Relieving Lower Back Pain with Dr. Fredrick P. Wilson

Podcast Transcript

Speaker 1:

There's so much health advice out there, lots of different voices and opinions, but who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough intimate health question so you get the answers you need. This is the Health Essentials Podcast brought to you by Cleveland Clinic and Cleveland Clinic Children's. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Kate Kaput:

Hi, and thank you for joining us for this episode of the Health Essentials Podcast. I'm Kate Kaput, and I'll be your host. Today, we're talking to osteopathic medical specialist, Dr. Frederick P. Wilson, about lower back pain. Back pain is the second most common reason that people visit their family doctors. And in fact, it's estimated that a whopping 80% to 90% of Americans will suffer from back pain at some point during their lives. So, what can we do about it? Dr. Wilson is the director of the Cleveland Clinic Solon Center for Spine Health and he's here with us today to talk about what causes lower back pain and how to both manage it and prevent it. Dr. Wilson, thanks so much for being here with us today.

Dr. Frederick P. Wilson:

My pleasure being here, Kate.

Kate Kaput:

Dr. Wilson, I know that this is not your first time here on the pod, but for those who might have missed our last conversation with you, can you tell us a little bit about what kind of work you do here at Cleveland Clinic and what kind of patients you typically see?

Dr. Frederick P. Wilson:

So I'm involved in the medical spine part of the clinic. We're part of the Neuro Institute. So being part of medical spine, we see patients with back and neck pain or things that could be related to back and neck pain, and we triage it and we treat conservatively, and that might involve sending people to physical therapy or if it's really acute and necessary, even to the surgeon right away. But our job is to be the first ones basically seeing people with usually chronic neck and back pain, but we see our share of acute as well.

Kate Kaput:

Got it. And so last time we talked, we spoke about upper back and neck pain. Today, we're going to talk about lower back pain. So, tell us a little bit about the basics of lower back pain. What's the difference, as you just mentioned, between acute back pain and chronic back pain, particularly in this part of the body?

Dr. Frederick P. Wilson:

Well, it's just a matter of timing really. So, acute back pain is back pain that's been lasting up to six weeks, and if it's from six to 12 weeks, it's considered subacute, and anything over 12 weeks is considered chronic back pain. So, most back pain is acute because most back pain tends to be strains and sprains and that sort of thing. And that generally will last days to maybe a couple of weeks and usually then it resolves itself.

Kate Kaput:

And so how often does subacute lower back pain become chronic back pain? How common is that escalation?

Dr. Frederick P. Wilson:

Well, I don't know exact percentages on that and we're kind of skewed because we don't see most of the acute back pain. Generally, it's seen by their family doctor or maybe emergency room or urgent care or something like that. So, if it's a fairly simple strain or sprain, we probably will never see them, but there are those who do go to the ER and then they're referred to us after they've been seen in an ER facility.

Kate Kaput:

So, what are some of the typical causes of lower back pain? What are some of the things that bring about this type of pain in the body?

Dr. Frederick P. Wilson:

So, besides the back sprain and strain we talked about, which could be from working too hard in the yard or playing football on a weekend or basketball and tweaking your back, something like that, herniated disks are not uncommon. They peak at age 40 generally, so it's an adult population. I've seen teenagers as well, but they typically are the 17- to 18-year-old football players who are lifting weights probably too much and they overdo it and they can herniate a disk. And it can also happen in older people, too, but typically it's the 40-year-old on average.

              Besides that, there are several conditions that can cause back pain. Spondylolisthesis is a forward slippage of one bone on another. But that could be a younger population 20 to 80 quite honestly. Besides that, there are some less common compression fractures, which are not uncommon in old geriatric population, are certainly less common in young adults. And muscle spasms are another very frequent thing that can really cause someone to be unable to move for a few days. So it's across the board.

Kate Kaput:

So, you mentioned herniated disks. Can you explain really quickly what that means because I think that's a term that a lot of us hear and don't actually really know what it refers to?

