Joey Wahler (Host): It can significantly impact our quality of life. So we're discussing curbing chronic back pain. Our guest, Robin Fencel. She's an Orthopedic Physician Assistant at University of Maryland Medical Center and part 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, Robin. Thanks for joining us.

Robin Fencel, PA-C: Hi there, Joey. Thank you for having me speak on this topic. You're spot on. Back pain is one of the most common reasons people seek medical attention and miss out on work.

Host: So when people are otherwise engaged from their usual work schedule, it's often because of just this very reason.

Robin Fencel, PA-C: You got it.

Host: So let's start with this. What constitutes chronic back pain as opposed to something less? And what are some common causes?

Robin Fencel, PA-C: So, acute vs. chronic, acute is something that is pretty short term vs. chronic is something that people live with.

Most commonly, back pain, people have the acute muscle strains or sprains. These occur for many reasons. They include improper lifting, poor posture, or even lack of regular exercise. Being overweight can increase their risk as well. We also know about bulged or herniated discs. In most cases, these injuries happen because of wear and tear of the spine, known as disc degeneration as you age.

Your discs become less flexible and you become more prone to tears and ruptures. Another thing that is a common cause of back pain is arthritis. This is what you think of as that wear and tear on the bones, as well as it can be from autoimmune disorders and even infection.

Host: A couple of the things you mentioned there, when we talk about people suffering from back pain because of deterioration or because of arthritis; those are things normally, of course, associated with older people, but back pain affects younger people as well, right?

Robin Fencel, PA-C: Correct.

Host: So back pain is sometimes also caused by other issues with connected parts of the body. What would some of those be?

Robin Fencel, PA-C: Some people who have, I'll take for instance, pancreatitis. We know pancreatitis, the pain can refer back to the back. You can also have back pain when you have kidney stones or things like that, so it's not always necessarily just due to the spine. You can also have some intra abdominal pathology as well.

Host: How about I know if you have tight hamstrings or issues with parts of the body that are directly connected to the back; that can be an issue as well, right?

Robin Fencel, PA-C: Sure. If you have tight hamstrings, a lot of times that can pull a little bit more strain to the back. So we do recommend that people are stretching regularly.

Host: And I'm going to ask you more about that in a moment. But first, when exactly, Robin, should someone seek medical care for back pain? How do you know when it's gone beyond nagging and needs to be looked at by a professional?

Robin Fencel, PA-C: Well, when in doubt, I would always seek medical attention. It's better to rule out something bad and to be proactive in your health.

Host: And so what are some of the signs that It's becoming at the level or has become in fact at the level where you need to see a professional.

Robin Fencel, PA-C: Well, addressing issues before they escalate can prevent minor problems from becoming major sources of pain. So I would say to get on the front end of it.

Host: What about tips for relief when you do have back pain? What would some of those be?

Robin Fencel, PA-C: Prevention, like we talked about as far as stretching. You can do core stabilization exercises such as planks and lumbar extensions, dynamic exercises that engage a strong core, deadlifts, some squats. Things like that. As long as they're done with proper technique, those can help being preventative.

And then also nutrition. Nutrition is a great way to help prevent some of the back pain and maintaining a healthy weight.

Host: So let's delve into each of those a little bit more. First, with regard to exercise, sometimes one of the issues that people have when they're suffering back pain, am I correct, is that they're imbalanced in what they're doing at the gym. Like if you're a guy you might be doing more arms, shoulders, chest, things that guys typically do at the gym with weights, but you might be ignoring your back and that can create back pain if you're not more balanced out in your workout routine, right?

Robin Fencel, PA-C: Yeah. In most cases, back pain should be relieved with exercise rather than by resting. The sedentary lifestyle, that contributes a lot to back pain. So starting safe and graduate exercises is always the best. The exercise in the gym shouldn't exasperate the pain. If it does, it may be time to decrease the difficulty or to call on a specialist, whether it's a spine specialist or someone that can help out with lifting mechanics.

Host: And then in terms of nutrition, how does that affect back pain? What are some of the basic foods that should be avoided or should be encouraged?

