The Back Coach

Back and neck pain can be caused by a number of things. If you’re able to identify the source of your back pain, it’s easier to determine your next steps to get to feeling better.

Risk factors for back and neck pain

Risk factors of back and neck pain include arthritis, a weak core, overexertion, being overweight, using tobacco or nicotine products, and occupational hazards, such as the use of machinery that vibrates. Women who are pregnant are also at a higher risk for experiencing back pain due to the changes their body is experiencing.

A weak core often leads to a sore back and neck

The most common cause of general back pain is a weak core. Your core is made up of abdominal and back muscles. If your core muscles are weak, it’s difficult to support your weight. When you can’t support your weight, you’re more likely to have poor posture, which can put pressure on your spine, causing back and neck pain.

Fortunately, there are things people can do to reduce their risk of back and neck pain that is the result of having a weak core. If you are overweight, losing weight through healthy eating and exercise takes the extra weight off your spine. By starting a routine of core-strengthening exercises, you can build these muscles which will make it easier to support your weight and maintain better posture.

Arthritic back and neck pain is common

Back and neck pain is also commonly caused by arthritis. “As joints get larger and arthritic, they begin to hurt just as they would in your knee or shoulder,” said Dr. Tim Reiter, Associate Professor of Neurosurgery at Penn State Spine Center. “When joints get bigger due to arthritis, they encroach on the territory that the nerve goes through, which can cause a pinched nerve.” If you have a pinched nerve, you will frequently have pain that shoots down your leg or arm.

Disc herniations are less common

Another cause of back and neck pain is disc herniation. “Think of a spinal disc like a jelly donut. A herniated disc occurs when some of the softer “jelly” of the donut pushes out into your spinal column,” said Dr. Reiter. When this happens, you will feel pain shooting down through your leg.

Herniated discs are much less common than arthritic pain or a pinched nerve, but can cause significant pain and sometimes require surgery.

Back and neck pain related to cancer and infection is possible

In rare cases, back and neck pain can be caused by cancer or infection. If you have a history of either and are experiencing back and neck pain, it is important to see your doctor immediately.

Dealing with back and neck pain

Even though it’s not what most back and neck pain sufferers want to hear, time is the best remedy for pain. According to Dr. Chris Zacko, Assistant Professor of Neurosurgery at Penn State Spine Center, most of the time back and neck pain is just that - pain. And while it’s not meant to dismiss the severity of the pain, pain is usually not an indicator of something more serious. Time is usually the best healer.

“For chronic back and neck pain sufferers who experience a flare up, it will take about four days to a week for the pain to calm down. After that, it takes about two weeks for the pain to go away entirely,” said Dr. Zacko.

Dr. Zacko added that if the flare up lasts more than four to six weeks, you should see a doctor as it can be a sign of a more serious underlying problem.

Healing time for injuries

Healing time for an injury is different than chronic back or neck pain flare ups. An injury usually takes longer than a month to heal. If you’ve done something to the muscle, like a strain or tear, or if you have a herniated disc, it will take about six weeks for the pain to subside and eventually go away. Fractures to the back can take much longer than six weeks to heal.

“Typically, for injuries, it takes about two weeks for the person to realize their life will get back to normal and they will heal. Then two weeks after that, the pain lessens,” said Dr. Zacko.

Combine time and treatments to alleviate pain

As a supplement to time, people suffering from back or neck pain can focus on walking and moving around, doing stretches and exercises (insert link to video), and take over the counter medications like ibuprofen, naproxen, or acetaminophen.

“Walking gets you to stand up, and gets the muscles working and healing. At the same time, it strengthens your back and abdominal muscles,” said Dr. Zacko.

You might feel tempted to lie down and rest when you experience back pain, but staying somewhat active - like getting up and walking - is actually more therapeutic. When your pain subsides, focus on strengthening your back and abdominal muscles to avoid chances of another flare up in the near future.

When you should see a doctor right away

There are certain indicators that may suggest a more serious problem. For example, if you feel weakness, like “drop foot,” which is the inability or difficulty in moving the ankle and toes upwards. Other indicators are numbness, debilitating pain that makes it impossible to function as normal, or problems with your bowel, bladder or sexual functions, you should see your doctor as soon as possible. If you have a history of cancer or infection and experience back pain, or if your pain wakes you up at night, you should see your doctor right away.

