just because there's more flexibility in movement within, your lumbar spine compared to your thoracic spine. Low back pain in the lumbar spine tends to be a little bit easier to treat than, Pain in your mid back. Pain in your neck, cervical type pain is more common than your thoracic pain. It's more on the scale of or frequency of your lower back pain.

Joey Wahler (Host): A while back. I had some lower back pain for a while. It lasted for a while. Fortunately, it's since gone away, I think, on its own. But I was told at the time by a physical therapist that it came from having tight hamstrings and it taught me a lesson, which is that some of that stuff in our body that we might not realize is all connected.

Dr. Dylan Morris: Yep. It's definitely all connected when you have tight hamstrings and tight hip flexors, it kind of pulls the pelvis into flexion, which can alter the in the lower back, which can be a source of pain.

Joey Wahler (Host): So as much as most of us hate to stretch at the gym or otherwise, that's one way of keeping that under control and warding that off?

Dr. Dylan Morris: Yep. Having increasing flexibility and having a strong, core and back, definitely helps prevent back.

Joey Wahler (Host): So simply put, what are a couple of the most common specific back issues that you see?

Dr. Dylan Morris: Definitely see, muscle strains. After a car wreck is a common one. We also see facet mediated back pain and then also see back and leg pain caused from a disc herniation. I think the misnomer is that people say, well, can't you just take my disc out and it'll help with my back pain, tends to not be the case. We usually take a disc out to help with pain that goes down the leg.

Joey Wahler (Host): Especially those of us who follow sports, we've heard of athletes who suffer from a herniated disc. How does a disc become herniated and just how sensitive are they to that?

Dr. Dylan Morris: So discs become a little bit more sensitive to bulging and herniation a little bit as we age. What happens in the mainstay with a bulging disc is you have some thinning or some weakening of the annulus, and then the disc can actually herniate out or push out into the spinal canal and push on a nerve. Most disc herniation’s heal on their own in about six to 12 weeks. Very few of the disc herniation’s that happen become symptomatic and even less so do we have to operate on them. Usually, if we have to operate on a disc and remove the disc, it helps with the pain that goes from the back down the leg, helping localized back pain.

Joey Wahler (Host): Just to backtrack for a moment, when should someone usually see a doctor for back pain? What's sort of the line that you cross where you know it's time?

Dr. Dylan Morris: Yeah. So the red flags that you would worry about with seeing a doctor or a surgeon is. Severe back pain, but if you have fevers and chills, that could be associated with an infection, or if you're having weakness in your legs or loss of bowel and bladder function, those would need to see a doctor or a surgeon earlier on. Because there could be, sequela or something more serious causing it than a muscle strain. Most of the time people try to do about six weeks of conservative treatment with regards to physical therapy, trying some anti-inflammatories and sometimes a muscle relaxer before they end up in the surgeon's office.

Joey Wahler (Host): Yes, I was going to ask you about nonsurgical options.

Dr. Dylan Morris: So if you're talking about with just regards to low back pain, the majority of that is treated non-surgical with anti-inflammatories, physical therapy, core strengthening, functional yoga tends to help as well as, chiropractic or massage therapy. Really, if you're operating on low back pain that's not from all the nerves being compressed in the back. Most of the time when we're offering surgery to people, it's more for pain that goes down the leg than actually within the lower back itself.

Joey Wahler (Host): So I'm going to ask you a little bit about surgery in a moment, but first, what tips do you have for us to keep our backs healthy on our own if possible, and avoid the need for spine care?

Dr. Dylan Morris: Yeah, I think the things that you can do on your own is, you can follow a home exercise stretching program or home exercise strengthening program. YouTube has some really good functional yoga videos. You can follow along with help with core strengthening and low back strengthening. Those have been found to be successful in treating low back pain. So I think the mainstays are core strengthening, stretching, keeping, and maintaining flexibility as well as over-the-counter anti-inflammatories if needed.

Joey Wahler (Host): About how often do people throw their back out, so to speak, by let's say, shoveling without bending properly when there's snow to be cleaned or picking something up? I guess similarly, by putting too much strain on your back. I guess one thing you try to keep in mind in those situations is to bend and not overdo it and try to focus if you can, on lifting with your legs as much as possible. Again, a sports analogy, kind of like a pitcher pushing off, trying to use that leg strength to take a lot of the emphasis or pressure off other parts of the body. Right?

