Your Checkup: What You Wish Your Doctor Explained
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Your Checkup: What You Wish Your Doctor Explained
Back Pain: Causes, Relief, Prevention
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Back pain affects 80% of people at some point in their lives, but the good news is that approximately 90% of cases improve within 6-12 weeks with proper care and movement. Understanding the causes, treatments, and prevention strategies for back pain can help you navigate this common but often debilitating condition.
• Most back pain is "non-specific" with muscle strain being the most common cause
• Common types include lumbosacral strain, SI joint dysfunction, and disc herniations
• Imaging (X-rays, MRIs) usually unnecessary in first 4-6 weeks unless "red flags" present
• Many people with no pain have abnormal findings on imaging
• Brief rest is okay but prolonged inactivity makes recovery worse
• Heat, over-the-counter pain medications, and lidocaine patches can provide temporary relief
• Physical therapy with core strengthening exercises significantly improves outcomes
• Your core includes abs, obliques, back muscles, pelvic floor, and diaphragm
• Good posture means stacking head, shoulders, spine, and pelvis vertically
• Common posture mistakes: tech neck, slouching, crossed legs, improper work setups
• Movement is medicine - think of your body as cement waiting to harden
• Seek medical attention for numbness, weakness, loss of bowel/bladder control, or persistent pain
If you learned something today, pass this episode along to a friend or neighbor who's dealing with back pain. You can sign up for our email list to receive written content and updates about future episodes.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Hi, welcome to your checkup. We are the patient education podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine doctor in the Philadelphia area, and I'm Nicole Aruffo.
Nicole Aruffo, RN:I'm Ed Delesky, a family medicine doctor in the Philadelphia area, and I'm Nicole Rufo.
Ed Delesky, MD:I'm a nurse and we are so excited you were able to join us here again today. I've got a few notes. Oh, I love how you smile as soon as you hear that. You get the little sense that something's happening, something is brewing. So we've had ourselves a really nice weekend.
Nicole Aruffo, RN:Yeah, because someone finally didn't have to work.
Ed Delesky, MD:Yeah, I mean back to the old days where I actually had to work a lot on the weekends three in a row, but not this one and so we got to spend time doing some really nice things. We went and had a date night on Friday. We went to one of our favorite restaurants I think we've talked about it before Giuseppe and Sons. I would say the whole experience was made by our waiter, Waiter, Server, what are we?
Nicole Aruffo, RN:doing these days. He was great Eric.
Ed Delesky, MD:He was awesome. He was down to earth, he was warm but funny. He went upstairs after I was like can I have a Grey Goose, dirty martini? I was feeling bougie and I was like can I get some blue cheese olives? And he says I'm sorry, we don't have the blue cheese. So he comes back with your drink and mine. And this man went upstairs to a separate bar and got the I guess it's Gorgonzola, I don't know. He went up and got the blue cheese and he stuffed those olives for me and that was really nice.
Nicole Aruffo, RN:It was a good martini.
Ed Delesky, MD:And it was a good martini. They like pulled the mozzarella right in front of you. I don't know You're better at describing that to me. I still don't really understand how that works.
Nicole Aruffo, RN:We don't need to get into that now.
Ed Delesky, MD:So, all in all, we had a nice dinner We'll spare you the details, I suppose and then the next day we had the Rittenhouse there was like a fair down the street on Walnut.
Nicole Aruffo, RN:I do have something that we need to talk about.
Ed Delesky, MD:Is it an intrusive thought, like you want to talk about it right now? Yeah, okay, what is it?
Nicole Aruffo, RN:It's an epidemic that is plaguing our nation, and do you know what I'm going to say?
Ed Delesky, MD:I have no idea what you're gonna say.
Nicole Aruffo, RN:It's this is like totally an intrusive getting into ubers and the drivers keep the windows open. Oh, because this has happened to us twice now. Okay, yeah, let's hear it. Actually I guess it was left, because we get like double credit card points or whatever on left actually five times. Oh really, yeah, oh okay that's why I don't care all right, I guess it might be worth the windows open, but if we weren't getting five times points, this has happened twice now in the last like two weeks yeah it really has the one?
