Pain Management Tips to Avoid Back Pain

Deborah Howell (Host): You know how your mom always told you to stand up straight? Well, she was on to something. Poor posture and other common daily activities can affect your neck and back, which can lead to pain. Welcome. I'm Deborah Howell and today we'll offer up some pain management tips to avoid back and neck pain and learn how rehabilitation and physical therapy can help.

Our guest is Dr. Jason Koh, the Triage Physician at the Memorial Care Spine Health Center at Orange Coast Medical Center. Hello, Dr. Koh. So glad you're with us today.

Thank you

Jason Koh, DO: so much, Deborah, a pleasure for me to be here today.

Host: Wonderful to have you. Let's dive right in. What are some common daily activities that could cause you to hurt your neck and your back?

Jason Koh, DO: So for the lower back, typically this is going to be a lifting or picking up things off the ground type of injury. Doesn't necessarily have to be a heavy weight per se, could just be picking up the keys off the ground or bending down to tie your shoes. You can injure your back when you're using improper body mechanics.

Other ways to injure the back would be, you know, sitting in the car and twisting, turning around to grab something from your back seat. I've had patients picking up their infants out of a crib hurt their back. So those are just some of the few ways you can commonly injure your back if you do something improperly with poor technique.

In regards to things like your neck, one of the most common ways to develop neck pain is actually sleeping on your stomach or sleeping with pillows, this can kind of turn the neck or crank the neck in a certain direction, and leads over time to pain in the neck due to compression of the joints and discs in your neck.

Obviously motor vehicle accidents, any kind of sudden or abrupt movement of the head or neck, poor ergonomics and posture, especially at your workstation if it's not set up properly. Those are all risk factors for developing kind of neck pain and lower back pain.

Host: Yeah. Let's talk about that last one a little bit. How can improper form or posture affect your neck and your back?

Jason Koh, DO: So slouching in your chair, that's obviously not recommended. We prefer patients sit with good posture, upright posture, maybe have a little lumbar support. When your lower back rounds forward or what I call forward flexion of the lumbar spine, it puts more pressure on the disc in your lower back, and more pressure on the disc leads to bulging of disc. And when the disc bulge backwards, they can hit sensitive structures like your spinal cord and your nerve roots back there.

In terms of the neck, most commonly we see people with poor posture rounding their shoulders forward. This causes a lot of tension and pulling on your trapezius muscles, which actually attach to your neck. So that causes extension of your neck and compression of the joints on the backside of your neck called your facet joints. Over time, repetitively, that can lead to shortening of muscles in the neck as well as compression of the joints in your neck and ultimately causing pain.

Host: Boy, I'm going to not take my heavy pickle bag out of my car by twisting around today. And I'm also sitting up straighter. Thank you, Dr. Koh. What are some ways to improve how you perform daily activities or your posture?

Jason Koh, DO: First and foremost, a lot of us work at computer stations, workstations now, and it's really important to set that station up ergonomically. Many companies offer ergonomic evaluations, oftentimes from a physical or occupational therapist. Setting that workstation up properly can really help to avoid common overuse type injuries.

You know, like I mentioned before, I recommend having a lumbar support in your chair to make sure your lower back is supported. Make sure your monitor and computer screen are directly in front of you and eye level so that you're not looking off to the side or looking up and down, because over the course of an eight hour day, this can lead to a lot of fatigue in the muscles and over straining of the muscles.

But honestly, most importantly, get up and move periodically. I can't emphasize this enough. Just moving is so important throughout the day. Our bodies were not meant to sit in front of a computer screen for eight hours a day. I really encourage my patients to get up at least hourly, walk, stretch, stay hydrated, because one of the biggest risk factors for degenerative disc is dehydration. Many of us stay glued to our computer screens, glued to our cell phones and laptops, we're not getting the adequate activity and hydration that we need to maintain overall spine health.

Host: What about those big exercise balls for sitting at work?

Jason Koh, DO: Those are good. They do really engage your core more, but it does require quite a bit of strength and core stability in order to maintain that throughout the day. Sure, one of those exercise Swiss balls are great, but I don't think someone would be able to sit an entire day on one of those exercise balls.

So there are kneeling stools as well. There's ergonomic office chairs, obviously. Like I said, I encourage people to change their seating position throughout the day and most importantly, get up and walk around and move.

Host: Yeah. And let's take that a step further. What exercises can people do at home to strengthen their back and their neck to prevent injury?

Jason Koh, DO: So with lumbar stabilization or what we call core strengthening exercises, it's really important to do them properly. Technique is the utmost importance. I've seen many patients come in after going to physical therapy clinics and they show me an exercise and they're doing it completely wrong. So it's really important to do the right exercise, the right technique. Because if you do something incorrectly over and over again, you're going to cause yourself more injury. But one of the main exercises we encourage is something called a posterior pelvic tilt. I tell my patients to lie on their back with their feet on the table, knees bent, and they tilt their pelvis backwards or push their lower back into the table.

