From Aches to Action: Inside the Back & Neck Health Center

Scott Webb (Host): Back pain is so common today, and my guest today, Dr. Andrew Hanna, Medical Director of the Back and Neck Health Center at Long Beach Medical Center, is here to help us to understand the causes of back pain and how the experts at the back and Neck Health Center can help.

Doctor, it's so nice to have you here today and you're the perfect person to have on because I suffer from back pain. And I know back pain is one of the leading reasons why people miss work and seek medical care. Just wondering, in your expert opinion, why is it so common today?

Dr. Andrew Hanna: It's so common today because a few things. It's commonly diagnosed and just because we've had more advancements in medical technologies such as advancements in MRI imaging that allow us to see what could be causing back pain, that's number one. And number two is the introduction of technology such as cell phones-- and when I say the back, I should include the neck as well-- but the introduction of cell phone usage has shown that it causes us to flex our necks more, meaning look down more. When we look down more at our phones to text message or just looking down at something to read or our posture at work, for example, when we do these types of things, we actually increase our intradiscal pressures. And when we do that, it is not healthy for our back. You know, we as human beings are meant to move around, are meant to be active individuals. But a lot of the American lifestyle of, you know, sitting around at a desk to work, a lot of obesity throughout the whole country, a lot of these things increase the load of pressure on our spines. So, I believe that is a reason why back pain is on the rise and continues to be on the rise and is so prevalent in our community, is because of those things.

Host: It just makes you wonder, Doctor, you know, because it is so widespread, yet so many of us don't go for help. We don't come to see you, we don't go see our doctors. We don't get the imaging. Do you think it's just a fear of surgery or just chalking it up to aging, perhaps? Like, there's maybe just some stigma there and I'm wondering how the center helps to break that stigma to get people to walk through the door and get the help they need?

Dr. Andrew Hanna: No, that's a great point you bring up actually. So, yes, a lot of people are just like, "Oh doc, I'm just getting older. It's normal, you know, aches and pains." And then, we have some people also where they're like, "Oh, I get this pain every once in a while. It goes away and it comes back." And then, there's also people that are just scared to tell their doctor about back pain because they're so terrified of the word back surgery. You know, the advancements we've made in medicine have just been so profound over the past few decades. There's so many ways to address back pain.

And our center here in Long Beach, you know, we continue to grow it, but we are very focused on a multidisciplinary approach. That approach is incorporating a team of specialists such as myself. I specialize in interventional spine and pain management. We have a team of physical therapists as well that specialize in spine management. And the beauty of our physical therapist that there are a lot of one-on-one therapy, meaning we don't really have assistance or aids seeing the patients. It's more so the doctor of physical therapy, spending that one-on-one time with our patients, activating their core muscles, getting them to strengthen their spine and their neck. And then, we also have spine surgeons, some of the top spine surgeons in the country.

So, you know, the point is when you have a multidisciplinary team, you could progress through the treatment in a stepwise fashion, making sure you don't miss the steps. So when I usually see a patient, for example, the first step is evaluating them and seeing what is the cause of their pain. Back pain is just a symptom. It doesn't tell us what's causing it. The key is figuring out what is causing the pain. Is it due to arthritis? Is it due to a disc bulge or a disc protrusion? And if nobody knows what a disc is, a disc is the little cushion between the bones in your back. And, you know, it can sometimes push back and push up on the nerves and cause what people would say is sciatica shooting pain down the legs, right?

But again, as I mentioned, the goal is, the first step is diagnosing the patient, figuring out what is causing the pain. Once we do that, then we talk about the options together. Take that first step together and talk about conservative options. You know, a conservative step is physical therapy, stretching, home exercise programs and other modalities to help with your pain.

Now, if that doesn't provide relief, then that's where I step in as an interventionalist. And we talk about a little bit more advanced procedures. Not really too invasive, they're very minimally invasive, but things like, you know, medial branch blocks or trigger point injections into the muscle, or sometimes even epidurals, things of that nature, and ablations included. But the point is it's a step-by-step approach. And when we've exhausted all steps and there's not really much left, then of course we get the spine surgeon involved. But when we have this multidisciplinary approach, it's been shown to have success with patients, they do get relief.

Host: Because I was going to ask you about the non-surgical options, but you went through them there. And I think, because it is so prevalent and you're talking about phones and posture and all of that, especially for younger adults and working professionals, it feels like early diagnosis, you know, might prevent them from ending up all scrunched up like an old man like me.

