Dealing with Back Pain

WebMD Live Events Transcript

Who better to talk to about dealing with back pain than the man who wrote the book on the subject? Harris McIlwain, MD, author of The Pain-Free Back: 6 Simple Steps to End Pain and Reclaim Your Active Life, joined WebMD Live on May 18, 2004, to answer your questions and offer his advice.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome back to WebMD Live, Dr. McIlwain. Before we dive into some questions, please tell us a little bit about the "six steps" you write about in your book.

MCILWAIN:
The six steps are for those who feel the need to control their back pain, to get old activity back.

  • The first step is to show you the ways and the types of exercise that can give you great relief, even within days, and show you how to do them safely.
  • The next step is the importance of your ideal weight and shows you how to achieve that with healthy eating choices that help back pain.
  • The next step is showing how to use complementary and alternative medicines, such as natural dietary supplements to alleviate pain.
  • The next step is making key lifestyle changes. We show how to sit, how to lift, how to do everyday activities, such as sitting at a computer without causing more back pain.
  • The next step is showing how to control stress, which makes back pain worse with some easy ways to distress.
  • The next step shows ways that massage and chiropractic, acupuncture and many other healing touch therapies can help you with your back pain and helps you discover which ones may be best for you.

MEMBER QUESTION:
According to studies, much back pain is the result of poor postural habits. Are you familiar with the Alexander Technique, which helps people obtain long-term relief from back pain by changing their postural habits?

MCILWAIN:
Posture is absolutely important. Many people find that some simple changes in the way they sit at a desk and how they stand and walk make a huge difference in their back pain. Massage and chiropractic are two techniques that work well. Some other techniques include Rolfing and Alexander and other types of bodywork. We think it is important to have a good therapist who can teach you proper ways to sit, stand, and lift. The Alexander technique is more than 100 years old and is used to reduce a painful muscle tension, improve posture, and reduce stress by re-educating your posture and activity.

MEMBER QUESTION:
I have had upper right back pain with no relief. I have tried PT and massage and the X-rays show nothing. Should I ask for an MRI?

MCILWAIN:
You should discuss it with your doctor, since an MRI is expensive and a nuisance, but if there is a good reason to suspect a problem that could be found by MRI, your doctor will tell you. The most common cause of back pain is in the muscles and tendons and ligaments around the spine, which would not normally show on an MRI, so it is possible that the results of the tests are negative because the pain is in the muscles, tendons, and other soft tissues, which don't show on X-ray.

In addition, you should try the solutions along with your doctor's advice, which usually include moist heat, such as hot shower or hot towels or whirlpool, and exercises to stretch and strengthen the muscles of the back. After a few weeks there is usually noticeable improvement, and the longer you do this program the better the relief. The exercises are one of the best ways to prevent back pain from returning when the pain is coming from the muscles and tendons around the spine.

MEMBER QUESTION:
I had surgery for a herniated disk last June and still have a lot of pain down the back of my leg. I'm back in PT and thinking about cortisone shots. What do you think about that treatment?

MCILWAIN:
There are different types of cortisone shots. Some types are localized to the tender areas around the lower back, and these are called trigger point injections. Then other types of shots are called blocks, and they try to stop pain by blocking the effects of the nerves that transmit the pain. In either case, depending on the type of problem you're experiencing now, it's probably worth a try if it was recommended. Either local trigger point injections or the nerve blocks, which are given usually in a series of three, when they work, may give relief for months at a time.

And of course this should be combined with the basic treatment program, including moist heat and gradually increasing exercises, which have to be guided by your doctor since everyone is different.