Mark W. McFarland, DO
Did you know that back pain is the number one reason for which people seek medical attention? Having a healthy, non-painful back is essential to living and working well. Let’s discuss some common back injuries and how I treat them.
Back Strain – One of the most common complaints I hear from patients is “I really wasn’t doing anything crazy, but all of a sudden my back gave out and I was on my knees in excruciating pain!” Back strain typically doesn’t happen all at once but is caused by cumulative “micro-traumas” to back muscle. A lack of exercise, over-doing it when working in the yard, picking up your grandkids, all of these little things add up. When your back muscles have had enough, they spasm and cause pain, making activity of any kind difficult.
Treatment for Back Strain is now much different than it was ten years ago. We used to recommend bed rest for back strain. Now, we recommend activity modification, Physical Therapy to strengthen the muscles of the back and core, non-steroid anti-inflammatory medications and the use of ice, heat and muscle rubs. Back strain can be quite painful, but almost always will resolve on its own with the proper care and attention to exercise. It just takes time and patience.
Bulging or Herniated Discs – Our spinal vertebrae have cushions between them, called discs. Think of a jelly doughnut that has filling which can be squished out if the doughnut is compressed. That is how our spinal discs are. The “filling” is called the nucleus pulposis and it can bulge or even be forced completely out of the disc if enough force is placed on it. When we fall, twist while lifting a heavy object or are involved in a car crash, we may feel or hear a pop in the back and then have pain. The pain may be felt in the back, but often will radiate into our arms, buttocks or legs and feet. That’s because the “jelly” in the doughnut has moved out of its normal home and is now pressing on a nerve root that comes from the spine and controls feeling in the arms or the legs.
Treatment for Bulging or Herniated Discs involves getting an MRI to determine exactly where the disc is problematic. I can typically make a determination as to what spinal level is affected by your symptomology, but the MRI will let me know how severe the injury is. We start with conservative treatment first, by prescribing oral steroids to reduce inflammation and Physical Therapy to relieve pressure on the nerve roots. If we don’t see improvement, I will often do an epidural steroid injection. This procedure delivers a steroid directly to the affected nerve root in the spine helping to reduce pain and inflammation.
If the pain and dysfunction persist, I may recommend surgery to remove the disc material that is pressing on the nerve root, called a microdiscectomy. If your spine is also unstable, you may require a spinal fusion to stabilize the spinal vertebrae. Thankfully, these procedures can often be done on an outpatient basis and are now minimally invasive due to better surgical techniques. Recovery times will vary based on your pre-operative condition, but most patients can be back at work within weeks of surgery and return to all activities within months.