How to Heal Your Back Problem Top Specialist on How to Fix and Protect a Painful Back

We shell out billions of dollars a year in search of back pain relief. But which treatments are worth the money? In this exclusive interview, a top orthopedic surgeon and sports medicine specialist explains what to do when you’re laid low by a painful back, and how to keep your spine healthy the rest of the time... Muscle and joint complaints have surpassed the common cold as the leading reason for doctor visits, and lower back problems lead the charge. An astonishing 80% of Americans are walloped off their feet with back trouble at some point in their lives, says Nicholas DiNubile, M.D., an orthopedic surgeon in Havertown, Penn., who specializes in sports medicine. In his best-selling book FrameWork (Rodale Books), DiNubile explains how to safely start, maintain and build a lifestyle and exercise program to boost muscle, bone and joint health. A follow-up book, FrameWork for the Lower Back, provides common-sense advice for preventing and treating disk problems, sciatica, and other conditions that leave us with stiff, achy backs. If you’ve ever had back pain, it’s especially important to practice healthful habits, he says. Even a brief back episode can put you at risk for trouble later. “The No. 1 predictor of a [future] back problem is a previous back problem,” he says. “It’s like a warning shot.” DiNubile should know. Not only has he worked as an orthopedic consultant to the Philadelphia 76ers pro basketball team and Pennsylvania Ballet, but he’s also had his own longstanding back issues. In this edited Lifescript interview, he shatters myths about bed rest, back surgery and medical imaging techniques, and explains safe ways to stay active when you’ve literally been knocked flat on your back. How did your back problem start? I had a friend, [and] we used to clown around every year on the beach. He’d come find me, and tackle me just to say hi, and we’d laugh it off. But one year, he came from behind and just hyper-extended my back in a way it was never meant to move. I wound up on all fours and had a hard time standing up. That was the beginning of some big struggles. How did you deal with your back problem? For a while, I put up and just tried to work around it. And there are plenty of days now when I have tightness and aches, and I suck it up and carry on. You’re a surgeon – did you consider surgery for your back problem? No. I knew there wasn’t a surgical option that would apply. The majority of back problems don’t require surgery. There’s probably way too much back surgery in this country. What finally helped you? A combination of things. I changed my mattress to one that was more accommodating, with a layer of memory foam on top. And I modified my exercise routine to put the focus on core workouts. But what really helped me was a chiropractor. How did that help? For 12 years, I was the doctor for the 76ers, and we had an excellent chiropractor. At games, when the players were on the court, I would have him work on me. Because of the injury, my back is vulnerable and tightens up. He’d mobilize the affected [muscles] and get them functioning. I’d use the opportunity to do my own work on my back problems, especially core strengthening and stretching. Many people who never suffered a traumatic injury wind up with a chronic back problem and pain. Why? You don’t have to get tackled by a maniac. The spine is pretty vulnerable, and little things can get to you. People hurt themselves bending over to tie a shoe. I tell people to watch their BLT’s – bending, lifting and twisting. What are other common triggers of back problems? Sitting too much. People think it relieves stress, but it puts heavy force on the spine. Poor aerobic condition also makes you more vulnerable. Muscles need oxygen, and disks and ligaments need a good blood supply to stay healthy. That’s one reason smoking is damaging to your entire frame, especially the spine. Being overweight [can also cause a back problem]. The more your frame has to support, the harder it works and the more susceptible to injury it becomes. Are women at higher risk for a painful back? Pregnancy definitely takes a toll. Postural changes put pressure on the spine. Ob-gyns say once you deliver it will go away. Well, sometimes it does, but [it can leave them] more vulnerable [to future back problems]. Plus, now they have kids to take care of. They’re bending and lifting all the time. It’s a breeding ground for back pain. What role does stress play with back trouble? It’s like putting lighter fluid on a fire. It might not cause back pain, but it certainly keeps it going. How does aging affect our backs? Gray hairs and wrinkled skin aren’t the only consequences of getting older. There are musculoskeletal changes – cellular, chemical and mechanical. Even if you don’t have a painful back, if you take an MRI you’ll probably see disk degeneration and some arthritis. What does disk degeneration look like? The disk is like a little jelly donut between each of your vertebrae. It keeps the bones from rubbing against each other. When you’re young, they’re bright and water-filled. With age, they start darkening and shrinking. It’s like grapes turning into raisins. They’re accidents waiting to happen. We’re the first generation to try