Back pain is one of the most common reasons people go to the doctor or miss work. According to the Mayo Clinic, 80% of the U.S. population will experience low back pain in their lifetime and the annual cost to the economy is $100 to 200 billion (two thirds of which is lost wages and productivity).
The causes for low back pain can be multifactorial (including muscle and ligament strain, disc injury and structural problems), says Hari Lakshmanan, M.D., physical medicine and rehabilitation physician at Kaiser Permanente. “In older populations, more chronic low back pain can be caused by arthritis to the low back joints and time-related degeneration of discs. Also common in older patients is sciatica, which is pain down the leg caused by narrowing of the central nerve canal in the spine.”
He adds that if there are underlying work/life stresses, or other mental health issues, low back pain can become even more debilitating. “This is not so much an age-related phenomenon, as an environmental one.” Still, Lakshmanan says, when pain has been present for less than a month with no history of trauma and no weakness in the legs, most back pain can be managed and improved without intervention from a medical doctor.
Thus enters the formidable cadre of healers that include chiropractors, acupuncturists, physical therapists, strength and conditioning specialists and other body workers. Data, compiled and curated by thegoodbody.com key statistics on chiropractic, shows that 35 million Americans are treated by chiropractors annually and 46% of the visits are for lower back pain. That makes it the most popular reason for chiropractic appointments.
A holistic approach
Casey Carter, of Great Day Wellness Center in Santa Rosa, is a licensed Doctor of Chiropractic, a Doctor of Oriental Medicine, a licensed herbalist and more. She uses several modalities in combination to address the physiological and biochemical needs of the body. Her “gentle” chiropractic contrasts with aggressive, high-force manipulation methods, and works with the body’s own natural healing abilities. This low-force treatment helps release chronically tight muscles and joints, re-establishes structural integrity, and identifies internal or external factors that compromise the body’s systems.
Carter gives an example of her holistic, complementary approach: “I can loosen up spasming muscles with acupuncture needles which are as fine as a cat whisker, or a hair on your head. They get into places where fingers can’t. When I put that needle into the skin, a pumping action pulls stuck blood from that damaged muscle up to the surface, and you feel better afterwards.”
She sees the human being not just as a spine, but as a complete entity with muscles, tendons, ligaments, joints, a heart, circulatory system, gut, and an emotional and spiritual center. “You start from where the person is and envision them in perfect health to get them closer to where they want to go.”
Carter says back problems are caused by a myriad of issues including repetitive movements on the job, accidents, improper lifting, being overweight and lack of movement. “The hardest thing to do is change our habits, and yet it’s the only thing we have power over.”
She continues, “We grew up with commercials that said, ‘When diet and exercise fail, try blah blah blah.’ Well, diet and exercise never fail! It’s pharmaceutical commercials that ingrain the idea that taking a pill is a substitute for supporting ourselves with good nutrition and exercise. There is no pill to take for back pain. There is purposeful intervention.”
Carter recommends adopting an alkaline diet, which means lots of leafy greens and fruits, and some proteins. “You don’t want to have an acidic diet with red meat only and red wine. That’s not going to transport your blood properly to the muscles. You want enriched, not deprived, muscles. An acidic diet will make you pretty stiff.”
“Symptoms show up last,” she explains. “Pain indicates what needs to be done right here, right now, but it doesn’t work well for the everyday citizen who is going about their day with slight aches and pains yet waits until the pain becomes excruciating before seeing a doctor.” Often the person ends up in emergency care and is given muscle relaxants that don’t address the underlying issue.
“MDs catch the pathology,” Carter says. “I look at what is falling through the cracks.”
Physical therapy and sports performance
Jeffrey Latz is a strength and conditioning specialist and holds a Manual Therapy credential. With a bachelor’s degree in kinesiology and a master’s degree in physical therapy, Latz believes the best way to guide someone through the rehabilitation process is to perform a very comprehensive initial evaluation and to “take the time to listen carefully to what they are trying to tell me.”
He elaborates, “I assure them that there is something we can do to get them more functional. When someone is in pain, it takes over many aspects of their life. So much emotion is involved. Paying attention to what they are experiencing, and active listening, helps with my diagnosis.
