Episode 1 - Top 10 Back Pain Myths
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Episode Summary
Carolina Neurosurgery & Spine Associates welcome you to Back Talk Doc, a podcast dedicated to empowering you to take control of your back pain and enhance your quality of life. On this inaugural episode, we introduce our host, Dr. Sanjiv Lakhia, a board certified physiatrist and specialist in physical medicine and rehabilitation at Carolina Neurosurgery & Spine Associates.
Dr. Lakhia is passionate about educating patients on how to care for their back by combining the best of holistic and conventional medicine approaches. He is the author of the patient education booklet, Back Talk, that addresses common questions you may encounter when searching for back and spine care options.
On this episode, Dr. Lakhia provides a straightforward approach to treating and preventing back and spine issues. Additionally, he addresses health and wellness issues, navigating the healthcare system, and safe and effective treatment options for back problems.
Future episodes of Back Talk Doc will feature interviews with prominent neurosurgeons, physiatrist, physical therapists, nutritionists, and other experts in the field of spine care and wellness.
Top 10 Back Pain Myths
Every episode of Back Talk Doc includes a Health Matters segment intended to provide actionable health information you can put into practice in your life immediately. This week Dr. Lakhia discusses the importance of sleep. He details the overall benefits of sleep and the strong correlation in medical research between sleep and pain. 11:50
Links Mentioned In The Episode
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Carolina Neurosurgery & Spine Associates welcome you to Back Talk Doc, a podcast dedicated to empowering you to take control of your back pain and enhance your quality of life. On this inaugural episode, we introduce our host, Dr. Sanjiv Lakhia, a board certified physiatrist and specialist in physical medicine and rehabilitation at Carolina Neurosurgery & Spine Associates.
Dr. Lakhia is passionate about educating patients on how to care for their back by combining the best of holistic and conventional medicine approaches. He is the author of the patient education booklet, Back Talk, that addresses common questions you may encounter when searching for back and spine care options.
On this episode, Dr. Lakhia provides a straightforward approach to treating and preventing back and spine issues. Additionally, he addresses health and wellness issues, navigating the healthcare system, and safe and effective treatment options for back problems.
Future episodes of Back Talk Doc will feature interviews with prominent neurosurgeons, physiatrist, physical therapists, nutritionists, and other experts in the field of spine care and wellness.
Top 10 Back Pain Myths
- Myth #1: Most patients with low back pain need surgery. - 3:09
- Myth #2: All herniated lumbar discs need surgery. - 4:31
- Myth #3: Sit-ups are good for your low back. - 6:20
- Myth #4: All back injuries need x-rays and MRI studies. - 7:46
- Myth #5: Only overweight individuals have low back pain. - 9:04
- Myth #6: If you hurt your back, bed rest is critical. - 11:05
- Myth #7: Over-the-counter drugs are totally safe for treating back pain. - 16:59
- Myth #8: Muscle relaxers, relax muscles. - 19:19
- Myth #9: Exercise causes back injuries. - 20:54
- Myth #10: Back braces help low back pain. - 22:22
Every episode of Back Talk Doc includes a Health Matters segment intended to provide actionable health information you can put into practice in your life immediately. This week Dr. Lakhia discusses the importance of sleep. He details the overall benefits of sleep and the strong correlation in medical research between sleep and pain. 11:50
Links Mentioned In The Episode
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Intro: 00:01 Welcome. You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health. Brought to you by Carolina Neurosurgery and Spine Associates. Where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years.
Intro: 00:22 And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 00:35 Greetings listeners. Welcome to the inaugural edition of Back Talk Doc, a podcast dedicated towards empowering you, the listener, to take control of your back pain and enhance your quality of life. My name is Dr. Sanjiv Lakhia, and I am a board certified physiatrist, a specialist in physical medicine and rehabilitation. I'm a physician and working with Carolina Neurosurgery and Spine Associates with offices throughout North Carolina and South Carolina. I've been in practice since 2006 and I'm very passionate about educating patients on how to take care of their back by combining the best of holistic and conventional medicine approaches. Throughout my career, it has become very evident to me that many people lack a simple or basic understanding about how to best take care of their back or their spine issues. Additionally, navigating the healthcare environment and determining which treatment options are the safest and most effective can be very challenging for most.
