Pink Prescriptions - April 2019
You Win When You Lose It! The Huge Healthy Effect of Weight Loss
April 2019 Issue
Oh, My Aching Back!
Bend and stretch … reach for the sky … Oops!
Ouch! Ouch! Ouch!
As most of us know, back pain can be a major pain whether it’s a chronic
or temporary condition. This month, Pink’s professional and medical experts tackle
the subject of back pain and its myriad causes and treatments.
Johnna Stevens, M.D.
Beaufort Memorial Hospital
How do I know if my back pain is a symptom of something more serious?
Back pain is one of the most common medical complaints primary care physicians are asked to evaluate. Most of the time, it’s due to a muscle strain or sprain caused by strenuous exercise, heavy lifting, or having poor form when bending over. The pain is usually on either side of the spine, or in the lower back, and improves in time with rest and anti-inflammatory medication.
But back pain also can be caused by a number of medical conditions. Pain that is directly over the spinal cord and accompanied by neurological changes, such as loss of bladder control, weakness in the legs or numbness or tingling in the legs, could be due to a spinal injury and should be treated as an emergency.
Over time, arthritis of the spine can develop, causing stiffness and pain in the back. Arthritis can be managed with anti-inflammatory medications, physical therapy and/or epidural steroid injections.
Flank pain, which occurs below the ribs in your back or sides, can be caused by kidney stones or a kidney infection. The pain is usually accompanied by other symptoms, including burning urinary pain, urinary frequency, blood in the urine or fever.
In rare cases, back pain can be due to something more serious, including:
Inflammation of the pancreas. It often causes abdominal pain that radiates to the back. The patient also would be suffering from vomiting and nausea and have trouble tolerating any food.
Aortic dissection. The pain is felt in the chest and radiates to the back and is accompanied by fluctuating blood pressure and pulse.
Cancer. Along with gnawing back pain, a tumor in the spine may also cause unexplained weight loss and unusual fatigue.
A spinal abscess caused by an infection inside the spine. It is often associated with intravenous drug abuse due to the high risk of blood-borne infection. Patients with this condition are usually very sick and experience other symptoms like fever and muscle tremors.
If you experience back pain that comes out of nowhere and is associated with other symptoms, such as chest pain, nausea, fever or neurological changes, you should seek immediate medical care.
But even if you know it’s a simple strain caused from strenuous exercise or lifting, there’s no need to suffer in silence. Your physician can recommend a number of remedies to alleviate the pain, including physical therapy, muscle relaxants and anti-inflammatory medication.
Dr. Johnna Stevens is a board-certified internal medicine specialist at Beaufort Memorial Bluffton Primary Care. A Georgia native and magna cum laude graduate of Valdosta State University she received her medical degree from Mercer University. Dr. Stevens can be reached at (843) 706-8690.
Mary K. Benedict, PT, DPT
Beaufort Memorial Hospital
Do high heels contribute to back pain?
Do shoe supports make a substantial difference?
Wearing high heels may be a contributing factor to the development or aggravation of low back pain. Think of your feet as the foundation of a house. Over time, the effects from an uneven foundation may start to show as you adapt to positions and postures that are unnatural for your body. A high heel shoe causes your body weight to shift forward; in response, your upper body must lean backward to compensate.
In addition, excessive pressure on the balls of your feet may contribute to hammer toes, bunions, and other foot problems. This position also places extra forward force on your knees, hips, and lower back. The research is mixed, but changes in posture may place additional stress on spinal facet joints, discs, and nerve roots, especially if you already have a back problem going on. Soft tissue changes may also occur, including shortening of the calf muscles.
Some conditions of the spine may actually feel relief with the addition of a small heel lift or wedge, so it is important to see a healthcare provider for specific advice. When selecting shoes, look for wedges, clogs, or shoes with a gradual slope and lower heel (less than two inches is best). Choosing shoes with a wider toe box or adding inserts such as Dr. Scholl’s Stylish Step, moleskin, metatarsal pads or heel pads may relieve foot pain, but have not been shown to have an effect on back pain. (Shoe inserts that provide arch support for sneakers or flats would have a bigger impact on the lower back.)
If you are experiencing pain related to wearing heels, try to limit heel wearing to three hours or less, and bring an extra pair of flat shoes for longer outings. Make certain to vary your shoes often and pay attention to your body when you start to feel soreness or pain.
Mary K. Benedict, PT, DPT, is a Physical Therapist at Beaufort Memorial’s Outpatient Adult Rehabilitation Services at the hospital’s Bluffton Medical Services in Westbury Park.
Dr. Laura Knobel - Laura Knobel, M.D.
What type of exercise and stretching can help back pain?