Maybe we can improve their motion and their strength, maybe we need to refer them to a physician. That’s why a thorough history and evaluation is crucial to what we do here.”
For Latz, what works best is an individual, mechanical examination that determines precisely how a person moves, what might be inhibiting the quality of that motion, and how that translates to how they feel. When people think of physical therapy, they think of doing exercises. For example, if your back hurts you must do core exercises, but the missing link is finding how someone can’t move and trying to create that motion.
“If a segment of the spine is dysfunctional from stenosis [a narrowing of the spinal canal that puts pressure on the nerves], or if you have a disc that is problematic, you don’t want to force motion there,” he says. “We work on getting motion above or below it, and it takes pressure off that segment. I assess the segment for its stability and motion, make sure the ligaments are doing their job. I do all this prior to putting hands on for a manual treatment to make sure it’s safe.”
PT should never hurt. Latz continues, “We give what the body will allow. A patient asked me how I know how far to go. ‘Is it my reaction?’ they asked. I said, ‘Your reaction is my failsafe. It’s what I feel that dictates what I do.’”
Many people stay away from movement that is problematic. For instance, rotation is difficult on the spine, but if you train properly, strengthen the muscles and make the spine stable, you can create rotation.
“I can look at you in your sport, maybe it’s golf or tennis, and see that you need to rotate your hips more or increase your reach,” Latz says. “But every thorough program is training the entire body. We have all these little neurological pathways that we train for motion, so it’s impossible to treat a shoulder without treating the back, strengthening the core, working the other side. I fool all the body parts into working together.”
Finding the crack in the door
Back pain specialist Dot Spaet of Novato has taught individuals how to rebalance their bodies to eliminate pain for more than 35 years and has done rehab work for 15 of those years. “I have a reputation for solving problems other people haven’t been able to solve,” she says. Spaet has recorded a 91% success rate with her back pain patients.
“My engineering background has made me an excellent troubleshooter. The basic laws of mechanics are: What is it doing? What isn’t it doing? What does it need to be doing? And, what do I need to do to get it there? That’s exactly what goes on in the body.” Spaet has a degree in mathematics from U.C. Berkeley and counts among her 14 certifications: functional muscle training, core conditioning, flexibility, stretching, yoga and Pilates.
The Spaet Method is a way of looking at all the ways a body can be out of balance—front and back, right and left, upper and lower, inner and outer. When the body is in balance, it doesn’t hurt. Her “million-dollar tip” is to discover your own body imbalances and work the opposite.
Spaet asks her patients a series of questions when giving an assessment. These may include: What are your movement patterns? Do you carry a heavy purse or briefcase always on the same side? When you put your pants on in the morning, do you always lift your left leg first? Do you always cross your right leg over your left?
Spaet suggests reversing the habits that make the body lopsided. “The foundation of yoga is opposites,” she says. “Bend forward and bend back, twist one way and the other, reach up one arm, then the other. Be aware of your posture, the position of your head. Just the noticing, just the awareness of using your body different from rote can make changes.” She adds, “It does, though, require taking responsibility for your own well-being.”
Spaet’s advice for office workers to avoid back problems is emphatic: move, move, move! Set an alarm on your phone to remind yourself to get up and walk around once an hour. Reach overhead with each arm when you’re on a conference call. If you stretch and move, your glutes won’t go to sleep and your hip flexors—the number one muscle that causes back pain—won’t be contracted all day from sitting.
In addition to muscle imbalance, compression is a cause of back pain. Gravity is pulling down on us all the time. That’s why some physical therapy sessions take place in a pool where gravity causes fewer limitations on movement. Water plays a part internally too. Keeping hydrated is excellent for your discs. Drinking more water is often overlooked when seeking relief for back pain. Experts recommend that a person drink half their body’s pound weight in ounces every day. (Not an easy task!) For every caffeine beverage consumed, add an extra glass of water to make up for the caffeine’s dehydrating effects.
When asked for an example of a difficult case, Spaet recalls a man who came to her after a very bad car accident. When she asked how much pain he was in on a scale of one to 10, he said “12.”