Sanjiv Lakhia: 01:36 That is why in 2018, in collaboration with my team at Carolina Neurosurgery and Spine Associates, I authored the patient education booklet, Back Talk, where I've gone over many of the common questions that you may encounter when trying to determine the best options for taking care of your spine condition, and low back pain in particular. So the response to this in my local community has been so overwhelmingly favorable and it opened my eyes to the fact that people such as yourself are thirsting for more knowledge on how to promote self care with regards to pain. Unfortunately though, the research shows that most patients retain only about 20% of what their doctor will tell them. So it's these factors that have compelled me to do more and led to the birth of our new podcast Back Talk Doc, where I hope to fill your mind with information that is simple to grasp and hopefully transformative in nature.
Sanjiv Lakhia: 02:31 So I'll accomplish this with a format that includes interviews with prominent neurosurgeons, physiatrist, physical therapists, nutritionists, and other experts in the field of spine care and wellness. Additionally, there may be episodes where I can apply my own expertise to break down complex topics in simplistic terms and provide you with more tools to promote self care, which I am a big fan of.
Sanjiv Lakhia: 02:56 Without further delay, I like to dive into today's topic. We're going to review the top 10 myths, or misconceptions, regarding low back pain, the causes, and the treatments. All right, so strap in your seatbelt and let's go.
Sanjiv Lakhia: 03:09 The first myth regarding low back pain that I encounter, and I'm going to review these in no particular order, but let's start with the fact that a lot of people believe most patients with low back pain need surgery and this simply isn't true. Now, it's important to understand that when you discuss low back pain, there are numerous causes for low back pain. But in general, most back pain is simply mechanical or muscular in nature. So most back strains or muscle pulls, muscle strains, resolve within two to six weeks with active rehabilitation. 75% of patients that come to our clinic can typically have their low back pain episodes resolved without surgery.
Sanjiv Lakhia: 03:53 Surgical indications typically focus more on pain that is radiating or traveling down your leg than just pure back pain. Now of course, there are special circumstances that require much more detailed attention, such as back pain associated with infection, fractures, or cancer. But in general, most of the bread and butter back pain that you and I encounter day to day can be handled without any surgical intervention. Active rehabilitation, exercise, physical therapy, that's really key and something we'll dive into deeper on future episodes.
Sanjiv Lakhia: 04:31 So moving on, number two. The second myth that I encounter quite a bit, or misconception that is, is that all herniated lumbar discs needs surgery. So for those of you who don't know lumbar discs, these are the cushions between the bones in our spine. They're the shock absorbers of our spine. And they, over time can become weakened, and in many cases the inner contents of the disc ... a lot of times if you speak with surgeons or other spine physicians, we may describe it as a gel in the disc. I've even heard it described as a rubbery substance. But anyway, just like gel can come out of a donut, you can have some of the gel within the disc leak out, and a lot of times that can cause quite a bit of pain. But the reality is, most of the time if you herniate a lumbar disc, you don't necessarily need to have surgery.
Sanjiv Lakhia: 05:26 A lot of times the herniated lumbar disc itself can heal without surgical intervention and the body can heal it over time. Similar to how a fresh grape can shrivel up and become a raisin. These discs are mostly made a fluid and can dehydrate some over the course of our life and become less painful. The other consideration is that if you take a hundred individuals off the street, let's say in an age range between mid 30s to 60s, and you randomly MRI their back at least a third if not more of those individuals will have herniated lumbar discs on their MRI findings but may not have any pain.
Sanjiv Lakhia: 06:02 So once again, there are very specific indication for surgery, which I'll be covering with prominent neurosurgeons in coming episodes. But keep in mind that if you do have a herniated disc, you're suffering from a herniated disc, there are numerous nonsurgical interventions and treatments that should be tried and can be offered before you look at surgery.