Dr. Dylan Morris: Yeah, definitely. I think, following good lifting protocols with keeping a straight back bending and lifting mostly with your legs is the best thing to do with regards to keeping yourself, healthy and not injuring it in the workplace. Percentage-wise, I think, the good majority of people that come into mind with back pain, complain, you know, I was doing something I turned wrong and then I had this stabbing, cramping, pain in the back. Which is usually a muscle strain causing a muscle spasm, which causes that, catching, grabbing sensation or that, sharp pain that kind of takes your breath away if you turn wrong or bend wrong.

Joey Wahler (Host): Mm-hmm. . So when is a patient usually a candidate for spine surgery?

Dr. Dylan Morris: Yeah. So the two things that we do in spine surgery is we decompress, which is to take pressure off the nerves. And then, we do a fusion if there's any instability. The mainstay of people that have the highest success rate is more if they're complaining of leg pain, like a stabbing, burning pain that goes into their butt cheek and down their leg. Those people are the people that we like to see in our office because you can do a small little outpatient surgery which takes about an hour to an hour and a half. Those people go home that same day and by taking the pressure off the nerve, it can help relieve their pain in their butt cheek and down their leg.

The harder thing to treat is chronic back pain that's been there for years and years and years. Nothing has really helped. There are procedures that are up and coming with regard to spinal cord stimulators and some other things that pain management can help with outside of having back surgery or back fusion for back pain. The success is not overly, successful with regards to a fusion for back pain.

Joey Wahler (Host): When people talk to you or you talk to them about spine surgery, does the word spine and the possibility of it being operated on tend to worry people? And what do you say to kind of quell those concerns?

Dr. Dylan Morris: I tell anybody that's going into surgery, it's not something that we take lightly. You know, it's the patient actually trusting their life in your hands. I think the things that you can do to mitigate. The risk or the worry of, well, I'm having spine surgery is, if you're in the lumbar spine, you tell people, well, yes, if something bad does happen, the chances of you being paralyzed are very low because we're not at the spinal cord level. If a nerve were to be injured, it would cause some weakness in one of the muscle groups, but most people can still function with a normal life, and they're not paralyzed, things like that.

I think there's ways to discuss both the risk and benefits of surgery and the expectations of surgery. And then when people come to a shared decision making, those people tend to do well because they feel like they were involved in the decision making process.

Joey Wahler (Host): Good to know. And then finally, in summary here, what's your overall message to those listening, if they're suffering from back pain, about how much help there is for them and what the chances are, generally speaking, that they can have something done to improve things, if not rid them of this pain.

Dr. Dylan Morris: Yeah, so the number one take home is that I would tell people and that I tell my patients, is that the good majority of back pain is self-limiting and that it tends to get better on its own and roughly. six to 12 weeks, which does sound like a long time. But that can be sped up with, physical therapy, anti-inflammatories, muscle relaxers. But the take home I tell most people is that, it's a self-limiting disease. It tends to get better on its own without any form of surgery. I do tell people now that we are having some kind of breakthroughs in the interventional pain management realm with regards to treatment of, chronic low back pain outside of having, your spine operated on, there's spinal cord stimulators.

There's different various injections with pain management that tend to show good relief or equivalent relief of having a back fusion for back pain. But the take home, I would say is that it's a fairly common, injury. A good majority of the time, it gets better on its own and most people tend to not need surgery for chronic low back pain.

Joey Wahler (Host): I would imagine those words alone are making a lot of people feel better. Folks, we trust you are now more familiar with how back pain is treated. Dr. Dylan Morris, thanks so much again.

Dr. Dylan Morris: Yeah. Thanks for having me.

Joey Wahler (Host): For more information, please visit skagitregionalhealth.org. Again, that's skagitregionalhealth.org. Now, if you found this podcast helpful, please do share it on your social media, and thanks again for listening to Be Well with Skagit Regional Health, hoping your health is good health. I'm Joey Wahler.