Back Pain – Main Line Spine

There is no single magic treatment that works for all forms of chronic low back pain. The first key in successfully treating it is to determine the source and cause. Then with a diagnosis, your medical professional can evaluate appropriate alternatives to relieve the symptoms.

Until about 20 years ago, the medical community believed there were only three primary sources for low back pain. Today, doctors recognize a fourth source of low back pain that involves damaged vertebral endplates.

We’ll bring you up to speed on what you should know about this pain source and a treatment option to consider if you are suffering from it.

What are three of the sources of low back pain?

For years, medical specialists believed the sources of low back pain were rooted in three spine structural components:

The zygapophyseal joints. These both allow and limit rotation and bending movements in the spine. Degenerative changes in the facet joints can lead to low back pain.
The sacroiliac joints. These joints link the hip and the lower spine. Low back pain can result from joint damage or injury.
The intervertebral discs. These provide cushioning and flexibility for the spinal column during everyday activities. Disc degeneration can pinch spinal nerves, leading to low back pain that may radiate into the legs.

There are many different conditions across these three sources that can cause problems for patients. The complexity of diagnosing them usually requires an in-depth examination by a medical professional.

What is a fourth source of low back pain?

The more recenlty discovered fourth source of low back pain can arise from a damaged vertebral endplate.

What are vertebral endplates?

The spine has a series of stacked small bones called vertebrae that form the spinal canal. Between adjacent vertebrae are intervertebral discs that provide cushioning and flexibility.

At the top and bottom of each vertebra are vertebral endplates. These endplates serve as the interface between each vertebra and the adjacent disc. (In the image below, the vertebral endplates are illustratated by the lighter yellow rings).

What is vertebrogenic pain?

As intervertebral discs deteriorate with wear and tear with age, stress occurs on the vertebral endplates. With this stress, the endplates may become damaged.

Damaged vertebral endplates can become inflamed, leading to vertebrogenic pain. The basivertebral nerve (BSN) transmits pain signals to the brain from the endplates.

What are the symptoms of a damaged vertebral endplate?

The symptoms of a damaged vertebral endplate are similar to that of a damaged intervertebral disc.

In both cases, patients describe:

The source of the pain is in the middle of the low back.
Pain that worsens with physical activity, prolonged sitting, bending, and lifting.

This similarity presents a challenge when identifying the difference between the two. A damaged vertebral endplate requires distinctly different treatments than a damaged intervertebral disc.

How do doctors determine if a patient has vertebrogenic pain?

To confirm that a patient has vertebrogenic pain, doctors use an MRI to look for specific changes that occur with endplate inflammation. These are called Modic changes.

They look for two of the three types of bone marrow changes: type 1, inflammation and edema, and type 2, fatty infiltration, which each indicate vertebrogenic pain.

Modic Changes Illustrated by Type — **Illustrations of Healthy Endplate Alongside Those With Modic changes:** Healthy endplate, Type 1, Type 2, and Type 3 changes.

What indicates if someone might be a good candidate for the Intracept Procedure to relieve vertebrogenic lower back pain?

A patient may be a good candidate for the Intracept Procedure if:

They have had chronic back pain for at least 6 months; and
They have failed to respond to conservative care for a period of at least 6 months; and
An MRI has shown that they have Type 1 or Type 2 Modic changes in at least one vertebrae from L3 to S1.

The Intracept Procedure

The Intracept Procedure is a minimally-invasive outpatient procedure for patients with vertebrogenic pain. The procedure targets the basivertebral nerve to relieve this chronic pain. It may be considered after other conservative options fail to relieve pain.

A doctor uses fluoroscopic guidance to target a radiofrequency probe. The probe heats the basivertebral nerve, stopping it from sending pain signals to the brain.
The Intracept procedure typically lasts an hour and takes place in an outpatient surgery center using local anesthetic and light sedation.
The Intracept back procedure is minimally invasive and preserves the overall structure of the spine.
The Intracept procedure recovery time, when most patients feel pain relief, is within two weeks after the procedure.

basivertibral-nerve — Vertebrogenic pain is a distinct type of chronic low back pain caused by damage to vertebral endplates, the interface between the disc and the vertebral body. The basivertebral nerve (BSN) transmits pain signals to the brain from the endplates.

What’s the Intracept Procedure success rate? A recent study on Intracept showed function and pain relief improvements that lasted more than five years¹.