There are a number of simple exercises that can help strengthen the lower back and prevent injury during sports activities. Here are a few:
Hamstring Stretches: You can do these with your foot on a chair. Bend forward on the hips (do not bend at the waist or with the shoulders as that can hurt the back). When you feel the stretch, hold it for 30-60 seconds, relax and do the other side.
Prone Hip Extensions: Lie on your stomach with your legs extended. Tighten the buttocks and lift one leg in the air. Hold it for 5 seconds, relax and do the other side. Try to get 10 sets on each side.
Piriformis Stretch With Rotation: Lie on your back on the floor. Pull one knee up to the opposite side of your chest and hold for 5-15 seconds. Release and do the other side. Repeat 5-10 times on each side.
Strengthening your core with weights, yoga, Pilates, etc. can help keep the back healthy. Just make sure you check with your physician before starting an exercise program.
How much does a mattress matter?
Mattresses come in many different styles and firmness. For most people, the mattress they choose is a very personal issue, some like soft, some like hard, some want one that will provide cooling or can change position. The firmer the mattress, the better back support. We always tell people if you have back pain, the worst thing you can do is sleep on a couch because it is too soft. If you sleep on a hard surface, like a floor, your back doesn’t have to support you, the floor is doing it, so your back can actually rest. Think in these terms as you consider the right mattress for you. There are so many options you should be able to find one that best fits your back.
Dr. Laura Knobel is a board certified Family Physician seeing patients of all ages in Plantation Park in Bluffton. She has a direct primary care practice where you can get your primary care for $50 a month or less. Office phone: 843-836-2200. Website: knobelmd.com
Dr. Rachel Clark - PULSEology
How can acupuncture make a difference in treating back pain?
As a chiropractor, spinal pain is the most common condition seen in my office. However, there is no one-size-fits-all treatment and co-managing patients with a licensed acupuncturist often leads to the most profound results and efficient recovery.
Acupuncture has been at the forefront of Chinese Medicine for over 4,000 years, while the Western world has slowly discovered its benefits. Acupuncture is based on the idea of energetics in the body. Treatment consists of inserting very small needles at various points on the body, specific to the condition treated. Usually these needles are not felt and are not meant to cause pain or discomfort during treatment. On the contrary, treatment with acupuncture needles creates a calming, pain relieving effect.
Back pain and injury are very common among weekend warriors—those who tackle large home projects, such as landscaping or painting, or those whose who participate in recreational activities, such as golfing or tennis on the weekends. Muscle strains in the lower back are common injuries, which can lead to pain, muscle spasms, and decreased mobility. Muscle strains occur when the muscle fibers are over-stretched and over-worked, even torn. Inflammatory chemicals produced at the site of injury are needed for healing, but promote higher levels of pain, especially with movement.
Acupuncture is an excellent option for relieving pain caused by muscle strains, osteoarthritis, or those suffering from chronic pain syndrome. Scientifically, the needling of acupuncture points is believed to stimulate the nervous system to release chemicals called endorphins, in addition to other neurochemicals, that leads to physical and emotional well-being. Additionally, the stimulation of local blood flow by the acupuncture needles aids in the healing process.
Although needling is the most common treatment acupuncturists provide, there are other treatments available that may be suggested by your acupuncturist, including cupping therapy, moxibustion, Tui Na Massage, Gua Sha (“scraping”), or the use of Chinese herbs.
Rachel Clark is a Board Certified Doctor of Chiropractic, Certified Strength and Conditioning Specialist, Certified Primary Spine Practitioner, and Clinical Director of PULSEology.
David Burke, RPh
Burke's Main Street Pharmacy
How can over-the-counter (OTC) products help with back pain?
Back pain is the second most common neurological condition within the United States, and typically occurs in the lower back region. Common causes include nerve pain or muscle spasms, which can occur from poor posture or sleeping habits. These injuries can produce small tears in the tissue, leading to pain and inflammation. Back pain is more common as you age because the cushion between the bones begins to wear and tear. Treatments include medications such as anti-inflammatories, acetaminophen, and topicals, CBD oil and creams, and medical devices such as braces, TENS units and orthotics.
Anti-inflammatories commonly used are ibuprofen, naproxen, and aspirin. They help with both inflammation and pain. However, these medications have a higher risk with stomach and heart problems than other products, such as acetaminophen. Acetaminophen helps with pain only and is not an anti-inflammatory. Topical OTC products include creams, ointments, and patches that typically include lidocaine for a numbing effect, menthol for a cooling sensation, and other products that create a feeling of heat. The heat from these products can help accelerate healing by causing blood vessels to dilate, increasing blood flow, oxygen and nutrients to the tissues. CBD is an alternate therapy for pain. This compound decreases pain and helps decrease inflammation in the body. CBD can be given as capsules, cream, and oil.