Nicole Aruffo, RN:what well? The one was on friday because it was pretty hot and we took an uber to the restaurant. And we get in the car, this girl has all four windows open and I'm like, oh my god, like it is 85 degrees out, like I just diced in my hair, like I got a 500 blowout and now it's ruined by the humidity and with your windows open, whatever, yep, but then the, which was like, fine, whatever it was like a local city drive, yeah, so it wasn't that big a deal but two weeks ago or whatever, we took an uber to dylan's wedding and, like we're obviously all dressed up and this guy has his windows open and we're flying down the highway yep, like a crisp
Ed Delesky, MD:65 with windblown hair, showing up to this wedding and, like you, had spent a while working on yours me equally or more you show up windblown and yeah, so that I think, um, we'll see it next time. I we got back. There was a ride we took from to and from a brewery for our friends engagement and they had the windows closed. Oh yeah, they did. So it's not exclusive, but it happens more than I would think and they're probably trying to save gas, you know, like not having the air conditioning on the whole time.
Nicole Aruffo, RN:I don't care.
Ed Delesky, MD:I know we are paying for a service, you know, yeah, that's a big one. I'm glad you brought that up, good thought, good thought. I was thinking about the. On Saturday, unbeknownst to us, you like sent me like this instagram story about this like event happening. It was like a whole written house thing on walnut street and it was cute. It was like a bunch of like vendors but like local stores and restaurants that we all know and love and they have their little thingies. And like the philadelphia pickle fish town pickle project which we had like a big pickle, that was so good yeah, that was cool.
Ed Delesky, MD:Like there's nothing like a large pickle on a stick for you to walk around a fair scene just munching on that thing. What it was good, it was crisp, it was refreshing, it's good. And then we were walking by because we had like done a nice run together and we eyed up this like long hot, long has been a lot like long hot peppers have been a big part of our life. Recently Was so on dinner on Friday and I was really trying to recapture that with the wilder tent.
Nicole Aruffo, RN:I don't know what it was, but it was delicious Porchetta or panchetta.
Ed Delesky, MD:I don't even remember, not sure what it is, but we definitely ate it, we enjoyed it. And then went to get ice cream. Oh God, all right, so 1-900-ICE-CREAM, delicious ice cream. I had a conniption. I'm not sure what was going on. Kind of a long line and there's two people working inside. Whatever, what have you? Excellent ice cream. Usually only get hard ice cream, so we finally get inside. 20 minutes waiting, not a huge deal, and you know you get your like. Was it chocolate?
Ed Delesky, MD:and vanilla swirl with a cookie butter dip. Yeah, that was delicious and I'm like okay, I know that I won't be able to handle a cone because it will start dripping down the sides and it was like 80 ish degrees outside so it'll drip down the sides. I have to like speed it. I just avoid it entirely. So can I get this in a cup? I'd have you know this was the thinnest cup for soft ice cream I've ever seen in my life very narrow base and we get outside and immediately I have to race to eat this ice cream.
Ed Delesky, MD:And then I start stressing out. And then we're walking and the pressure of the situation rises and my fist is tightening and now there's ice cream dripping down the sides on my hands, down my hands, down my arm, now it's onto my shirt and my shoes. And I'm continuing to walk, continuing to grip tighter. And what do you say? What did I say when you tell me to relax?
Nicole Aruffo, RN:oh yeah, I did, I did, I did do that. You said okay, because you were getting more frustrated that the ice cream was melting and then because you were getting more frustrated, you had a tighter grip on the cup, which just made it come out faster, because it was such a narrow base there was like four inches of ice cream above the base, above the end of the cup, and I have to rush through it.
Ed Delesky, MD:So then, here I am, pouting in Rittenhouse as people are like galloping around with ice cream on my shirt, like a toddler, and ice cream on my lip because I was.
Nicole Aruffo, RN:He got like on the very edge, like on like the hem of his t-shirt got two drops of chocolate ice cream and he was pouting sitting there.
Ed Delesky, MD:He's like I wanted to wear this shirt for the rest of the day I was pissed, and then I came back and I like didn't cook the steak to perfection. And then yesterday I was just taking myself or whatever day that was.
Nicole Aruffo, RN:Let's talk about the steak.
Ed Delesky, MD:I was just.