Wrapping it up, there are two key takeways if you have lower back pain:

Vertebral endplate damage should always be considered as a possible alternate pain source in addition to spinal disc degeneration.
For appropriate patients with vertebrogenic low back pain, the Intracept Procedure can be an effective option.

Reference

Fischgrund J. Ryne A. Macadaeg K. et al. Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 5-year treatment arm results from a prospective randomized, double-blind sham-controlled multi-center study. Eur Spine J. 2020 Aug;29(8):1925-1934. doi: 10.1007/s00586-020-06448-x [PubMed]

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When you are in pain – particularly if it’s low back pain – your initial reaction may be to stop all activity and rest. In fact, however, the opposite is often true.

Let’s stop for a moment and not get ahead of ourselves. If you have back problems, you should first see a medical professional for diagnosis and guidance before following any treatment protocols. But after you do, your doctor will often recommend that you work to move and stay active, despite the pain.

a woman participates in gentle exercise with others — A woman participates with others in gentle exercise to increase flexibility and strength and improve cardiovascular fitness

Lower Back Pain Is Often Persistent

When you have an acute musculoskeletal injury, it’s important to get pain, swelling, and inflammation under control as soon as possible. One recommended treatment approach to do so is RICE:

Rest
Ice
Compression
Elevation

However, this kind of “take it easy” approach is normally only recommended for a period of 48 to 72 hours. If your pain persists after that, you should be seeing a doctor to find out why.

Low back pain is often chronic. However, it can come and go on an ongoing basis at different levels of severity. ICE, heat and taking over-the-counter anti-inflammatories may help – but you need to do more to help yourself for the long term. You need to move.

Mechanical Pain

80% of all back problems are mechanical in nature. This means that these problems will respond best if you keep moving – even if your pain is persistent.

Your spine is made up of a series of joints. Mechanical pain occurs when anything happens that restricts the movement of one or more of those joints. This is why back pain is also accompanied by stiffness. A bulging disk, ligament issue, or forms of arthritis can create obstructions within the structure of your spine.

If you move the right way as your medical professional has recommended to you, you can release those obstructions. And as they are released, stiffness is reduced, and you usually will experience less pain.

Sitting Too Long and the Pain-Spasm-Pain Cycle

Most of us know that sitting too long can be bad for our health. However, it also can be a cause of back pain. When you sit too long, your joints aren’t being used. The area of your low back is a nerve-dense location, and with the immobility of sitting too much, it can start what’s known as the pain-spasm-pain cycle – where a skeletal muscle spasm causes pain in your spine.

The pain-spasm-pain cycle can first be triggered from an underlying condition such as a herniated disc, arthritic joint or bulging disc. When that happens, usually without warning, one of these conditions suddenly triggers a muscle spasm in your spine.

In turn, the triggered muscle spasm causes ischemia, which is a lack of blood flow in and around the muscle. The ischemia then causes pain. The muscle sees that pain as a threat to the spine – and reacts in an effort to protect it with another new spasm.

As a result, you can get locked into a never-ending back pain-spasm-pain cycle.

The good news is that your medical professional can help you break this cycle with therapies that will release and reset the affected muscle.

Diagram illustration of how a trigger can start an ongoing pain-spasm-pain cycle — A muscle spasm triggered by an underlying back condition can start a never-ending pain-spasm-pain cycle.

Get Moving!

One of the most important things that people with low back pain can do is to stay as physically active as possible in daily life and exercise regularly. Not moving enough can weaken your core muscles, make the pain worse over the long term, and lead to other health problems. It’s a fact that regular physical exercise has been shown to reduce pain – but do it after reviewing your plans with your doctor.

If you have low back pain, it’s a good idea to go about your daily life as normally as possible, and not to let the pain limit your activities too much. Don’t isolate yourself but get out and do the things you enjoy. This will make it easier for you to cope with your back pain.

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Driving can be a stressful experience. The daily traffic on the Schuylkill Expressway. Drivers who dart in front of you without the courtesy of a turning signal. The challenge of successfully clearing center-city traffic light cameras. The short fuse of fellow drivers exacerbated by traffic jams.

But this isn’t the worst of it. If you have neck, back or shoulder issues, sitting in a car for an extended period can be excruciating. Even without back problems, sitting in a car’s seat for a long drive can lead to discomfort and soreness.

