Joey Wahler (Host): Many people suffer from back discomfort, and along with that comes some common misconceptions about their condition. So, we're discussing back pain and some of its myths. Our guest, Dr. Louis Bivona. He's a spine surgeon at University of Maryland Orthopedic Associates at Upper Chesapeake Health and member of the UM Spine Network.

Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. Thanks for listening. I'm Joey Wahler. Hi there, Dr. Bivona. Thanks for joining us.

Dr. Louis Bivona: Hi, Joey. Thanks for having me.

Host: Thanks for hopping aboard. So first, what are some of the common myths about the causes of back pain that you hear most often in your practice?

Dr. Louis Bivona: Yeah. I think one of the most common myths about the cause of back pain is people having disc bulges, and that's the sole reason for their back pain. The reality of the situation is there are many, many causes of back pain. While disc bulges may cause back pain, it could be muscular, it could be coming from the joints, which would get arthritic in the back. It could also come from the ligaments or the discs. So, I think there's a lot of information out there that people can look up to see all the other causes of back pain.

Host: Now, just following up on that, for one thing, improper lifting is a common cause of back pain, isn't it? But often, people don't seem to be aware of how damaging that can be. Am I right?

Dr. Louis Bivona: Oh yeah. of course. People tend to bend over and curl their backs like a cat when they lift up something where the proper technique would be more from lifting from the hips and the knees while keeping the back straight. In general, if you do curl your back to lift up something, generally that's going to cause like a muscle strain, which is very benign and very treatable.

Host: Shoveling improperly when there's snow on the ground also can be a problem, can't it?

Dr. Louis Bivona: Oh, of course. This time of year, we've gotten a couple of snowfalls already. Again, proper technique with shoveling, making sure you're not shoveling too much wet snow is also very important. Almost, it comes down to knowing your limitations.

Host: Because especially when it's a heavy snow and you're out there shoveling for a while, you sometimes kind of think you're getting into a groove, but you don't realize the damage you're doing as you're doing it because often it doesn't really make itself felt until a little bit later on, correct?

Dr. Louis Bivona: Of course, it's the classic back injury. You're out there, you're shoveling snow, you're feeling good. You may actually feel pretty good for an hour or so after; however, the next day, you're really feeling it. So, being careful with, again, trying not to tackle too much is very important.

Host: Another thing that I have found personally I wasn't aware of about back pain until somewhat recently is that if you have a weaker lower body, weak hamstrings, weak quadriceps, if those parts of your body aren't quite as strong or developed as some others, that can lead to back pain. Can it? Because it's all connected. And I didn't realize just how connected it is.

Dr. Louis Bivona: Oh, of course, lower extremity strength is of paramount importance to your overall back health. That's why I encourage all my patients to make sure they're active. I think walking is one of the best exercises, because it really does strengthen the lower legs.

The other thing that can be very damaging to the back and result in back pain is core strength. If you have a weak core, you're going to have back pain. So when we see people in clinic and they're reporting back pain, one of the first things I will do is send them to physical therapy to work on their core strengthening and also to work on their low extremity strength.

Host: And correct me if I'm wrong, but you can have a relatively strong core, even if you're a bit overweight, right? It's kind of like the joke I sometimes tell when people say, "You don't have a six pack." I say, "Well, I do, it's just under my gut."

Dr. Louis Bivona: That's exactly right. Exactly right. You know, it does require a lot of effort if you're overweight to kind of keep you upright. And yeah, you may have a somewhat strong core, but you know, again, it may not be strong enough to help support your back.

Host: Gotcha. So, how about common misconceptions about treatments for back pain? How is it typically diagnosed and treated?

Dr. Louis Bivona: Sure. So when you go see your doctor, the first thing they should do when you have back pain is get x-rays. And x-rays should be with you standing up. And by getting those x-rays, we're able to look at your overall alignment and make sure that everything is okay. When people think that they're going to their doctor for treatment and we talk about all of the modalities, really the standard of care for back pain alone is conservative treatment with physical therapy, medications like Tylenol and ibuprofen. Very rarely is surgery indicated for back pain, and I think that's probably the biggest myth. There are pretty much no amount of rods and screws that are going to really improve your back pain. Your back is not like your hip or your knee with only a couple bones and some arthritis. Basically, the back is a large mobile structure with multiple joints, multiple discs, and determining where that pain is coming from with all those moving parts is nearly impossible. So, many, many people come in and they think that, "Oh yes, a back surgery is going to get my back pain better," when that couldn't be further from the truth.