Sanjiv Lakhia: 06:20 Moving on to item number three. The third myth that I hear quite often and I see quite often at the gym is that sit ups are good for your low back. This is old school thinking and has been largely debunked. Dr. Stuart McGill is a prominent professor in Canada and he's an expert in spine biomechanics. And he's documented that sit-ups can put hundreds of pounds of compressive pressure on your spine and lumbar disc. It promotes abnormal muscle patterns. For example, your psoas muscles, which are essentially strap muscles along your spine that anchor into the front of your hip joints, can become extremely tight when you do a lot of crunches or sit ups and this can promote abnormal posture.
Sanjiv Lakhia: 07:06 Additionally, sit-ups are a form of spine flexion. In other words, it mimics bending over repetitively. And there is a fair amount of danger with this, particularly if you have a bulged disc or herniated disc, repetitive flexion can squeeze the disc and cause further injury. So there are many good alternatives and in an upcoming episode I'm going to have a great physical therapist on for an interview and we're going to discuss alternatives to sit-ups and other ways to strengthen your core, strengthen your back, and do it safely. The plank exercise, as many of you may know of, is a really good alternative to start with, but there's certainly more to that that we'll get into in future episodes.
Sanjiv Lakhia: 07:46 Number four. Number four is that all back injuries need x-rays and MRI studies. If you're out there and you've hurt your back and you have an appointment coming up with a spine physician, I'm pretty sure you're expecting to receive some sort of diagnostic picture like an x-ray or an MRI, and you may not get that at the doctor's office and I'm here to tell you, don't be totally disappointed.
Sanjiv Lakhia: 08:09 There are very specific indications for x-rays and MRI studies. The literature is very clear that it is not necessary to x-ray everyone who comes into the office with low back pain. Now, if you have a mechanism of injury that's concerning, for example, a fall, and your concerned for a spinal fracture or a broken bone, certainly x-rays are indicated. But in general, if you go to the ER or an urgent care and you complain of straining your back lifting something, many times you'll leave there just with medication without x-rays. Other indications for MRI studies are quite specific as well. And if you don't meet those, then it has been shown to really be unnecessary and sometimes can present confusing information. So again, keep in mind that x-rays and MRIs play a valuable role in the evaluation of your back injury, but not all back injuries need x-rays nor MRI imaging, at least an initial phase of care.
Sanjiv Lakhia: 09:04 That brings us to number five. The fifth myth that I encounter routinely or that I hear, is that only overweight individuals have low back pain. Or another way to put that is that only overweight individuals are at risk for back injuries. So I'll tell you right up front that is very common to see low back pain develop in individuals across all body types. The body mass index is a tool that we use, a calculation that we've come up with to evaluate your weight as it compares to your height. And I will see individuals on an average day, if I see 30 patients, at least half of them will come in with a low BMI and the other half with a higher BMI. So there's not a direct correlation between weight and back pain. Now there is some scientific literature that suggests for every pound you are overweight, it adds another one to two pounds of excessive pressure on your lumbar disc.
Sanjiv Lakhia: 09:59 So what I like to tell people is that, I don't blame your back injury on your weight situation. I don't think excessive weight is a cause of back pain, but I will say that it's always part of the solution. So for example, if you feel like right now you're not in an ideal weight range for your health and you suffer from a degree of chronic low back pain, then you will certainly benefit from taking steps towards achieving an ideal body weight. And there are a couple of reasons for that.
Sanjiv Lakhia: 10:27 The first thing we just mentioned, which is pure physics, right? It's pressure on the disc from body weight. But the other one that I think people don't think about and that you should consider is that if you are overweight or if you have a degree of obesity, it is well documented that this triggers increased inflammation throughout your body. So inflammation is a causative link between most of the health conditions in this country today from pain, cancer, mood disorder, heart disease. And if your body is on fire, that's only going to turn the dial up on your daily pain levels. So taking steps towards reducing that can be quite helpful.