That causes a little extension of your lumbar spine and straightening of your lumbar spine, and that opens up those facet joints and stabilizes your trunk. This is called neutral spine position. It's actually one of the most stable position your spine can be in. It's very well protected in this.

So I encourage patients to first learn how to engage that muscle called the transversus abdominis muscle. And that is your body's internal like corset. So everything from that point forward is building off of how to engage your core while moving the rest of your body.

Host: Can you do that in a chair?

Jason Koh, DO: You can actually, you can sit against the back of the chair and you tilt your pelvis backwards, pushing the low back into the backrest. And that will essentially straighten out your spine a bit. And that requires you to engage your transversus abdominis muscle. It's the muscle that goes around your trunk.

It's not those, you know, really nice six pack abdominal muscles that people always want to have. It's the one that goes around the entire abdominal and lower back.

Host: Got it. Now, if pain does occur, how do you know when to see a doctor?

Jason Koh, DO: We always talk about the red flag symptoms. So this is, you know, back pain associated with any kind of significant trauma be it a car accident, fall from height, or even, you know, minor trauma in an older patient. If they just slip and fall in the bathtub, important, if they have acute back pain or sudden back pain, a result of trauma to definitely come in and see a physician.

The other red flag symptoms that we talk about are going to be back pain associated with sudden change in strength, weakness, something like a foot drop where you can't pick up your toes, back pain that radiates into your legs or neck pain that radiates into your arms causing weakness. Any kind of sudden change in your ability to control your bowel and bladder, having incontinent episodes of bowel or bladder.

Those are all very important red flag signs and warrants immediate evaluation by a physician. Another potential one would be back pain associated with fever and chills. Sometimes we can associate that with the you know, a bad infection in the spine. So that definitely warrants further investigation from a physician.

Host: Dr. Koh, can you tell us about the non-surgical and holistic approaches the Spine Health Center at Orange Coast Medical Center offers?

Jason Koh, DO: So non-surgical treatments, are going to be, you know, recommendations on how to improve the way you perform your day to day activities to avoid injuring your spine. It can go as simply as ergonomic and postural recommendations, a discussion about their work habits and activities, their extracurricular activities, how they perform exercises in the gym.

For those who need a little more in depth training, our physical therapists are specially trained in the treatment of spinal conditions. The PT prescriptions that we write as physicians are typically more detailed. They provide a little more guidance and, and a framework for the therapist to design a therapeutic exercise program.

Obviously, we're physicians, we can recommend any kind of topical or oral medications to reduce the pain. Of note, we generally don't prescribe opiates out of our clinic. I think, looking at our history, less than 1 percent of our patients have actually been prescribed opiate medications. So I think we're very proud of that fact that we've kind of treated back pain and neck pain without the use of these really heavy opiate and narcotic medications.

Host: So true. And why do you feel that the Spine Health Center at Orange Coast Medical Center is different from other spine or neck pain programs?

Jason Koh, DO: I believe that our difference is really the approach to back pain. With the initial appointment in our non-surgical spine clinic, you will see a physiatrist, a specialist in non-operative spine care. Physiatrists are physical medicine and rehabilitation doctors. They'll perform a thorough history, you know, review your prior records, your previous imaging, any previous treatments that you've had.

And really come down to identifying what the pain generator is. And then we focus the treatment around that cause of your symptoms, not only based on an image or a report. You know, MRIs, you know, can show so many different abnormalities. And many of these are abnormalities or what I term age related degenerative changes.

And these are actually findings in the spine as people age and many of them are actually not even a cause of patient's symptoms of pain. So what we try to identify is the actual pain generator and then develop an effective treatment plan around that condition.

Host: Start from the source. Where can people learn more about conservative treatments for back and neck pain?

Jason Koh, DO: So, they can call directly to our Center for Spine Health. The phone number there is 714-861-4830. Or they can simply look us up on the web at memorialcare.org/OCSpineHealth.

Host: Now, is there anything else you'd like to add to our conversation before I let you get back to your day?

Jason Koh, DO: Good news is though, 80 percent of the people that have back pain or an acute episode of back pain will recover within three weeks, with or without treatment. That shows us that the body is able to heal itself. Okay, 90 percent of those patients will recover within six weeks.

Again, if we do nothing at all, patients will recover from back pain. So it's reassuring to let people know not to freak out if their back bothers them every now and then completely normal.

Host: Well, I love ending on a high note. Thank you so much, Dr. Koh, for your time and your expertise today. Really enjoyed having you on the show.

Jason Koh, DO: Thank you so much, Deborah. I appreciate it.

Host: And for more info or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.