Nicole Aruffo, RN:I took myself way too serious Because I'm not in the boys chat with Mike and Karthik, so they better be listening. I know Mike does when he like does stuff in his basement. I don't know if Karthik does, but we're going to find out, because we went to whole foods, got some steak. Eddie came back, cooked it. I like my steak cooked a little bit more than he does, like a solid medium is how I like it. He cuts it. He's like oh no, this is more medium rare here, try it. I was like no, I don't like it this way, blah, blah, blah. So he like cuts off a piece, puts it back on for me, yada, yada, yada. So then he proceeds to go to the boys chat with mike and carthick being like don't you hate when a woman doesn't like a perfectly done medium rare steak? Da, da, da, da, da. Then come to find out once he got done, having his second hissy fit of the day, that actually his steak was rare and how I had it when I put it back on was medium. Yeah.
Ed Delesky, MD:So the idea of the steak you know not to be done with a prime rib was to cut it into slices and then take that and put it aside some noodles that I made and I chose the wrong steak for slice cutting and I didn't get the chance because I was so wrapped up in the amount of time to put it on the cast iron and it was so wrapped up that it was like an event and I was downstairs, no one was watching me. I'm like huffing and puffing over this steak and I forgot to touch it to gauge. And if I touched it I would have recognized that I just put the whole whole hock back on there. But no, I didn't. Now I know for next time, we've been doing more sirloin this time, like recently, and so this was a little out of the realm. Maybe a flank steak next time, who knows? But yeah, I did.
Ed Delesky, MD:I did text them because I was upset and then I was wrong and I can openly admit that.
Nicole Aruffo, RN:I recognize that there's no well, because you like, they're like your second girlfriends, or maybe I'm your second girlfriend, I don't know. But we sat down to eat and his little thumbs are going quick on his phone and I'm like, oh my god, he's like rage, texting mike and carthag how mad he is about this steak. So what are?
Ed Delesky, MD:we going to talk about today, Nick.
Nicole Aruffo, RN:Let's see, let me see here Today we're talking about low back pain.
Ed Delesky, MD:Is that relatable at all?
Nicole Aruffo, RN:Yeah, all of our backs hurt. Let's talk about it.
Ed Delesky, MD:Yeah, it's true. About 80% of people experience low back pain at some point. Let me sit with that for a second. 80%, that is four out of every five people that you know, eight out of every 10, 80 out of a hundred people experience low back pain at some point.
Ed Delesky, MD:Thank you, I really try hard. Oftentimes, luckily, it's not dangerous, but of course it can significantly interfere with daily life. But there's good news to all of this and that's why we're going to take care of you guys here today and talk about it. When I talk about daily life, one thing up front that I want to say is that back pain usually goes away, which is a good thing. Usually goes away, which is a good thing, and by this I mean approximately 50% get better in one to two weeks.
Ed Delesky, MD:I'm in that category. Recently you were 90% of them get better in six to 12 weeks. That's really good news. That is a month and a half to three months that's really good news. That is a month and a half to three months. Nine out of 10 of these get better and the hiccup with this is that about 85% of them recur. About 85% of them recur in approximately one to two years. So that is a troubling piece. That's a little frustrating that for the vast majority of people it goes away, but it can be a relapsing, remitting type of thing. And I mentioned daily life because back pain actually tends to have a really big impact on people's function and return to work. If someone misses approximately six months because of low back pain, there is about a 50-50 chance that they go back to work.
Nicole Aruffo, RN:Six months is a long time.
Ed Delesky, MD:Six months is a long time. If they missed about a year of work from low back pain, there is a 25% chance that they go back. That's a long time. So that's a long time. Most of these get better. But it's important that we understand what's going on when we have low back pain, what your doctor's probably thinking about when you go in with a concern of low back pain. Or maybe you're just at home and you have low back pain and are wondering what the heck we can do. So hopefully today we're going to tell you more about what are the causes, what you can do, when to seek help and how to prevent it.
Nicole Aruffo, RN:Tell us about causes or I guess the most common causes of low back pain.