to stay active all our lives, and we’re living longer. We’re pushing our bodies. So there’s an explosion of musculoskeletal problems. There’s a mismatch between longevity and durability. We weren’t designed to go as long as we’re going. Does that mean a back problem is inevitable? Changes in the body are inevitable, but problems aren’t. You can rebuild muscle at any age. Studies involving 90-year-olds found that after a 12-week strength-building program, strength improved dramatically. Those who had used walkers were able to get around with canes, and those who had used canes walked without them. What activities are best for back health? Being more fit aerobically protects against back pain. There was a famous study of firefighters on disability claims. The people who had the worst aerobic fitness were most likely to miss work from lower back problems. How does heart and lung fitness help your back? We’re not sure. It probably helps with microcirculation, the blood supply that nourishes the nooks and crannies of your musculoskeletal system. And it keeps your weight down. But cardiovascular fitness by itself it isn’t enough. What else can help prevent a back problem? Core strength is really important. That’s not just six-pack abs. It’s your back muscles, obliques [the muscles on the sides of your abdomen], the back extenders and the muscles of the pelvis. They’re the support structure around the spine. I recommend a routine that works out all of these muscles. The exercises should be done every other day. Many “core” exercises you recommend are based on yoga – for example, the cobra and cat poses. How does yoga prevent or relieve a back problem? Yoga is great for back strength, enhanced flexibility and learning to relax. Many people are competitive about exercise. They’re out there playing hard, trying to outdo everyone else. The nice thing about yoga is it’s not a competition. What other fitness disciplines do you like for backs? A lot of the martial arts, especially the soft styles like tai chi, are great for posture and strength. What are back-friendly options for an aerobic workout? Walking. Swimming is fantastic, even if you have an acute back episode or just a run-of-the-mill chronic backache. If you’re not a swimmer, or your lower back is just too sore for you to swim, try water walking, water jogging or even water aerobics. The water supports your body, and it’s a comforting environment if you have a painful back or back spasms. You can do things that might be too uncomfortable on land, with gravity working against you. Any nutritional advice to promote back health? Vitamin D deficiency is a much bigger deal than we thought. Some studies have linked it with back pain. I make sure all my patients, men and women, [get] enough vitamin D3 [the more absorbable form] and calcium. When people have really bad back pain, shouldn’t they just rest? The old days of bed rest are over. We usually suggest a day or two off your feet, if you need that, to get into positions that are more comfortable. After that, it’s counterproductive. Why? Motion is lotion! I see a lot of people who are on disability for life – they have sedentary jobs, they’re not digging or building things or using their backs for work. If you’re staying home, hooked on soap operas and taking pain medication, you’re not getting better. If all you can do is get in a pool and move around a little, you should do that. But people often worry that movement will aggravate the problem. You need to learn the difference between hurt and harm. Many lower back problems are so painful that people get frightened and assume that movement will harm them. It’s not true. If you can deal with the hurt and work around it, you [won’t] harm yourself or make things worse. Should you get a magnetic resonance imaging [MRI] scan to figure out what’s wrong? You probably don’t need one. I had an X-ray after I was tackled, but I’ve never had an MRI. I knew it wouldn’t change my treatment. Still, spine MRIs can be very helpful in cases of [severe,] chronic back pain or if there’s significant leg weakness or numbness. It’s best to talk to your doctor. Should people take painkillers for back pain? Narcotics can help in the very short term, but they can lead to secondary problems like addiction. I’ll reluctantly prescribe them for a few days if patients need them to get comfortable and move around. I prefer the over-the-counter pain meds such as NSAIDS [non-steroidal anti-inflammatory drugs, including Advil and Aleve] for short-term use. But [drugs] won’t solve a back problem. Is massage helpful? I’m a big fan of massage for pain relief. But it [won’t] cure anything – you shouldn’t rely only on passive modalities, in which someone else does all the work. If you get some relief from it, you should use that period of improvement to do things [that] make yourself better. What are those things? It’s a lifestyle change and an attitude. You have to create new habits and stay active. You have to have the right mindset. I can tell when I walk into [an examining] room [that] if the patient is stressed out or negative, it’s going to be impossible to get them out of their back pain. Remember, you are part of the solution to any health problem you face. For more expert advice and information, visit our Chronic Pain Health Center.