An interview with
Robert S. Djergaian, MD, Physiciatrist
PeaceHealth Southwest Physical Medicine & Rehabilitation
The next time you're in a crowd, take a look at the adults around you. One in three probably has a sore back.
Maybe you're one of them. Back pain is one of the most common afflictions in our society, according to the American Academy of Physical Medicine and Rehabilitation (AAPMR). For many people, persistent back pain can lead to chronic disability. But most back aches improve in a few weeks.
What are the causes?
It's not hard to pin down the causes for most acute back pain. Sometimes it results from a minor movement, such as leaning over a sink or bending over to pick up something off the floor. Muscle strain from activities such as yard work or heavy lifting—especially if you aren't used to them—are other major causes of back pain. Muscle injury can also occur following a motor vehicle accident.
PeaceHealth Southwest's Brain and Spine Center of Excellence has created a new program to address comprehensive management of spine pain. Various medical and surgical specialists and other staff have combined their expertise to provide integrated, complete care.
What can I do in advance of seeing a doctor?
You can get some relief simply by stopping whatever activity aggravated your back. But keep your muscles flexible; don't stop moving altogether. One or two days of bed rest is the limit.
Here are some recommended treatments that you can do yourself:
- Heat and cold: Ice reduces swelling, so use it right after the injury and then several times a day. After a few days, brief periods of heat from a hot shower or a heating pad can improve circulation. (Never use a heating pad in bed.)
- Over-the-counter medications: Pain relievers and anti-inflammatory, non-steroidal medications may help.
- Strength and flexibility exercises: Your doctor or physical therapist can show you exercises for your back, stomach and other muscles that help support your spine.
- Aerobic fitness: Swimming, walking and other aerobic exercise can help prevent further injury by keeping you fit.
When should I get more help?
If your back pain lasts longer than a week with home treatment, or if you also have numbness or tingling that radiates down your leg, you should call your doctor. Also, you should see a doctor immediately if you have numbness or tingling after a fall or other trauma-this could indicate a spinal fracture. Similar symptoms can be caused by a herniated disc.
The vast majority of patients with chronic back pain are most appropriately treated nonsurgically. Doctors who specialize in this area will often prescribe exercise to strengthen muscles that support the spine and other exercises to promote weight loss and physical fitness. Often medications and sometimes spinal injections are part of the treatment plan.
Even with some fractures, nonsurgical treatment may still be the best choice. Your doctor may suggest some rest, stronger pain medicine or physical therapy. Southwest offers kyphoplasty, a relatively new minimally invasive procedure, which can repair spinal fractures caused by osteoporosis.
What are my surgical options?
If other treatments don't work for you, however, one of these surgeries at PeaceHealth Southwest may be an option:
- Laminectomy removes a small part of a vertebra to provide access to a damaged spinal disc (the cushioning pad between vertebrae). It may also be done in older people for a condition called spinal stenosis.
- Diskectomy removes part of a damaged spinal disc that may be pressing on the spinal cord. Several newer methods, such as microdiskectomy, use smaller incisions than traditional surgery.
- Spinal fusion joins two or more vertebrae with bone grafts for stability. It's the most common back surgery for people with severe bone or disc problems.
- A new artificial disc also is available for certain back problems.
Deciding whether spine surgery is the best treatment option can be a challenging decision. Talk to your doctor about the best solution for you.
Dr. Djergaian is medical director for PeaceHealth Southwest's Department of Physical Medicine and Rehabilitation. His office is located in the Physicians' Pavilion. For an appointment, call (360) 514-3142.
You can locate a doctor to help you with back and neck pain on our Find a Doctor area.
Published September 2007.