Ed Delesky, MD:Yeah, this, I think, is going to be a little bit of a frustrating answer, but it really like Wizard of Oz pulls back the curtain for what your doctor is probably thinking about. The most common cause of low back pain is really unsatisfying. It is a non-specific low back pain and by this I mean that there tends to be no identifiable cause. Of those unidentifiable causes, a muscle strain is most common. There are a lot of deep muscles in the back and they're very important. We're going to talk about them later in the episode a little bit. But they often go unnamed, Like unless someone is really into anatomy back there, or like by some random chance a spine surgeon is listening or a physical therapist perhaps. But these muscles often go unnamed. But there are so many layers of them in your back that help you stand up straight, and very frequently when there's an injury to someone's back, it is because one of these muscles is injured.
Ed Delesky, MD:There are other common problems. I usually pitch it to people as there's three really common types. There is a lumbosacral strain, which is what I just described. There is SI, joint dysfunction, which is where the pelvis. The joint where the pelvis and the spine meet up, has a lot of ligaments and tendons and those can become injured from abnormal movements, chronic changes over time. And there's also disc herniations, which is the lumbar radiculopathy. We'll define some of these terms in a little bit as well.
Ed Delesky, MD:Lumbar radiculopathy is where a disc, which is kind of a firm but squishy material that lives between the bones of your vertebrae, allowing absorption of the compression and the stress of the spine in the vertical axis. In certain situations the disc itself can go out of place and pinch a nearby nerve, which causes back pain that often radiates down the leg. Does that sound familiar? So there are disc herniations, there's also disc bulging, there is also arthritis or breakdown of the joint or joints in the spine, and then there is a concept called spinal stenosis, which is a narrowing of the spine. What does that truly mean?
Ed Delesky, MD:If the spine is considered to be this hard, bony structure, there are holes that allow for the softer structures or the nerves to exit the spinal cord and exit the cage of the spine and go out and do their function. But as we age there can be a process where these holes, these passageways narrow, leading to pinching of the specific nerves, which can also lead to problems. When it comes to back pain. We talked about some of the more common ones just there, but there are more rare but serious ones that we probably won't take as much time to cover today, but these include infections, tumors and a pinching of the lower parts of the spinal cord. That's so significant that it causes different symptoms, including numbness in the groin, dysfunction in bowel or bladder function, and this is called cauda equina syndrome, which is something that needs to be evaluated very seriously and very quickly. Surgeons will become very interested in you in that case.
Nicole Aruffo, RN:Okay, let's talk about everyone's favorite thing.
Ed Delesky, MD:Yeah, honestly.
Nicole Aruffo, RN:When um, let's talk about when typically you would need to get imaging for your low back pain.
Ed Delesky, MD:Yeah. So I think this is a hot button issue and I'll say clear and plain here is that imaging is often not helpful, at least in the first four to six weeks, unless there are red flags that are present. And these red flags include associated unexpected weight loss, a history of cancer, trauma, prolonged high doses of steroids, a serious, significant fever or, say, neurological symptoms. And I think everyone, or I think a lot of people, go forward and they want the MRI, which is the thing that people really want, and there's a couple different hurdles that have to happen before people get the MRI. And even then the MRI may not bring all of the illumination to what's going on that someone may be hoping for. After four to six weeks and four to six weeks of like, continued thoughtful treatment and there's no improvement, clearly most insurance companies will need an x-ray first before they even consider approving an MRI. Now, clinically, this also rings true that someone with low back pain really probably doesn't need x-rays or an MRI in that first six weeks, unless any of those things are present, because it's not going to change what we do. It doesn't change what the person should do to help treat themselves, and that's one key piece that maybe you've picked up from listening to all these episodes, like if you're not going to do anything with the test, it's not going to change what you do. Maybe you shouldn't do it.
Ed Delesky, MD:And another thing is a lot of people walking around on the street who have no pain at all, and this number has been tossed around 25%, 40%, many, many people with no pain at all.
Ed Delesky, MD:If you were to take an MRI of their back would have bulging discs or herniated discs and they would have no pain whatsoever.
Ed Delesky, MD:And so what I say there is that even if you got this MRI of your low back to help get a better description and make sure everything was quote okay, it may be out of place of what the pain.
