On Tuesday evening, January 12, the Navigating the Medical System Lecture Series, hosted by Congregation Etz Chaim of Kew Gardens Hills, featured an informative medical lecture on lower back pain with Dr. John Park, Chief neurosurgeon at NewYork-Presbyterian Hospital Queens. Christina Yoon, Community Outreach Representative for the hospital, welcomed the audience on Zoom. Then, Dr. Mel Breite, Founder and Director of the Navigating the Medical System Lecture Series, introduced Dr. Park.
Dr. Park’s lecture included extensive details so everyone learned an enormous amount of information about lower back pain, including anatomy, causes, treatments, and prevention.
He began by sharing that 80 percent of Americans will have lower back pain that can range from a dull constant ache to sharp pain. Acute pain is usually relatively recent and short-term. Most is self-limited and will resolve itself with self-care and no residual loss of function.
Symptoms that warrant urgent attention include loss of usual bowel or bladder function, urinary retention, and severe or worsening of weakness in legs due to pain. Twenty percent of those with acute back pain develop chronic back pain. Eighty percent get better. Even if chronic pain persists, this doesn’t mean that there is a serious medical condition.
Dr. Park then explained the anatomy of the lower back. There are five lumbar vertebrae – L1-L5 – and sacral vertebrae called S1. Vertebrae are connected by discs in the front and joints in the back. There are round pads that act like shock absorbers and cushion bones. Nerves are in the natural opening in the bone. Vertebrae are connected in the front by disc and in the back by joints. This allows bending forward and backward. Bones are connected by ligaments, which are bands of tissues. Tendons attach the muscles to the spinal column and together help support the spine. There are 31 pairs of nerves coming off the spinal cord. The nerves come off the roots of the spinal cord and control body movement and transmit signals from the body to the brain.
Most low back pain is due to disruption in the way one or many components of the back fit together and move. Common causes for lower back pain include Scoliosis (curvature of the spine), Kyphosis (excessive outward arch of the spine), and Lordosis (abnormally exaggerated arch in the lower back). Other causes include sprains or tears of ligaments, strain or tears of tendons or muscles, and a bulging or ruptured disc causing nerve compression. This pinches nerves against the bone.
Compression fractures of the bones can cause pain in the bone or nerve. Collapse of the disc can be caused by arthritis. Arthritis can also cause inflammation of bone and facet joints. He shared, “There are many causes for low back pain.” Also, overgrowth of ligaments and joints can be caused by arthritis. Slippage of the bones can cause pain. “All the different causes of low back pain require different treatments. There is no one-fits-all treatment.” He then shared more possible causes, such as an infection, kidney stones, endometriosis, Fibromyalgia, tumors, and pregnancy.
If pain continues, then you need to see a physician. He listed risk factors, which include age, Osteoporosis, lack of fitness, being overweight, and genetic components. Most back pain is not in your genes. There are also job-related factors, like being too sedentary or lifting heavy things. Mental health, anxiety, and depression can influence back pain because it can cause someone to focus on the pain. Stress affects the body, including muscle tension. Also, smoking restricts blood flow and oxygen to the disc.
When a doctor is diagnosing the pain, he needs to take a complete medical history and ask where is the pain, when and how did it begin? Do you have weakness or numbness, or bowel and bladder function issues? A neurologic exam will assess for nerve damage.
He explained that x-rays are good for seeing broken bones, injured or misaligned vertebrae, or eroded vertebrae. An MRI will show bones, discs, nerves, spinal fluid, and ligaments, as well as how nerves are functioning. MRI is the gold standard for imaging. CAT scans are better than x-rays, because they show bones and bone spurs. A CAT scan would be indicated if you have a pacemaker or there is another reason you can’t do an MRI. Bone scans detect infection, fracture, or a tumor. Blood tests reveal infection or cancer.
Electrodiagnostic is a painful test that determines if there is good nerve conduction.
Dr. Park shared some treatments for lower back pain, which include Tylenol, aspirin, or NSAIDS like ibuprofen or Motrin. There are also muscle relaxants and steroids or prescription drugs for arthritis or inflammation. Also, topical pain relief can come with creams or gels. In addition, alternating heat and ice can be helpful. Gentle stretching is good – but not rigorous exercise; bed rest and surgery are not typically recommended for low back pain.
For chronic pain, step one is early treatment with analgesics and NSAIDs – or opioid drugs, but those are a last resort. Also, anticonvulsants and antidepressants can quiet nerve pain. First try self-management with heat or cold. Do exercise to strengthen your core or abdominal muscles. Step two is physical therapy and exercise, targeted to the lower back, which promotes good posture and strengthens core muscles.
He also mentioned chiropractors and acupuncture and cognitive therapy as other possible aids with low back pain. Dr. Park emphasized that “it is important to get the proper diagnosis to get the proper treatment.”
Surgery is not always successful and it can take months before you notice benefits from it. He detailed various types of lower back surgery. Then he shared preventive measures. Avoid jolts or strain to the back. Maintain correct posture. Bend your knees when lifting heavy objects. Exercise regularly and find low-impact age-appropriate exercise that targets strengthening core muscles. Maintain a healthy weight. Eat a nutritious diet and supplement with calcium, phosphorus, and Vitamin D. Use furniture that provides you with good posture. If you sit a long time at work, switch your position often and periodically walk around. A pillow at the small of your back can release pressure there. Wear comfortable, low-heel shoes and sleep on your side with your knees curled up. Sleep on a firm surface and don’t lift objects that are too heavy. Also quit smoking.
The community is grateful for this wonderful program, and a special thank you goes to Dr. Park, who came straight from six hours of surgery to voluntarily share all of this valuable information with us.
By Susie Garber