An estimated ten million adults suffer from chronic back pain annually. For some, back pain is so debilitating that it interferes with work, routine daily activities and recreation.

In the past, there were few options for patients who weren’t helped by physical therapy, nerve blocks, back-strengthening exercises or injected medications. But now, thanks to new minimally invasive techniques, more people are not only finding relief, but also regaining their mobility.

The majority of patients suffer spine problems related to degenerative conditions. These degenerative conditions can result in instability and intrusion into the spinal cord and surrounding nerves, causing back pain and/or radiating pain in the arms and legs.

To correct these problems, people who haven’t responded to conservative therapies have opted for spinal fusion, a procedure that fuses the vertebrae together.

A new minimally invasive technique, called Lateral Access Spine Surgery, is making this procedure easier and more effective for patients. Unlike older techniques that access the spine through the back or abdomen, lateral surgery approaches the spine from the side. This avoids disrupting the major back muscles, bones and ligaments.

As a result, operating time is often reduced, patient blood loss is minimized, and recovery time is significantly shorter.

As one of the few physicians in our area performing Lateral Access Spine Surgery, I’ve been impressed with how much it has helped my patients. But like all procedures, lateral surgery may not be suitable for everyone.

If you or a loved one suffers from chronic back or leg pain, I encourage you to make an appointment with a spine surgeon to discuss available treatment options.

Some of the most common age-related changes that can occur to a person’s spinal discs include:

• Loss of fluid – This reduces the ability of the discs to act as shock absorbers and makes them less flexible. Loss of fluid also makes the disc thinner and narrows the distance between the vertebrae.

• Tears or cracks – The jellylike material inside the disc may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, rupture or break into fragments.

Degenerative disc disease is partially inherited and therefore common among family members. However, the condition is also more likely to occur in people who smoke cigarettes, those that do heavy physical labor or those that are obese.

Symptoms of degenerative disc disease can vary person to person. Some individuals may experience pain in the back and neck, while others with the same amount of disc damage may not experience any discomfort. For the most part, where the pain occurs depends on the location of the affected disc. An affected disc in the neck area may result in neck or arm pain, while a damaged disc in the lower back may result in pain in the back, buttocks or legs. With both of these scenarios, the pain will often intensify with physical activity such as bending over, reaching up or twisting, and can begin as a result of a major or minor injury, or just a normal motion. The pain also may start gradually and for no known reason and get worse overtime.

At first your physician will most likely take a conservative treatment approach, which may include placing ice or heat on the pain stricken area and the use of over-the-counter medications such as ibuprofen to reduce the inflammation. If this conservative treatment approach does not reduce the pain, your physician may recommend physical therapy to help strengthen the muscles in your back and increase flexibility. In some cases, depending on the level of disc degeneration, your physician may recommend surgery to remove the damaged spinal disc.

If you experience neck or back pain for an extended period of time you should consult an orthopedic spine specialist. They will be able to identify the underlying cause of the pain and place you on a treatment plan that will be you back on your feet in no time!

So, what is a spinal fracture and how can it be detected?

Spinal fractures range from painful compression fractures, often seen after minor trauma in a patient with osteoporosis, to more severe injuries such as burst fractures and fracture-dislocations that occur following auto accidents or a serious fall. These severe injuries frequently result in spinal instability, with a high risk of spinal cord injury and pain.

Some of the most common symptoms that may indicate that you’ve experienced some form of spinal fracture are sudden or severe back pain, worsening of back pain if you walk or stand, some pain relief when lying down, difficulty and pain when bending and twisting and deformity of the spine. If you experience any of these symptoms you should seek treatment from an orthopedic spine specialist who will help classify the extent of your fracture and provide you with potential treatment options.

Your orthopedic spine specialist will use a few basic ways to classify the extent of your injury.

Major and minor spinal fractures: A minor fracture means that a part of the posterior (back side) elements of the vertebra has broken—the parts that aren’t as vital to spinal stability. If you fracture this part of the vertebrae, it’s usually not too serious. However, if you fracture part of the vertebral body, the pedicles, or the lamina it is considered a major fracture because it increases the possibility of nerve damage and causes the spine to become unstable. If it’s broken, you can have serious problems with the vertebrae lining up correctly, which will make it difficult to support weight and distribute the force of your movements.

Stable and unstable spinal fractures: Stable fractures don’t cause spinal deformity or neurologic (nerve) problems. With a stable fracture, the spine can still carry and distribute your weight pretty well. If a fracture is considered unstable it is difficult for the spine to carry and distribute weight. Unstable fractures also have a chance of progressing and causing further damage, or spinal deformity.