Ed Delesky, MD:It may not be the pain generator that is causing your symptoms, and so that as a whole layer of confusion to this issue. So the real key is understanding your symptoms and their timeline, kind of like what we were talking about before, that 90% of them get better between 6 and 12 weeks and not rushing into tests because they may just be more expensive, more timely and may not give you any benefit truly, and I say that knowing that there is a group of people out there who get benefit from getting the image, and so that's why you need to specifically work with your doctor to figure out where you fall if you're dealing with this. Are you someone who needs an MRI, or is there a lot of room for you to improve and talk about stability in your back and your core or what lifestyle changes you can make to work on these things?
Nicole Aruffo, RN:Excellent. So you know we, oh, what was that?
Ed Delesky, MD:That was my name. So we've done a lot of pontificating about like types of low back pain and imaging studies and kind of laying the background, but this part is the really like the take home tangible stuff for our audience. What can you do at home? Okay, so we're in my situation. I was at the gym. I was getting really excited about like doing an explosive lift. I feel like, oh, there it is, I did something to my back. What should someone like that think about doing?
Nicole Aruffo, RN:There are a lot of different things that you can do at home. When this initially happens or you kind of first feel that twinge of back pain Most common is probably going to be like laying on a heating pad for comfort or applying like ice or cold. Honestly, whatever makes you feel better, do that one. That's a key thing. Yeah, um, some over-the-counter medicines you can take, like an nsaid, so like an advil or an aleve or some tylenol. Um, if you know those medications are safe for you, to take sure, lidocaine patches can help numb you up a little bit and provide some temporary, temporary relief I'm just gonna jump in here real quick, is that you shouldn't put a lidocaine patch on and heat, because it increases the amount of medicine delivered.
Nicole Aruffo, RN:So don't do that, sorry not doing that um the massage gun? We love a theragun that actually helps.
Ed Delesky, MD:Look, I mean you're not going to find any like literature about a massage gun out there, or maybe you will, I don't know. You can call us in the fan mail. That was, I think, the most helpful thing. Like you did that to me at night and woke up the next day and felt vast improvement. Not that we're sponsored by theragun or anything. I kind of wish that would be cool. Yeah, and then there's a whole class of medications out there that were pushed a while back. I'm talking about opioids, plain and simple. They are usually not needed for this. They may cause more no, not even may they cause more harm than benefit in this situation, and there is a time and place for them. It's in cancer patients, and acute pain, low back pain is not the answer. Please steer clear when you can, sorry.
Nicole Aruffo, RN:And then the thing we're going to kind of talk more about that you can do at home. That's really important. I feel like I actually have a lot to say about this is staying active Excellent, because you know, like brief rest is okay and taking a break from, you know, going to the gym or running or whatever kind of activity that you're doing you know is safe to do right off the bat. But prolonged inactivity will actually make your recovery worse.
Nicole Aruffo, RN:So much worse your recovery worse, so much worse, because you need to one, especially talking about your back, which is what we're talking about, obviously, like you need to keep all the muscles around your lower back stronger and like your core stronger, because if they're not, then you're just going to keep getting injured or you're going to take a really long time to recover that's a great point and like the longer I was in pt.
Nicole Aruffo, RN:One time and one of the pts was talking to this guy who was like in his 80s and was there for like whatever, but like in great shape, took really great care of himself. And the guy was talking to the pt, because the pt was I don't know asked them like how, like you know, like what have you done your whole life? Like, how are you?
Nicole Aruffo, RN:yeah this fit and whatever. And the guy like the 80 year old said to the PT and was like your, our bodies are like cement and they're just waiting to harden and it's you know kind of that old adage of like a body in motion stays in motion but, I think that's really true in this case too. That's a nice analogy.
Nicole Aruffo, RN:Like if you are just like laying in bed I mean, even if you're like sick for a couple of days and you're laying in bed or laying on the couch, you don't feel good. So if you have an injury to your back and then you're not moving and like keeping things mobile and like keeping everything else around it mobile and strengthening it, then that doesn't help and like keeping everything else around it mobile and strengthening it, then that doesn't help.
Ed Delesky, MD:That is a great message and you even mentioned like a key element in there where it can be great to stay active and do exercises at home, and we're going to talk about like a couple of different ways.
Nicole Aruffo, RN:Yeah, pt is like really great for that, especially with those little you know all like the little muscles in there and doing these like little exercises that you're probably like, oh this is stupid, this isn't doing anything, but it actually, if it's something that you take seriously and yes continue to do, you know, like every day, or whatever they.