“No matter what I asked him to do, he replied, ‘It hurts!’ In a serious situation like this, I look for what I call ‘the crack in the door,’ or the wedge. This fellow was on the floor in yoga tabletop position when I asked him, ‘Can you move your legs the width of a piece of paper?’ He looked at me like I was nuts! But then he said, ‘I can move a tiny bit.’ I said, ‘That’s your homework, go practice moving the width of a piece of paper.’ He came back in a week, and now he can move an inch. And that became our crack in the door. He built on that movement, was super diligent. Eventually, we got Mr. 12, as I call him, down to a pain level zero in a few months. If you have pain, start asking what kind of movement do you need and what kind of movement therapist can help you?”
As a self-help back pain specialist, Spaet provides a tool kit rather than physically working on her client’s body. With her coaching, a person learns exactly what they need to do to be aware of pain coming on, and then how to short circuit it before it arrives. Her final caution for foiling back problems is to go slow and be gentle. Use breathing to help let go of tight muscles. Be consistent in your practice.
“If you feel good and want to keep feeling good, create habits of moving, stretching, gentle twisting, forward bending, slight backward bending. Stretch the quads and hamstrings; do lunges sitting in a chair. Don’t eat the things that cause inflammation (sugar, including fake sugar, gluten, dairy). And drink plenty of water!”
BStong4Life®Napa Valley Center
Scott Heun, D.C., a certified chiropractic sports physician, is the founder and director of BStrongforLife, a health facility in Napa specializing in care of the spine and extremities. Voted Best of the North Bay in 2019 by the North Bay Bohemian, he evolved his career out of participation and interest in sports and worked as team doctor for the Stanford rugby team. In the mid ’80s, he became certified in Pilates as a rehab vehicle to help injured professional athletes. Heun and his associates both continue the clinical tradition of his late father, chiropractor Richard Heun, and go beyond tradition by utilizing state-of-the art digital technology and computer-aided assessment tools to serve their patients.
Heun understands that nutrition plays a big role in relieving back pain. In fact, on his clinic’s staff is a doctor who specializes in helping people who are “over fat.” He uses that term rather than “overweight” because if weight is mostly muscular, it doesn’t matter. It’s the fat-to-muscle ratio that matters.
“If a person is 30, 40, 50 pounds obese, we can start addressing chronic spinal pain by working on that,” says Heun. “If we are talking about back pain, or muscular skeletal injuries in general, recovery is going to be predicated on whether you have the building blocks to put yourself back together. Adequate vitamin D is a huge factor in all kinds of physiological processes. Does the patient have enough protein in their diet? If someone is really deconditioned and their nutrition is not very good, then their motivation will not be very good, and they won’t feel like exercising. We try to intercede and break that cycle so they can get stronger again.”
Heun works closely with several physicians and has found that with the kind of thorough assessment he does (medical history, taking x-rays, and communicating at length and in detail with the patient about what’s going on) he may uncover something that has been missed or has been ignored or dismissed as being inconsequential. “That’s not to demean anyone,” he says, “that’s just way we operate.”
He gives an example of how, through his initial examination, detailed questioning, and corroborating lower spine radiographs, he found that an individual’s chronic back pain was because of an abdominal aneurism—a ballooning of the big blood vessel called the abdominal aorta which runs very close to the lumbar spine. The patient was immediately referred to their physician for abdominal surgery.
“That kind of thing doesn’t happen every day, but it happens often enough that it bears mentioning,” says Dr. Heun. He thinks discoveries like this account for why more and more people are choosing “alternative” or complementary health providers to deal with intractable back pain. Sometimes it’s because of the newer tools at his disposal, like high energy laser light that is used for tendonitis or joint injuries, or sometimes it’s just his 30 years’ experience in observing how people move.
A woman suffering from lower back pain walked into Heun’s office. “I took a look and asked her to walk back in again. I noticed right away that her legs were not the same length.” After some testing during the exam, he put a five-millimeter lift in the patient’s shoe. “I never had to do any treatment, spinal manipulation or anything,” Heun recalls. “She came back five days later and hugged me, saying, ‘I have no more pain.’”
