While we’re considering and celebrating our curves this time of year, the compensatory curve is not top of mind.

Our spine’s curvature, aka our compensatory curve, is of little concern until we are in pain, but so much of our health depends on the alignment of our body, especially our spine. Why wait until after the pain? Since 80% of Americans will experience an episode of back pain sometime in their life, how can you be proactive to avoid this statistic? 

OrthoCarolina Adult & Pediatric Spinal Surgeon, Dr. Todd Chapman, shared with me about back pain prevention, alternative treatments, and what to do when back pain becomes more than just aggravating:

What are some of the common reasons for back pain? 

Certainly as we all age, life gets busy; for some of us physical fitness and general health is not as much of a priority, and our bodies can suffer as a result. Core muscle atrophy, disuse, and general aging can contribute to back pain. There are some well-known studies demonstrating that about 80% of Americans will experience an episode of back pain over the course of their lifetime. 95% of people will have recovery within a few months and a benign course, but unfortunately, 20-45% will have a recurrence within a year and up to 85% will have a recurrence over their lifetime. Aging itself is actually commonly referred to as the number one cause for back pain. Others include arthritis, disc degeneration, osteoporosis, and nerve compression (stenosis).


When is back pain not normal?

Back pain is and can be normal to some extent. It is estimated that over $100 billion is spent on back pain annually. Anyone experiencing any of the following symptoms should seek immediate medical treatment because these are red flag signs that back pain is not normal:

  • thoracic pain (upper-back).
  • new onset of fevers associated with Lower Back Pain
  • recent unexplained weight loss
  • loss of control of bowel or bladder function,
  • history of cancer/malignancy
  • recent illnesses
  • change in the ability to walk, control or feel arms, or legs
  • saddle anesthesia (genital region)
  • recent trauma
  • age at onset <20 or >55 years old 
  • long-term steroid use or IV drug use or
  • inability to get into a comfortable position and/or night pain.

How does improving posture improve back pain? 

Certainly posture, core strengthening, and general exercising can relieve the majority of back pain. While it may not be immediate relief, it will likely provide gradual improvement and lessen the pain. Persons with red flag signs should seek immediate medical treatment.


How can I work on my posture?

Core exercises are the best way to improve posture and lessen back pain. Weight loss can assist with this as well. Abdominal muscles, side muscles, and the muscles of the back are all vitally important to core strength and posture. Cardio, spin classes, walking, yoga and pilates are great exercises for core strength. The majority of low impact exercises are beneficial. They may cause acute flares of back pain initially, but in the long term, these modalities will provide some durable improvement in symptoms. Continuing these activities on a regular basis is important to prevent further pain. Swimming is an excellent activity for people with back pain to strengthen the core muscles.

What types of movements do you suggest people modify to prevent back injuries?

We find that bending, twisting, and lifting improperly can cause flares of mechanical back pain. We try to encourage people to lift with their legs, not their backs. This means squatting low while not bending forward to lift objects off of the ground. Also, trying to squat and lift without twisting. 


Why do our backs get more creaky?

Our spines age, like all the other parts of our bodies. Much as we get hand, shoulder, knee, and hip arthritis, we get arthritis of our spines. The joints that allow our spines to bend and twist are subject to arthritis. The discs that act as the shock absorbers between the bones (vertebrae) have 2 parts, the annulus and the nucleus pulposus. The annulus acts as the rubber on a tire, containing the nucleus pulposus. The nucleus contains a large amount of water and is hydrated. As we age, the nucleus can desiccate, or lose the volume of water, and this causes us to be more creaky and have episodes of back pain.


How can people protect their vertebrae if they have knobby-like backs?

Knobby like backs, where parts of the bones are more prominent, typically are thin, with lower muscle mass about the spine. Strengthening the muscles of the spine can help provide cushioning about the prominent spine bones. The spine is also more prominent in very thin people. Maintaining a healthy weight can help preventing the bones from being too prominent.

What does extra body weight do to someone’s back?

Extra weight adds force and pressures on the spine, asking more of the bones and discs. This can lead to accelerated wear and tear on the joints and discs, which can increase lower back pain.  Maintaining a healthy weight can decrease this likelihood. Many physicians believe that every extra pound you carry can translate to up to 5 times the weight on your spine.


Can a massage, acupuncture, chiropractic care ever be harmful?

Any intervention carries some risks. Massage, acupuncture, and chiropractic care are typically safe, low- risk treatments. They should not be the first line treatment for any patient with red flag symptoms as these will likely require more targeted and directed treatment, but for the majority of common back pain, they can be safely included in the treatment protocols.


How do you determine if someone needs back surgery?

Spine, or back surgery is always reserved as the last treatment option, when pain or disability has been ineffective to non-operative treatment. Physicians take into account the patient’s symptoms, their limitations, their expectations, and the underlying causes of these in order to discuss with the patient  surgical treatment options. There are many surgical options and these are guided through a conversation with the patient to allow him/her to make decisions based on desired functional outcomes.


What signs do you usually see before someone gets to the point of needing back surgery?

Typically patients experience back and arm or leg pain before needing surgery. Their symptoms will impact their lives to where they are not able do what they desire and they have attempted conservative, non-operative management without success. It is usually at this point that surgery becomes the desired option. Each patient can experience different symptoms and these can affect and impact them differently. A conversation between the patient and surgeon can help determine the right timing for surgery.


What is recovery like?

There are multiple types of surgery, so here’s what recovery looks like for each back surgery:

  • Decompressions (laminectomies, discectomies) can be outpatient procedures where patients typically get immediate relief of their radiating arm or leg pain. They will likely experience some post-operative neck or back pain at the surgical site, but this usually resolves within about 2 weeks and patients can typically anticipate being back to their normal life within a few weeks to a couple of months.
  • Fusions, or surgery where screws, rods or plates are placed to stop abnormal motion and pain, require a longer recovery. Unlike a decompression, where there is removal of an element of the spine compressing nerves, a fusion requires that after surgery, the bones fuse (knit together or heal) to take the load off of the implanted stabilization devices. They typically involve a more in-depth surgery which can mean a longer recovery. There is a higher demand on the body to heal and to fuse the bones, so it can take several weeks for the post-surgical recovery. Typically patients will be back and participating in their usual activities within a few months.
  • Finally, the largest operations, or fusions for scoliosis, kyphosis, or fractures, can require months of post-operative healing. All of these surgical treatments require some rehabilitation, either self-directed or guided with physical therapists to safely and expediently have a return to the desired outcome. To this end, we are constantly evaluating and adopting minimally and less invasive options. The goal of these procedures is to achieve the desired outcomes with less tissue damage and less post-operative pain. Decreasing tissue damage at the time of surgery while accomplishing the surgical goal is a vital piece of our approach to providing improved outcomes while minimizing the risks at the time of surgery.  This has also been shown to decrease time in the hospital, decrease post-operative pain, and provide earlier return to function. It has shown improved patient outcomes and faster achievement of post-operative goals.

Dr. Todd M. Chapman, OrthoCarolina











If you’d like to learn more about back pain and how to assess what is “normal”, check out OrthoCarolina’s online resources here.

For more information, contact a professional at OrthoCarolina.


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