Joey Wahler (Host): It's one of the most common medical conditions in the United States. So we're discussing back pain. Our guest, Dr. Esteban Cuartas. He's an Orthopedic Surgeon with Montefiore St. Luke's Cornwall. This is DocTalk presented by Montefiore St. Luke's Cornwall. Thanks for listening. I'm Joey Wahler. Hi, Dr. Cuartas. Thanks for joining us.

Esteban Cuartas, MD: Hi, thanks for having me.

Host: Absolutely. So first what are generally speaking the most common causes of back pain?

Esteban Cuartas, MD: Yeah, so back pain is this big clinical entity that is, as you pointed out, is one of the most frequent reasons for visits to the doctor, either primary care doctor or specialists, or even the emergency room. It's an extremely common clinical problem. And the causes are very varied, ranging from benign causes to sometimes benign and unexplained and poorly understood causes to more specific causes, such as disc herniations or arthritis or scoliosis or more serious diagnosis like cancer or infection.

Host: So that being said, how often would you say from your experience, back pain is caused by quote unquote mitigating circumstances like lifestyle, diet, things that are somewhat within a person's control themselves.

Esteban Cuartas, MD: Yeah, so the largest block of patients that have back pain have what we can eventually, term non-specific, back pain, either acute or chronic, and the non-specific is just a terminology that we use really to specify that there's no specific diagnosis such as a disc herniation or stenosis or other more significant clinical problems that are causing it. So the vast majority of cases fit into this nonspecific back pain, which also helps us understand that it tends to have a benign behavior. It tends to go away on its own to certain extent. It tends to respond to anti inflammatory medications, sometimes muscle relaxants, and it, is usually very responsive to physical therapy as well.

Host: And speaking of which actually, I've had lower back pain in the past that has in fact gone away after not too long of a time in part, I suppose, at least due to the fact that I went for physical therapy and the cause was that I was diagnosed with tight hamstrings. So there's actually an important connection between your legs and your back in that instance, right?

Esteban Cuartas, MD: Yeah, there's a very interesting, balance that happens between the legs, the pelvis, and the lower back. And we actually term that the spinal pelvic balance. And involved in that balance are the hamstrings. And when they're too tight, they don't allow the pelvis to move normally, and that has an impact on the lower back, for example. Same thing goes for the hip capsules, and also for the lower back, muscles and the lumbar stabilizer muscles.

Host: And if you're not in shape, generally speaking, that's certainly opens you up to a better chance of having back pain, doesn't it?

Esteban Cuartas, MD: Yeah, so I think what I find a lot of times, is either in some cases, folks want to do the right thing, they want to become more active and become more fit, and they start going to the gym or exercising say more often, more aggressively, but they haven't gone through a period of strengthening and of rehabilitation really from their previous lifestyle. And so I usually counsel patients on proceeding slowly and paying special attention to strengthening the core and working up to a higher level of fitness, not just going all out on their first day at the gym.

Host: And that's an interesting point. I want to ask you about that because another thing with working out and back pain, I know from, again, personal experience is that if you say, for instance, do a lot of work on your arms and your chest, which a lot of men do for instance, of course, and you, relatively speaking, ignore your back; that can lead to problems, right? Because a lot of times, for instance, not even during exercises in the gym, but perhaps just when you're picking weights up or putting them back, which involves the back muscles, quite a bit, if you're working on and strengthening these other parts of the body, it can lead to problems if your back isn't getting a workout as well. Can't it?

Esteban Cuartas, MD: Yes. I think that's a, that's a great point. It's very, it's very common and very easy to just go straight for the more typical exercises for your pec muscles and your biceps and your triceps, and on the one hand, muscle tissue is actually quite dense and it's heavier, so it does change sometimes the sort of weight balance between the upper body and the lower body.

And on the other hand, the lifting or the actual exercises, also can stress the back. For example, we do find quite a number of younger folks that are doing deadlifts and doing squats with weights on their shoulders, and this is something that, you know, is quite common in the very athletic population in sports, just to try to get a little bit of an edge in terms of explosive power and sort of speed and that type of benefits. But for the regular athlete that's just trying to stay fit; sometimes these exercises, especially if the form isn't perfect, can lead to back injuries.

