Back to Health: Proven Ways to Relieve Lower Back Pain

Intro: This is Weekly Dose of Wellness, brought to you by Memorial Care Health System. Here's Deborah Howell.

Deborah Howell (Host): Have you been living with constant or occasional pain in your lower back? Well, you're far from alone. In this episode, Dr. Stephen Huo, an Orthopedic Spine Surgeon at Memorial Care Orange Coast Medical Center, will tell us about some proven ways to relieve lower back pain so you can get back to health. Welcome, Dr. Huo.

Stephen Huo, MD: Hi, Deborah. Thank you for having me.

Host: Thanks for taking the time. So, lower back pain affects millions. What are some of the most common causes you see?

Stephen Huo, MD: Yeah. So in my office, day-to-day practice, the most common main causes are muscle or ligamentous strains, usually from like sudden injuries such as heavy lifting with improper technique or even something simple as repetitive movements that strain the back muscles and ligaments. There's also a large component due to spinal degeneration, and that could include degenerative disc disease, which is just a natural part of aging where the spinal discs wear down, which can lead to pain and stiffness, and just osteoarthritis of the facet joints, which are the numerous joints in the spine, which allow for a range of motion.

And of course, we always have to consider injuries such as herniated or ruptured discs, which can cause pressure on the nerves, and that can cause what we commonly call sciatica, where you have a irritated nerve that causes pain radiating down the legs.

Host: Now, what are some early warning signs that lower back pain may become a chronic issue?

Stephen Huo, MD: It's commonly quoted, it's about 90% of acute low back pain resolves or improves within six weeks or sooner. Now, that being said, there's a couple important red flag warnings that you want to look out for that might indicate a more serious underlying condition. That can include a history of trauma where there's high energy or impact, where it's a fall from a significant height or a car accident and, of course, any worsening pain that spreads down your legs, or into your buttocks. And that could suggest that there might be a nerve involvement.

And of course, kind of in conjunction with this, any neurological symptoms, numbness, tingling, weakness, and these can all be red flags for potential nerve compression as well. This is a little bit more rare. But if you start having bowel or bladder dysfunction or loss of control, this can be a very serious condition that would require prompt medical evaluation. And of course, even more or less likely, anything such as fever, unexplained weight loss, this could potentially signify either an infection or tumor in the spine, which is luckily quite rare.

Host: Good. I'm glad it's quite rare. Now, talk to any mom, how much of a role does posture play in back pain, especially for people who work at desks or maybe stand all day?

Stephen Huo, MD: Yeah. So, posture is huge. I see this on a daily basis. People, like you said, either standing or sitting for prolonged periods at the desk. There's different ways that the posture can affect and cause back pain. So, I think all of us have slouched or rounded our backs at some point at the desk. And this can compress the spine whereby it increases the pressure on the disc and can lead to pain and discomfort. And also, ergonomically, if your desk is not set up quite right. So if you're staring at the computer screen and your head posture is kind of tilted forward, this can cause strain of the neck and back muscles.

And then of course, kind of alluded to earlier, improper lift techniques. A lot of people injure their back with excessive strain. And there are proper lift techniques that therapists can instruct to kind of minimize this risk. And of course, any prolonged sitting or standing without breaks. This is a very common one that I see where people are at their desk sitting for hours. And this can certainly add to muscle fatigue and stiffness.

Host: Now, are there any stretches or strengthening exercises that you recommend people do at home to support their spine?

Stephen Huo, MD: Yeah. So, there are several. Of course, physical therapists are the masters of this, and they can definitely tailor the exercises to the specific fitness level and body type of every patient. But, for example, a couple stretches, you could do a pelvic tilt, which is essentially lying in your back with your knees bent and your feet flat on the floor and you gently tilt your pelvis up and down and then pressing your lower back into the floor and then releasing. There's also the cat-cow stretch, where you're standing on your knees and hands, and then alternately arching your back and rounding out your spine, and then dropping your belly towards the floor, and thereby arching your back. So, this is very commonly done in yoga.

And then, in terms of strengthening exercises, one of my all-time favorites, planks. And of course, this is where you're supporting your body weight on your forearm and your toes and keeping your body in a straight line from the head to the heel. Now, of course, some people, this might be a little bit too difficult, so there are modifications where you could go down on your knees instead of your toes. And there's even more modifications for those who need more of a challenge. And I stand by this, I do this three to five times a week. And I do think it helps prevent back exacerbations.

