When you’re looking for back pain relief, the last thing you need is an activity, treatment, or advice that makes matters worse or gives you new health problems.
In recent decades, medicine has increasingly become a "buyer beware" type of environment, and this is especially true for neck and back treatments (and diagnosis). Below is a list of things to think carefully about, do diligent research on, probe your doctor or physical therapist about, or perhaps even seek a second or third opinion on, should one or more of them apply to you.
As an example, let's take spinal stenosis, spondylolysis, and facet joint pain. All three conditions affect the back of the spinal column. When you try to exercise -- or even just move through your regular daily activities -- with any of these conditions, you may find that you increasingly favor a position in which your spine is flexed. This is called flexion bias.
Back extension may be painful if you have a flexion bias. In other words, if you do an exercise that involves arching your back, your symptoms may increase. For this reason, exercises that extend or arch the spine may be not be your best bet. Twisting exercises (in which you rotate the spine) also are not suggested if you have a condition that is associated with flexion bias.
The opposite is true, however, if your back or neck condition is associated with an extension bias. In other words, if arching your back actually makes it feel better, then it’s likely that spinal flexion exercises (bending forward) may get you in trouble.
A classic example is herniated disc. If you have a herniated disc, chances are that when you bend your spine forward, you experience pain down your leg or arm, or other nerve symptoms. In this case, you might benefit from resting on your stomach (in the prone position). Exercises in the prone position include: prone press up for beginners, and the yoga cobra pose if you’re more advanced and/or your back injury is on the mend.
Please note: It's important to speak with your healthcare provider before doing any of the exercises I've listed above. These were given for informational purposes only.
2. Getting a Diagnosis for Back Pain When You're PregnantExpert opinion as to the safety of bone scans, CT scans and x-rays during pregnancy is mixed. Most opinions come with at least a cautious warning.
According to the University of Michigan Health system, these diagnostic imaging tests are contraindicated (which means they should not be used) during pregnancy. UM recommends against using these diagnostic tests to evaluate acute low back pain in pregnant women.
The American Pregnancy Association says that x-rays of the abdominal area have a higher likelihood of affecting the uterus, and that tests such as these should be used only when the benefits outweigh the risks.
3. Too Much Activity Right After a Back Injury Or SurgeryAlthough controlled, gentle motion is sometimes used in order to speed up your recovery right after an injury or surgery, range of motion (flexibility) exercises are generally contraindicated at this time. This is because activity may irritate healing tissues, which may increase your pain and make the injury worse. Once more time has elapsed, exercise may be one of the best things you can do to manage your pain or speed injury healing. At first, though, it’s best to take it really easy.
4. Take the Wrong Medications
Taking medication for your back pain is supposed to make you feel better, right? It often does just what it is supposed to, but there are also certain situations in which it is important to pay close attention to the details.
For example, some doctors prescribe opioid (narcotic) pain medication for back or neck pain. Although they may provide relief in the short term, narcotics come with the risk of addiction as well as adverse events. Related: Blog Post: Opioid Misuse Issues
With many other treatments available on the market, opioids may not be the best solution to your back pain. The evidence for their effectiveness as a long-term pain reliever is not all that great. A 2010 Cochrane review looked at 26 studies involving a total of 4,893 patients taking this type of drug for at least 6 months. The reviewers found “weak evidence suggesting that patients who are able to continue opioids long-term (many had to drop out due to adverse events or insufficient pain relief) experience clinically significant pain relief.” The reviewers also found no conclusive evidence for improvement in either quality of life or function in the patients taking opioids.
Another thing to watch for is the other medications you take along with your pain meds. Certain classes of drugs don't mix. For example, if you take a MAO inhibitor for depression, taking amitriptyline for your chronic back pain is an absolute contraindication. If you are at all unsure, or if you are taking more than one type of medication, please speak with your doctor.
Many people keep their back pain managed quite well by engaging in water exercise regularly. But even with its excellent reputation, aquatic therapy does have some instances in which it should not be used. These include, but are not limited to, people who have a fear of water, a history of seizures, or an open or infectious wound.
Exercising in water when you're afraid of it most likely won't be productive for you. If you have a seizure while in the pool, you might swallow too much water or hit your head on the cement. Going into a pool with an open wound may make your infection worse or spread it to others. For these and other reasons, it is imperative to clear aquatic exercise with your doctor before trying it. Be sure to review all your other medical conditions with her so she can accurately provide you with direction.
6. Maxing Out On Your Surgical Options Too Soon
There's a saying: When you're a hammer, everything looks like a nail. If you're meeting with a surgeon to discuss your treatment options, this adage may come into play -- meaning, a surgeon might naturally recommend having a surgical operation. But is surgery always the answer in every one of these cases? Probably not.
At the very least, maxing out on your surgical options right from the beginning is not recommended by reputable medical organizations. These are just a few examples of types of surgeries that may not be the best bet:
- The Washington State Department of Labor and Industries issued guidelines in 2009 stating that having a spinal fusion the first time you have a laminectomy or discectomy to treat a one-sided nerve root compression is not recommended.
- For people with cervical spondylotic myelopathy (neck arthritis that causes symptoms in your spinal cord), The Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons both do not recommend fusion and laminectomy together, citing a lack of evidence that the addition of a fusion to the laminectomy actually improves your ability to function after the surgery.
While research-based clinical guidelines have been published in order to counsel surgeons on when an operation should or shouldn't be performed, many doctors disregard them. I often receive emails from readers who share their stories about how their lives were altered for the worse after an inappropriate surgery. My advice? Ask your surgeon lots of questions before proceeding with a surgery that they've recommended. If necessary, you may want to seek out a second opinion as well. Remember that you are in charge of your health, and it's wise to do your research and be a proactive participant in your treatment.
American Pregnancy Association. Pregnancy and X-Rays: Good or Bad? Accessed: June 10 12 http://www.americanpregnancy.org/pregnancyhealth/xrays.html
Ammer, C., The Encyclopedia of Women's Health. 6th ed. Facts on File, Inc. 2009.
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Medical Treatment Guidelines. Surgical Guideline for Lumbar Fusion (Arthrodesis) Washington State Department Of Labor and Industries. November 1, 2009. http://www.lni.wa.gov/ClaimsIns/Files/OMD/MedTreat/LumbarFusion.pdf
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Noble M. et.al. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD006605.http://www.ncbi.nlm.nih.gov/pubmed/20091598
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University of Michigan Health System. Acute low back pain. Ann Arbor (MI): University of Michigan Health System; 2010 Jan. http://guidelines.gov/content.aspx?id=23939&search=acute+low+back+pain+pregnant
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