Typical seat design doesn’t help. Many car seats are designed for average body types. The problem is that many of us are constructed differently than that ‘average.’ If we are taller, shorter, wider or more slender than the averages that auto manufacturers refer to as ‘norms’, we’ll have a harder time comfortably fitting into seats designed for those average dimensions.

Which brings us to one of the most important things to keep in mind. All our bodies are different. So although we’ll provide you with some tips to alleviate your back pain when driving, you’ll need to find a mix of those tips that works best for your own uniqueness.

man intently looking forward, driving a car

1. Your Seating Positions and Seat Adjustments Should Promote an Upright Spine

If you want to avoid back pain when driving, keep the thought of maintaining a good posture in mind.

Before you start driving, get comfortable. Pull your wallet, cell phone and other bulky items out of your pockets. Position yourself properly with your back fully against the back of your seat.

Adjust your seat back or forward, up or down so that you aren’t up too close or have to strain forward to see. Your seat height should be as high as your knees – and there should be a gap between the back of your knees and the front of the seat to promote healthy circulation.

When your seat is reclined to about a 30-degree angle, it normally will support the least amount of lower back disc pressure.

2. Hold Your Steering Wheel Properly

Relax your arms so that you have a gentle bend at your elbows. Place your hands so that they are at the 9 o’clock and 3 o’clock position which will allow you to rest your elbows on the vehicle’s armrests to alleviate stress and pain on your upper back.

3. Adjust Your Headrest and Keep Your Head Back

If your head rest can tilt forward, adjust it so that you can drive with your head touching it with your chin level and your shoulders back. Don’t force your head backward however if you can’t adjust it forward enough so your head touches – what is most important is maintaining good posture.

The top of the headrest should be no lower than your eye level.

4. Use Your Car Seat’s Lumbar Support Correctly

If your car has a lumbar support, adjust its depth by moving it from flat until it comfortably fills the arch of your back. When set correctly, you should feel an even pressure from your hips to your shoulders.

If your car doesn’t have adjustable lumbar support, you can use a lumbar pillow. These are widely available from a range of providers.

5. Adjust Your Mirrors

Prevent neck strain by making sure your rear-view and side mirrors are properly adjusted. External mirrors can be adjusted horizontally and vertically.

It’s easy to check you’ve got this right: you should be able to see the traffic behind you without having to crane your neck. Once adjusted properly, if you find yourself wanting to adjust the mirror during your drive, it may be a sign that you are starting to slump in the seat.

6. Use Cruise Control

If your car has a cruise control option, use it whenever possible. By using cruise control, your legs can be bent and help support some of your body weight. This takes some of the load off your spine and reduces your chances of developing back pain while driving.

7. Shift Your Position Periodically

When possible, try to move a little in your seat. Even 10 seconds of movement and stretching is better than sitting still. At a minimum, adjust your seat and change your position slightly every 15 to 20 minutes. Pump your ankles to keep the blood flowing and provide a slight stretch in your hamstring muscles. Any movement that is safe to do in the car will help you out.

8. Take Frequent Breaks During Long Drives

Stopping frequently while on a long road trip may not be ideal but it can help reduce the stress on your spine. At each stop make sure you get out, walk around and stretch before getting back on the road again.

Sitting in one position in a car will stiffen up your back muscles and can lead to achiness and possibly muscle spasm. Everyone should ideally take at least a 15-minute break for every 2 hours of driving. If you’re prone to back pain, you may want to take breaks more frequently, such as every 30 to 60 minutes.

9. Apply Heat to Your Back

If your car has a heated seat, turning it on can bring some relief. If you don’t have heated seats, there are heated seat covers available on the market that sit on top of your car’s seat. Heat can help loosen your muscles and joints and possibly reduce your back pain.

It Will Take Some Time to Find the Adjustments that Work Best for You

Setting up your car seat so that it works best for you as an individual will take a bit of trial and error. Start with the suggestions that we have provided and try it for a few days – and then start to make small gradual adjustments one at a time.

You’ll eventually find the right combination of adjustments that minimizes the stress on your back and which provides you with the most comfortable driving position possible for your unique body.

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Back pain and spine problems are among the most common reasons Americans visit a doctor. But according to a report from John Hopkins Medicine, fewer than 5 percent of people with low back pain are good candidates for surgery.

What should you be asking before you have back surgery? In most cases, most back surgery is an elective procedure. It is not urgent. Let’s look at some important questions that you should be researching as you sort through your choices.