Dr. Andrew Hanna: Absolutely. Absolutely. And that's why I always encourage physicians alike who are not specialists in this to not shy away from, "Hey, if your patient is having back pain, you know, of course, refer them over. We'll take care of them." But I also encourage patients don't be afraid to speak up and talk about your pain. You know, a lot of people think their a little pain here or there means nothing. But as you said, as time progresses, whether you're sitting in incorrect positions or looking at your phone too long in one position, physics wise, you are increasing load on certain parts of your body, and that's going to have an effect.

I truly don't think it's a coincidence that we're having so many young people under the age of 30 show up to clinic with neck pain, with severe neck pain. That's not common. And the reason being is because a lot of these kids and a lot of these young adults and young professionals are exposed to their phone or exposed in seated positions that are not healthy for them for long term causing these types of pains. So intervening early, getting them in a therapy program, teaching them appropriate ergonomics, making sure their workstation is set up correctly is very key for preventative measures.

Host: Yeah. And I wanted to stick with that. You were talking before, we're just talking about the team basically there, right? I want to have you talk more about that, this sort of integrated approach to spinal care. That it's not, "We have to drive over here to see this person, or go over there to see that person," or "It's three towns away for this care." You know, you're all right there together. It's all integrated. Maybe you can talk just a little bit more about that.

Dr. Andrew Hanna: Of course. So, you know, at Long Beach Memorial, our focus in our spine center and our back and neck health center is a whole team approach. Meaning when I'm sending out to physical therapy, I have the physical therapist involved. I know the physical therapist is going to do one-on-one physical therapy, and they're not going to have other assistants doing the work. Again, that doctor of physical therapy is working with you one-on-one.

If we need to advance care because that physical therapy is not providing relief, here at Long Beach Memorial, I'm able to intervene and be like, "Okay, well, these are the next set of steps that we need to take together," which is doing those types of injections depending on the diagnosis. Now, if the injections and the treatments that I provide don't provide significant relief or sustained relief, then the last step obviously is getting the spine surgeon involved, which is also here at Long Beach Memorial.

So, there's a lot of aspects all in-house that we could take. It's a team effort to work together. Because sometimes, for example, I'll do an injection and the patient gets significant relief. They come back to me and I tell the surgeon, "Hey, there's no reason this patient needs surgery anymore. They're doing great and they've been great for six, seven months. You know, let's just keep them on this conservative route." And most surgeons will totally agree. They're like, "Great. That's fantastic." That's what we want.

And same thing with physical therapy. I'll have the physical therapist call me and be like, "Dr. Hanna, this patient's doing great. They're not having much pain. I see the patient, the patient's like, "I'm doing great with therapy, Doc," then at that point, there's no reason to even do injections. So, it's having that interdisciplinary communication and that interdisciplinary team all work together in the benefit of the patient's wellbeing, because the spine is composed of so many things. You have your muscles, you have your tendons, you have your ligaments, you have your discs. And having a whole team together address all those things as one unit is so important.

Host: Yeah, I'm sure it is. And I'm just thinking about the sort of the care plan, if you will, and thinking about the factors, you know, that go into deciding does a patient get PT injections, go to the conservative route or go directly to surgery, whatever it might be. I'm just wondering, when we think about the factors, does it sometimes include patient goals? You know, like if they're really active, they're a mountain climber, they're a pickleballer, whatever it might be. Take us through how do you determine the course of action or the care plan, if you will, for patients.

Dr. Andrew Hanna: Yeah. You know, it's individualized to each patient. Each patient that does come in. The goal is to figure out and diagnose the patient, what is causing the back pain as I mentioned earlier.

Once we get that diagnoses, the first primary step is conservative care, how I said, which is getting physical therapy involved. But hypothetically speaking, let's say I have a mountain climber come in and want to see me. And that mountain climber is, you know, they're like, "Hey, Doc, my back hurts. I've not been able to mountain climb for the past two months." They have had a decrease in their quality of life. They've had a decrease in their level of function because they're used to mountain climbing. You know, this is something they did and this is something they want to continue doing.

My goal when I step in as a doctor is to ask them or tell them, "Well, how can we get you back to that prior level of function?" So, that's what I'm trying to get them back to. Now, we start off again conservatively with therapies. If that provides relief, great. If not, then we advance the steps. But again, the goal is to get them back to that prior level of function, hopefully exceed that level of function without exacerbating their underlying pain.