Sanjiv Lakhia: 11:05 That brings us to number six. The sixth myth or misconception that is very common with regards to low back pain is that if you hurt your back, bed rest is critical. Now we're going to get into this in more detail after this break.
Sanjiv Lakhia: 11:25 As an osteopathic physician, I've always had a strong interest in promoting health and wellness. Each episode will feature a health matter segment. Or we'll break up the episode and provide you with tips and information on popular topics in the wellness field that you can use for yourself. And this week I'd like to briefly discuss the importance of sleep.
Sanjiv Lakhia: 11:50 To me, sleep is the important lever we have to affect our health. The benefits of sleep are so widespread and I view it as more important than the benefits of changing your nutrition or of exercise. The research is very clear that obtaining good sleep is critical to promoting a healthy immune system, mood, it helps with your daily energy, and your overall athletic and job performance. So there are broad effects of positive sleep on your health. In particular, when you're talking about dealing with low back pain or pain of any type, there's a strong correlation in the medical research between sleep and pain.
Sanjiv Lakhia: 12:32 Why is that? Well, it turns out that the same brain chemicals that play a major role in pain also are critical in your sleep. Chemicals like dopamine and serotonin. These are chemical messengers that help regulate our sleep wake cycle, but also it can be out of whack, so to speak, when you're suffering from chronic or acute pain. So I don't want to get into all the science today regarding sleep. There's plenty of good resources out there. In fact, probably one of my favorite resources, there's a book called, Why We Sleep by Matthew Walker and we can put a link to that in the show notes. So if you really want to understand the science behind it, I recommend reading his information.
Sanjiv Lakhia: 13:16 But today I'd like to provide you with just some simple tips for better sleep and these are tips that I mentioned in my book Back Talk that you can pick up at backtalkdoc.com. But I'm going to go over and share with you just a few of them at this moment.
Sanjiv Lakhia: 13:31 Number one, I think it's critical that you avoid caffeine after two o'clock. Caffeine, as you know, is a stimulant and it's found in many beverages and foods. For example, certainly colas, teas, coffees are the well known ones, chocolate as well. So read the label of everything you eat and drink. But the half-life of caffeine is about six to eight hours. So if you can stop your caffeine intake around 2:00 PM let's say you go to bed around 10:00 PM, then it's not going to be disruptive to your sleep-wake rhythm and cycle.
Sanjiv Lakhia: 14:04 I also think it's important to really prepare for sleep at nighttime. So that means try and have an hour period before bedtime where you're kind of winding down. And this is where you're turning off computers, electronics. And setting up a routine. Perhaps taking a warm bath at night or reading a fiction book or novel that's not too taxing on your brain.
Sanjiv Lakhia: 14:27 You want to avoid really eating large meals at least three hours before you go to sleep. There's actually good research that if you eat late at night or right before bed, you have an increased risk of developing Alzheimer's disease. So really finish up the meal at dinner and try to avoid late night snacking if you can.
Sanjiv Lakhia: 14:43 The other one to consider is that in your sleep environment, typically we sleep better in a cooler environment, so I try to keep my thermostat set between 68 and 70, and that allows for a more restful sleep pattern.
Sanjiv Lakhia: 14:58 Lastly, I think if you're someone who really has to work right before bed, you're on your iPad or iPhone, consider the effects of blue light. It's quite detrimental on our melatonin levels in our brain. Melatonin is one of the master hormones that signals to your body that it's time to go to bed and to sleep. So if you have to use electronics, consider purchasing some blue blocking glasses. I myself have a clip on pair that I use during bedtime. Yes, my wife and kids make fun of me for it, but it definitely has an effect on helping me to fall asleep in a more deeper manner. So I hope you find these sleep tips useful, try and implement those in your daily routine and hopefully obtain better, more restorative sleep.