Ed Delesky, MD:However often they tell you to do stuff and then it really can totally help and, like you know, people are busy and so going the three times a week that someone may prescribe for physical therapy may not be so reasonable in someone's busy life, or you make time and space for it because it's important to you but even not even going like doing them at home.
Nicole Aruffo, RN:But doing it at home, even if you go once a week and then, like they always give you stuff to do at home that you have to keep doing. It's not like you go in. Your 30 minute pt session is going to cure everything.
Ed Delesky, MD:It's something that you have to keep doing exactly you really like you harped in on this when I was down, you did and like there were even subtle like pelvic tilt motions that, yeah, I love a pelvic tilt are tough to describe and like I can only imagine like you were like hands on, like showing me what to do, but then like, like I can only imagine that, like if someone didn't have someone like you not that you're a physical therapist, but you have a lot of experience like going through stuff like this, that like guiding them, like I was naive, I was like, oh, like cat cow, yeah, that's what I'm gonna do, which sure, there's some of that but like there were so many different things and positions that you showed me that I think a physical therapist is very, very helpful for, especially invest in it like you're investing in a skill or you're learning knowledge, and then you take that and do it at home, like you said. Yeah, excellent point. And one specific arm of physical therapy that has been studied specifically for lumbar radiculopathy. So when I say radiculopathy, I mean that pinched nerve in the back with the shooting pain down the leg.
Ed Delesky, MD:One quick note here is specifically the McKenzie back protocol or the McKenzie method. You can look this up online, but it is a focused effort for repeated movements and their specific exercises that the goal is to centralize the pain, and so I say a radicular pain and you take that pain and the idea with these exercises is to move that up towards the back, where the initial pain generator is. It's particularly useful for disc-related pain or sciatica but truthfully it's not appropriate for all types of back pain. It honestly works best when the movement improves the symptoms and you know, in our future, like aches and pains types episodes, we'll refer back to this website. But the UCSF sports rehab website is has a whole for patients section where you can go in there and you can see like they have like shoulder stuff, but specifically they have core strengthening and they have back protocols that are especially important to think about.
Nicole Aruffo, RN:Your back muscles are part of your core. Your core is not just your front. This is a great transition to this next part of your core is, like you know, yeah, strengthen, you know, like your back muscles and even working with, like your hips and like your glutes. But your core all around, including your back, is so important for stabilizing all of those little muscles and strengthening them and making sure that you don't get hurt again.
Ed Delesky, MD:Oh my gosh, yeah. So let's. Why don't we like take a little time to take our little tributary away from this and talk about the core a little bit more? And when we're saying this, we're not talking about six pack abs. You've hinted at the definition here. The core is so much more than that. It's abdominal muscles, it's obliques, it's back muscles, it's your pelvic floor and your diaphragm all of this is your core right.
Nicole Aruffo, RN:So your core is not just the front, it's all the way around. There's a lot of different parts to it yeah, and. And if that's if you know the core, like the center of your body, is weak, then you'll have poor, then you have lower stability in your body and, honestly, like you should be kind of mindful of that and thinking about that just as you age, not even having anything to do with back pain.
Ed Delesky, MD:Sure.
Nicole Aruffo, RN:So you can stand up straight when you're 80. Exactly, and so that you don't have like balance issues when you're you get to that age where people fall.
Ed Delesky, MD:Yep. So tell us, since you talked about standing up straight, tell us how posture impacts your spine and opportunity for low back pain, but also just longevity altogether.
Nicole Aruffo, RN:So poor posture. So like slouching, leaning forward, neck forward. It loads our spine unevenly, which we don't want.
Ed Delesky, MD:Yeah.
Nicole Aruffo, RN:You don't want an uneven load on your spine. Ideally, your head, shoulders, spine and pelvis should all kind of like stack on top of each other, not slouching sitting rolled up like a pretzel on the couch like I do all the time. Um, you know who has really great posture? Alex, he does. Yep, he does have great posture. You said something to me when we like first met about my posture, and I don't know if I ever told you this, but I was like like consciously working on my posture and that was such a good compliment yeah, your posture was so great at the time.
Ed Delesky, MD:It still is at the time now. I'm just a troll no, I'm like, I look like I belong under a bridge.