Host: And it makes me wonder, maybe I should have asked somebody 30 years ago, how do we maintain long-term spine health and mobility? Like, what's the plan? We talked about how, you know, you're seeing more and more young people in the office, right? Whether it's phones or otherwise as the cause. But how do we do that? How does the center help patients to maintain better long-term spine health?

Dr. Andrew Hanna: I think education on spine health is key. And I'm happy you asked that question because we want to focus a lot of medicine now on more preventative measures. So, educating patients on proper ergonomics at work, proper ergonomics in the home, the appropriate way of sleeping; how many pillows should one be sleeping on? How long should one be sitting versus standing? And then, healthy diet. Of course, high water intake is key, as well as protein consumption and strength conditioning, right? The spine is, you know, the foundation of our body. The spine is the structure that holds us up. Without the spine, you know, we're not able to stand. So, I do believe that the focus needs to shift towards getting people to understand how do we strengthen our muscles? How do we make sure we are maintaining appropriate ergonomics? How do we make sure that we're eating healthy? How do we make sure we're not overweight? All these things contribute to poor spine health. But intervening and having someone point out these deficiencies can help the patient in the long run prevent worsening of their spine condition.

Host: You know, I've heard, from speaking with other experts about other topics, about nurse navigators. And I was reading about the patient care coordinator with your center and wondering if you can help listeners to understand exactly what that role is, how they help patients to just kind of, you know, navigate through this back journey, if you will.

Dr. Andrew Hanna: Of course. No, I love that you brought up the patient coordinator. So, I love our patient care coordinator, and the reason I love it is because a lot of people, they get lost in the pain world. And what I mean by that is they show up, they're like, "Doc, I'm in pain." You know, they get referred to therapy and then the patient kind of gets lost like, "Well, I did therapy," but the patient forgets to follow up or they're not reminded to follow up, and they kind of just get lost.

But having a point-of-care contact means our clinic and our staff is trained to-- if I place an order for physical therapy, the patient goes to physical therapy. That point of care is like, "Okay, don't forget your follow-up is with Dr. So-and-so on this date. We want to follow up after, you know, six physical therapy sessions or 12 physical therapy sessions. We want to see how you're doing and improving." So that way, there's this continuity of care in the spine and in the pain realm.

Because a lot of patients, they think that-- and rightfully so-- I'm a patient too, although I'm a physician, but I'm also a patient. But the point is we get lost in the medical realm. You know, nobody knows where to go, what to do, where do I follow up, how do I do this? So, our patient care coordinator kind of helps coordinate the whole flow of the system for patients. It allows them to remind the patient care coordinators will reach out, as I mentioned, tell the patient, "Hey, you've done this amount of physical therapy. Dr. Hanna wants to see you again." They come back, see Dr. Hanna. I refer them and, you know, do a procedure. The patient coordinator will help coordinate that. If the patient gets relief, then great, fantastic. We document that. And then, we can kind of progress them appropriately along the path and along the steps to help them find relief. So, having this one point of contact prevents loss of care and holes in the healthcare system, right? It allows us to know what's going on to provide you the best interdisciplinary care.

Host: Right. And of course, people have to help themselves. They have to answer that call when the patient care coordinator calls. But yeah, absolutely. Just get a sense here as we get close to finishing up here, when you picture like the person who would benefit the most, the people who would benefit the most from the back and neck health center, what does that look like? Who do they look like? And what do you hope that folks take away from the experience?

Dr. Andrew Hanna: So, you know, that's a great question. And this sounds like such a funny answer, but if you have back pain or neck pain, you will benefit from our back and neck health center. And what we plan for them to take away is a very good evaluation, understanding that they're going to walk out with a diagnosis. Again, pain is a symptom. It's not really a diagnosis. It's a symptom. It's figuring out what's causing your pain is the key. And I always remind patients of that, is always walk out with a diagnosis, why do you have pain, right? And if we know why you have pain or we build a list of possible reasons you might have pain, we can come up with a list of the possibilities of treatment for you. That's the key is matching the diagnosis with the treatment plan. So, anybody with any type of back and neck pain can benefit from our center.

Host: That's perfect. I appreciate your time, your compassion. Thank you so much.

Dr. Andrew Hanna: Thank you for your time and thank you for having me.

Host: And for more information, go to memorial care.org/backneckhealthcenter. and if you enjoyed this episode, please share it on your social channels and check out the entire podcast library for additional topics. This is Weekly Dose of Wellness, brought to you by Memorial Care Health System. Thanks for listening.