Robert Moore was in bad shape. An executive for a financial-services company, he spent long hours sitting, either at his desk or traveling from Washington to New York. He seldom exercised—he was in his fifties and 10 to 15 pounds overweight. Like many Washingtonians, he was too busy to address the nagging pain in his back.
“It got to the point where I was lying on the floor of my house unable to move because I had a sudden episode,” Moore recalls. His back had given out in the worst way: A disk had exploded near the end of his spinal cord, temporarily paralyzing him from the waist down. All this time, he had been ignoring a herniated disk.
It took a seven-hour surgery at George Washington University Hospital and more than two months of rehabilitation for Moore to learn to sit up and walk again. While he has since made significant changes to his life, he still suffers the occasional flare-up. “Once you have an injury that catastrophic, you tend to always have back-pain issues,” he says.
Although Moore’s nerve-damaging injury is rare, back pain is not. About 80 percent of Americans suffer from acute or chronic back pain, according to the National Institutes of Health. It’s the second-most common reason for lost work time after the common cold.
Pain specialist Dr. Mehul J. Desai says that in the Washington area two types of people are most likely to have back problems: workers who sit at a desk all day and “weekend warriors” who don’t exercise regularly but play hard on weekends. More often than not, his patients fall into both categories.
“We have people who are hyper-scheduled at work and the gym to the nth degree,” says Desai, director of pain medicine and nonoperative spine services at the GW Pain Center. “Whether they’re working or playing, it’s hard.”
Back pain often is treated improperly or, worse, goes untreated. Fortunately, traditional back surgery isn’t the only option. A healthy back is possible with both medical and holistic therapies—plus making changes to your daily habits.
Exercise and Stretching
Contrary to popular belief, inactivity after a back injury does a patient no favors, says Dr. John Dombrowski of Washington Pain Center: “Years ago when someone had a back injury, he was told to rest. We’re finding out that it’s the worst thing to do.”
Rest is important initially, but entering a physical-therapy program soon after an injury is vital to recovery. Without PT, Dombrowski says, you’re likely to experience “a longer climb back to where your body was normally.” A physical therapist can design a safe stretching-and-exercise regimen catered toward each patient’s fitness level and injury.
Moore, now in his seventies, attends physical therapy twice a month in McLean. He says he’s “religious” about walking 30 to 45 minutes every day and wears a pedometer to make sure he gets in 10,000 steps daily: “Now if I don’t walk every day, I am miserable and my back acts up. There are few things that are as bad for backs as being sedentary.”
While exercise is key to a healthy back, too much vigorous activity can also lead to injury, says Dr. Phil Schneider of Montgomery Orthopaedics.
From 9 to 5 Monday through Friday, Ashley Rozendaal, 28, sits for long periods at her job as student-athlete counselor at American University. Once 5 o’clock strikes, her sneakers are laced and she hits the gym for intense cardio and weightlifting. Even though Rozendaal exercises regularly, she has thrown out her back at least five times in the past few years. She suffered her most recent spasm in March while playing contact football with the DC Divas.
Participants in classes such as “boot camp” and CrossFit perform high-intensity exercises—from sprints to Olympic weightlifting—in short bursts. “People here are really interested in performance, despite the fact that they’re not professional athletes,” Schneider says. “A lot of popular exercise programs have come along, and people get very excited or engrossed in them. They do the most they can with their bodies.”
Rozendaal admits that her body rarely gets a rest from intense workouts. “I can’t tell you the last time I took a yoga class,” she says. “I’m sure it’d be beneficial to switch out a day of weightlifting for it, to give my body something more healing.”
A 2011 study found that when patients with chronic low-back pain did 75 minutes of yoga or stretching a week for 12 weeks, nine in ten had better back-related function and less use of pain medications. Overall relief lasted at least six months after the programs.
Minimally Invasive Procedures
Each year, nearly 600,000 traditional back surgeries are performed in the US for herniated disks, degenerative disk disease, and other spinal ailments. But many of the patients continue to have persistent pain.
“The vast majority of back-pain patients do not need surgery,” says Schneider, who specializes in minimally invasive spine surgery. A 2002 Johns Hopkins report found that fewer than 5 percent of back-pain sufferers are good candidates for surgery. Typically, immediate surgery is required only if a patient has a tumor, an infection, a spinal fracture, or nerve damage.
In recent studies, minimally invasive procedures have become an increasingly popular option to open back surgeries. Minimally invasive procedures use smaller incisions and advanced computer technology to avoid damaging muscles, while traditional surgery requires cutting through muscle to reach the spinal cord. Minimally invasive procedures mean less bleeding during surgery, reduced postoperative pain, and less scarring, and they cut the recovery period by half. Traditional back surgery typically requires a hospital stay of a few days, whereas patients who undergo certain minimally invasive procedures can sometimes return to work the next day.
A steroidal injection is another minimally invasive option that’s long been used as a powerful anti-inflammatory to decrease pain. However, the relief is only temporary, lasting as little as a few weeks to as long as a year, depending on the severity of the pain. Patients also shouldn’t have more than three injections a year, according to the Journal of the American Medical Association.
“Epidurals are only going to calm inflammation,” says Dr. Roger A. Denney, a pain specialist and anesthesiologist at Inova Fairfax Hospital. “So you have to come at it in a multi-modal way. That includes physical therapy, some medications, and maybe [steroid] shots. One shot won’t fix everything.”
While physicians were once skeptical of holistic treatments, new research shows that these approaches provide additional healing benefits and are on the rise among patients suffering from various types of pain. A recent survey at George Washington University Hospital found that a majority of its patients are interested in adding natural therapies, including acupuncture, to treatment.
“There is a value to it,” says Dr. Dombrowski, who became a licensed acupuncturist to keep up with patient demand. “It’s not helpful for everything, but it complements [overall pain treatment].”
Moore has visited an acupuncturist for almost eight years and says that to experience the benefits, he’s found it necessary to receive treatments regularly.
“A lot of people think, ‘I’ll be holistic for the next six months and then I can go back to doing what I want to do,’ ” he says. “But you can’t do that. It’s diet, exercise, using healing modalities—making them all a part of your life.” (See page 102 for holistic treatments commonly used to treat back pain.)
Some patients find temporary pain relief with manual manipulation of the spine and surrounding muscles, a treatment practiced by chiropractors. A 2000 study in the Journal of Manipulative and Physiological Therapeutics found that patients with chronic back pain reported quicker relief after seeing a chiropractor, compared with those treated by family physicians. However, a 2011 study in the journal Spine found that chiropractic’s impact on acute low-back pain proved no better or worse than other approaches, including physical therapy, medication, and exercise.
When to See a Doctor
Common back injuries, such as muscle spasms, usually heal on their own, says Dombrowski. “You often don’t need to see a specialist—they get better in six weeks,” he says, as long as you maintain a treatment plan that involves gentle stretching and anti-inflammatories. Icing can help reduce swelling immediately following an injury. If after four to six weeks the pain remains or worsens, see your primary physician.
See a doctor immediately if you experience severe pain that doesn’t improve. Another red flag is numbness or tingling, especially in the legs, which could be a sign of nerve compression.
A version of this article appears in the June 2013 issue of The Washingtonian.