Ways to reduce, prevent vicious cycle of pain
Neck and back pain are common problems that most people will experience in their lifetime.
Unfortunately, most people who have one episode will go on to have a recurrence at some point. Sudden paralysis resulting from these episodes is fortunately very rare. Unlike heart disease or hypertension which can be silent killers, when spine conditions are problematic they have symptoms.
Recent studies have shed light on the some of the causes and management of spine problems. Degenerative disk disease and arthritic changes in the joints of the spine have historically thought to be a wear and tear condition. It is now known that genetics has an important role too. The genetics for degenerative disk disease are multifactorial similar to heart disease, obesity and diabetes. Multifactorial genetic diseases do not have a single gene that is responsible but multiple genes. Lifestyle and environmental factors also play a significant role in the expression of multifactorial genetic conditions.
Patients with a family history of neck and back problems have a six fold higher risk of degenerative disk disease. Genes or DNA codes direct the synthesis of important molecules inside our spine like collagen, vitamin D receptors and cartilage. Problems or variation with these genes and others have been linked to degenerative disk disease.
Another interesting genetic study compared neck and back pain between identical twins. When one of the twins spent substantially more time driving or lifting repetitively, the MRI findings were not significantly different. Even with a family history, there are ways to reduce or prevent recurrent episodes of neck and back pain related to degenerative spine conditions.
Environmental factors such as a sedentary lifestyle, obesity and smoking increase the risk of painful degenerative disk disease. Smokers are three to four times higher risk of developing degenerative disk disease. Smokers are also at higher risk of requiring surgery because the disease they develop is more severe.
Sedentary lifestyle and obesity are very common risk factors seen in patients with recurrent pain. A common misconception is the feeling that “if I don’t do anything my back won’t bother me.” Inactivity leads to a weak back or neck that is more easily injured. Kiniesophobia is the fear of movement and it is very common in degenerative spine conditions. Unfortunately, this fear sets up a vicious cycle of pain, inactivity and more pain.
The spine is a well-designed part of your body that requires stretching, strengthening and aerobic exercise to maintain optimal function. Stretches for the back and legs can prevent strains and help maintain proper biomechanics. Flexibility itself helps people lift with their legs and not with their back.
Strengthening exercise for the back and the core is helpful for spine biomechanics as well. The low back and abdominal muscles are targeted in core strengthening exercises. These muscles provide an internal brace to the bones, disks and ligaments of the spine. Conditioning with strength training can prevent or minimize problems for both neck and back pain. Exercise is generally safe for the spine unless some recent trauma has resulted in a fracture.When patients have pain lasting more than three months, pain during exercise generally does not equate to ongoing harm or injury.
Regular aerobic activity has many health benefits including prevention of heart disease, diabetes and some forms of cancer. The 2008 Physical Activity Guidelines for Americans recommend 150 minutes per week of moderate aerobic activity in all adults, even those with disability.
A specialist in spine disorders will frequently try to determine if the exact cause of the pain is the disk, a pinched nerve or the joints in the spine. This process involves taking a comprehensive history and performing physical exam. The gold standard for spine imaging is the MRI scan.
MRI findings on a radiologist report do not equate to the identification of a pain generator. Correlation with the history and physical exam is essential. One study found 27 percent of asymptomatic volunteers to have disk problems on a MRI scan even though they had no history of back pain. Frequently, severity of degenerative change on MRI does not correlate with the severity of pain the patient experiences. The pattern and characteristics of pain from the spine can change with time. Sometimes a patient’s pain pattern cannot be explained by the MRI scan.
When back or neck pain is chronic, severe or associated with pain radiating into the arm or leg, weakness, numbness or incoordination then it is time to seek help from a specialist. A specialist in spine disorders should help determine the location of the pain generator and optimize the treatment. Almost all spine conditions have a wide variety of treatment. A specialist should reassure you of your spine’s stability and encourage activities that are appropriate for recovery.
Dr. Andrew Utter is a fellowship trained board certified spine surgeon and neurosurgeon specializing in minimally invasive and complex spine procedures, spinal deformity and scoliosis surgery and spine and brain tumor surgery. Utter has been with the Spine Institute of Louisiana, part of Specialists Health System since September of 2009.
