Monday, February 13, 2012
Construction and factory works may have a special place in their heart for Derrick Rose of the Chicago Bulls. They can relate to waking up with back stiffness that makes it hard to get out of bed. They can relate to suffering through ha shift at work as their back tightens and makes it difficult to bend over. They can relate to having so much pain that it hurts too much to work. A week of low back spasms has caused Rose to miss two basketball games and he is on his way to a back specialist for further care. Regular people can’t relate.
Low back pain strikes almost everybody sometime in their life. Usually, it’s a pulled muscle from lifting a too heavy object or from spending too much time bent over or from a minor fall or accident. The structures that surround the back and protect the spinal cord usually are able to tolerate day to day stresses applied to the back but on occasion, a twist or pull or jolt tears a muscle, pulls a ligaments or stresses a disk. Pain reminds a person that they’ve done something that the body doesn’t like and it’s time to assess the situation. While elite athletes rush to a chiropractor, physical therapist or back specialist, most normal people try to treat themselves b ybeing kind to their body and taking it easy.
Going to the doctor for an acute backache can be very frustrating. There can be a disconnect between what the patient wants and what the doctor thinks they want. Patients are often concerned that something structurally wrong is happening in their back while the doctors think that the patient just wants pain relief. Pain relief is a good thing, but doctors teaching and patients understanding works better. It doesn’t help that the questions asked may seem to have no connection to the back problem itself. What does bladder and bowel function have to do with the back anyway?
When a patient presents for low back care without a major injury or fall, they can be put into two categories, impending disaster or not. The diagnosis that is a true neurosurgical emergency is cauda equine syndrome, where the nerve roots that leave the end of the spinal cord become inflamed or trapped and stop working. This can cause significant pain and numbness in the legs and back but it also causes problems with the bladder and bowel. If the patient cannot empty their bladder and goes into urinary retention or if they lose control of their bowel and become incontinent of stool, red flags go up that the spinal cord is at risk. Paraplegia is the complication of cauda equine syndrome and time is of the essence to make the diagnosis and get a neurosurgeon involved. AN MRI needs to be done yesterday.
If there aren’t any bowel or bladder issues, then there is all the time in the world to sort things out. If no there is no trauma or fall, then most times, plain x-rays of the back aren’t needed because it is unlikely that there is a broken bone in the back. Instead, a thorough exam of the back and legs to look for inflammation of the sciatic nerve is the most important test that can be done. If muscle power, sensation and reflexes are normal, then symptomatic care is an appropriate first step in helping the back get better. Most recommendations suggest that bed rest is not necessarily the best thing to do; instead, activity as tolerated gets the back moving again. Medications might help to attack the pain symptoms in different ways with anti-inflammatories, pain medications and muscle relaxants. Each doctor has their own approach depending upon the patient’s situation.
Prevention is a much better way to go and it’s a lifelong commitment. The body is a tool that needs to be well maintained just like any other machine. The spinal column is in the middle of a circle of muscles that include not only the back but also the abdominals. These core muscles need to be strong and flexible to allow the spine to do its job. AS well, excess weight puts a strain on the back, especially if there is a beer belly pulling the top of the body forward and down.
People are less than thrilled about being prescribed weight loss, pilates, yoga and stretching to prevent future back problems. This is where the doctor teaching comes in. It is too easy to write a pain prescription and shoo the patient out the door. Neither party feels particularly fulfilled about the visit. Instead, the doctor needs to take the time to explain why the back hurts, what structures are involved and what tests may or may not be helpful in sorting things out. The patient needs to understand what’s happening and ask questions if the situation seems fuzzy. Treatment options are just that … options. They may include exercise, medications, physical therapy, chiropractic manipulation or a combination of any or all. The purpose is to get the patient back to their normal functional capacity as soon as possible and to prevent future back issues.
Dr. Wedro weighs in
“The difference between doctors who look after mere mortals and those who look after elite athletes may have to do with how many tests they can order, regardless of the cost.”