Dr. Frederick P. Wilson:

A lot of people call it a slip disk or herniated disk. So, a disk is outer shell, fibro shell. Inside that shell is jelly, kind of like a jelly donut. And when we are very young, it's mostly water, it's like 90% water, but as we get older the water dries in that disk. But in a younger person who herniates a disk, that fibro shell tears and that jelly can extrude onto that hole into the spinal canal and it can pinch a nerve or it even has enzymes in it that are caustic to the nerve, so it can irritate the nerve that way. And when that nerve is irritated, you have pain along that nerve, usually down the leg. And if it's enough pressure for enough time, it can cause weakness in the muscles that nerve goes to as well.

Kate Kaput:

That jelly donut analogy is quite the visual to imagine, but I think that's very helpful. What about poor posture or sitting or standing for long periods of time?

Dr. Frederick P. Wilson:

Posture is another big one. We see that a lot in upper back and neck pain, but we see it in low back pain as well. Most people these days are not sitting the way they should. They tend to lean forward over their computer. Their computers are generally lower than they should be. So again, if your neck or if your head isn't over your upper body, it puts things out of balance. And so the rest of your back extensors [muscles] are trying to keep you from falling over. So, you can overdo your back.

              If you're sitting long periods of time, especially if you're vibrating like a bus driver, a truck driver, that actually can increase the risk of herniated disk. A vibration is hard on the disks. So, we need to try to sit with good posture to use our muscles to reduce the risk of problems.

Kate Kaput:

Now, given all of the different causes that this kind of pain can have, I'm going to guess that your answer to the next question is, that this is a pretty broad question that I'm about to ask you. But what are some of the different types of pain that people might experience in this part of their body, which is to say, what does the pain feel like? Is it aching? Is it sharp pains? What might you experience when it comes to lower back pain?

Dr. Frederick P. Wilson:

I probably hear aching because we ask all the patients that when we see them because different descriptions can mean different things, but probably what I hear 50% of the time or more is aching. But if they have spasms, they could have cramping in their lower back. If they have a herniated disk that's pressing on a nerve, they can say it feels burning or even electric going down into the buttock and down the leg. Stabbing, we hear frequently enough. So, all sorts, but probably aching is the most common.

Kate Kaput:

And so is there any way to differentiate for yourself kind of before you see a doctor, is there any way to know whether you're experiencing short term pain that's likely to resolve or if you're experiencing something that's more serious?

Dr. Frederick P. Wilson:

Well, I would say it kind of depends on what caused the pain. I mean, if you're working in the yard or playing basketball and you strain your back, odds are, it's a strain, it's going to last a few days, cold packs 20 minutes every two hours, and ibuprofen or Aleve®, something like that, and it ought to fade away. But if you're getting pain that's shooting down the leg and it's really quite excruciating and you can hardly walk, well, that is likely more significant and it may be time to see somebody.

Kate Kaput:

That makes sense. What role, if any, do stress and anxiety play in lower back pain?

Dr. Frederick P. Wilson:

I see stress and anxiety more in upper back pain because when people are stressed, they tend to have their shoulders lifted up. And when they're lifting their shoulders, it's their muscles and their back doing that. So those muscles fatigue and get sore and tight and you can actually feel those muscles be very tight like a tight rubber band. Less so in the back, but maybe a little bit more tightness. But when I see people who tend to have really tight muscles, it tends to be upper back.

              You see that a lot in fibromyalgia as well. Let's say a condition of kind of widespread myofascial pain. And typically, where I see the pain the most is in the neck and the upper back. And a lot of these people really are anxious or stressed. And so, again, it's seen more from kind of the mid back up.

Kate Kaput:

Got it. So, you started to go into this a little bit in terms of if you injure yourself playing basketball or something, let's say you wake up on the wrong side of the bed, or maybe you tweak something while you're working out, or you sneeze and you kind of feel that weird tweak. What is the first line of defense for this kind of pain kind of when you know where it came from? When something happened, now you've got a pain. What can you do about it to start?

Dr. Frederick P. Wilson:

Well, probably if you think it's nothing serious, again, we usually go cold for the first three to five days and cold being, you wrap some ice cubes in a Ziploc® bag and maybe you throw a towel around it. Apply that ice right to the tender spot for about 20 minutes at a time every two hours, again, for the first three to five days. And I do think that maybe Aleve®, Advil®, something like that would be helpful as well. And as far as activity, we don't want people just laying down for two days, because then you're putting your risk from blood clots, that sort of thing. So, we tend to tell people to do activity as tolerated.

