Back Pain and Spine Health

By Darin J. Awaya, M.D.

Back pain is a very common health issue that most people will experience sometime in their lifetime, affecting about 80% of adults. It is the most common job-related disability leading to missed days of work. Addressing and taking care of your spine health is important for everyday function.

What causes low back pain?
This is the most frequently asked question in a spine surgery practice. This question is asked on a daily and possibly an hourly basis in my office. If you suffer from low back pain, you are not alone. The answer to this question is complicated because there are many possible pain generators in the lower portion of your back. The three most common sources of pain are the nerves, the discs, and the soft tissue. 

The most forgiving source of pain is the soft tissue. The soft tissue includes muscles and ligaments and is frequently injured in an “athletic” type activity or when performing an activity that is not a part of the daily routine. Patients often see this type of pain when starting a new exercise or hobby. Simple rest and at home stretching exercises should help with symptoms and this type of problem usually resolves spontaneously.

The discs are the shock absorbers in the spine. This type of pain is typically a dull ache in the lower back and upper buttocks. This pain is felt with some but not all normal activities of daily living. The discs that are the most likely to wear out are the “lumbar” or lower discs. By about age 50, most of us have some degree of degeneration, but usually this degeneration does not cause significant pain. If the discs continue to wear, they can become unstable. This instability will result in pain that is not consistent with life’s normal aches and pains and can be unpredictable. Treatment for end stage disc degeneration is complex, therefore consult a physician for a treatment options. 

The most important cause of lower back pain is due to irritation or compression of a nerve. This type of pain is more accurately called sciatica. This is a pain that radiates from the lower back down the one or both legs. The pain is described as shocking or radiating. This type of pain can result in nerve damage and should be investigated by a physician. Treatment options include anti-inflammatory medications, physical therapy, and as a last resort surgery. This is the most common scenario in which your physician will request advanced imaging such as MRI. A majority of cases do not require surgery, but of all the listed causes of back pain, this is the one that is most likely to require surgical intervention.

Why is posture important?
In today’s technological and sedentary lifestyle, posture is becoming increasingly a concern. The spine has evolved to support upright posture. However, it is not in the final stage of evolution. Things can still go wrong. Spinal balance is the principle key to all surgical interventions. Imagine your spine as a telephone pole, and then imagine that the tension wires holding up the pole are your muscles. When the pole is balanced, very little effort is needed to keep the pole upright. As soon as the pole starts leaning, the wires attached to the telephone pole or the muscles in your forearms start to become tense. If the pole continues to lean it will eventually fall over despite the best effort. It doesn’t take much energy to hold up a balanced spine. If the spine starts to lean (bad posture), the muscles in your back become tense and eventually will start to hurt. If the balance cannot be self-corrected, conditions such as scoliosis will develop. 

To help keep the spine balanced, core strength and flexibility are the key. Strength and flexibility can be improved with activities such as swimming and yoga. The guidance of a physical therapist is also key to improving these functions. Remember strength or appearance is not the goal. A balanced spine is all that is necessary to improve and prolong your spinal function. 

Is spine surgery dangerous?

The answer to this question is ALL surgery can be dangerous. The popular notion is that paralysis is common. Spine surgery is risky, but not to the extent of this popular belief. During surgery we now have the capability of monitoring the spinal cord and nerves. Newer anesthetic techniques also improve bleeding allowing much more complex surgeries to be done. Most importantly, experience has made most of spine surgery routine. The most common of surgeries are now being done weekly if not daily by most spine surgeons. Familiarity, repetition, and practice in any activity from playing guitar to surgery are the key to success. Obviously, ability is an individual skill, but it is a good habit to ask if your surgeon is board certified. Board specialty examinations are rigorous and based on each surgeon’s OWN practice. Certification is a good screening tool for you when selecting a provider.

Who are the different providers in the Spine Community?
Probably the most confusing question related to spine care is which provider should I consult. There are three levels of providers. 

Primary care physicians provide first line treatment for most spine related problems. PCPs are also the most accessible and frequently have an already developed relationship with the patient. This results in timely care. 

The second category of providers are those that deliver non-invasive but spine specific care. This category includes physical therapists, chiropractors, acupuncturists, as well as physicians such as Physical Medicine and Rehabilitation providers, Anesthesiologists, and Rheumatologists. These providers will help patients with physical improvement and pain relief without the use of surgery. Other options include medicine, injections, and bracing. 

The safety net of spine care is the Neurosurgeon or Orthopedic Spine Surgeon. In general, referrals to a surgeon are non-operative, however, if any there is any suspicion of surgery, a referral should be made. Conditions that are more likely to require surgery are tumors, infection, or trauma. That being said, a majority of surgery is done for problems like sciatica or degenerating discs that have failed non-operative management.

DR. DARIN J. AWAYA is a Board Certified Orthopedic Spine Surgeon and member of PMAH. He practices at Pali Momi Medical Center, Mary Savio Plaza, and Kuakini Medical Center.

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