Scott Webb (Host): Many of us suffer from lower back pain, and my guest today wants us to know that he can help if we're suffering, but also that we can help ourselves by doing some simple things at home and at work to prevent lower back pain. And I'm joined today by Dr. Benjamin Berthet. He practices pediatrics and internal medicine with Salinas Valley Health.

 This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb.

Doctor, it's nice to have you here. Today we're going to talk about low back pain, and I'm somebody who suffers, sadly, from low back pain. So great to have you on and your expertise. We're going to get to prevention, treatment, all that good stuff. But just a basic one here, why should we even talk about low back pain? Why is this a thing we need to talk about?

Benjamin Berthet, DO: Yeah, absolutely Scott. Sorry to hear that you have low back pain.

Host: I appreciate that.

Benjamin Berthet, DO: One of the reasons why I wanted to talk about it today is, really it is one of the most common reasons that people go see a doctor. When I kind of looked up the numbers, you know, over people's lifetimes, more than eight out of 10 people will experience low back pain at some point.

 And then if you look at any point in time, almost half of people are experiencing some degree of back pain. So, given how common it is, I thought it'd be something that would be good to talk about today.

Host: Yeah, I think a lot of people suffer, Doctor. Some maybe suffer in silence. Others not so silent, of course. But I think that, you know, between, acute back pain of course, which is something that might send us to the doctor or the ED immediately, but, something more like what I'm suffering from, meaning chronic back pain. I'm sure that's, that affects a lot of folks and it affects their quality of life. So great to have you here. Let's, get into that then. Like what are the causes of low back pain?

Benjamin Berthet, DO: When someone comes to me and they say, I have low back pain, really I need to put it into in my mind two big categories. The first category, it's by far the most common category and it's the least dangerous, thankfully. And these are really the soft tissue parts of the body, which means these are the muscles and the ligaments and these can get really strained or really tight and cause a lot of pain.

 And these can both happen over the short term, right? Like you said, acute back pain within a couple days and can be very painful. Or this can also form that chronic back pain that honestly can go on for years for for many, many people. So for that most common category of the soft tissue, statistically thankfully more than 85% of that back pain that people have in general consists of that kind of back pain.

 And that's a lot of what comes to primary care and most of those pains will go away on their own within a matter of weeks. And there are some treatments that we can talk about a little bit later, that can help them feel better, faster and make that pain go away faster. The other category, which is much less common, but it is more dangerous.

And that is why I definitely recommend people be seen by a health professional and have someone check out their back pain and see what's going on. So this category includes sometimes the bones around the spinal cord, which are all those nerves that go to the body, those bones sometimes can move or they can fracture and they can pinch the nerves, which can cause permanent damage.

And then sometimes there are like I said, more dangerous causes, which sometimes can put people in the hospital. And these can be infections around the bone. There can be autoimmune diseases. There can be different cancers and sometimes referred pain. So if anyone's ever had a kidney stone or pancreatitis, or sometimes inflammation in the colon; all of those pains of organs in the belly, that pain, can show up on the back.

Host: For sure. As you say, for the, for most folks, it's the soft tissue. Are there some things that put us maybe at higher risk? Is it the yard work around the house? Is it the type of work we do? Like who's at the highest risk?

Benjamin Berthet, DO: Yeah, great question. So definitely those things can be included. Some of the things that put people at higher risk for having low back pain, these include people who smoke, people who are obese or overweight. People like you mentioned, who do a lot of heavy work. And this can be just either things around the house or people who just have really physically demanding jobs where they're bending over all day long or they are lifting heavy things.

 Or alternatively on the other side, if people don't move around and they just have a desk job and they sit all day, that can really put them at increased risk for back pain. And then, the last thing I would mention is people who have mental health difficulties. So if people who deal with anxiety or depression, or if their work can be really psychologically difficult and demanding, that also puts them at increased risk for having back pain.

Host: It is interesting you mentioned like simply just sitting a lot or sitting on uncomfortable surfaces, or not sitting the right way. Like, probably the way I'm leaning forward right now, instead of sitting up in, in my chair like a big boy, like lots of things can affect our backs. Right?

Benjamin Berthet, DO: Absolutely. Absolutely. And unfortunately one of the most common things I hear is people kind of normalize this thing of just say, oh, I'm getting older. Oh, you know, it's normal to have back pain. And I would argue it is not. And it's definitely something that can be addressed and people don't have to deal with, you know, and just suffer in silence, like you mentioned, for years and years. That's not a fun way to live.

Host: Yeah, I think so many of us do that. We normalize it. We just say, well, you know, I'm getting older, so therefore everything should hurt. And the more experts I speak with, the more I learn, you know what, that's just not true. You don't have to suffer, you don't have to be in pain, but you do have to go see a doctor perhaps.

And that's what I wanted to get to next. What happens when we come to see you? Like, take us through the process of trying to diagnose, you know, maybe the cause if it wasn't acute, if it's more chronic, like what happened to the patient, how long have they been suffering? That kind of thing. So help us with diagnosis. What happens when we see you?