              If you have to move around slowly, OK, move around slowly. Maybe you don't have to go into the office. These days, many of us have to go to the office, most of us. So, kind of take it easy, do what your body will tell you is OK. And give it a few days. And if you're not getting better, then again, time to call your primary.

Kate Kaput:F

So, maybe don't start playing a full game of basketball again, but do try to kind of keep yourself moving.

Dr. Frederick P. Wilson:

No, don't go out and try to be the hero of the game.

Kate Kaput:

Right. You mentioned that cold is recommended. Can you speak to cold over heat? Why is heat not recommended in cases like this?

Dr. Frederick P. Wilson:

Heat is better for chronic pain. So again, chronic spasm, heat is good for. Chronic injuries like a tendonitis or a bursitis actually are overuse injuries and so they're more chronic and heat does well with those. But for muscle spasm, cold is actually better. If you put heat on your spasming muscle, actually it'll feel good while you're doing it. But when you take that heat away, the muscles actually come back and maybe even worse, there's a rebound effect. But if you use cold, you don't have that rebound effect and it'll feel quite soothing.

Kate Kaput:

And what about those kind of over-the-counter patches that you sometimes see for back pain?

Dr. Frederick P. Wilson:

The ones I usually recommend for patients are the ones that have the lidocaine in them. Lidocaine of course is the same as Novocaine® and so it can help numb some of the nerves that are just underneath the skin. There are other brands of patches that have other kinds of ingredients, but as long as they include the lidocaine, they're all fine with me. And heat, if you have kind of this warm patch on there. Again, heat for chronic is good, but if you had acute pain, I would actually avoid a heat patch or a patch that's heated.

Kate Kaput:

So, let's talk a little bit then about some of that chronic pain. Having lower back pain can interfere with all kinds of everyday activities like sitting and driving and sleeping. And so I'd like to talk about sleep in particular to start, since that's a pretty big one. How can people with lower back pain find relief so that they can get a good night's sleep?

Dr. Frederick P. Wilson:

I tell people to listen to their body because different problems do better in certain positions. Like if you have arthritis in your joints, your body won't want to lay on your back because you're actually in extension. When you're in extension, you're putting more pressure on those joints, it's going to hurt. People who have arthritis tend to want to lay on their sides and maybe put a pillow between their knees.

              People who have a herniated disk actually might prefer sleeping on their back because extension is good for a herniated disk. If that disk is coming out towards the spine and you put yourself in extension, you're pushing that jelly back from where it came from. So then, the disk actually feels better that way, its exercises, or extension. I have even some people who want to sleep on their stomachs, because you're really in extension when you're sleeping on your stomach and so that feels best to them. But more often than not, laying on your back or on your sides is relatively comfortable.

Kate Kaput:

So, that was actually going to be one of my questions. I've read that it's bad to sleep on your stomach if you have lower back pain, that it can make it worse. But is it like you said, if it feels good for you, then it's worth trying?

Dr. Frederick P. Wilson:

I tell people listen to what your body's telling you. If it's hurting, lay on your stomach, don't lay on your stomach. If it's hurting lay on your back, don't lay on your back, lay on your side. So, try to find what your body tells you. And we often use those clues to diagnose the pain, because your body gives you a lot of information, what makes it better, what makes it worse. So, when we talk to patients about that, we say, "What position do you sleep in bed these days? Does the pain wake you out of your sleep? And is there a position that you have to assume then to make it go away?" Things like that. So, it can be very informative.

Kate Kaput:

And what about the actual tools of sleep? Is there any common wisdom around a soft mattress versus a firm mattress, a fluffy pillow versus a firm pillow, anything like that?

Dr. Frederick P. Wilson:

I usually recommend firm over soft as far as mattresses. And as far as pillows, I tell people you want your head to be not higher or lower, but more even. So, either one firm pillow or two kind of softer pillows.