Are There Effective, Safe, Non-Surgical Treatments That May Help Relieve My Back Pain?

A first step in answering this question is finding the underlying cause of your back pain. That process can be complicated and elusive. And if no doctor can locate a structural cause for your pain, any back surgery won’t work. But at the start, if a non- or minimally-invasive option has the potential to work, then that should be your priority focus.

Over-the-counter anti-inflammatory medications like ibuprofen and naproxen and pain relievers that contain acetaminophen can be effective – but make sure you consult with a doctor before starting any ongoing pain medication regimen – even if it is only over-the-counter.

Studies have shown that physical therapy can help manage back pain by decreasing both disability and pain. So can lifestyle changes that are recommended by your doctor, particularly such as losing weight and regular, low-impact exercise, which may also significantly relieve back pain.

Trigger point injections and fluoroscopically (x-ray) guided therapeutic injections can also provide relief if more modest approaches aren’t effective. Beyond that are a series of alternatives including radiofrequency neurotomies, regenerative medicine, pain medication management, spinal cord stimulation, percutaneous lumbar decompression, and minimally invasive interventional spine procedures – to name a few.

Your key takeaway from this should be to explore every option at your disposal before committing to a back surgical procedure.

Man sitting, deep in thought, considering a decision. — In most cases, most back surgery is an elective procedure. It is not urgent. Take time to think through your options.

What Surgical Procedure is Being Recommended to You – and Why Is It Being Recommended?

Main Line Spine works with some of the best spine surgeons in the greater Philadelphia area – and when appropriate, we refer patients to them.

But these spine surgeons also frequently refer patients to Main Line Spine. Their common reason to refer to us is that they determine many patients who visit them haven’t reached a point where spine surgery is yet appropriate. And those surgeons recognize that Main Line Spine’s specialty as Physiatrists is to relieve back pain and restore function and mobility using treatments and therapies that don’t require major surgery.

But if you are considering back surgery, make sure that you are clear on what type of surgery is being recommended – and what it involves. Will discs be removed or vertebrae fused? Will hardware be implanted? Will you need a bone graft? How long will the surgery take, and what should you expect with recovery? Will you need rehabilitation, how long will your activities after surgery be restricted, and how long will you be out of work?

Make sure also that your surgeon explains to you exactly why he or she is recommending the specific surgery. How long will the expected results last and does having this surgery mean that you cannot undergo other types of treatments if the problem recurs? And will undergoing this surgery increase the likelihood of experiencing other kinds of back problems in the future?

Back Surgery Can Be Highly Successful

For patients with serious structural problems or disease, back operations can be highly successful. However, what’s important is that you exhaust your non- and minimally-invasive alternatives for pain relief first before opting for major back surgery.

In some cases, there is a phenomenon known as “Failed Back Surgery Syndrome” (FBSS). This medical term is a bit of a misnomer. It doesn’t necessarily mean that you or your surgeon have failed. It simply means that you have persistent back or neck pain after spine surgery. There are a variety of reasons and causes.

This may evidence itself immediately, or months after the surgery. Statistics can be difficult to come by, although a recent article published by Penn Medicine claims that “up to 40% of patients have experienced continued pain after surgery.”

Some patients can have surgery that feels great for 5 to 10 years – and then an adjacent area of the spine develops a new problem.

In all of these cases, the first step is to get a new diagnosis and figure out with your health care team what the underlying cause is as a starting point.

Recurrent Back Pain

Regardless of whether you have had back surgery or not, there are always new alternatives to try – both those that currently exist as well as those that are emerging from medical science. If you are experiencing recurrent back pain, don’t put off a discussion with appropriate specialists to determine the next step that you should consider to work toward back pain relief.

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John F. Kennedy’s back issues probably started at the age of 20 when playing football, but their exact cause is unknown.

He was rejected from both the Army and Navy during WWII because of his bad back. However, his father’s political connections enabled him to join the Navy.

While serving in the military, he faced a traumatic combat incident. Two of his crewmates tragically died in the event. He managed to save a crewmate, but this heroic act likely further injured his back.

President Kennedy presented a healthy and energetic appearance to the world. In reality, he was a man in constant pain.

An Era of Limited Back Treatments

Unfortunately, John F. Kennedy, our 35th President (commonly called JFK), lived in an era with limited medical options. These options were often experimental and extreme.