Host: Now, when should someone with lower back pain see a doctor instead of trying to treat it at home?

Stephen Huo, MD: Luckily, most of the pain kind of resolves on its own over time, but any lower back pain that doesn't improve within a few weeks of home treatment, such as with over-the-counter remedies with Tylenol, Advil, stretching and activity modifications or those with pain that's accompanied by more concerning symptoms like numbness, weakness, or bowel bladder issues should definitely go see a doctor sooner than later.

Host: What are some of the most effective treatment options for back pain available today?

Stephen Huo, MD: It's nothing too fancy. I mean, the first-line treatment, and this encompasses and addresses most of the back pain, is like over-the-counter medications. Advil, Aleve are very popular ones, Tylenol. Physical Therapy, really to strengthen the core and back. And it's very important to keep continuing these exercises even after the pain has subsided. And then, activity modifications to try to incorporate more low-impact activities. What I mean by that, instead of running and doing contact sports and like tennis or, unfortunately, even golf, where it does cause quite a bit of rotational strain on the spine; swimming, pilates, ellipticals, yoga, these are all great exercises that are very easy on the joints. And finally, of course, adhering to good ergonomics like we talked about at the workplace. Making sure you have good posture, taking frequent breaks, and then also maintaining a healthy weight.

Host: How about breathing and breathing exercises?

Stephen Huo, MD: I think breathing exercises are very important. I think it often goes overlooked. But I think a lot of exercise regimens these days, yoga included and even meditation, they really incorporate breathing, which I do think, having done so myself, I'm a firm believer it does help.

Host: Great. And how do you approach pain management for patients being part of a spine program that's 99.9% opiate-free?

Stephen Huo, MD: While opiates are an important adjunct to our kind of multifaceted approach in addressing spinal issues, including pain, the fact is that we as a country are currently in an opioid epidemic. And we definitely try to limit its use as much as possible.

That being said, referring back to earlier, the majority of the treatments are very addressable with NSAIDs, the nonsteroidal anti-inflammatory medication and Tylenol. It's not one thing that's going to fix everything, right? So, I believe the good news is that majority of the treatment is within the patient's control. So, I think that is a very empowering thing, because it really pertains down to lifestyle.

It's not easy, I'll admit to lose 5, 10, 15 pounds. Start going to the gym, start a regimented workout regimen with stretching, and also making those ergonomic adjustments at work. But I am a firm believer that if you were to make all these little changes, they definitely do add up and that can definitely keep you off the opiates and definitely give you a much better chance of having less pain or be pain-free.

Host: Right. I mean, in other countries, they don't even allow them. My friend had a terrible accident in Greece and they said, "Nope, no opiates."

Stephen Huo, MD: Yes. A couple Asian countries, they're very strict on opioids. And they have the same problems we do, but they seem to be doing just fine.

Host: Yeah, a lot of it is preventative. And as you were talking about, maybe losing a little weight, maybe going to the gym a little more. But it's consistency, that is the key, right?

Stephen Huo, MD: Absolutely. I think that's the hardest part. I mean, anyone can go to a couple sessions of gym or physical therapy. That's not a problem. But just that discipline to keep maintaining that, I think, that's really the key.

Host: Anything else you'd like to add to our conversation?

Stephen Huo, MD: Well, I mean, I know this is just kind of a little glimpse into back pain, which is I think like the number two most common reason-- if not number one reason-- to see a doctor. You can definitely find out more about our program at memorialcare.org/spine. And we do have a very multidisciplinary team that we're very proud of and we track our outcomes. We encompass everything from non-operative to surgical treatments, and we have a great team of physical therapists, physiatrists, pain specialists, and both orthopedic and neurosurgeons who both operate on spine such as myself. So, yeah, I would invite everyone who's listening to please check out the website if you have any further questions.

Host: We thank you so much, Dr. Huo, for your time and your expertise today. We really enjoyed having you on the podcast.

Stephen Huo, MD: Thank you for having me. My pleasure.

Host: And once again, you can learn more about the Spine Health Center by visiting memorialcare.org/spine. That's all for this time. I'm Deborah Howell. Have yourself a terrific day. Do your cat-cow.