Conquer Back and Neck Pain - Walk It Off! (29 page)

Those at risk for osteoporosis (small postmenopausal women, smokers, former smokers, non-exercisers, women who entered menopause prematurely, people on steroids and/or with chronic diseases, coffee drinkers, and those who consume heavy amounts of alcohol) should have a BMD (bone-mineral density) test performed. This test determines how much calcium you have in your spine. The results can predict your risk of developing a painful deforming vertebral fracture. Depending on the results of the BMD test, you may need to be treated with medications that increase the strength of your bone and decrease the risk of painful vertebral fractures. There are a number of effective medications available for this purpose. Your PCP can help you select the one that is right for your circumstances.

There was a time when you would see every salesperson in home repair stores wearing a weight lifter’s belt to prevent back injuries. A combination of soft science and clever marketing had convinced many employers to provide their workers with weightlifter’s belts. Subsequent well-designed clinical studies demonstrated that these belts did nothing to prevent back injuries and the belts disappeared overnight. The employers should have read about the Los Angeles firefighters (see
Chapter 9
, page 120). The firefighters who remained physically fit were less apt to injure their back on the job. Employers would be much smarter to encourage their workers to work out regularly and stay in shape. Once again, the best way to prevent back pain is to keep fit.

While we were walking one day, my wife pointed out an advertisement on the back of a Miami-Dade bus which read: “Automobile Accident Clinic, We help you with your pain, we work with your lawyer.” I have observed over the years that one of the biggest impediments to relief from neck and back pain as the result of an auto accident is a combination of medical treatments and legal advice on how much the injury is worth. This is particularly true when the doctor and the lawyer work together, which is a potentially bad combination for you. You can be assured that their interest is to make sure your pain is disabling and your treatment is extensive, expensive, and lasts until your case is settled. Unfortunately you may have lost your job, your family (because they cannot stand your complaining any longer), become hooked on narcotics, and become so depressed in the process that life is not worth living. Not infrequently the unnecessary medical expenses, legal fees, and lawyer’s contingency fees leave nothing from the settlement for you. Even worse is that your painful injury would more than likely have resolved itself if it had been left untreated! Instead, you are left with an unresolved chronic pain syndrome and you no longer have access to the doctor and lawyer who were manipulating your case.

The good news is that the most common, painful, demoralizing, and otherwise troubling spinal injury — whiplash to your neck from a rear-end collision — is rarely a serious injury today. Although it is one of the most aggravating and anxiety-producing injuries that you can sustain to your spine, it is usually self-limiting and requires minimal treatment for relief.

When you bend your neck forward you can only go far enough for your chin to strike the front of your neck. When you bend your neck backward, the only restraint are the ligaments in front of your spine. The term whiplash refers to an injury to the neck that occurs as the result of a rear-end collision. If you are a passenger in a car that is struck from behind, your neck will suddenly be whipped backward. In older cars that aren’t equipped with proper headrests that restrain how far backward your neck is whipped, you can sustain terribly disabling sprains of the ligaments, muscles, and even discs in the front of your neck. The whiplash injury’s awful reputation is a result of the severe hyperextension injuries passengers in such older cars have suffered in rear-end collisions.

For the past 20 years, with the advent of proper headrests that are positioned properly behind and close to your head, the severity of whiplash injuries has decreased dramatically. I have seen patients who were riding in cars that were struck so hard from the rear that the whole back of the passenger seat was broken, and yet they were not severely injured. The headrest kept their head in line with their body, thus preventing a sudden whiplash of their neck.

Why is it so common for people who suffer a whiplash injury of their neck to sue for pain and suffering? There are several reasons. The injury is usually brought on by someone who was not paying attention while driving, and the way it occurs makes the victim feel vulnerable and angry. They do not see it coming, and it frightens them. The symptoms of whiplash can be most aggravating, including headache, nausea, neck pain, difficulty sleeping, and anxiety. If they are treated with an immobilization collar, bed rest, massage, manipulation, and narcotic pain medication, the symptoms will linger forever. On the other hand, if they walk it off, use heat and/or ice, whichever works best, and anti-inflammatory medication, the chances are that the symptoms will subside completely within a matter of four to six weeks. It is difficult to follow this approach if your doctor and your lawyer are telling you that you are seriously injured and that you should be compensated for your pain and suffering.

Whiplash injury of the neck is essentially a sprain of the muscles, ligaments, and sometimes discs in the front of your neck. We have learned from treating sprained ankles that walking them off hastens healing. The same is true for a neck sprain. A soft collar may help for a day or two, but a hard plastic collar only makes things worse by inhibiting healing. The best way to get quick relief from the majority of whiplash injuries is to walk them off.

Is there ever a time when a whiplash injury is dangerous and you should not try to walk it off? There are two situations in which you should seek expert help from a qualified orthopaedist, neurosurgeon, neurologist, or physiatrist. Any older person with a history of neck pain may have spinal stenosis. When spinal stenosis narrows the spinal canal and constricts the spinal cord, a further sudden narrowing of the spinal canal from a whiplash injury can injure the spinal cord and cause a form of injury to the spinal cord called central cord syndrome, in which the arms may become weak but the legs are spared. Any feeling of weakness in the arms or legs following a whiplash injury should be diagnosed immediately. If you have a sensation of pins and needles or stabbing pain in the arms or legs with bending your neck forward following such an injury, it is a sign that the spinal cord has been injured and you should seek help. Do not keep testing for these symptoms if they occur once; just seek expert help right away. If you have immediate onset of severe neck pain and difficulty swallowing following a motor vehicle accident, or if you were knocked unconscious, then you should seek help. Sometimes it is not apparent immediately following an accident of any sort that you have sustained a serious neck injury; therefore, if any of these symptoms should come on later, ask for help.