Due to his status, Kennedy had access to the best doctors and medical facilities available. Before becoming President, he underwent two major and two minor back surgeries that were advanced for the time. However, in hindsight, it’s possible they made his health problems worse.

John F. Kennedy gives a speech from the resolute desk in the White House. — President John F. Kennedy gives a speech at the resolute desk in the oval office.

Medication Mismanagement

Further complicating the situation, a physician named Max Jacobson was used to provide injections to ease Kennedy’s back pain. This doctor was known for his famous clientele and was popularly called ‘Dr. Feelgood’ and ‘Miracle Max.’

Dr. Jacobson treated the President with shots containing vitamins, hormones, and methamphetamines. The last ingredient was considered innocuous in the early 1960s. It wasn’t until later in the decade that many realized the medical usage of methamphetamines was hard to justify.

Fortunately for the President, he decided to look beyond pain medication for his lower back issues.

Restoring Mobility and Pain Relief from Physiatry

Dr. Hans Kraus, a physiatrist, was then sent to evaluate Kennedy in 1961. Kraus was a leading expert in the newly evolving fields of physiatry and sports medicine.

Dr. Kraus originated an approach for treating lower back pain that remains widely used today. He used it with President Kennedy as well as his other patients.

His concept started with an in-depth evaluation to guide a comprehensive rehabilitation program. This approach used trigger point injections very selectively. But the key for Kraus was to combine those injections with therapeutic exercises focused on flexibility. This was further coupled with strength exercises to rebuild muscle.

Kraus determined that Kennedy’s postural muscles were weak and stiff during his initial assessment. He also realized that the different regimens of Kennedy’s other doctors were working against what he was trying to achieve. He asserted complete control of all medical treatments for the President’s chronic back pain care.

This concept of orchestrating a patient’s treatment is a significant part of physiatry today. Physiatrist doctors frequently lead in coordinating individual patient treatment plans across multiple medical disciplines and providers beyond physiatry alone.

Dr. Kraus’ medical records reveal his success in treating Kennedy’s back pain. When we lost the President, this physiatry-oriented approach had nearly cured him.

Dr. Kraus’ Medical Legacy

Dr. Kraus attended medical school at the University of Vienna in the 1920s. This was a period of growing demand and higher quality standards for physicians and hospitals. Surgeons like Dr. Kraus were motivated to discover better treatments and therapies than the long-accepted status quo.

As Kraus built his early medical practice, he discovered a connection between the healing of fractures and exercise.

In the 1930s, Kraus authored a study of several hundred patients with wrist fractures and casts. He asked half the group to do a simple set of exercises that he developed. Some of these custom exercises were as basic as shrugging the shoulders.

Dr. Kraus then observed that the patients that did the exercises healed far faster than those who did not. These improvements with exercise were evident even with more severe injuries. Those insights established the foundation of his treatment philosophy that he followed for the rest of his life.

As Germany set its eyes on Austria in 1938, Kraus fled to New York with his family. He ended up at New York-Presbyterian Hospital in Manhattan, becoming a U.S. citizen in 1945. He continued his research at New York-Presbyterian, building on his understanding of the connection between exercise and health.

This all led him to become one of the pathfinders in developing the physical medicine and rehabilitation, and sports medicine medical specialties. His work on managing and avoiding musculoskeletal injuries continues significantly to impact the field of physiatry today.

An Epilogue on Dr. Kraus’ Treatment of President Kennedy

The severity of President Kennedy’s back pain and the impact on his life was significant. When he was out of view of cameras or the public, the President often used crutches to move around. His condition was a well-guarded secret.

Given that, how do we know about Dr. Kraus’ treatment of our 45th President? Ten years after Dr. Kraus’ death, his widow donated his White House medical records to the Kennedy Library. Two medical school physicians, T. Glenn Pait, MD, and Justin T. Dowdy, MD, reviewed those records in depth.

In 2017, they published their findings in a paper in the Journal of Neurosurgery. Details on that document and a link to download it can be found here:

Article Link: John F. Kennedy’s back: chronic pain, failed surgeries, and the story of its effects on his life and death.

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Almost everyone gets acute back pain from time to time. Maybe you did too much yard work, sat in a long car ride or were a little too enthusiastic in a pickup softball game. The end result – you get a backache or get some back pain.

