Maggie McKay (Host): When your back is out, it can be debilitating, painful, and always inconvenient. So today, we're going to find out how to prevent back pain, injuries, and surgery with spine surgeon, Dr. Justin Tortolani. Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System.

I'm your host, Maggie McKay. Thank you so much for being here today, Dr. Tortolani. Would you please introduce yourself?

Justin Tortolani, MD: Thanks so much, Maggie. I'm Justin Tortolani and I'm the Director of the Spine Institute at University of Maryland St. Joseph Medical Center.

Host: All right, so we have a lot of questions to get through and I can't wait to hear more about it because just yesterday I was like putting on clothes the wrong way and I twisted my back and like the whole rest of the day I was in great pain. So what are the most common causes of back pain and injuries and how can people avoid them?

Justin Tortolani, MD: I mean, by far the most common injury is an injury to the disc. These are very common injuries, especially with lifting or moving awkwardly. And then there's obviously muscular strains that happen to the weekend warriors or the people that are shoveling or raking as is the case now this time of year.

So I would say muscular injuries and disc injuries by far the most common. And then as far as prevention goes, I think that we talk so much about treatment these days, we don't focus enough on the prevention. Obviously, prevention would put me out of work, but prevention is really, really key. I think one of the most important things is watching your weight.

Right now in the United States, obesity is an epidemic. Over 60 percent of our population is obese. So getting our weight down, really important to take stress off the muscles and discs in our low back. And then having a healthy fitness lifestyle where we're keeping our core muscles strong, our abdominal muscles strong, and our back muscles strong are some of the first and easiest steps towards prevention of injury.

Host: Wow. I would not even have thought of that. See, that's why you're here today about the weight. So speaking of exercise or physical activities, which ones are the best for strengthening the back and preventing injuries?

Justin Tortolani, MD: Well, often people are new to the game, so they're not exactly sure where to get started. So something called isometric exercises. These are exercises where you're just holding a specific pose, are nice because they can strengthen muscles without putting a lot of stress on the spine. So there's something called a plank, which you're horizontal to the ground, you're on your forearms and on your toes, your knees, and you're just hovering over the ground and you're holding your back and body over the ground in such a way that you have to be using your abdominal muscles.

So that's a simple exercise called a plank. And there's also simple exercises where you're on your back, which are called bridges, where you're just bringing your pelvis off the ground or stomach tucks where you're doing a partial curl kind of sit up. And these are really simple exercises to initiate core strength.

Host: Okay, speaking of the plank, because just today we were doing it in my boot camp, and I was wondering, some people are flat, their back, but some people, their backside is up. Does it matter?

Justin Tortolani, MD: Yeah. So you want to be as parallel to the ground as possible. So you are nice and flat. You don't want to sag too far down in your middle. You don't want to be in a jackknife position either. But honestly, some people where they're starting with their core is such that they can't really tolerate being in that perfectly flat position and they'll have to bend a little bit or they can just go on their knees and it takes a lot of the mechanical stress off.

Host: Okay, good to know. How important is posture in preventing back pain and what tips can you offer for maintaining good posture?

Justin Tortolani, MD: Posture, especially with our population that sits for their work, which is a large percentage of folks, is critical. During the pandemic, when people basically went indoors and converted to sitting for their job, we saw a lot of back injuries and issues just centered from the fact that they weren't sitting with appropriate posture.

They're using a laptop, they're on a couch, they don't have a desk chair. They don't even have a, a regular desk. And so people get into a slouch posture where their head is forward and they're craning to look at their screen. Well, the antidote for that is to simply use a lumbar corset or lumbar pillow. You can put it in your chair. That gets your shoulders back, it gets your chin back, and the other critical piece is having your monitor at eye level, so you're not craning down or looking up. So, those simple ergonomics, have a lumbar pillow if you don't have a lumbar support in your desk chair, and then get your monitor at the midpoint of your eyes when you're sitting with sort of a natural posture.

Host: That's good to know, because you know how they have those, they're like this and you put your computer on top of it. I always wonder, like, if you're looking up, is that okay, if you have good posture?