Remember to question the real necessity of treatments such as narcotics, muscle relaxants, repeated manipulations, and hard plastic collars for a whiplash. Beware of the doctor or chiropractor who encourages you to see his lawyer associate. Most legitimate doctors who I know refrain from referring their patients to a lawyer because they feel it is a conflict of interest to be involved in your legal case related to a motor vehicle accident. Good doctors are your advocate and want you to have the most effective, safest, and least expensive treatment. They do not want to be in conflict with your lawyer. They can best watch out for your interest if they are not associated with your lawyer. Most lawyers are ethical and also want the same thing for you, and they can function better if they do not have a relationship with the doctor. These issues are important for your health, particularly when it comes to whiplash injuries of the neck.

I have seen many patients through the years who are suffering from chronic back pain syndromes as the result of too much and too many types of treatment. They are cured by stopping all treatment and by not seeing doctors anymore! This has led me to believe that many people could avoid suffering from chronic back pain by avoiding certain treatments and too much treatment. For example, if you want to avoid chronic pain, never let your doctor place you on strong narcotics (see
Chapter 8
). Never go to bed for more than a day or two for back pain. Don’t have repeated “maintenance” adjustments of your spine (
Chapter 9
). Don’t have a spinal fusion for back pain caused by degenerative disc disease, especially if it was diagnosed by a discogram (
Chapter 8
). For that matter, don’t have a discogram. Clinical studies show that people with discogenic back pain do better with exercise than with spinal fusion. Don’t become dependent on any treatment. Always have a plan with your doctor to stop any treatment at an appropriate time. If you suffer from depression along with back pain, seek out treatment for the depression from your primary care physician, not a pain management specialist or spinal surgeon. Exercise, don’t smoke or drink excessively, and watch your weight. These are some ways to prevent suffering from chronic back pain.

I saw a young man in my clinic two and a half months after I had performed a spinal fusion on his low back. He was accompanied by his wife. He informed me that he had been working since a month following the surgery and that he had some good news. His wife blushed as he informed me that she was pregnant with their first child. I congratulated them and inquired how far along she was in her pregnancy. She said as best they could tell around two months. He said that they were sure she conceived shortly after he had come home from the hospital following his spinal fusion! He said he wanted to make sure “it” still worked following the spinal fusion. We all had a good laugh, the story made my day, and they agreed that I could relate it to you as a segue into the subject on sex and back pain. I am not telling you that you should be able to have normal sex so soon after a spinal fusion, since their case is the exception, but I am saying that often the inability to have sex while suffering from a painful spinal condition may be secondary to fear, anxiety, or over-precautionary advice from your doctor, and not from the actual condition.

In the 1980s a colleague of mine wrote a book on back pain for the general public, which contained a whole chapter on sex. The chapter was replete with line drawings of couples having sex in various positions to illustrate how to avoid exacerbating a painful back condition. I am sure that this chapter helped sell a lot of books, but I am not sure it was completely necessary or particularly helpful to the readers. I am sorry to tell you that there will be no illustrations to accompany this discussion, but only helpful advice on how to enjoy a normal sexual experience despite suffering from back pain. There will also be some hints on how not to aggravate back pain while enjoying sex.

On the questionnaire that I have patients fill out regarding their back pain before they are seen in my clinic, there is a question concerning difficulty with sex. Most of the people who answer this question in the affirmative have multiple medical problems such as depression, obesity, hypertension, and/or diabetes in addition to their painful spinal condition. Most otherwise-healthy people, with the exception of people who have medical-legal issues (as discussed earlier in this chapter under “How to keep whiplash of the neck from destroying your life”), do not have difficulty with sex despite a painful back. It is my observation that “difficulty with sex” is a problem that is associated with general health and emotional issues more than with painful spinal conditions.

It is known that male smokers lose their libido at a relatively early age. Obesity, lack of exercise, diabetes, and hypertension are associated with a loss of interest in sex. When a person complains of “difficulty with sex” because of back pain, more often than not the problem is related to some other health issue such as depression, diabetes, smoking, obesity, and/or medications rather than the painful back condition per se. Successful rehabilitation of the individual usually corrects the libido problem. Restoration of a normal sex life is a good incentive to lose weight, exercise, stop smoking, and stop taking pain medications. All of these measures also relieve back pain.

What if you have a chronic back problem such as spinal stenosis and having sex aggravates your pain? How can you satisfy your partner and at the same time be satisfied from lovemaking in face of a chronic painful spine condition? Here are some hints. Determine the movements that aggravate your pain. For example, with spinal stenosis arching your back can aggravate neck and back pain. When this happens to a man, the best way to prevent it is to assume the bottom position during intercourse. In this way he can keep his neck and low back in a flexed posture. Lying on the side is also an option.

Women with spinal stenosis in the low back may find it more comfortable to assume the top position during intercourse. Also, spreading the legs can aggravate the symptoms of spinal stenosis. Women who suffer from spinal stenosis may find that lying on the side and having their partner approach from behind is the most comfortable and satisfying way of having intercourse. The woman does not need to arch her back or spread her legs during this approach.

Except in rare circumstances, sex is safe if you can find a comfortable position and your partner understands and accommodates your needs. Unless your doctor has specific reasons why you should not participate in sex, you can find a way if you have the will.

In my experience, wearing a brace, sleeping on a special bed, sitting in a special chair, or a using a disabled parking sticker will not prevent you from having chronic back pain. Only regular exercise, not smoking and drinking excessively, and watching your weight will prevent you from suffering from chronic back pain. The really great news is that these measures really work, they are totally under your control, and they are affordable!