Did you know?
BACKtoGOLF was the original name of the business Jeffrey Latz, physical therapist and strength and conditioning specialist, founded with a partner in 2001. The name helped them get people in the door at first, but the practice has expanded its sports-oriented reputation to include those recovering from surgery, joint replacements, worker’s comp injuries and more. Latz now owns the clinic himself and has three women with doctorates in physical therapy on his staff, along with about eight part-time PT aides who are SRJC or SSU undergrads.
Back Pain Prevention Strategies
Move, move, move! Do whatever is convenient: walk, garden, use the stairs instead of the elevator, get up from your desk every hour. Swimming is great, so is low impact aerobic activity, like brisk walking. A sedentary lifestyle paves the road to back pain.
Strengthen your core and stretch. Exercise builds up muscles that keep the back healthy. Take a class in yoga or Pilates to stretch tight muscles and build up weak ones.
Drink water. Experts recommend drinking half your pound weight in ounces. For example, a 136-pund woman should drink 68 ounces of water daily. If you think of the discs as sponges, it’s easier to see how water is needed to keep the sponges pliable so the spine can move more easily. (See video at the following link for more on how water can help get rid of back pain: getoutofbackpain.com/library-free-information/.)
Don’t smoke. Among other things, smoking can decrease blood flow to the spine and increase the risk of osteoporosis. It also prompts more coughing which can lead to herniated discs. Reach out to your health provider for support for how to quit smoking.
Maintain a healthy weight. Excess poundage puts extra stress on your back. Your diet should contain a wide variety of vegetables, fruits, whole grains and beans, as well as moderate amounts of dairy products, poultry, fish and eggs. Get good fats from olive oil, nuts and seeds. Avoid added sugar, refined oils, processed meat, refined grains, and highly processed foods. Eat red meat only occasionally.
Sleep right. A poor sleeping position can aggravate back pain. Try sleeping on your side with a pillow between your knees or with a pillow that keeps your neck and spine in a neutral position. If sleeping on your back, slide a pillow under your knees. A comfortably firm mattress is usually best. Figure out what’s right for you.
Practice proper posture and body mechanics. At the office, make sure you have an ergonomically-sound workstation; in the warehouse or in the fields, lift correctly. Use your legs, do not twist and lift, hold the load close to your body.
Make time for relaxation. Work/life stress aggravates back pain. Find ways to relax and breathe.
What Employers Can Do
From a business and productivity perspective, it makes sense for a company leader to initiate a performance assessment. Scott Heun, D.C., a certified chiropractic sports physician, advises businesses not to wait to optimize ergonomics in a facility because the longer you hesitate, the worse problems can get. If workers are out of shape and have co-morbidities, surgical interventions are expensive and might not work. “Pain is the last thing to show up and is the warning sign that something is wrong,” he says.
Even if no one is complaining, employers should support preventative measures by supplying employees with sit-stand desks, workstations that consider correct height and position of computer monitors, quality desk chairs, and the opportunity for personnel to get up and move during the workday.
“The better a person’s body is performing and the more solid they are in overall structural integrity, the better their focus and mental acuity,” Heun says. “If someone has constant pain, or even pain on the level of annoyance, it could change their interactions, especially if they are in sales or face-to-face with customers. It is a big distraction to have discomfort all the time, and it diminishes an employee’s effectiveness.”
In his Napa practice, Heun treats many cellar workers, especially during crush. Some wineries offer stipends through their health-care programs so workers can regularly visit his clinic. When consulting with small firms, he has instituted basic mobilization exercises that people can do to promote good spinal hygiene. “Bottom line: companies should invest in their people.”
Hari Lakshmanan, M.D., physical medicine and rehabilitation physician from Kaiser Permanente, agrees that ensuring everyone has the best possible ergonomics and safe work practices is “a good place to start and a great way to show that business leaders care. Just as important is offering wellness programs that not only promote healthy diet and exercise, but also support mental health. This goes a long way toward ensuring that people stay productive and reduces the risks of debilitating low back pain.”
[Lead photo courtesy of Duncan Garrett Photography]