Kate Kaput:

Got it. So you can kind of choose which one you like there. If you like soft pillows, there's still an option for you. So, OK, let's discuss some things like sitting and driving, which again, if you have chronic lower back pain, can be really excruciating at a certain point. Is there any way to ease that pain and make these kind of activities more comfortable?

Dr. Frederick P. Wilson:

Well, if you have a herniated disk, generally the worst position for you is sitting. Again, if you've got a disk and it's pushing out this way and you're sitting, you're in a flex position. So, you're actually pushing that jelly back where the nerves are. So, your worst pain is sitting. So, people are squirming in their seat if they're driving, and especially if they have leg pain, and then they have to reach out for their gas pedal or their brake, they're pulling on that nerve and that just makes it hurt even more.

              But people with arthritis tell me, "I can sit for six to eight hours without getting out of the car and be fine. It's getting out the car that bothers me." Because once they stand up now they're putting their pressure back on their joints and that's when they start having their arthritis pain again. And spasms, though, too, typically are worse in a forward flexed or sitting position. And they're better when you're laying down or flat because now you've got all those muscles kind of pulled straight, not allowed to cramp. So again, it kind of depends on what the problem is.

Kate Kaput:

If you are a person who has back pain while sitting, are there things that you can do to lessen that pain, those kind of pillows that you sit on while you're driving, do you just make frequent stops to get out and walk around? Is there anything in particular that you recommend?

Dr. Frederick P. Wilson:

Well, I do tell them that I say get yourself maybe a big towel, roll it up, you could even put tape on it, pardon me, and put that behind the small of your back. So what's that doing? Again, it's keeping your back out of a flexed position. It's putting it into an extended position and that's going to push that jelly forward. It's better for your muscles as well because you keep those muscles more stretched out, not allowing them to cramp and cause back pain that way.

              So the towel is good. I tell them also that they need to drive like their grandmother. So, that means that you have to sit closer to the wheel, hold on with both hands and try to keep your shoulders back, but take it nice and slow and be close to the wheel rather than kind of laying back and reclining in your driver's seat.

Kate Kaput:

Really hands at 10 and two. This is good news for me by the way because I already drive like somebody's grandmother. So, what if you're one of the people like you mentioned, somebody with arthritis who doesn't have trouble sitting, but who has trouble kind of getting out of that sitting position. Any specific recommendations there to ease that transition?

Dr. Frederick P. Wilson:

Well, these people also have pain when they get out of bed. The same thing. They're putting their weight on their joints all of a sudden. So, I tell them when they're in bed to do flexion knee-to-the-chest exercises and then they'll be better when they get up. Hard to do those when they're in a car driving. But I tell them to get their legs out of the car and try to pull themselves out holding onto the door or the car and taking it slow and getting up slow. And if they're not doing it quickly, it's going to hurt less.

Kate Kaput:

So, a real slow and steady wins the race there.

Dr. Frederick P. Wilson:

Slow and steady.

Kate Kaput:

I remember that the last time we spoke when we were talking about upper back pain, I asked you about standing desks and you said those are actually better for people with lower back pain. So, if you typically have a sitting all day kind of desk job, how can a standing desk help or not?

Dr. Frederick P. Wilson:

Again, with a herniated disk, and you think of businessmen who are really putting in the hours at the desk, they're going to be 40-years-old, give or take, 40, 45, and that's the age of the disk problem. So, if it's a disk pain they're having, sitting, flexing makes it worse. So they prefer actually standing. So if you get the desk to a higher level so they can stand, then they can kind of throw their shoulders back, put themselves into extension, and it actually is more comfortable.

              When I walk into a room of someone who's got a herniated disk they're not sitting, they're actually pacing in the room because they're better when they're standing and they're walking. It just hurts too much to sit. So, a sit-to-stand desk, they can frequently change positions and work for a longer period of time.

Kate Kaput:

Got it. So again, it really depends on what your specific pain is from. So, let's say that you're experiencing lower back pain. When should you see a doctor and what kind of doctor might you want to start out with?

