Back & Neck Pain: Surgery Not Needed
Neck and back pain are some of the most common conditions for which patients seek out medical care. It is estimated that 8 out of 10 Americans will have at least one significant episode of back or neck pain in their life. For many, this can be a recurrent or persistent problem. Fortunately over 90% of the cases can be treated without surgery or other invasive procedures. The most common underlying cause for back pain is poor body conditioning. With our sedentary life styles, it is no wonder that we become deconditioned. Even persons who exercise regularly are prone to developing back or neck pain problems. Without doing specific back and neck stretching and strengthening exercises, we are setting ourselves up to have back pain. Something as simple as bending over to tie a shoe, reaching up in the cupboard or even sneezing can trigger an acute back pain episode. Neck pain is frequently caused by “sleeping wrong at night”, sleeping on a plane or just straining the neck when lifting or playing sports. All of these variations of neck and back pain have as a cause, muscle, tendon and ligament strain. Particularly in the back, individuals will have gradual tightening of the back and hip muscles and not even feel it. Then, when a “minor event” such as coughing occurs, these already tight muscles go into sudden spasm which then is felt as pain. With the acute spasm, patients can have trouble turning their head, bending over, walking and sleeping. Fortunately most of these conditions can be treated without surgery, invasive procedures or even MRI scanning.
In the vast majority of patients, a careful history and detailed physical exam is the basis for developing a treatment plan. Most patients show significant back and/or neck muscle spasm with tenderness. Some patients can have exquisite tenderness in the sacroiliac joint – where the tail bone meets the hip bone. The rest of their neurological exam is usually normal. In these individuals having a CT or MRI scan of the neck or back is not a necessary part of the initial treatment plan. A specifically designed course of hands on physical therapy combined with neuromuscular therapy in combination with self administered neck and back stretching and strengthening exercises will result in favorable outcomes the majority of the time. Sometimes anti-inflammatory medications or muscle relaxants can be of benefit. Narcotics should be avoided as they are habit-forming and do nothing to clear up the pain. In very specific cases, limited use of nerve blocks in the sacroiliac area or lower neck may be helpful. Epidural steroids, for the most part, are not particularly helpful and carry significant complication risks with them; particularly in the neck. For patients that do go on to have MRI studies, it is not uncommon to finding xray abnormalities but these do not necessarily explain the pain that that individual is experiencing. The important message is that the MRI findings must correlate exactly with the patient’s symptoms and neurological exam to have clinical significance. MRI studies of normal individuals without back pain have been done. The results have shown that approximately 38% of these MRI scans showed abnormalities and yet the patients had no symptoms. The conclusion is that just because the MRI scan shows “something”, it does not necessarily mean that that is the cause of your pain.
With careful management and patient cooperation to do the exercises most patients have significant relief with subsequent clearing of their pain within 4-6 weeks. It is then important that patients continue to do their neck and back exercises on a regular basis, as part of their daily exercise routine. With doing this back surgery or neck surgery can almost always be avoided. The most important step in getting better is to seek out care from a knowledgeable, medical physician such as a neurologist or physiatrist who specializes in the non-surgical treatment of neck and back conditions. More information on back disorders can be found at my website or at Spine Universe.