Justin Tortolani, MD: Yeah, looking up is okay, but I think, like, if the center of the monitor is dead center with the middle of your eyes, that's really the key. You'll look up for some of it, you'll look down for some, but you're not going to be craning your head up or down very much.

Host: Okay. So you mentioned diet, exercise, ergonomics. Are there any other lifestyle changes that we can adopt to reduce the risk of developing back problems?

Justin Tortolani, MD: So it turns out that just global conditioning like cardio conditioning is important for increasing blood flow to your low back muscles and probably your lumbar spine and discs as well. So some form of cardiovascular fitness is really important. There have actually been some studies linking high blood pressure to back pain, likely related to poor blood flow to these key muscles in our body.

So, maintaining cardiovascular fitness is probably as important as the core strength and the posture.

Host: That's very interesting. When should people with recurring back pain seek medical attention and what non-surgical treatments are available? Because I think a lot of people are very afraid of back surgery.

Justin Tortolani, MD: Our whole goal is to keep people out of the operating room, but some of the key red flags are leg symptoms. So, if someone has pain shooting down their leg, or we use the term radiating pain, or radiating numbness, or tingling, or any weakness in their foot or leg; those are alarms that should sound and trigger someone to either call their primary care physician or come in to see one of our providers.

Host: So that is maybe an indicator of back problems?

Justin Tortolani, MD: Yeah, that's an indicator that the back problems have gone so far as to put pressure on the back nerves, or the spinal nerves, and that can be more concerning. As far as some of the key treatments, we mentioned simple core strengthening and weight reduction, but often will initiate physical therapy for back school, which teaches people how to lift safely, also gives them exercises that they can do on their own, and just educates them about good spine health, a lot of the stuff we've already talked about.

Host: Dr. Tortolani, is it accurate that when you are going down to lift up something heavy, you should always bend your knees?

Justin Tortolani, MD: Yes.

Host: It is true.

Justin Tortolani, MD: That is accurate. Yeah, we want to hinge with our knees and our hips. These are our natural hinge points. And so, if we're lifting something off the ground, we really don't want to have to engage our back. We call it a cantilever move, where you're literally bending at the waist to lift, rather than bending at the hips and knees to lift.

Maggie McKay (Host): So we talked about this a little bit, but what are some other early warning signs that back surgery might be necessary and how can people reduce their chances of needing that surgery?

Justin Tortolani, MD: So the early warning signs, we mentioned a little bit about leg symptoms, those are always reason to seek additional care. I mentioned the weakness. Weakness is really important and that can sometimes mean urgent surgery. There's things that require emergent surgery, which is if patients lose bladder or bowel function, so if you are worried at all, you're having leg pain plus any loss of your typical bladder or bowel function, that can be very alarming.

And then the final thing I have people watch out for is night pain that wakes you from sleep at night. So it's one thing if you're uncomfortable and you're having a hard time getting to sleep, it's different if you are already asleep and back pain causes you to wake up from sleep. That can be a sign of something concerning like a spinal infection.

Host: Oh, wow. Are there any takeaways in closing that you'd like to add?

Justin Tortolani, MD: I mean, I think the biggest takeaway is that the stuff that we've already mentioned; things like a healthy lifestyle with core strength, cardiovascular fitness, and efforts towards weight reduction. I'll make a little bit of a plug for the GLP 1 drugs. These are drugs like you see advertised on TV, one of which is called Ozempic.

And we're seeing these can have a gradual effect on weight loss in a healthy fashion. Obviously, it can have a dramatic effect on diabetes, etc. But I think a lot of patients, if they're hurting, feel like they can't exercise like they normally would and therefore can't burn calories. And, Ozempic and other GLP 1 drugs, I think, are a way around that.

Host: Good idea. This has been so informative and educational. Thank you so much for all this useful information.

Justin Tortolani, MD: I really appreciate you inviting me and taking the time to talk to me. Thank you.

Host: Absolutely. Again, that's Dr. Justin Tortolani. Find more shows like this one at umms.org/podcast and on YouTube. I'm Maggie McKay. Thanks 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 and please share this on your social media.