That acute back pain may linger for a few days or few weeks. The good news is that kind of pain almost always goes away. You generally find things that get you by for that short period of time. It might be over-the-counter pain relievers, home remedies such as heat or ice, or maybe see a physical therapist or chiropractor to help you get through it.

A woman with lower back pain clutches her left back with her hand.

Chronic Back Pain

When you have chronic back pain however, you normally will seek out medical professionals. Chronic back pain is pain that just doesn’t go away. You’ve tried all your home remedies and maybe you’ve seen your family doctor a few times. But the pain continues to linger and persist.

Fortunately, there is an extensive range of treatments available ranging from conservative to more aggressive. Starting at the low end of this spectrum are alternatives such as physical therapy, medications, and injection-based treatments, to name a few. And at the top end of the spectrum is spine surgery.

However, what many back pain sufferers and medical professionals often miss are a growing number of pain relief alternatives that sit in the space between conservative treatments and major surgery. And among those alternatives are three classes of neuromodulation therapies: spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG), and peripheral nerve stimulation (PNS).

These are options that merit consideration when you want to avoid back surgery, or when back surgery has failed to provide the pain relief you are seeking. They also may be appropriate when you doctors haven’t been able to identify the specific musculoskeletal cause of your pain. We’ll take a brief look at each of them here.

Spinal Cord Stimulation (SCS)

A spinal cord stimulator is a medical device that delivers a set of mild electrical currents to disrupt pain signals traveling between the spinal cord and the brain. It is like a pacemaker for chronic pain.

It involves implanting a neurostimulator under the skin along with thin wires called leads. Together they provide pain relief by modifying pain messages before they reach your brain.

Before any permanent stimulator is implanted, a trial procedure is always used to help determine the likelihood that this therapy will work for a patient. This takes place over a 3 to 10 day period where an external stimulator mimics the treatment that would be delivered by the permanent implant.

The level of pain relief stimulation can be adjusted. Depending on the specific spinal cord stimulator, that adjustment can be done by the patient themselves according to when they need it throughout the day, or automatically with some newer technologies.

Both the trial and permanent implantation procedures are usually done on an outpatient basis. This device has over a 50-year track record of use, and in skilled hands, the serious complication rates are very low.

Dorsal Root Ganglion (DRG) Stimulation

Dorsal root ganglion stimulation is another outpatient neurostimulation therapy, similar to traditional spinal cord stimulation. However, rather than placing the electrodes over the spinal cord as in spinal cord stimulation, leads are implanted on the dorsal root ganglion, a cluster of neurons that represent the sensory gate of the spinal cord.

As sensory feedback moves to your brain, it first must pass through the dorsal root ganglion before entering the spinal cord. Thus, when those dorsal root ganglion neurons are properly stimulated, they can modify pain messages before they move to the spinal cord and other areas of the central nervous system.

Also, like spinal cord stimulation, dorsal root ganglion stimulation involves an initial trial to ensure the therapy is likely to be effective. Then the system is implanted under the skin during an outpatient procedure.

Dorsal root ganglion stimulation has number of advantages in appropriate situations. First, it can be targeted in a much more refined way than spinal cord stimulation and uses only 10 percent of the energy that spinal cord stimulation uses, leading to far longer battery life.

In addition, the leads are less likely to shift in comparison with spinal cord stimulation (although some surgeons are far better than others in how they anchor spinal cord stimulation leads to minimize slippage). And finally, given anatomical realities, patients receive the same pain relief whether laying down, standing, sitting, or walking – where the level of stimulation varies for spinal cord stimulation patients as they shift their position.

Peripheral Nerve Stimulation (PNS)

Peripheral nerve simulators work much like spinal cord simulators, except that we send the mild electrical currents directly to nerves outside of the spinal cord. Peripheral nerves run from your spinal cord to the limbs or organs in your body. Thus, if you have joint pain, a peripheral nerve stimulator would be localized directly at the joint where pain is being experienced.

Recently, a new generation of peripheral nerve stimulation devices has been developed. These new devices allow external pulse generators to transmit impulses wirelessly to the implanted electrode, and their implantation is significantly less invasive. Some devices and therapies are designed so that there is no permanent implantation necessary.

Chronic Back Pain Relief Alternatives at Main Line Spine

Main Line Spine’s team includes some of the nation’s leading experts in spinal cord stimulation, dorsal root ganglion stimulation and peripheral nerve stimulation medical technologies. These treatments, when combined with our multifaceted and compassionate care, deliver a high level of pain relief for our patients.