Nicole Aruffo, RN:I know, when we took our engagement pictures, you like said something about that, about like having poor posture. Well, she like, and how she you like wanted her to pose you, yeah.
Ed Delesky, MD:The quickest aside is that, like she was great because she asked us like our insecurities and I was like, yeah, it's my posture and I don't want to look like I live under a bridge. Tell us a little bit more. What are some really common postural mistakes and easy things for people to fix?
Nicole Aruffo, RN:Well, number one is definitely craning our necks to look at our phones.
Ed Delesky, MD:Yeah, I feel like everyone does that big time the tech neck.
Nicole Aruffo, RN:Yeah, slouching in your chairs, like I am currently right now, or sitting with your legs crossed for too long.
Ed Delesky, MD:Like, I, am currently Yep.
Nicole Aruffo, RN:I mean and there are simple corrections to these like having a chair with lumbar support, looking at the height of whatever screen you're looking at, whether that's your like laptop or your phone, and then foot placement, so essentially, just not sitting for a long time crossing your legs.
Ed Delesky, MD:Yeah, so like more specifically, I guess that the screen should be at the eye level and feet should be flat on the floor and, like you said, low back supported. I think work from home setups are a huge culprit because, like you could be working for hours and you can be on the couch, like there are some days where, not that I like work from home a ton, but like if I am, sometimes I'm laying in the corner and I'm like 90% of my body's flat and my neck is up. Not that that's actually happening that way, but you know.
Ed Delesky, MD:I feel like a lot of people have standing desks, though but the standing desk was something I was going to just get into that that's. That can be a really important avenue for changing it up, changing that posture, Building core strength is another opportunity for improvement and really you don't need a gym or crunches to build a strong core. I mean, really you can just try to hold a plank for 20 seconds or do a few exercises called bird dogs. Try to hold a plank for 20 seconds or do a few exercises called bird dogs. These movements specifically help really build the stability of your spine and really you get bonus points if you can breathe deeply, because your diaphragm is also a part of your core that like diaphragmatic breathing is really important and you can find a lot of um.
Nicole Aruffo, RN:They like made me do this in PT, which at this point was probably like 10 years ago, but doing that and like they had me do like different, like pelvic tilts and stuff, but to engage your deep core because it's like you know, the like eight pack or whatever that's you know not visible for plenty of us.
Nicole Aruffo, RN:But then you know the like eight pack or whatever that's you know, not visible for plenty of us, but then you know like under that and around that are all smaller little muscles that go all the way around, like the corset that we were talking about, so doing things to engage all of those deep core muscles. And there are a lot of um like physical therapists and stuff on, like TikTok that you can like find exercises for.
Ed Delesky, MD:Totally. Probably lots of YouTube videos too, but it's also worthwhile to go support them, like financially, like in person, as a part of their practice as well, and so all of that ends up being really important for managing at home. And none of this stuff happens overnight. You really have to think about your behavior change and making it a habit and doing these things consistently, kind of like we were getting at. This is kind of like an advanced thing. This isn't just for when you are feeling unwell and you have low back pain. This is a step above that. This isn't to prevention, this isn't to body maintenance. This isn't to like body maintenance and living better, not just longer. Specifically. So there are several other opportunities for treatment. Some are more studied than others. We'll kind of list them off here, and some people get more benefit than others and some people swear by this stuff. So cognitive behavioral therapy can be really important for someone, training to better understand their body.
Ed Delesky, MD:When it comes to understanding pain, some people love yoga or Tai Chi and massage. Like we talked about, the massage gun can help a ton. Acupuncture helps certain people and chiropractic care can help people as well, though it's not a sweeping generalization that across the board. Everyone needs a chiropractor. But sometimes people get benefit and I'm sure there's a lot of people who feel really strongly and, on the other end, feel really strongly in a negative way about chiropractors or the care that they provide, not the people. So sometimes it works for people. Sometimes you need to be careful and think about what's going on and we'll kind of leave that there.
Nicole Aruffo, RN:I also think it's important when you're kind of, I guess it's important to also find like having back pain is like really, really frustrating and annoying. For what did we say?