Benjamin Berthet, DO: When someone comes to see me, like you mentioned, it is very important that we get the full story and all the details about when that pain started. Where is that pain? Does that pain move from anywhere? How long has it been there? Right? Did it start yesterday or has this been the same pain that has been going on for several years?

Or if it started a month ago and it's getting much, much worse. Those are all different pieces of information that tells me what kind of pain I'm dealing with. And then I also combine that with the physical exam. So usually when someone goes to see a doctor, right, you talk, the doctor asks you some questions, and then they do an exam where like, we listen to your heart, we listen to your lungs.

 We can see on your body where the pain is and if there's any other concerning signs and if need be, we can order different blood tests or imaging tests to give us a better sense of what the cause of the back pain is.

So initially it's just pretty straightforward. We talk and then we do a physical exam, and then we might, if need be, do a little bit more investigation to see exactly what kind of back pain we have, whether it's in that first category or if it's in that second category, and then we can go from there.

Host: Right. Yeah. Patient history, I I've learned from the experts at Salinas Valley Health. Like that's just so important, just listening to the patients, right? So what did you do? When did you do it? How long have you been suffering? And then as you say, it might advance to blood work, imaging, that kind of thing.

Wanna give you a chance here to debunk, if you will, any, myths or misconceptions about low back pain.

Benjamin Berthet, DO: Some of the misconceptions about back pain, like we had mentioned before, is a lot of people just normalize it, that pain is just something that happens when we get older. And the pain I would argue, can be prevented. Especially if it's in that first category of really tight muscles or ligaments. But people can do active things in their day-to-day life to help treat the back pain when it comes on.

But then if they do this, those same things regularly, they can prevent that back pain from ever coming on so you're able to sit at a basketball game or mow the lawn and you don't have to worry about, you know, waking up the next morning and feeling this big ache in your back.

Host: And barely being able to get outta bed, which is the case with me. Good stuff today. Doctor, just want to give you a chance here that you were talking there about like things that we can do, right? So let's talk about maybe some simple daily habits or exercises that we can do to strengthen our lower back and those core muscles.

I remember seeing a commercial once that said, if you want to basically have a healthy back, a strong back, you gotta strengthen the front, I think I know what that means, but from an expert.

Benjamin Berthet, DO: I'm really happy that you brought that up because I think that is a very, very important part. As human beings, we are meant to stand upright, right? We're not meant to lean forward or, or lean back. We're meant to stand upright and have our two eyes, you know, horizontal and flat with the ground.

And our body's supposed to be in balance between the front and the back, right? So if one side is weak, we'll fall forward or we'll fall backward. And it's important to have a good balance. So, oftentimes when, you know, if we have a desk job and we sit all day and we don't use those muscles regularly, then the back muscles can get weak.

But also the front muscles as well, what we call the abdominal muscles. And sometimes if our body gets weaker, if those muscles and ligaments get weaker, then sometimes the other muscles and ligaments that we would not normally use, will have to tighten up and get very, very tight to help compensate for that weakness and I don't know if you've ever had a cramp in your leg or anything, but a really tight muscle or a tight ligament can be very, very painful. But just think of it, it's a cramp that never goes away. So that is something that can definitely be addressed. So as far as some daily habits or exercises that people can do, like you mentioned, I think working on both the front and the back and keeping them in balance to some degree, can help really prevent a lot of back pain, and it does not have to take a lot of time. So when I think about stretching the back and the front, honestly, the safest way would be to just sit on the ground and try to touch your toes. It's okay if you can only get to your knees, but as long as you slowly every day get closer to your toes, I think that could really help stretch the back.

 And then, to stretch the front, I don't know if you've ever done yoga or it's called a Cobra yoga pose. So if you just lay flat on your belly and you push up with your hands on the ground and kind of stretch back and arch your back, that can help stretch the abdominal muscles. And we might be surprised how tight that feels, but a little bit of stretch is actually good because that helps loosen up some of those muscles that can be tight. And then when it comes to strengthening, definitely one of the most common recommendations from a doctor is to go to physical therapy. You can have a professional work with you to help strengthen and stretch the muscles themselves, but something simple at home, that I think someone could do is, what I call a plank. So that's where, again, you're laying on the ground and you prop yourself up on your elbows and your toes, and you try to keep your back as straight as possible, and that helps strengthen the muscles in the back.

And then for the front, the good old crunches where you're, you lay on your back, you bend your knees and you try to lift your shoulders up towards your knees. That can really help strengthen the muscles on the front. So I think it's this balance of doing a little bit of stretching and strengthening and honestly, if we did each of those exercises, four exercises, one minute each per day, so that's just four minutes a day, I think that could help prevent a lot of back pain that people experience.

Host: Yeah, that's a pretty good bargain. You know, four minutes a day. Obviously, you know, if we have the more chronic type back pain that's been around for a long time, it would be good to speak with an expert, right? And, maybe run some tests, figure out what's going on there. But really appreciate your time today. Thank you so much.

Benjamin Berthet, DO: Yeah, my pleasure. Thank you for having me.

Host: And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor, or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.