HEAL YOUR BACK 1100--555544__BBoorreennsstteeiinn..iinnddbb ii 1100//2200//1100 99::2288 AAMM 1100--555544__BBoorreennsstteeiinn..iinnddbb iiii 1100//2200//1100 99::2288 AAMM HEAL YOUR BACK Your Complete Prescription for Preventing, Treating, and Eliminating Back Pain David Borenstein, M.D. M. Evans Lanham • New York • Boulder • Toronto • Plymouth, UK 1100--555544__BBoorreennsstteeiinn..iinnddbb iiiiii 1100//2200//1100 99::2288 AAMM ATTENTION: This book includes the most up-to-date information about conventional and complementary therapy for low back pain, based upon my thirty-two years of clinical experience with people with spine problems. The object of this book is to educate people about low back pain and offer relief of this disorder. Despite these good intentions, this book cannot offer any guarantee about the ultimate resolution of your back condition. Do not be tempted to use this book as a substitute for a medical evaluation. An examination by a health professional is always an appropriate approach to the evaluation of low back pain. Your physician has the unique advantage of listening to your description of your problem and completing a physical examination before forming an opinion about the cause of your back pain. The information in this book may differ from the advice offered by your health care provider. The recommendations in this book are not meant to replace medical treatment or diagnosis by your physician. When in doubt about the advice you have received, obtain a second opinion from another health care professional. Ultimately, you are solely responsible for your own medical decisions. Published by M. Evans An imprint of The Rowman & Littlefield Publishing Group, Inc. 4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706 http://www.rlpgtrade.com Estover Road, Plymouth PL6 7PY, United Kingdom Distributed by National Book Network Copyright © 2011 by David Borenstein All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the publisher, except by a reviewer who may quote passages in a review. British Library Cataloguing in Publication Information Available Library of Congress Cataloging-in-Publication Data Borenstein, David G. Heal your back : your complete prescription for preventing, treating, and eliminating back pain / David Borenstein. p. cm. Includes bibliographical references and index. ISBN 978-1-59077-185-3 (pbk. : alk. paper) — ISBN 978-1-59077-186-0 (electronic : alk. paper) 1. Backache—Popular works. 2. Backache—Treatment—Popular works. 3. Backache— Prevention—Popular works. I. Title. RD771.B217B6695 2011 617.5'64—dc22 2010037696 ™ The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI/NISO Z39.48-1992. Printed in the United States of America 1100--555544__BBoorreennsstteeiinn..iinnddbb iivv 1100//2200//1100 99::2288 AAMM This book is dedicated to all my patients who have given me the honor of being their physician. This work is the result of their persistent requests to put my explanations of their back problems on paper. 1100--555544__BBoorreennsstteeiinn..iinnddbb vv 1100//2200//1100 99::2288 AAMM 1100--555544__BBoorreennsstteeiinn..iinnddbb vvii 1100//2200//1100 99::2288 AAMM Contents Acknowledgments xi Introduction: One Big Sneeze Can Do You In and the Twist and Shout xiii PART I: TAKING THE MYSTERY OUT OF LOW BACK PAIN Chapter 1: Understanding Why Your Back Hurts 3 Is It Mechanical or Medical? (cid:129) How Your Back Works (cid:129) Pain Is Different in Men and Women (cid:129) How Your Pain Threshold Fluctuates Chapter 2: Working with Your Doctor 19 Questions to Help You Find the Cause (cid:129) The Physical Examination (cid:129) Doctors and Health Care Professionals Who Treat Low Back Pain Chapter 3: What Diagnostic Tests Can—and Cannot— Tell You 33 Pictures May Not Tell the Whole Story (cid:129) Conventional X rays (cid:129) Magnetic Resonance Imaging (MRI) (cid:129) Computed Axial Tomography (CT) (cid:129) Myelography (cid:129) Bone Scan (cid:129) Discography (cid:129) Bone Densitometry (cid:129) Electrodiagnostic Tests (cid:129) Blood Tests PART II: KNOWING YOUR TREATMENT OPTIONS Chapter 4: The Basic Back Pain Relief Program 51 Control Physical Activities but Limit Bed Rest (cid:129) Using Over-the- Counter Medications (cid:129) Applied Therapy (cid:129) Aerobics: Expanding Your Comfort Zone—Gradually (cid:129) Maintain a Positive Attitude (cid:129) If