Cause and Effect
Physiatrists at AAMC get to the bottom of back pain
Every time your foot hits the ground, from the time you’re a toddler all the way through your golden years, the impact is transmitted upward through your body. Helping cushion the impact are the arch in your foot, the shock-absorbing parts of your knee and hip, and the muscles in your back.
The discs between the vertebrae in your spine provide stability for spine motion and also provide shock absorption.
Over time, inactivity and lack of use weaken the impact-absorbing muscles of our back. As that happens, the discs in the spine are forced to absorb more day-to-day impact. Eventually, a disc degenerates or “gives out” (herniation or rupture) under the pressure. When that happens, as it does to 80 percent of us, we have “a low back pain episode.”
Fortunately, said Brian Kahan, D.O., a physiatrist at AAMC, most of the time the episode is temporary and will take care of itself. “Of the 80 percent of the population who will experience back pain, the pain eventually subsides without treatment of any kind,” he said. “People take pain relievers and take it easy for a few days and the pain goes away.” Even in the remaining cases much of the time pain can be treated and alleviated without surgery.
Then there is the 20 percent of the population in which back pain does not resolve on its own. Thomas Sang Wook Lee, M.D., also a physiatrist at AAMC, stresses that not all sources of back pain are progressive, nor does an individual case necessarily fit a pattern. “If pain does not resolve within two to four weeks then it bears further investigation,” he said. “The point is to devise a treatment program tailored to the needs of an individual patient.”
Physiatrists (fiz-ee-A-trists or fi-ZAHY-uh-trists) are doctors who practice in the specialties of physical medicine and rehabilitation. Their training and professional focus is concentrated on the muscle and skeletal systems,tissues and nervous system. Said Dr. Kahan,“We are very closely attuned to the way those systems interact, how to correct them and ‘reeducate’ them when they are damaged by injury or disease.”
Nature’s way of telling you
Dr. Kahan associates the increase in the number and frequency of back pain to weakened back muscles caused by sedentary lifestyles. “People are not as active in the modern era as they were when many people worked with their backs,” he said. “Today more of us work with our hands and brains.We sit at desks or behind the wheel of a vehicle for hours at a time. The massive, intricately structured musculature of our back gradually weakens.”
The result often is progressive damage to a disc and a low back pain episode. Many episodes resolve with no treatment or can be treated without surgery because the body heals itself.When a physiatrist becomes involved in treatment, the process is one of orchestrating, expediting, and enhancing nature’s ability to help the body heal. In other instances, a diagnosis may indicate minimally invasive surgery or one of many available options among spinal injection treatments.
Says Dr. Lee, “In a case where pressure on a nerve causes bladder or bowel incontinence, or the disorder is causing progressive weakness, surgical intervention is mandated at a very early stage. In other instances, we consider spinal injections or surgery when therapy or medication options are not effective.”
A range of good options
Depending on the severity of the pain and whether it persists, a physiatrist may recommend an anti-inflammatory medication, a pain relief medication, and two to three days of bed rest. “We need to modulate pain,” says Dr. Kahan, “but after that, with the exception of serious trauma to the spine, it’s soon time to get up and start moving and exercising, time to start reeducating muscles.”
By “reeducation,” Dr. Kahan means physical therapy. The reeducation and rehabilitation of muscles begins with exercises prescribed by a physiatrist and overseen and administered by a physical therapist.
When therapy and other options don’t work, physiatrists can turn to spine injections or minimally invasive surgery. Said Dr. Lee, “depending on the circumstances we can weigh the benefits of procedures like epidural steroid injections, facet joint injections, sacroiliac joint injections, among others, or a minimally invasive procedure called Percutaneous Disc Decompression.”
Physiatrists at AAMC consult with a network of spine care specialists that includes neurosurgeons, orthopedic surgeons, and interventional radiologists. For back pain sufferers in this region, the physiatrists and other specialists at AAMC offer comprehensive and wide-ranging resources for answers—and for relief.