Lower Back Pain

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LOWER BACK PAIN

JOHN PETROZZI: Hi. Welcome to Living Is Easy with John and Josh on 89.7 FM Eastside Radio.  I’m John Petrozzi.

JOSHUA HARPER:   And I’m Josh Harper. What’s on the show today, John?

JOHN PETROZZI:   Well Josh, I thought today we’d talk about lower back pain. Hopefully, we can shed some light on that. If there are any listeners out there, send your questions through and we’d love to answer them for you.

JOSHUA HARPER: And how will we be talking about it?

JOHN PETROZZI:   Did you know that actually 80% of the Australian population will suffer from back pain at some stage in their life?

JOSHUA HARPER:   Is that right?

JOHN PETROZZI:   Yeah. So that’s 8 people out of 10. It’s huge.

JOSHUA HARPER: So most of our listeners probably have and will experience it?

JOHN PETROZZI:    Exactly. When they say “back pain,” they mean actually debilitating back pain which means that they will be off-work for at least 3 to 5 days.

JOSHUA HARPER:   Really?

JOHN PETROZZI:   Yeah.  So this is actually a big problem out there that needs to be sorted out. We need to try and figure out what causes the back pain for most of these people. Also, more importantly is actually how prevent it, because prevention is always much better than trying to chase a cure for something. Trying to chase a cure means you’re throwing a lot of money at something, and always you’re probably looking it at just symptom relief, as opposed to fixing something for once and for all.

JOSHUA HARPER:   And you know a lot about this being in chiropractic, John?

JOHN PETROZZI:   I’ve been a chiropractor now for over 10 years. Probably about 60 to 70% of new patients coming through the door would be suffering from back pain at some stage of their lives. Whether that’s back pain with migraines or back pain with shoulder pain, its always back pain in there somewhere. So what tends to go wrong with most cases is, basically—you know what the spine looks like, Josh? It’s basically bone stacked up on top of each other.

JOSHUA HARPER:   Yeah, right.

JOHN PETROZZI:   The bones basically sway from side to side. They side bend and they also rotate, and they flex forwards and backwards. They’ve got a disc between the bones which is basically a jelly center, hard core fibrous tissue between the bones which is called the disc – intervertebral disc. The job of the disc is to basically produce shock absorption as well as malleability and stability. You can imagine within the spinal cord itself is a big long canal which is the spinal canal. There’s a spinal cord in there.  If you look at your thumb, the width of your thumb, that’s how thick the spinal cord, is. It’s quite thick and it’s really, really sensitive as well.

JOSHUA HARPER:   I’ve heard the spine’s consistency is like toothpaste?

JOHN PETROZZI:   Yeah it is. It’s very mushy.

JOSHUA HARPER:   Yeah.

JOHN PETROZZI:   But it’s quite tough as well.

JOSHUA HARPER: Okay.

JOHN PETROZZI:   Back at uni, when we had cadaver studies, you could pull on this thing and it wouldn’t break.

JOSHUA HARPER:   Oh, really?

JOHN PETROZZI:   Yeah.

JOSHUA HARPER:   Wow.

JOHN PETROZZI:   Yeah. Actually the brain and the spinal cord communicate through a fluid called cerebrospinal fluid, which is basically a water substance. It allows the brain to float in the skull.

JOSHUA HARPER:   Really?

JOHN PETROZZI:   Yeah.  So here’s a tip for you: If you get dehydrated, your brain doesn’t sit as high as it normally would if you were dehydrated.

JOSHUA HARPER:   So is that why you get a headache if you get dehydrated?

JOHN PETROZZI:   Yup, exactly right. So basically when someone puts their back out, what actually happens is that the bone gets slightly misaligned, but that misalignment is enough to make what are called some pressure on the nerves that come out on the spine around to the back muscles.

JOSHUA HARPER:   Yeah.

JOHN PETROZZI:   So, you know a little snail? You know when snails crawl along, when you’re a kid you used to just touch their head and the head would retract really quickly?

JOSHUA HARPER:   Yeah.

JOHN PETROZZI:   That’s exactly what happens with the spine as well—a very small amount of pressure, whether that’s mechanical pressure on the nerve, touching, or inflammation around the nerve—what generally happens is the body tries to take pressure off that nerve by tilting the vertebra away from that nerve.

JOSHUA HARPER:   Right.

JOHN PETROZZI:   I don’t know if you’ve seen people walking along the street, who instead of walking crooked are leaning off to one side or leaning forward. Some of them have back pain, but what generally happens is their body has adapted to the back pain by producing a reflex and tilting the body right away from that nerve pressure.

JOSHUA HARPER:   Does that not make it worst on the other side?

JOHN PETROZZI:   It will over time, exactly.

JOSHUA HARPER:   Yeah.

JOHN PETROZZI:   Yeah, because the body will fatigue and cause more problems on the opposite side.

JOSHUA HARPER:   Yeah, right.

JOHN PETROZZI:   But for the short term, it allows the body to still maintain proper function without causing more damage. The body is an amazing thing, it really is. With a misaligned vertebra or with a sprained joint, it’s exactly the same as spraining your ankle. You know when you sprain your ankle, you get inflammation and swelling around the joint?

JOSHUA HARPER:   Yes.