Dr. Frederick P. Wilson:

I tell people generally to start with their family doctor. I mean, like you were saying at the beginning of the show, 80% to 90% of people will have back pain. So, that means your primary doctor sees it all the time. So, he will have some idea of what to do. And generally, we don't need to do much of anything depending on what caused it. If it's a fall or something like that or trauma, that's another thing. But if it was just a little bit of a tweak, I'd start with the primary and he can tell you about the cold packs, maybe the patches. Perhaps they'll give you a muscle relaxant, tell you to use Aleve® or Advil®.

              I would say if the pain is severe and you can't get into your family doctor, OK, it might be time for urgent care or X-ray because they could do an X-ray right then and there and get you on a quicker plan of treatment. So, it kind of depends on how bad is it. If it's shooting down your legs, that usually is worse. If the pain is just so excruciating, you can't move, maybe it's time to call 911. So, I've had at a lot of patients, even with muscle spasm, where they were so bad, they couldn't get off the floor and they had to call the ambulance to take them to the ER. But once they were in the ER, no big deal. X-rays are good. They're sent home with some medications.

              So, generally you're looking to see is it so severe that you can't stand it? Is it going down one or either leg? Is there any weakness? Certainly if there's any issues with leakage of bowel or bladder or numbness in what they call the saddle anesthesia, the parts of your body that would sit on a saddle, if they're numb or tingly, you know you've got a bigger problem and you need to be seen. Patients who wake at night also is an issue because that's usually doesn't happen unless it's pretty bad.

Kate Kaput:

I should have asked this earlier on, but can you actually explain when you sprain or strain something, whether it's a little bit of a basketball tweak or you sneeze and something hurts, what is actually happening in your body when that happens?

Dr. Frederick P. Wilson:

You may have some micro tears or some of the muscle fibers or even ligaments, and that can release some inflammatory chemicals, which can cause swelling and pain. So, generally, again, ice will reduce that swelling, so it should reduce that pain. And it also helps prevent more of those chemicals from forming. So, if you can get that ice on right away, it's going to be better for you. But usually there's no broken bones, but it's more little tears of muscle or tendons or something like that.

Kate Kaput:

So, it doesn't feel good, but it's hopefully oftentimes not kind of for the long haul.

Dr. Frederick P. Wilson:

Correct.

Kate Kaput:

Got it. So when you go to see a doctor for lower back pain, how will they go about diagnosing you and what sort of questions might they ask? What kind of screenings might they do? Walk us through the process of a doctor trying to figure out what your pain is.

Dr. Frederick P. Wilson:

So, we had the medical director of spine who started medical spine at the clinic. And he and I discussed that once upon a time. And we both agreed that the history is so critical that if you don't know what they have by the time you finish their history, an exam itself won't tell you the cause. So, generally I'll keep going with the history until I have a pretty good idea what it is. And we're trying to discern, is it pain inflection like with a muscle spasm or disk, or is it pain and extension, which could be more to do with the facet arthritis or perhaps you've got that spondylolisthesis, that forward slippage that also hurts in extension.

              So, you want to break it down into pain inflection or pain and extension and how did it occur? Was it a fall, was there trauma, could there be something serious going on like a compression fracture or herniated disk? So you really want to get to what exactly makes it better. What makes it worse? Does it hurt climbing stairs? Does it hurt when you cough or sneeze? There's these little factors that can really help you to home in on what you think the problem is.

              So, once we do that, then we do an exam more or less to just ensure ourselves that we're correct with our diagnosis from the history. And I do a lot of virtual medicine, so I'm doing it pretty much all by history, but you can do it because 80% is history. So, there is an exam. You're looking for weakness, you're looking at tendon reflexes, straight leg raising signs, which are indicative of a sciatic nerve being pinched. And then after that, you might want to get an X-ray if you're thinking there could be a fracture or given the history. You can see arthritis on an X-ray so you might want to look for at. And then generally, if I don't think it's mechanical and I can't do any manipulation, then I'll send them to physical therapy and see if we can work it out over the next three to four weeks.

Kate Kaput:

How might a doctor like you who specializes in osteopathic manipulation be able to help with various types of lower back pain? And while you're answering this question, tell us exactly what we mean by osteopathic manipulation.