Beyond these basic terms, other words your orthopedic spine surgeon my use to describe your condition include:
• Compression fracture: This is the most common type of fracture in patients with osteoporosis, or whose bones have been weakened by other diseases such as bone cancer.
• Burst fracture: This type of fracture is caused by severe trauma (e.g., car accident). It occurs when the vertebra is essentially crushed by extreme forces, typically in multiple places. Because the vertebra is crushed completely, bony fragments can spread out and cause spinal cord injury.
• Flexion-distraction fractures: If you’re in a car accident where your body is pushed forward, you may get a flexion-distraction fracture. Your spine is made to flex forward, but if there’s a sudden forward movement that places incredible stress on the spine, it may cause the vertebrae to break.
• Fracture-dislocation: If you have any of the above fractures and the vertebrae moves significantly, you have a fracture-dislocation. Usually, these fractures make your spine very unstable.

The most important thing is that you seek medical treatment if you feel any sort of discomfort in your back or spine. Even the slightest spinal fracture could turn into a larger issue down the road.

Many of my patients are surprised to learn that a disorder of their lower back could cause mild to intense leg pain. Known as sciatica, this condition occurs when one or more of the five sets of nerve roots in the back are compressed. Several different types of spinal disorders can cause spinal nerve compression and sciatica. The six most common include:

• Lumbar bulging or herniated disc – If a disc bulges or becomes herniated, disc material can press against an adjacent nerve root and compress delicate nerve tissue, which is the worst cause of sciatica. In this case not only does the herniated nucleus cause direct compression of the nerve root against the interior of the bony spinal canal, the disc material itself contains an acidic, chemical irritant that causes nerve inflammation. This often leads to extreme numbness, tingling, pain and muscle weakness in the legs.

• Lumbar spinal stenosis – Leg pain similar to sciatica may occur as a result of lumbar spinal stenosis, which happens when the nerve root passage way becomes narrow or closed due to nerve compression. The pain is usually brought on by certain activities such as standing or walking, and can be relieved by sitting down.

• Spondylolisthesis – Characterized by one vertebra slipping forward over an adjacent vertebra, spondyloisthesis often affects the lumbar spine. When a vertebra slips and is displaced, spinal nerve root compression occurs and often causes sciatic leg pain. This condition can develop at birth or might be acquired from spinal degeneration, trauma or physical stress.

• Trauma – Sciatica can result from direct nerve compression caused by external forces to the lumbar or sacral spinal nerve roots. Trauma from a motor vehicle accident, a fall or physical impact while playing a sport can injure the nerves or cause fragments of broken bone to compress the nerves.

• Piriformis syndrome – The piriformis muscle is located in the lower part of the spine and connects to the thighbone, which assists in the rotation of the hip. When this muscle becomes inflamed and begins to spasm it can irritate the sciatic nerve, causing sciatica.

If you think you are suffering from sciatica, you should contact an orthopedic spine specialist for a proper evaluation. A proper diagnosis is the first step to reversing the damage and relieving the pain.

· Myth: Back surgery is the best medical option – While some injuries do require surgery, simple back pain can be treated with rest, physical therapy and anti-inflammatory medication. If the pain does not subside after using conservative methods of treatment, then surgery may be the next course of treatment. Ultimately, it is best to talk to an orthopedic spine surgeon to evaluate your pain or injury and determine the right course of treatment.

· Myth: Stay in bed until the pain goes away – If you have acute strain or injury, rest is important for a few days, but lying in bed for longer than that can cause muscles and joints to stiffen and weaken, which slows your recovery. If you must rest in bed, make sure to get up every hour and walk for a few minutes to keep back muscles strong. Using a heating pad or taking a hot shower can also loosen the muscles and reduce pain.

· Myth: Exercise is bad for your back – Conditioning your back muscles and stabilizing your spine can be done by strengthening your core and abdominal muscles. Yoga and flexibility exercises are also a good way to reverse muscle weakness and decrease stress on the spine.

If your back pain does not subside within a few weeks, you develop a fever or feel tingling or numbness, see an orthopedic spine surgeon immediately for a proper diagnosis. Don’t let back pain, or misconceptions about back pain, keep you from living a full life.

From baseball to soccer to football, everyday millions of children and young adults participate in sports activities. These activities teach children team work and improve their physical fitness, coordination and self-discipline. It also increases their chance of experiencing sports-related injuries such as concussions, sprains, fractures, muscle tears, and back and neck injuries. However, there are measures that can be taken to help prevent these types of injuries, such as:
• Undergoing medical exams prior to the sport’s season, which should include concussion screenings and physical evaluations;
• Using proper protective gear, such as shin guards for soccer and helmets for football and baseball;
• Staying hydrated and always warming up before practice or a game;
• Never playing through pain or an injury.

If an athlete does experience an injury it is important that it is not ignored or taken lightly.
Sports-related injuries in children are of great concern because their bones, muscles, tendons and ligaments are still growing. To avoid long-term damage, young athletes should seek immediate care for any minor or serious injury.

Following are several signs to help determine if immediate care is needed:
• Inability to play following a sudden injury;
• Decreased ability to play due to a chronic or long-term complication following an injury;
• Visible deformity of the athlete’s arms or legs;
• Severe pain from a sudden injury, which may prevent the use of an arm or leg.