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Losing weight is a challenge. But not losing those extra pounds you are carrying around can have a severe negative long-term impact on your joints and musculoskeletal system.

Excess weight and obesity are linked to heart disease, stroke, some cancers, diabetes, high blood pressure, gallbladder disease, and osteoarthritis. Unhealthy weight stresses almost every organ in the body, so it is no surprise that it also increases the risk for back pain, joint pain, and muscle strain.

This issue is widespread. According to the CDC, more than 73% of all U.S. adults over the age of 20 are overweight or obese. This leads to back, neck, and joint issues that are significantly impacting the quality of their lives.

What impacts are we talking about?

Neck and Back Pain

If your weight slips into an unhealthy range, your chance of degenerative disc disease increases by 30 to 79 percent.

Every extra pound pulls your pelvis forward, adding strain to back muscles and ligaments. Discs adjust for that excess weight, and they can become herniated in the process of doing so. In turn, this damage can compress the spaces between the bones in the spine, causing pinched nerves and piriformis syndrome, where muscle spasms cause pain and sciatic nerve irritation.

If you have arthritis, extra weight can aggravate this condition and trigger the onset of osteoarthritis. Excess body fat also stimulates the production of chemicals that contribute to joint damage.

Joint Pain

Are you aware that the stress on your knees is 1.5 times your body weight when you walk on a flat surface? So, if you weigh 160 pounds, your knees experience stress that feels more like 240 pounds. When you are walking up an incline, your knees’ stress increases to 3 to 4 times your weight. So the knees of a 160-pound person can feel as much as 640 pounds of pressure.

If you are 20 pounds overweight, you are taxing your knees with up to 80 pounds of extra stress and strain. This additional weight on your knee may lead to pain or an injury. And there are similar excess weight impacts on your other joints, particularly with your spine and hips.

Studies have shown that losing just 10 percent of our body weight can make a significant difference. Following a diet and exercise program can reduce pain, improve joint function and lead to less arthritic inflammation.

Your Goal Weight Based on the Body Mass Index

How much should you weigh? The most common tool to evaluate proper weight is the body mass index (BMI). It is a number calculated from an individual’s height and weight. In most people, it represents a relative measure of body fat, although in some cases it may be inaccurate. It tends to overestimate body fat in individuals who are more muscular than the norm.

The BMI that you should target for yourself should be determined in a conversation with your healthcare provider.

BMI is classified as follows:

BMI under 18.5 is underweight.
BMI 18.5 to 24.9 is typically healthy weight.
BMI 25.0 to 29.9 may indicate overweight status.
BMI 30.0 to 39.9 may indicate obesity.

You can calculate your BMI by referring to the chart below, or using the Body Mass Calculator provided by the National Heart, Lung, and Blood Institute, found at the link HERE.

Tanita weight, body fat & body water scale.

Set Diet and Exercise Goals that Will Work for You

Some of us love exercise, others of us hate it. Regardless of your own preferences, the bottom line is that exercise and physical activity are good for you. Study after study show that individuals who exercise regularly not only live longer, they live better.

If you can’t do a vigorous exercise program, just doing everyday physical activities can provide positive impact. Gardening, walking the dog, or taking the stairs instead of an elevator are a good start. And it will help you stave off some diseases and disabilities that often occur with aging.

Studies now even suggest that people who begin exercise training in later life, such as in their 60s and 70s, can build their physical strength and also experience improved heart function.

Controlling your weight can be a more complex problem. Food selection can both have an impact on packing on pounds, as well as how you age. Don’t skip breakfast. Eat a balanced morning meal that includes protein, fat, and carbs that will give you the energy you need for your day.

It’s best to talk to your doctor before starting any diet to get their guidance. But after you do, consider eating small meals with a few snacks in between, or consider fasting. Eat until you are no longer hungry, but not until you’re full. Exercise daily, even if it is only in moderation. And be wary of eating when you are stressed or starved for comfort – emotionally motivated eating can ruin any diet.

Strive for a Lower BMI – and Fewer Medical Visits

Excess weight and lack of exercise can lead to spinal disorders and neck, back, or joint problems. Specialized care is available when that happens – but it is better that you try to avoid these issues if you can.