Host: Absolutely. So before I ask you about treatment options in a moment, what kinds of things can people do on their own to ward off back pain? Or maybe if they have it and it's not too serious to try to send it on its way?

Esteban Cuartas, MD: So I tend to really encourage people to focus largely on their cardio fitness. These are typically, exercises such as brisk walking, maybe even jogging, biking or spinning or peloton or elliptical. These are more complex movements. And I think that focusing on that as a large part of your fitness routine sort of balances the muscles out and avoids focusing too much on say, for example, building up your pecs or building up your biceps, which can lead to sort of an imbalance in the strengthening. So I tend to encourage a big portion of the exercise routine be dedicated to the cardio and then specifically, strengthening certain muscle groups as necessary.

Host: And whether it's in the gym or just in life in general, when you're lifting something heavy, maybe taking something out of your trunk, carrying something up or down stairs, what have you; how important, Doc, is it to, as they say, lift with your legs as much as possible to relieve that back strain?

Esteban Cuartas, MD: The basic three rules for lifting is number one, bend at the knees, don't bend at the waist. When you bend at the waist, say to pick up something from the floor or a weight from the floor for that matter, if you bend at the waist, the length of your waist and your torso all the way to your arms becomes a force multiplier, like a lever arm, and so it multiplies the force that your lower back feels.

The second rule is, don't lift and twist and that goes back more towards the discs in between the bones in your spine are not very well suited to the twisting motion. They're more suited to compressive forces, so they can take a load as long as the load is applied evenly and carefully; but they're not well suited to a loaded twisting motion and that can lead to disc tears or annular tears which are the preface to a disc herniation.

The next rule is don't hold heavy things far away from your body and that's also for the same reason for example that we don't want the lever arm to multiply the forces that your lower back feels. And that goes for some gym exercises, that goes for lifting, for example, I see this often with young moms and dads lifting, baby equipment that is large and unwieldy and you're really holding it far away from your body.

 And then the final rule, which is sort of corollary rule, is when something's very heavy, use your brain as well to lift. What I mean by that is use machines. Use help, use rollies, rolling tables, just think about it before you go at it and try to lift something by yourself.

Host: Yeah, some of the best moving people that work for moving companies that come and move your heavy furniture in your house; they're not necessarily the biggest, strongest guys, but as you say, they know how to use their noggin to move things wisely, right?

Esteban Cuartas, MD: Yeah, like moving pianos, that's quite a complex thing.

Host: We'll definitely leave that to them. A couple of other things. So, treatment options. What are the most common treatment options for general back pain?

Esteban Cuartas, MD: Treatment options, so yes, for this type of general non-specific back pain, over the counter anti-inflammatories are quite helpful. With those we always need to remember that we can't take them around the clock. And we can't take them for too many days because they can irritate the lining of your stomach and lead to gastritis or even an ulcer.

Also, certain patients that have, for example, hypertension or kidney problems, need to, beware, because they can increase your blood pressure, and they can also hurt your kidneys. Tylenol is a different type of medication. It can help with pain, it's analgesic, but it does not have that noxious effect on the stomach, or the kidneys, or your blood pressure.

So for some patients, that may be a good choice, for an over the counter medication. And the second, sort of mode of treatment that is quite helpful for these patients is physical therapy. Sometimes the first thing the physical therapist does is they do an assessment and they assess where this patient is at, how well they understand their body mechanics, their level of fitness, their spinal balance, and all these points help tailor a course of physical therapy for them.

Host: Well, folks, we trust you're now more familiar with back pain. Dr. Esteban Cuartas. Thanks so much again. And for more information about their orthopedic services, please do visit MontefioreSLC.org. Again, that's MontefioreSLC.org. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler, and thanks again for listening to DocTalk presented by Montefiore St. Luke's Cornwall.