Sometimes, sports-related injuries occur after office hours or on the weekends. If and when this happens I recommend that my patients visit the emergency room or an orthopedic walk-in clinic like the one we have at Methodist Sports Medicine / The Orthopedic Specialists. One of our fellowship-trained orthopedic surgeons is available to treat patients with sudden or recent sports or active lifestyle-related injuries. Patients can visit our Avon or Greenwood locations Monday through Friday from 8 a.m. to 10 a.m., or our Carmel location Monday through Saturday from 8 a.m. to 10 a.m. For more information, please visit www.methodistsports.com or call 317-817-1200.

Winter is upon us, and with it comes snow, ice and winter sports. Nowadays, adults and kids are turning to non-traditional games, such as downhill ski racing, snowboarding and ice climbing. From the airing of the X Games and the need for a bigger thrill, these extreme sports are drawing more and more fans and enthusiasts. While these sports can be fun, they also can lead to injuries if not done properly.

According to the American Academy of Orthopaedic Surgeons, snowboarding is the leading cause of winter sports injuries, sending nearly 150,000 people to emergency rooms and doctors’ offices. Coming in behind snowboarding is skiing and snowmobiling.

If you are one of the millions of people that will take to the ice and snow this season, here are some tips to protect your back and stay injury-free during the winter months:

• Warm up and cool down. Stretch for about 30 seconds or more and do some light exercise for three to five minutes to warm up your muscles. This allows for blood to flow to your back muscles and prepares your body for your activity. A cool down after the sport reduces cramping and tightening.

• Gear up properly. It is important to wear the correct footwear, protective gear and layers to keep warm. Not only is the proper gear important, but staying warm is essential to preventing frostbite and keeping muscles flexible.

• Don’t imitate stunts. Don’t try any stunts you see on TV. Those are practiced moves that can cause an untrained athlete to injure themselves if not done properly. Also, abide by all of the rules of the sport when participating.

• Never practice alone. Because extreme sports are just that, extreme, you should never practice alone. Make sure someone is with you at all times in case of an injury.

• Take frequent breaks. Just like with any exercise, take breaks regularly. Also, make sure to drink plenty of water to stay hydrated.

• Use good technique. Remember not to twist or jerk your body in a way that is uncomfortable. It’s also a good idea to take lessons by a trained professional to prevent possible back strain or injury.

Winter injuries should not be ignored. If you do experience pain, it is essential to obtain a consultation with an orthopedic specialist who can diagnose your injury and determine the proper course of treatment. Depending on the extent of your injury, your doctor may recommend rest, prescription pain and anti-inflammatory medicine, or possibly surgery.

Many people do not realize that backpacks that are too heavy or worn incorrectly could injure a person’s bones, muscles and joints.  In fact, according to the U.S. Consumer Product Safety Commission there were 12,309 backpack injuries in 2008, sending kids to doctor’s offices, hospitals and emergency departments. 

To minimize injury, consider following these guidelines:

• Choose the right backpack: The safest backpacks have two wide, padded shoulder straps, a padded back and a waist strap.  These features promote better circulation and comfort, and ensure that the weight in the backpack is evenly distributed.

• Always use both shoulder straps: If worn incorrectly, backpacks can strain muscles and increase the curvature of the spine.

• Pack light and right: A backpack should never weigh more than 10 to 20 percent of the child’s total body weight. It’s also important to pack heavier items closest to the center of the back where the weight is better supported.

• Unload frequently: Students should stop at their lockers or desks as often as possible to unload some of the weight from their backpacks. If they do find themselves carrying a heavy load, they should remember to bend using both knees when wearing or lifting a heavy backpack. 

Parents should also encourage their children to learn back-strengthening exercises that build up the muscles used to carry a backpack.  If a student begins to experience pain or discomfort caused by a heavy backpack, don’t ignore it. It could lead to long term lower back pain and other complications that may eventually require rehabilitation and even surgery.

These issues and concerns are leading many sufferers to ask “how can back pain be properly managed?”

• Rest: If your back hurts, rest. This doesn’t mean stay in bed for a week. Long-term rest can actually make back pain worse, as it often leads to stiffness and muscle weakness. After a short break, gently stretch your back muscles, and work on strengthening your stomach and leg muscles. Strengthening all muscle groups can actually help to reduce nagging back pain.

• Medications: If stretching and exercise doesn’t alleviate the pain, try adding a medication (e.g., Tylenol, etc.) to your treatment plan. Some over-the-counter medications relieve pain, reduce inflammation, and relax muscle spasms.

• See Your Doctor: If you’re experiencing back pain more frequently, and rest and over-the-counter medications don’t seem to be doing the trick, it’s time to see a doctor. A medical professional can rule out if disease or infection may be causing the pain, and determine the best course of treatment. Once your doctor has confirmed the source of your back pain, surgery may be recommended to reverse the damage.  However, surgery is typically considered the final resort and is only utilized once non-surgical treatment options have been deemed ineffective.

The overall goal is for you to resume normal or near normal physical activity as soon as possible.  If you are unable to accomplish this at home, it’s important to consult an orthopedic spine specialist who can help get you back on track.