10 back-injury myths
Editor’s note: This is part one of a two-part series on back-injury myths by Dr. Scott Raub.
Many people believe disc degeneration is a disease in the sense that there is a pathological problem or deficiency with the discs in their back. Disc degeneration is actually part of our aging process and can not be reversed. It’s important to recognize that disc degeneration doesn’t always equal pain. Just because our discs degenerate and lose some of their normal characteristics as we age doesn’t necessarily mean they will become painful. We can treat disc issues that look abnormal on an MRI, yet these efforts may not always yield therapeutic results.
Many patients point to a spot on their back and say “it hurts right here.” But where it hurts isn’t always where the pain is coming from. The most common spot patients point to is their buttocks area. It’s actually very rare that the problem is coming from that area. It’s usually coming from the lumbar spine, but the patient is getting referred pain to the buttocks area. We want patients to continue pointing out where it hurts, but we also want them to be aware that where it hurts isn’t always where the pain is coming from.
Many people have a belief that if they see a spine specialist, they will end up having back surgery. The truth is that most spine specialists do not want to do surgery unless they’ve exhausted every other option treatment-wise. For the vast majority of patients with back pain, surgery is always elective. If they don’t want it, they don’t have it have it. We can provide alternative treatment options and try making some modifications in their activities.
There are agreed upon standards when prescribing medications, especially in the acute phase following an injury. We use medications initially for pain, inflammation and relaxing the muscles to get patients past that acute stage. As we get into the sub-acute or chronic stage however, we have to be mindful of what we’re prescribing and for how long. Medicines like Vicodin and Percocet are very easy to prescribe, but with prolonged use it can become a challenge to wean patients off these medicines. Together, doctors and patients should strive to utilize fewer medications over time for back pain.
We educate patients about managing their pain by modifying their lifestyle, modifying their activity, and accepting the fact that doing certain things may hurt more than others. Chronic back pain patients need to know they are going to have some pain, but we can get it to a manageable level. For example, if they ski a lot, they may not be able to ski the bumps like they used to. Or, they may not be able to ski back-to-back days. Most people who live with back pain need to place a high priority on strengthening their back muscles. Having good core strength will support the spine, abdominal and buttocks area. Good flexibility in the hips and hamstrings will help reduce some of the stress patients are placing on their spine and allow them to tolerate more load. In addition, there might be alternative care treatments such as massage and chiropractic care that may help manage pain symptoms that relate to alignment and muscle tone. Dr. Scott Raub is a physiatrist with Vail o Summit Orthopaedics. He specializes in non-surgical spine care and electrodiagnostic testing. Be sure to visit the VSO website to watch the video of Dr. Raub talking about back pain myths on the VSO website at: http://www.vsortho.com/#doctors=/dr-scott-raub&community=/10-myths-back-injury.
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