Though it’s rare, there are times when back and neck pain are indicators of more serious problems, like cancer or infections. If you’re experiencing any of the following symptoms in conjunction with back pain, you should see your family practice doctor right away. Your doctor will evaluate you and determine if you need to see a specialist.

• Back or neck pain that wakes you up at night
• Fevers associated with back or neck pain
• Weakness with back or neck pain, like “drop foot” which is the inability or difficulty to lift toes or foot upward
• Numbness with back or neck pain
• Problems going to the bathroom
• Problems with sexual functions
• Unexplained weight loss
• Pain in the middle of the back

Remember these symptoms are not conclusive, and just because you experience them it does not mean you have a serious problem. As a precaution, it is important to talk to your doctor if you have back and neck pain along with these symptoms so he or she can rule out any serious problems.

Changes in lifestyle can lead to less pain

Obesity is one of the largest risk factors for back and neck pain. When you are obese or overweight, the extra weight you carry puts pressure on your spine and can cause pain. Obesity is typically caused by poor diet and lack of exercise, so if you are overweight, it’s important to make lifestyle changes to lose excess weight, which can help reduce your risk for back and neck pain.

“Those who get regular cardiovascular exercise are less likely to have back problems and develop back pain,” said Dr. Mark Knaub at Penn State Spine Center. This is due to the likelihood that those who exercise more carry less weight and have stronger abdominal and back muscles - or core muscles - which are responsible for keeping the spine in its proper posture.

Tobacco and nicotine use is also closely tied to back and neck pain. Nicotine affects blood circulation, which can lead to degenerative or arthritic pain. By quitting or reducing tobacco use, you could potentially help ease your back and neck pain.

Focus on small changes to improve lifestyle

When making lifestyle changes to your diet and exercise, it’s important to be realistic about your goals. “Someone who is sedentary most likely isn’t going to go and run a marathon,” said Dr. Knaub. “Start small, with realistic goals. Walk around the block. Walk with your dog. Work up to walking five times a week for 30 minutes.”

Focusing on your core muscles is also important, as these muscles are critical to keeping your spine in its proper alignment. Develop a routine for exercising your core muscles - simply going for a walk is a great way to begin to strengthen these muscles.

Over time, small changes will lead to larger lifestyle changes. These lifestyle changes may be just what you need to reduce your pain.

Pregnancy causes strain on your body, specifically your lower back. Back pain during pregnancy is very common, and is caused by changes happening in the body, including weight gain.

One of the best things a pregnant woman can do to alleviate back pain is walk. According to Dr. Mark Knaub, Associate Director of Spine at Penn State Spine Center, it’s important to keep moving. Over time, doctors have learned it’s actually detrimental to back health to be on bed rest for an extended period of time.

“Rest for a relatively short amount of time - a day or two - and then start to be more active and resume normal activities,” said Dr. Knaub. “The reality is you need to modify your activities as much as possible. Avoid heavy lifting, twisting, and bending,” Dr. Knaub added.

Consider exercise and treatments to alleviate pain

While it might not be possible to get rid of the back pain entirely, there are things pregnant women can do to alleviate and manage pain. Pregnant women should consider applying heat (link to heat/ice video), improve posture (link to posture video), and participate in aqua therapy or aerobics.

If yoga is a consideration, it’s important to maintain correct posture. Penn State Health experts recommend that pregnant women see a therapist for exercises they can do to stretch and strengthen abdominal and back muscles - often referred to as the core - to ensure correct posture and technique.

The good news for pregnant women with back pain is that unless they have dealt with chronic back pain before, the pain will likely subside. To avoid future back pain flare ups after pregnancy, Penn State Health experts recommend making core strengthening exercises a regular part of your routine.

In this video, physical therapist Bob Kelly talks about the right way to stretch your back.

85% of people experience back pain at some point in their life. Most aren't sure if or when to call a doctor. In this video, Dr. Tim Reiter talks about how to decide when to see a doctor about your back pain.

In this video, Dr. Mark Knaub offers suggestions about buying the mattress that is right for your back.