Dr. Frederick P. Wilson:

So, osteopathic manipulation involves working on the vertebra. We have each vertebra one stacked on top of another. There are different small muscles holding them in balance, and you can get one vertebra kind of turn on another and that can cause little spasm of the smaller muscles or pulling on the tendons, that sort of thing. It can reduce range of motion and cause pain. And if you've got localized pain, it can cause more spasm in the larger muscles as well.

              So by using certain techniques, and we have 10 to 12 different kinds of manipulative leaks, we try to balance the stacked vertebra one on top of another correctly. If they're stacked correctly, then you take all the muscle spasm out and you generally help reduce the spasm and the pain and then get better more quickly.

              I think manipulation for mechanical pain, there's nothing better because if they have something causing the pain, if you take away the pain generator, the pain goes away. Whereas if you take an Advil®, you are addressing the pain, but you're not fixing the pain generator. So, if you can fix the pain generator, they're going to be much better off because the pain's going to go away.

Kate Kaput:

The Advil® is sort of a bandage, not a solution.

Dr. Frederick P. Wilson:

It's a bandage. You're not fixing anything, you're just reducing that pain message from reaching the brain somewhat.

Kate Kaput:

That makes sense. So, you started to mention physical therapy in some cases. Can you tell us a little bit more, if nothing seems to be working for lower back pain, what kinds of interventions are next like physical therapy, injections, surgery? What do you sometimes see in cases where you kind of can't get this pain to go away any other way?

Dr. Frederick P. Wilson:

Well, generally I do physical therapy first because usually physical therapy will make it better. They go typically a couple times a week and again different exercises for different problems. As we said, sitting in forward flexion can bother a disk, so extension exercises make the disk better. In arthritis, extension makes it worse so we do more flexion exercises like knee-to-the-chest. And so they help more work through it. And sometimes, they can actually pin down the diagnosis since they're seeing patients several times. And so they can see what actually is making them better and what makes them worse.

              So, they will do certain kind of exercises and adjust those exercises to how the patient responds. And also, not just will physical therapy make it better, but typically medical insurance demands conservative treatment be done, in case you're thinking of getting an MRI to take a deeper look. So I tell my patients, "Yeah, I'd like you to go to physical therapy. I think it's going to help you. But also, if we're starting to worry about things down the road, it will allow you to have the MRI. And if you don't do anything like that, generally they won't allow it."

              After that then you know what is going on, then you can consider injections. If there is a herniated disk they're not getting better with physical therapy, the injections consist of injecting cortisone right at the site of the herniated disk or the inflammation. That reduces inflammation, it reduces pain. Greater than 90% of herniated disks resolve on their own. So, all you're trying to do is buy time. If you can get them with less pain, then they are doing and continue with the physical therapy. You're just making them more comfortable until they heal.

Kate Kaput:

That was going to be one of my questions, too. Can a herniated disk go away on its own? I think-

Dr. Frederick P. Wilson:

90% to 95% generally will. So only 1 in 20 should have surgery as a rule.

Kate Kaput:

Great. I think that's probably one of those big misconceptions. It seems like you have a herniated disk. "Oh my God. I'm going to need surgery." And it sounds like that's overwhelmingly not the case.

Dr. Frederick P. Wilson:

Absolutely.

Kate Kaput:

Got it. OK. We now know that 80% to 90% of people are going to experience back pain at some point. If you are someone who's lucky enough not to experience lower back pain yet, how can you make sure that you stay that way? Let's talk prevention. What are some of the ways that you can best prevent back pain?

Dr. Frederick P. Wilson:

Well, we talked about lifting correctly I think in the past. So, you should never be lifting with your back. Like, you got this big 30 pound bag of groceries in the back of your car. You don't want to bend over and use your back to lift it up. You want to pull that bag so that it's very close to you and then kind of squat down and use your legs. Not your back. There are certain things that you don't want to do, like smoking accelerates disk disease because it interferes with the circulation. You've got just reducing your weight.

              Increased weight or obesity will cause more arthritis. So, if your weight is better, you're less likely to get arthritis. Working on your posture, because people who have poor posture are more likely to get neck pain, upper back pain, and lower back pain. So, you want to keep working on your muscles.

