Navigating Back Pain

Navigating Back Pain

The spine is, arguably, the most important structure in the human body. It is an extension of the brain, a pathway for the neurological signals that keep us beating, breathing and moving. It is the base of our skeleton, where our limbs and movements begin—it is our backbone.

So, it’s no surprise that when something is wrong with our spine or the surrounding muscles and tissues in our back, it affects us in a fundamental way.

That is certainly true for Hilerre Kirsch, a theater teacher at New Trier High School in Winnetka, Ill., who, like almost 31 million other Americans today, woke up with lower back pain.

“I was writhing . . . I was in such extreme pain,” she says. What started last January as a muscle spasm turned into a full-blown medical nightmare over the course of eight weeks, leaving Kirsch bedridden, in tremendous pain and completely miserable.

After waiting weeks for cortisone shots to offer some relief, Kirsch’s primary care physician sent her to the emergency room. When an MRI revealed two herniated discs, she was rushed into surgery. The pain was so severe that Kirsch says she thought, “If this surgery doesn’t work, I don’t want to wake up.”

Kirsch is not alone. “We have an epidemic of back pain in the United States,” says Dr. Mark Hoover, a chiropractor with a private practice in Chicago. As our lifestyles have become more sedentary, we bend and compress our joints and limbs more than we used to, he says. This increase in flexion may be partly to blame for the rise in back pain. “Sitting is actually a recent posture for humankind,” says Hoover.

Besides upper respiratory infections, back pain is the most common reason to visit the doctor’s office and one of the most common reasons for missing work, according to the American Chiropractic Association. In 2009, it was estimated that Americans spend as much as $85.9 billion on trying to relieve lower back pain every year.

There are two categories of back pain—acute (anything lasting between three to four months) and chronic. “Many people make the mistake of assuming the pain will resolve on its own and wait too long to go to the doctor,” says Hoover.

“I was worried about being perceived as a whiner,” Kirsch says, as to why she waited to go to the ER when her treatment wasn’t working.

“Treat your pain early,” Hoover says, regardless of how you think you’ll be perceived. He further advises that if the pain lasts six weeks or longer, you should absolutely be in front of a doctor because the chances that back pain will become chronic greatly increases after three months.

But, with chiropractors, physiatrists, neurosurgeons and acupuncturists, it’s hard to know which doctor and treatment to choose. The answer is: It depends.

“Back pain is so varied. There are a million causes,” says Dr. Joshua M. Rosenow, a neurosurgeon at Northwestern Memorial Hospital. The less serious causes are mechanical. You pull a muscle shoveling snow or have an ache that won’t go away—think slipped discs and strained muscles. These are problems that can usually be fixed with physical therapy and lifestyle changes. Rosenow is also an assistant professor of neurosurgery and director of functional neurosurgery at the Northwestern University Feinberg School of Medicine, department of neurological surgery.

“People typically come to us when their pain has not responded to conservative therapy such as medication, physical therapy and injections,” says Rosenow. “About the only people that we typically skip conservative therapies with are people whose back problem is actually severe enough to cause neurological problems, such as [muscle] weakness, bladder and bowel problems.”

Director of Clinics at the Illinois Back Institute Dr. Jeff Winternheimer says, “There are a lot of options people should try,” before surgery, such as chiropractic work and physical therapy. Acupuncture is also a viable treatment option. The Archives on Internal Medicine recently conducted a study, reporting that, in some cases, acupuncture relieves back pain better than medication and physical therapy.

Winternheimer created Functional Disc Rehydration therapy and recently appeared on the talk show “Windy City Live” to discuss back health. Disc Rehydration therapy is a combination of different physical therapies he used to cure his own back pain years ago. Using traction and harnesses, the unique therapy eases pressure off the spine to rehydrate and correct bulging and slipped discs. A study done by Winternheimer showed the therapy to be overwhelmingly successful.

Kirsch, who had surgery for a different herniated disc before in 2007, says she feels “100 percent better,” since both of her surgeries. She considers the operations to be successful treatments for her back pain. But, often, surgery is a last resort, reserved for more serious cases involving arthritis, neurological disorders, tumors or fractures. Although it’s rare, the only way to tell whether the cause of your back pain is serious is to get an MRI, which is why Winternheimer always orders one for his patients.

Still, if the cause is less serious, don’t entirely rule out surgery. “Surgery, when appropriately applied, can be extremely successful,” says Rosenow. “There are some patients who do great with surgery,” he adds. It really depends on the cause of your pain and your individual body. The only way to tell whether surgery could help is to get a consultation from a neurosurgeon. If you’re not considering surgery, you should still see a back specialist of some sort, advises Rosenow.

And, know that a doctor’s appointment isn’t a quick fix. “We need to make some lifestyle changes,” says Winternheimer. “Most back pain is caused by people performing simple daily tasks the wrong way over and over, like sitting at our desks and getting up from our chairs by bending at our spines, instead of our hips,” he says.

Hoover and Winternheimer agree that educating patients on how to correct these behaviors is essential. Every treatment plan should include self-care at home. Hoover also recommends asking friends for doctor referrals.

Both Hoover and Winternheimer say that most of the time, if patients don’t improve, it’s because they’re not following up on self-care. “It’s like a diet,” says Hoover. “If you want results, you have to change.”

Kirsch’s advice for others: “Make your doctors listen to you, and trust your own body.” And, remember that you have options.

Published in Chicago Health Winter 2012