One of the most common questions with back pain is whether to apply heat or ice. In this video, Dr. Mark Knaub offers advice on when heat is appropriate, or when you should apply ice.

You asked, and Dr. Mark Knaub, Associate Director of Spine at Penn State Spine Center answered.

What is ankylosing spondylitis?

Dr. Knaub: Ankylosing spondylitis is an autoimmune disorder that affects the skeletal system in many places, particularly the spine. It is a chronic inflammatory arthritis that can also affect the peripheral joints, like the shoulder, hips and knees, similar to rheumatoid arthritis.

What does ankylosing spondylitis do to your body?

Dr. Knaub: Ankylosing spondylitis usually starts as back pain and stiffness. The pain is caused by inflammation in the joints and is characterized as morning pain and stiffness that improves throughout the day. However, over time, the bones in the spine begin to fuse together, making movement difficult. This is called ankylosis.

Who gets ankylosing spondylitis?

Dr. Knaub: It’s believed that ankylosing spondylitis is genetic, but environmental factors that are not easily identified right now may play a role in determining whether a person will develop the disorder.

The disorder is also more common in men and usually presents in people in their 20s or 30s.

Is surgery required to fix ankylosing spondylitis?

Dr. Knaub: Most people with ankylosing spondylitis never require surgery.

Though rare, there are two groups of people who might need to have surgery as a result of ankylosing spondylitis. The first group is comprised of people who develop a deformity. This can cause kyphosis, which means the spine is tipped forward relative to normal. In severe cases, these people aren’t able to stand up straight, and their faces are directed at the ground. Surgery might be necessary to correct this.

Other patients with ankylosing spondylitis that might require surgery are those who experience an episode of trauma, like a car accident that results in a fracture that needs stabilizing.

What risks are associated with ankylosing spondylitis?

Dr. Knaub: Even though the spine is beginning to fuse together and form more bone, people with ankylosing spondylitis have spines that are usually more brittle. This puts these patients at increased risk for fractures from a trauma injury.

Like mentioned above, people with this condition are also at risk for developing kyphosis, which is a deformity that occurs when the spine tips forward.

How common is ankylosing spondylitis?

Dr. Knaub: Ankylosing spondylitis is rare and occurs in less than 1% of the adult population.

Is there anything that can be done to slow the progress of ankylosing spondylitis?

Dr. Knaub: If ankylosing is caught early, there are things that people can do, like physical therapy and taking anti-inflammatory drugs to manage pain and prevent or delay deformities.

Even though more than 80 percent of adults experience back pain in their life, only a very small percentage of people require surgery. When it comes to your back and neck, it’s important to consider non-surgical options before considering surgery. If after you’ve exhausted all non-surgical options, consult your doctor to discuss whether surgery is right for you.

How long should I wait to consider surgery?

“It’s hard to generalize the amount of time someone should wait,” said Dr. Tim Reiter, Associate Professor of Neurosurgery at Penn State Spine Center.

“If you have pain that shoots down through your arm or leg, you should wait a month to see if the pain subsides before considering surgery. If it’s purely back or neck pain - so if you’re able to function as normal and aren’t experiencing shooting pain - then you should wait at least six months before considering surgery.”

The difference between pure pain and pinched nerves

Pain that shoots down through your arm or leg is often caused by a pinched nerve. Pinched nerves can be decompressed with surgery. Pure back or neck pain, characterized by being annoying and very painful but not life-changing, is typically arthritic pain. Arthritic back and neck pain is common and difficult to fix with surgery.

How to cope with pain

When asked what to do to cope with pain, Dr. Chris Zacko, Assistant Professor of Neurosurgery said, “Walk. Walking gets you standing up and gets the muscles healing.”

Even though it might seem like it’s best to lie down and rest when you have back or neck pain, you will heal faster if you get up and move around. Avoid bending, lifting and twisting, and focus on walking to work your muscles.

When you should see a doctor right away

There are some back and neck pain situations that are more serious and warrant seeing a doctor sooner. If, in addition to pain, you are experiencing weakness, “drop foot,” or if your bowels, bladder or sexual functions are affected, you should see a doctor.

As with all surgeries, there are risks associated with back and neck surgery that should be discussed with your physician before a decision is made.