Back Pain Is Chronic [vii] 1100--555544__BBoorreennsstteeiinn..iinnddbb vviiii 1100//2200//1100 99::2288 AAMM Chapter 5: Recognizing and Treating Mechanical Low Back Pain 63 Muscle Strain, Spasm, and Trauma (cid:129) Disc Degeneration and Osteoarthritis (Lumbar Spondylosis) (cid:129) Herniated Disc and Sciatica (cid:129) Piriformis Syndrome (cid:129) Cracked Vertebral Bodies (Spondylolysis and Spondylolisthesis) (cid:129) Spinal Stenosis (cid:129) Scoliosis Chapter 6: Recognizing and Treating Medical Causes of Low Back Pain 83 Infection (cid:129) Bone Tumors and Cancer (cid:129) Inflammatory Diseases (cid:129) DISH Syndrome (Diffuse Idiopathic Skeletal Hyperostosis) (cid:129) Ochronosis (cid:129) Fibromyalgia (cid:129) Polymyalgia Rheumatica (cid:129) Tension Myositis Syndrome (cid:129) Myofascial Pain Syndrome (cid:129) Blood and Vessel Disorders(cid:129) Diabetic Neuropathy (cid:129) Pain from Nearby Organs (cid:129) Back Pain in Pregnancy and Menstruation Chapter 7: How Can I Keep from Getting Bent Over? 101 Osteoporosis (cid:129) Osteoporosis Diagnosis (cid:129) Men and Osteoporosis (cid:129) Keep Your Bones Strong (cid:129) Regaining Height (cid:129) Preventing Falls Chapter 8: Back Pain in Kids: Is It Just Growing Pains or Is It More Serious? 113 Growing Pains (cid:129) Nonspecific Low Back Pain (cid:129) Kids’ Red Flags (cid:129) Adolescent Scoliosis (cid:129) Adolescent Dowager’s Hump— Scheuermann’s Disease (cid:129) Adolescent Spondylolisthesis Chapter 9: How and When to Use Medications Effectively for Pain 121 NSAIDs and COX-2 Inhibitors (cid:129) Muscle Relaxants (cid:129) Opioid and Nonopioid Analgesics (cid:129) Corticosteroids (cid:129) Other Pain Therapies Chapter 10: Treatment with Exercise and Physical Therapy 137 Working with a Physical Therapist (cid:129) Flexion Exercises (cid:129) Extension Exercises (cid:129) The “C” and “S” Curves (cid:129) Transcutaneous Electrical Nerve Stimulation (TENS) (cid:129) Iontophoresis: Another Form of “Injection” Therapy (cid:129) Getting in the Water Chapter 11: Complementary Therapies 157 Manual Manipulation (cid:129) Massage and Other Bodywork Techniques (cid:129) Acupuncture (cid:129) Yoga and Other Body, Mind, and Spirit Techniques [viii] Contents 1100--555544__BBoorreennsstteeiinn..iinnddbb vviiiiii 1100//2200//1100 99::2288 AAMM (cid:129) Mind-Body Therapies (cid:129) Meditation and Relaxation (cid:129) Body Self-Awareness (cid:129) Magnet Therapy (cid:129) Homeopathy (cid:129) Nutritional Supplements Chapter 12: What to Know Before You Consider Surgery 183 Understanding the Risks (cid:129) Discectomy (cid:129) Spinal Fusion (cid:129) Spinal Instrumentation: The Hardware Store (cid:129) The Artificial Disc—Buyer Beware (cid:129) Emergency Surgery (cid:129) Anterior Spine Surgery (cid:129) Spine Spacers (cid:129) Choosing an Orthopedic Surgeon or Neurosurgeon (cid:129) Your Hospital Stay (cid:129) After Surgery—The Hard Part (cid:129) Failed Back Surgery Syndrome (cid:129) Future Surgical Treatments PART III: LIVING WITHOUT BACK PAIN Chapter 13: Lower Your Risk for Back Pain with Prevention: The ABC Plan 203 A—Abstain from Smoking (cid:129) B—Better Body Mechanics (cid:129) C— Correct Diet (cid:129) Keep Working Chapter 14: Enjoying Sex without Hurting Your Back 213 It’s Not All Physical (cid:129) Painless Positions (cid:129) Medication and Libido (cid:129) Sexercises (cid:129) Back Surgery and Sexual Function Epilogue: Being Back in Control Will Heal Your Back! 221 Glossary 223 Appendix A: Dr. B’s Back School FAQ 229 Is Any Particular Chair Helpful for Low Back Pain? (cid:129) Does Inversion Boot Therapy Help Back Pain? (cid:129) Do My High Heel Shoes Cause Back Pain? (cid:129) Does Prolotherapy Help Low Back Pain? (cid:129) What Does the Circular That Comes with My Prescription Drug Package Mean? It Scares Me Half to Death. (cid:129) How about Botox Injections for My Back Spasm? (cid:129) Which Is the Best Aerobic Exercise Machine for a Person with Back Pain? (cid:129) Can I Go Horseback Riding? (cid:129) What Sports Can I Safely Play If I Have Back Pain? (cid:129) Can I Play Golf without Increasing My Back Pain? Appendix B: Medications for Low Back Pain 239 Appendix C: Best Back Resources 245 References 249 Index 261 About the Author 275 Contents [ix] 1100--555544__BBoorreennsstteeiinn..iinnddbb iixx 1100//2200//1100 99::2288 AAMM