Host: So, that's yet another misconception or myth, right?

Dr. Louis Bivona: Yes, of course.

Host: So, moving on, what are some red flags, so to speak, that indicate when someone should seek medical help for their back pain? And what steps can they take on their own in the meantime to try to alleviate that discomfort?

Dr. Louis Bivona: Of course. So red flags, things that make me nervous when people come in with back pain are patients with end-stage renal disease, people who are on dialysis; people who are taking immunomodulators for maybe rheumatoid arthritis or other immunocompromising diseases; in addition, uncontrolled diabetics. This may indicate a possible infection, okay? So, you know, I would ask you if you have had any fevers or chills recently.

The other concerning thing the past medical history would be have you had a previous cancer, have you been treated for cancer. And generally, we'll ask you if you've had any recent weight loss. Many different types of cancer can go to the spine, so we want to make sure that we rule out all the bad things. In order for just treatment, the basic treatment to start out with is medications. The best medications to start out with are just your general over-the-counter medications like Tylenol and ibuprofen. And certainly, when you come see us, you know, we could modify your medication regimen based off of what we think is going on with your back.

Host: Gotcha. So, what would be the key factors that would influence the prognosis and the long-term management of back pain? Is it, for one thing, what you were just talking about, namely pre-existing condition?

Dr. Louis Bivona: I don't think that's necessarily true. I think the biggest prognostic factor for patients is their willingness to be active. And that means getting involved with physical therapy, trying to get up, trying to be an active participant in strengthening their core, their legs, like we talked about earlier, and just really showing initiative to, let's say they're a little bit overweight, trying to lose that extra 10, 20 pounds, because that takes so much pressure off the back. So really, when you come in to see me and you have back pain and you have those comorbidities, I really try to encourage my patients to be active, walk, get involved with physical therapy and maybe lose a little bit of weight.

Host: So, you're saying then that regardless, usually, of their condition otherwise, that it's still well within their control, if you will, to manage that back pain going forward.

Dr. Louis Bivona: Of course.

Host: How about some potential complications that can arise from untreated or improperly managed back pain?

Dr. Louis Bivona: Yep. So, the complication profile, while not unbelievably serious, is that acute back pain can turn into chronic back pain and that can be severely debilitating. You know, people with chronic back pain, essentially many, many people file for disability, they become depressed, and it affects their overall life. So, when you have an acute episode of severe back pain, the goal is to try to get rid of it as quickly as possible and prevent it from becoming a chronic problem.

Host: A couple of other things. Any specific lifestyle changes or exercises to help prevent or alleviate back pain? You've stressed being active, having a strong core. How about some simple exercises people can do, even if they're not in the greatest shape, they may not have the most time, et cetera?

Dr. Louis Bivona: Yep. So, the most simple thing you can do is get up off your couch and start walking. Or If you want to stay on the couch, those little bikes that they sell on TV, you've probably seen the infomercials for them, they get your legs moving. Simple leg lifts to strengthen your core while laying down are always great exercises. Even getting on a recumbent bike is great idea. It never hurts join a gym and get involved with an athletic trainer who can show you some very basic exercises. I understand that maybe going to a gym might be a little intimidating, but there are many, many gyms out there that are more than accommodating for everybody.

Host: And so, in summary, doc, what's your message for those listening that are suffering from back pain? It sounds like although it's a common malady, you're pretty optimistic that most people can see improvement, yes?

Dr. Louis Bivona: Of course. So, I think the main message is many, many people have back pain. And while it can be very difficult to treat, it is treatable, but it requires effort on my part and effort on the patient's part to get better.

Host: And when it comes to exercise, whatever you do, something's better than nothing, right?

Dr. Louis Bivona: Exactly. Exactly. We want people up and walking around and active.

Host: Just get off the couch and take a walk. Anybody can do that, right?

Dr. Louis Bivona: Of course.

Host: All right. Well, folks, we trust you're now more familiar with back pain and back pain myths. Dr. Louis Bivona, valuable information. Thanks so much again.

Dr. Louis Bivona: Thank you.

Host: And you can find more shows just like this one at umms.org/podcast. Again, that's umms.org/podcast, as well as on YouTube. Now, if you found this podcast helpful, please do share it on your social media. And thanks again for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.