Sanjiv Lakhia: 15:40 All right, let's return to our top 10 list of myths, or misconceptions, regarding low back pain. And we were on number six, which is bed rest is critical with acute back injuries. Again, this is old school thinking. Years and years ago, if you strained your back, you were put on a bed rest protocol for about six weeks. And now we know through modern day research, this is actually quite detrimental. The current recommendation is relative rest with light activity. So certainly you want to use common sense here. If you pulled your back mowing the grass or lifting a box, and you're in excruciating pain, then a degree of rest with ice is important. But within 24 to 48 hours you should get back into some light activity. I always like to recommend low impact aerobic exercise. So what are examples of those? I would say walking, even the elliptical machine, or even possibly a stationary bike. Keeping your body loose will keep the muscles warm and really promotes better function and a quicker return to full activities. So once again, bed rest is not the recommendation at this point for acute back injuries.
Sanjiv Lakhia: 16:59 That brings us to number seven on our list. And the seventh item I want to discuss today is the misconception that over-the-counter drugs are totally safe for treating back pain. We frequently will use drugs like ibuprofen and Tylenol to help manage our inflammation and pain. And these can easily be purchased at the local pharmacy or grocery store and oftentimes they are quite effective. But there are some risks that I think you should know about because I'm sure you have this in your medicine cabinet or pantry. I think you should break it down into two different categories. One is the anti-inflammatory medications. These are your typical ibuprofens, Aleves, Motrins and these help reduce inflammation in your body. But be aware they can cause irritation of your stomach, a condition called gastritis. And prolonged use is hard and stressful on kidney, your heart, and even possibly your liver.
Sanjiv Lakhia: 17:54 So you want to take them judiciously. You definitely want to take them with food. If you have any history of stomach ulcers, you probably want to avoid them. And if you also were on any blood thinners, let's say for a heart condition, you have to be very careful mixing nonsteroidal antiinflammatory medications with your blood thinners as it can promote bleeding. So definitely exercise some caution and talk with your doctor if you have any concerns.
Sanjiv Lakhia: 18:18 The other drug that's commonly used for pain that's over the counter is Tylenol or acetaminophen. Now Tylenol, the actual mechanism of action for Tylenol is not really known, but it doesn't specifically reduce inflammation. It's not a narcotic, but it is generally thought to be safe to help manage your pain. I think the one caveat is that, if you take too much Tylenol it can be stressful and even damaging to your liver. So if you have any preexisting liver issues, you probably want to avoid this and you want to keep the Tylenol under certain limits and doses.
Sanjiv Lakhia: 18:50 So if you're taking Tylenol to help manage your pain, how is speak with your physician about how much is too much so they can educate you and keep you safe. So keep in mind that over the counter drugs, while accessible and oftentimes are a good first line to help treat your pain, they are not without potential complications. And there have been many a person who has been admitted to the hospital with bleeding ulcers and other complications from the nonsteroidal anti-inflammatories. So definitely be aware.
Sanjiv Lakhia: 19:19 Staying on the topic of medications, the eighth item in my list of top 10 myths for low back pain is that muscle relaxers, relax muscles. I cover this topic briefly in my book Back Talk. But the answer to that is that the muscle relaxers in general, don't typically actually work on your muscles.
Sanjiv Lakhia: 19:39 So let's say you are outside playing basketball or doing something strenuous and you feel like you pulled your muscle. Many times if you go to the local urgent care or call your doc, they'll call in a muscle relaxer for you and it can make you feel better, but you should understand that muscle relaxers in general, they work on the nervous system and the brain in particular and we don't really know exactly how they work. Common drugs like Flexeril, Robaxin, their mechanism of action hasn't been clearly detailed. But I like to think of it as, if you're going to take a muscle relaxer, it's almost equivalent to having a stiff alcoholic beverage. Indirectly, it will relax your central nervous system, which then can relax your local muscle strain. But with that comes side effects, brain side effects in particular. So you can experience drowsiness, confusion, and then there's also side effects like dry mouth and constipation, which are rather unpleasant.
Sanjiv Lakhia: 20:32 There are also drug interactions with muscle relaxers, so you should discuss with your physician how to take these safely. And just keep in mind in general, if you're going to be on muscle relaxers for your back pain, try and limit when you take them to the evening. Certainly don't mix them with alcohol and be very careful if you're going to drive because the muscle relaxers don't only work on muscles.