At Main Line Spine’s practice, we see many musculoskeletal issues and pain problems daily that are the result of BMIs in the overweight range and above. By taking control of your weight, you’ll enjoy far fewer medical visits and a happier life.

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There are many potential causes of an aching back. They may be the result of an accident or due to a sports-related injury. They may originate congenitally from conditions such as scoliosis. But in most cases, upper or lower back pain develops through what we do in our day-to-day lives.

How we take care of ourselves, through exercise and a healthy weight, is important. But improving your posture can have a major impact on prevention.

The Importance of Good Posture

Posture is how you hold your body while standing, sitting, or performing tasks like lifting, bending, pulling, or reaching.

From your earliest memories, Mom told you to sit up straight. If you spend hours in your day working at a computer, and you sit with a bad posture, you are putting excess stress and strain on your spine, joints, muscles, and ligaments. But if you sit up straight, you are putting your spine and body in proper alignment, avoiding that excessive stress and strain.

Improving Your Posture

How do you change your bad habits to fix this problem? Here are a few suggestions:

Sitting at a Desk

When you sit at your desk at work, hold your shoulders and arms at a 90-degree angle. Position your monitor straight ahead at eye level – don’t place it where you have to look downward to see it.

Image emphasizing office worker's skeletal system as they sit at a desk working with a computer screen

A 2014 study by Kenneth K. Hansraj, a spine and orthopedic surgeon in Poughkeepsie, NY, reviewed the problem of continually looking down at your phone or tablet. Dr. Hansaj found that when you hold your head in line with your shoulders, it only weighs about 10 pounds. “But for every inch that you tilt it forward, the amount of weight it places on your spine nearly doubles.”

Sit up with your back straight and your shoulders back. Your buttocks should touch the back of your chair.

Move Around As Much As You Can

A 2017 study in the Annals of Internal Medicine concluded that not only is moving around frequently important to help alleviate back pain, but failure to do so was linked to a higher risk of early mortality.

The study’s results suggest that moving every 30 minutes can keep some of the negative effects of a more sedentary lifestyle in control. As Philadelphia Magazine noted, now “you have perfectly acceptable health-related excuse to take more breaks.”

Exercises

Shoulder blade squeeze. Sit up straight in a chair with your hands resting on your thighs. Keep your shoulders down and your chin level. Slowly draw your shoulders back and squeeze your shoulder blades together. Hold for a count of five; relax. Repeat three or four times.
Upper-body stretch. Stand facing a corner with your arms raised, hands flat against the walls, elbows at shoulder height. Place one foot ahead of the other. Bending your forward knee, exhale as you lean your body toward the corner. Keep your back straight and your chest and head up. You should feel a nice stretch across your chest. Hold this position for 20-30 seconds. Relax.
Arm-across-chest stretch. Raise your right arm to shoulder level in front of you and bend the arm at the elbow, keeping the forearm parallel to the floor. Grasp the right elbow with your left hand and gently pull it across your chest so that you feel a stretch in the upper arm and shoulder on the right side. Hold for 20 seconds; relax both arms. Repeat to the other side. Repeat three times on each side.

Work to Make It a Habit

Sitting with good posture can feel unnatural at first if you have been avoiding it for years. It may take some time to get used to, but don’t let that stop you from getting back on the right track.

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KING OF PRUSSIA, PA – Dr. Jeffery Rowe of Main Line Spine recently completed the first Minuteman® G3 procedure in Pennsylvania. The Minuteman® G3 was developed by Spinal Simplicity LLC as an innovative, minimally invasive, simple solution to treat complex spinal disorders.

Dr. Jeffrey Rowe, MD (center) stands between two colleagues after completing the first Spinal Simplicity G3 procedure in Pennsylvania.

The device is intended for the temporary fixation of the thoracic, lumbar and sacral spine while awaiting bony fusion to occur. It is designed for attachment to the posterior non-cervical spine at the spinous processes through its bilateral locking plates. It is intended for use with bone graft material placed within the device.

The Minuteman® G3 is indicated to treat patients with Degenerative Disc Disease, Lumbar Spinal Stenosis, and Spondylolisthesis. Generally, patients who could be eligible for Minuteman have not found lasting relief with conservative therapies like Physical Therapy, Epidural Steroid Injections, Medial Branch Blocks, and Radio Frequency Ablations.

Dr. Rowe views the Minuteman as one of the options he now considers to treat his patients’ back and leg pain.

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