Nicole Aruffo, RN:80% of people who have back pain yeah especially, you know, if you're a more active person and it can be annoying to have to do something that you like to do less, or have to make modifications, or maybe you just aren't doing something for a while, but which which this like sounds dumb. But if something hurts you don't do it, you know, at least until you, you know, kind of like build back up to it. It's kind of like that comic or like that cartoon of a patient and a doctor and the patient says, when I do this, it hurts, and the doctor says, so don't do it, like that's the same thing here.
Nicole Aruffo, RN:Yeah, that's an excellent point with the movement and how not moving makes things worse. But that can kind of be someone's initial reaction of if you're hurt, let me just rest.
Ed Delesky, MD:Right.
Nicole Aruffo, RN:Which rest is good, but not for a prolonged amount of time.
Nicole Aruffo, RN:direct comparison, but just for example, if you like had surgery or you had some like orthosurgery or you had say you had like you tore your ACL and you had that fixed. You're not just laying in bed until that quote unquote heals Like there are there. You know you have to go to PT and there are movements that you have to do. And I mean, if you go back to your surgeon and say you didn't do any of this, they're probably not going to be very happy with you.
Ed Delesky, MD:Right.
Nicole Aruffo, RN:So movement is important.
Ed Delesky, MD:Movement is medicine. Yeah, excellent point. And sometimes you know I think we've taken a very large and important cause. Stay in our lane. We know what we're here for is to talk about the things you can do at home and how to have important conversations with your doctor. But sometimes there are times when you do have to call the doctor and by no means are we trying to help you decide when and when not to. But you should look out for these things to seek more urgent care. So if you have back pain and new numbness or weakness, you should probably think about calling your doctor. And if you have loss of bowel and bladder control and back pain, don't pass, go Call your doctor. They may tell you to go to the hospital.
Ed Delesky, MD:There are also other concerning signs. We kind of mentioned them before, but we'll mention them again for completeness sake and really hammering home the point. Fever, night pain, unexplained weight loss, trauma, a history of cancer and steroid use and back pain that's new and different and worsening are all really important things to call the doctor and we had this like demarcation of four to six weeks If there's back pain that's lasting longer than four to six weeks without improvement. And you've been doing all the right things and that's such an important piece and you've been doing all the right things. That deserves further evaluation.
Ed Delesky, MD:We're not going to pretend here like we can cover all of the next layer treatments of back pain, including like injections or surgeries that are often offered. Sometimes surgeries help, sometimes they make it a little more complicated. But that's really just a later down the line conversation. We wanted to stick to our agenda here today to have the most fruitful episode possible, and so we really wanted to make a couple main points as we kind of close out our episode here this week. And so, in summary, we just want you to recognize that back pain can feel scary, but for most people it gets better and you don't have to go through with guessing. You should keep moving, apply some heat, stay off the couch for too long, know when it's time to go get a check with your doctor and if you learned something today, pass this episode along to a friend or a neighbor who's dealing with back pain, and you know let's all take care of each other. Do you have any last thoughts?
Nicole Aruffo, RN:I don't think so.
Ed Delesky, MD:Okay. Well, thank you for coming back to another episode of your Checkup. Hopefully you were able to learn something for yourself, a loved one or A neighbor with low back pain.
Ed Delesky, MD:Please, for this week, send us your thoughts in the fan mail. We really do want to hear and if the more we get, the more we'll be able to sit down with each other and kind of dive into the conversation. So you can find the fan mail. Anywhere where the episode descriptions are and we welcome that goes right to my phone and I read them. So if you got anything to say, put it there. Hopefully it's nice.
Nicole Aruffo, RN:Have we heard from our loyal listener?
Ed Delesky, MD:We haven't heard from our loyal listener recently, so we'll have to communicate with him and if you learned anything from this episode, send it to a loved one or a neighbor. You can sign up for our email list, which I think you might benefit from, because we're going to expand our content into the written word and there might be some other stuff coming down the pike. But, most importantly, stay healthy, my friends. Until next time. I'm Ed Dolesky. I'm Nicole.
Nicole Aruffo, RN:Rufo.
Ed Delesky, MD:Thank you, goodbye, bye. This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health. Bye. This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for complete information tailored to you. In short, I'm not your doctor, I am not your nurse, and make sure you go get your own checkup with your own personal doctor.