Sanjiv Lakhia: 20:54 Number nine on our list today is that exercise causes back injuries. I hear this quite often that, "I'm just going to stay inside. I don't want to exercise because it creates more pain and causes more problems." I think in certain circumstances avoiding exercise is prudent. Particularly if you have an acute injury, it makes sense that you can't go out and play sports, you can't go for a run, until you've recovered. But the medical literature is very clear that individuals who live active lifestyles have less injury and less pain.
Sanjiv Lakhia: 21:25 So examples of this could be having a sustained daily walking program, riding a bike, and even using resistance training. I think the benefits far outweigh the risk of injury. Now, you do have to consider proper posture and safe technique with exercise, and that's where working with a knowledgeable physical therapist or athletic trainer can come into play. I see routinely individuals that injure their back doing activities such as CrossFit or weightlifting with inappropriate technique. So I think you have to understand where you are on the spectrum of your health and get into things slowly. And if you use the rule of thumb, that low impact over high impact, and lower weight, higher repetition weight training as good starting points, that'll keep you out of trouble. But obviously I'm a big fan of exercise and I recommend it as a way to stay in shape and prevent injury.
Sanjiv Lakhia: 22:22 All right guys, we're nearing the end today. We're at number 10 on our list of top 10 myths regarding low back pain. And this is a question I get almost every week in the office from my patients and I'd love to address it now, and that is that back braces help low back pain. This is largely untrue. There are certain specific situations where bracing your low back can help with the pain and in our practice we tend to limit this predominantly to spinal fractures. So you can have an acute fracture, for example, if you fall off a ladder or develop a compression fracture. Getting a brace to stabilize a fracture can tremendously alleviate your pain. Other examples where a brace is useful would be, let's say in a young athletes. Particularly an individual who participates in a sport that extends the spine where you lean back repetitively, you can suffer what's called a pars fracture, which is a small bony fracture in the lower part of the back. And in an acute setting where you have acute pain, bracing can provide relief.
Sanjiv Lakhia: 23:25 Outside of that, the indications are few and far between. So in spite of what you see on TV or who's promoting the newest brace or the ad that you get in the mail, using a back brace isn't really going to help your pain. And the reason is that those who wear a back brace routinely, actually promote weakness in their core muscles. So you will get further deconditioned and it can intensify your back pain over time. That's why we're big promoters at our group of physical therapy and exercise. If you need to stabilize your spine it's always better to do it with core muscle strength than it is to do it with external means like bracing.
Sanjiv Lakhia: 24:02 Okay. That concludes our review of the top 10 myths regarding low back pain. I hope you enjoyed that. Thank you for listening today. I know you have lots of options out there in the podcast universe and I really appreciate you taking the time to hear about the information I wanted to provide today.
Sanjiv Lakhia: 24:23 So if you'd like to learn more, please check out our website at backtalkdoc.com. Keep in mind you can also order a copy of my patient education booklet, Back Talk and this can be ordered on that website. And I would really love it, if you know a friend or a family member who also suffer from low back pain, please feel free to share this episode with them.
Sanjiv Lakhia: 24:44 I look forward to bringing you up-to-date and useful information regarding the care of your low back in future episodes. I'm really excited about our upcoming episodes where we'll be covering some exciting topics, including the power of the glutes in strengthening your spine and protecting your back. I also have upcoming, a discussion on lumbar spinal stenosis with one of our neurosurgeons. That's going to be very informative for you. I know there's many of you out there who suffer from this condition, which can be quite debilitating. And then we hope to cover in future episodes, topics such as minimally invasive spine surgery and regenerative spinal medicine techniques. So until then, remember that the best medications that we have in life are sunshine, fresh air, clean water, deep sleep, and laughter. And that the best form of health care is self care. So be kind to yourself and others. And thanks again for listening.
Outro: 25:40 Thank you for listening to this episode of Back Talk Doc brought to you by Carolina Neurosurgery and Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com.
Outro: 25:58 We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.