Back braces and wraps are also used to support back and stomach muscles. Braces are best used for chronic pain that lasts longer than three months, but they have the potential to weaken stomach and back muscles over time. TENS units supply the body with an electrical pulse to help with nerve stimulation. Orthotics such as footpads, heel and shoe inserts, and ankle braces can help correct any imbalance with your posture that worsens your back. Braces and orthotics should be custom fit to each individual.
David Burke, RPh is a registered pharmacist and partner of Burke’s Main Street Pharmacy. He is the Chairman of the HH Hospital Board of Governors and a member of the Cardinal Health National Advisory Board. Burke’s Main Street Pharmacy prides itself on being large enough to serve you and small enough to know you. Located at 1101 Main Street, Hilton Head Island; 843-681-2622.
Sarah Hankey, CHC
NuBODIA Wellness & Weight Loss
Is there a direct correlation between weight and back pain?
Individuals can experience back pain for a variety of reasons. One of the most common causes can be excess body weight, which would naturally cause the pelvis to tip forward and put more pressure on the sciatic nerve. I hear complaints about sciatic back pain most frequently in overweight clients.
However, there is a more important underlying concern associated with back pain: Inflammation! Excessive body fat challenges the body on dangerous levels. The back pain is a red flag your body is shouting, “Hey, something is going on here I don’t like; I’m going to irritate you until you take care of it!” Chronic inflammation that is continuously ignored and only treated for symptoms can lead to a variety of serious complications and disease.
Losing weight will not only alleviate back pain as a symptom, but also permit your body to heal on a deeper level. That’s the beauty about losing weight in a healthy manner; with time, your body will thrive and everything will start functioning and feeling better.
Each body is unique and requires special attention to understand its needs. If you’re interested in alleviating your pain, get the support you need to achieve your goals and get BACK to life!
Sarah Hankey, CHC, is an Integrative Nutrition Health Coach and a partner at NuBODIA Wellness & Weight Loss. She is passionate about helping her clients to discover the foods that nourish their bodies and minds. Sarah provides guidance, support, and accountability with a compassionate and caring heart. 14 Westbury Pkwy #103, Bluffton. (843) 816-3733. www.nubodia.com
Dr. K. Craig Boatright
& Dr. Jeffery Reuben
Hilton Head Regional Healthcare
What’s the difference between back pain and sciatica?
Running from your spinal cord to your buttock and hip area and down the back of your leg, the sciatic nerve is the longest nerve in your body. It controls muscles behind your knee and in your lower leg and provides feeling to the back of your thigh, part of your lower leg, and the sole of your foot.
It only stands to reason if the sciatic nerve is compressed or pressured —a condition called sciatica—the result is frequently pain, weakness, numbness or tingling down your leg. Depending upon the cause of sciatica, it frequently goes away on its own in four to eight weeks.
Some self-care measures to try include a few days of bed rest, nonsteroidal anti-inflammatory drugs (such as aspirin or ibuprofen), heat or cold on painful muscles, and stretching. If those measures don’t work, or if your pain lasts more than four weeks, call your doctor.
In addition to a physical exam, your doctor is likely to use tests to rule out causes of your discomfort. Those include a spinal X-ray, MRI or CT scanning.
Most of us experience wear and tear of the spine as we age, however sciatica is most likely to occur between age 30 and 50. Other risk factors include jobs that require twisting or carrying heavy loads, living an inactive lifestyle, sitting for long periods of time, or having diabetes, which can damage nerves.
Steps you can take to help prevent sciatica include exercising to strengthen your abdominal and lower back muscles, maintaining good posture when sitting, taking frequent breaks to walk around, and using good body mechanics when lifting heavy objects.
What are the newest treatments for back pain?
If you are experiencing chronic back pain that is unresponsive to non-surgical treatment, you may be a candidate for minimally invasive spine surgery in conjunction with ExcelsiusGPS.
ExcelsiusGPS is designed to improve accuracy and optimize patient care by using robotics and navigation, much like a GPS in your car. On the day of surgery, medical images are taken and imported into ExcelsiusGPS. The surgeon uses these images to determine the size and placement of implants and creates a patient plan based on the patient’s anatomy. The plan is used to guide the rigid robotic arm to a specific region of the spine, similar to a planned route on a GPS. The surgeon uses this route to accurately place the implants using instruments. Throughout the procedure, the surgical instruments and implants are continuously displayed on the screen for the surgeon and staff to monitor. This display allows the surgeon to view live feedback during the procedure for more precise placement.
For more information, hiltonheadregional.com or excelsius-GPS.com
The Spine Center at Hilton Head Regional Healthcare is led by a pair of accomplished spine surgeons, Dr. K. Craig Boatright and Dr. Jeffery Reuben, and together they offer leading treatments for a wide range of back, neck and spine conditions. To learn more about the Spine Center at Hilton Head Regional Healthcare, call 800-984-9810