              And typically, we've seen older people, in our last talk we talked about how they start leaning, punching forward when they get older because they've lost a lot of the strength in the upper back thoracic extensor muscles. So, you want to kind of work on keeping those strong and the “Superman” exercise or scapular squeezes, pulling those shoulders back. And if you can get your shoulders back and head over your body, then you're going to be in much better balance and be less susceptible to causing yourself back strain and pain.

Kate Kaput:

Can you walk us through that “Superman” exercise one more time?

Dr. Frederick P. Wilson:

“Superman” is you're laying on your belly in a prone position and you've got one arm extended and the other leg extended like you're flying.

Kate Kaput:

I like the video demonstration for anyone who's watching the video. It's very helpful. OK. So, are there any red flag symptoms to watch out for when it comes to lower back pain? You've given us of them, but anything else that would indicate an emergency situation?

Dr. Frederick P. Wilson:

Anytime you have radiating leg pain with weakness you need to be seen. If there's definitely weakness, you definitely need to see somebody right away. If you've got back pain with fevers and chills, you could have a kidney infection or other kind of infection that could be serious. If you can't walk, if you've sustained trauma, so you could have a compression fracture. If it is waking you through the night or if you have some kind of a palpable mass in your back that's tender, it needs to be seen. And so that's when you really need to see your doctor.

              If you've got progressive neurologic issues, we talked about sacral anesthesia. If you've got a history of cancer in the past, and all of a sudden you've got back pain that won't go away, especially if it's awaking you at night and you're losing weight, that's an issue. And any kind of bowel or bladder leakage dysfunction could be because you've got the nerves getting pinched in your lower back.

Kate Kaput:

Dr. Wilson you've mentioned radiating pain. Can you tell us a little bit more about what that means and kind of when it's indicative of a back problem versus maybe something else like a hip problem?

Dr. Frederick P. Wilson:

Well, they can sometimes be quite difficult to parse through, but typically hip pain will give you groin pain on that side, or maybe anterior thigh pain, maybe even lateral hip pain where the sciatic nerve is actually not one nerve, it's three nerves, and each nerve goes to a different location in the leg. So we try to pin down where the pain is in the leg because then you can determine at what level the herniation likely is at. If that pain is running down the outside of the calf to the top of the foot, that's the L5 level, which is the last disk level.

              If you've got pain that is going to the back of the calf, that's likely L4 and that's the one level above. And so we all do it because in the end if we have to consider a shot or something like that, we know where we think the problem is at from a good history. And then if we get the MRI and that's exactly where the problem is, we can say, "Aha, that's the problem." It all fits. It's like a puzzle. And so we really need to get a good idea of where exactly that leg pain is located.

Kate Kaput:

So, as with kind of anything else, keep track. If you're experiencing this kind of pain probably makes sense to keep track and maybe even write it down, put it in your notes app, so that when you're going to see your doctor you can kind of give them that very specific feedback of where your pain is coming from, what is numb, et cetera.

Dr. Frederick P. Wilson:

For sure.

Kate Kaput:

Anything else that we haven't talked about today that you think is important for folks to know?

Dr. Frederick P. Wilson:

Our back is just so critically important to being able to have a good act of life. And you've got to work for it, there's no getting around it. It's something that you have to work towards because if you want to become that person who's hunched forward, you're not going to be able to do a lot of things that you would like to do. So, you need to stay active. You need to do some walking so that your bones are strong as well and you're less likely to get compression fractures. You need to keep those extensors [muscles] involved. You need to try to have good posture and you need to lead a healthy life.

Kate Kaput:

I think that's a good reminder and a good note to close on. The reminder that good health is worth working for and you do have to work for it.

Dr. Frederick P. Wilson:

It is, absolutely.

Kate Kaput:

Thank you so much for that reminder. And thank you for being here with [us] today and for speaking with us on such an important topic.

Dr. Frederick P. Wilson:

My pleasure, Kate, once again.

Kate Kaput:

To all of our listeners, to learn more about back and neck pain care from Cleveland Clinic, please visit www.clevelandclinic.org/spine. Thank you for joining us today.

Speaker 1:

Thank you for listening to Health Essentials brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. You can also follow us on Facebook, Twitter, and Instagram for the latest health tips, news and information.