Robin Fencel, PA-C: I personally believe that nutrition is a modifiable factor that can affect pain levels and this is because of its effects on inflammation and just overall health. There is some recommendations coming around in the literature, especially with the aging population, that about a gram of protein per pound of body weight, that's gaining traction.

Knowing to avoid foods, pretty much anything processed, sugary or high in salt. Some examples of this are refined carbohydrates like the white breads, pastries, and sugary cereals. These all can spike blood sugar levels and can increase pain, as well as saturated and trans fats like the fried foods. All of these can promote inflammation in the body.

The salt, high sodium leads to fluid retention and can cause blood pressure issues, which can also aggravate conditions like arthritis. So keeping it simple, foods that are simple, fruits and vegetables, rich in antioxidants, vitamins, minerals, these all can help reduce inflammation. A lot of people have heard of the broccolis and the berries, those being particularly beneficial. Whole grains, those also are very helpful for anti inflammation. And using your healthy fats, like your nuts and your seeds, your salmons, your walnuts, things like that, that can help reduce inflammation. And spices, turmeric and ginger, especially, have some anti inflammatory properties. And one of my personal favorites, which I love to have every morning, is a cup of green tea. Those ones can help fight off the inflammation.

Host: And so what you're saying there is interesting because you're basically telling us that eating healthy is important for promoting less back pain or no back pain hopefully, not just to avoid being overweight, but because we're dealing with that factor of inflammation or anti inflammatory, certain foods contribute directly to that.

Robin Fencel, PA-C: You got it, Joey.

Host: So a few other things, first, kind of an age old question here, heat or ice for back pain, or maybe a little bit of both back and forth.

Robin Fencel, PA-C: Yeah, this is the age old question. And it really doesn't matter. Each person is different, and whichever provides better relief, I tell my patients to go for that.

Host: And so tell me, cause I've always wanted to ask this question. And I think I finally have the right person to ask because you would know, you ready? I don't want to put the pressure on you here. When we're putting heat or ice on something like back pain; you just said basically take your pick. Why does it work? What's going on there in the body that those things are effective?

Robin Fencel, PA-C: Sure. Well, heat draws blood flow to an area. When something's warm, it has a little bit more blood flow. Blood flow you want with healing properties. The heat also loosens up the muscles too. So for somebody that may have a strain that's been going on for a bit, the heat can be helpful. Ice, I like a lot in the acute periods, because it helps reduce some of the inflammation.

Host: So ice more for acute and heat probably more for something that's more of an ongoing issue then, yeah?

Robin Fencel, PA-C: That's generally what I use for myself, but again, whichever provides better relief for the patient, they're pretty harmless either way you go.

Host: How about tips when it comes to over exertion, something like lifting. Maybe tell us, remind us please, Robin, about the importance of lifting heavier objects more with your lower body, with your legs, to avoid putting too much pressure on your back. And a lot of that is just being mindful of that, right? Thinking about not putting pressure on your back.

Robin Fencel, PA-C: So lifting with your legs is critical. That takes out the strain of the back. It also helps you keep the proper alignment of your spine. You really want to avoid exercises that round the spine, and a lot of times when people are lifting something heavy and not using their legs, they hunch over and round their back. This creates a muscular imbalance and puts more pressure on the whole spine itself, so keeping that proper posture along with using your legs is best for your lifting mechanics.

Host: And then finally, in summary here, generally speaking, having said all of the above, what would you tell people about the chances of helping chronic back pain? Obviously, each case is different, but generally speaking.

Robin Fencel, PA-C: Generally speaking, I would say for chronic pain, something that they've been going on for a while, they should definitely seek a specialist. Each case is different. You want to rule out that something bad isn't going on and address all modifiable factors, and they might also need some other intervention that they can't modify themselves. So if it's chronic, I would have them seek medical attention.

Host: Well folks, we trust you're now more familiar with curbing chronic back pain. Robin Fencel, valuable information indeed. Thanks so much again.

Robin Fencel, PA-C: You got it. Thank you for having me, Joey.

Host: Absolutely, and you can find more shows just like this one at umms.org/podcast, as well as on their YouTube channel. Now, if you found this podcast helpful, please share it on your social media. I'm Joey Wahler, 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 joining you again.