JOHN PETROZZI:   That’s exactly what happens to the spine as well. So the little joints become swollen and it starts to get some cells that get damaged and strained. Whenever you get a cell that bursts open, it basically spills all of its inside contents outside, which makes basically the external environment around that cell becomes toxic and causes an inflammatory response.

JOSHUA HARPER:    Right.

JOHN PETROZZI:   Inflammation is actually normal as well.

JOSHUA HARPER:   Is this noticeable if you got a back problem and…?

JOHN PETROZZI:   Not always. Sometimes people might only feel the symptom maybe 2 to 3 or 4 days after that they’ve exactly caused something to their spine. Like yesterday, I had a guy; he’s an electrician, and he just come back from a long flight overseas. He didn’t have very good bed overseas. He had some pretty heavy luggage to bring back. What he did as he came back, a week later, he started playing touch football again. Just gave it a try, and he felt some pain straight away, but it seemed to go away. Then a week later, he’s coming to the practice and he’s bent forwards. So it means that whenever you have an injury that gets caused, the problem doesn’t become apparent until sometimes a week or two later.

JOSHUA HARPER:   How can you tell? Do you just have just to wait?

JOHN PETROZZI:   Sometimes you do, but most of the time, you start to experience some tightness through the spine or maybe some referred pain down your leg.

JOSHUA HARPER:   Yeah.

JOHN PETROZZI:   Or maybe even to the feet. Other sorts of symptoms and signs that might be apparent would be cramps, muscles strains down the leg. We’ll talk about that after the break.

[Break]

JOSHUA HARPER:   Welcome back to Living is easy with John and Josh on 89.7FM Eastside Radio. Today, we’re talking about lower back pain.  John, how can you tell if you’ve done some damage to your lower back?

JOHN PETROZZI:   Well, sometimes you actually feel the back pain straight away and it will be localized pain right down through the lower back area just below your rib cage. Sometimes the pain extends down to the belt line.  Then also the pain can also radiate into your upper hips or gluts, and sometimes can refer down into the back of the leg and even into the calf muscle, which is the lower part of the leg and also down into the foot.

JOSHUA HARPER: And this is because it’s hitting nerves?

JOHN PETROZZI:   Yeah well, a few things can happen. Pain-sensitive structures in the area would be the disc. If you actually prolapse or damage or tear a disc—which is that spongy section between the bones—that can produce a really deep aching and very uncomfortable pain around the local area. Sometimes it will refer pain down the buttocks as well, but of most the time, it’s localised pain and it’s deep and dull and a nagging sort of pain.

Other pain-sensitive structures would be the little joints around the back of the spine. That sort of pain is more of a sharp, stabbing pain and the pain seems more superficial like on the surface. Some people mistake that pain as muscular pain. What they tend to do is have a hot shower and they think that it would reduce the pain. But really, if it’s a sprained joint, you should really use the same sort of treatment protocol that you would for a sprained ankle.

JOSHUA HARPER:   Yeah.

JOHN PETROZZI:   For instance, if you sprain your ankle, you know how the joint becomes very swollen and hot and sore? Well, if you put a hot pack on it, what would happen, do you reckon?

JOSHUA HARPER:   It will get bigger?

JOHN PETROZZI:   Yeah, exactly. A lot of people actually use a hot pack on their back when they’ve got a sprained joint.

JOSHUA HARPER:   Yeah.

JOHN PETROZZI:   Heat actually attracts blood and fluid into the area and causes more swelling. So really when you’ve got a sprained joint, like a sprained ankle or sprained joint in your spine, you should really want to cool it to try and reduce some of the swelling or control some of the swelling.

Again before the break, we spoke about inflammation. Inflammation is a natural part of healing. The body actually tries to flush a whole lot of fluid into the area to try and get rid of the damaged cells, so it can bring brand new cells and nutrients into the area so the body can heal the damaged area. Inflammation isn’t always a bad thing but it’s just a matter of controlling it so they control your pain levels as well.

JOSHUA HARPER:   So is it a bad thing to put an ice pack onto it?

JOHN PETROZZI:   No, especially if it’s stopping you from doing things as well.

JOSHUA HARPER:   Okay.

JOHN PETROZZI:   Again, there’s something to be said for the body’s, I suppose, mechanisms to stop you from doing things, because all it’s trying to do is to stop you from re-damaging the area. So the brain and the nervous system always knows best. Unfortunately, we come in from the external environments, and say, “Hey, we can make that feel a lot better for you. We can put some ice pack on it. We can medicate you to try and reduce the pain and the swelling.” But really the body is doing and acting that it knows what to do to try and heal the thing the best way that it knows how.

JOSHUA HARPER:   Yeah, it’s trying to help you in the long run.

JOHN PETROZZI:   Exactly right, yeah. The sorts of things that produce back pain would be things like bad posture. Bad posture is a really, really big one, especially given the fact that a lot of people use computer these days. We’re sitting at the computer for an hour, at least, at a time. I’ve got some patients that actually sit there- one guy was sitting there for 13 hours a day, and he wouldn’t go to the toilet because he had so much work to get done. He sort of trained himself not to go to the toilet. He has his lunch there at the computer and-

JOSHUA HARPER:   There are a lot of jobs like that.

JOHN PETROZZI:   There are. Yeah. So it’s a really matter of having those jobs and that lifestyle, but also integrating some sort of routine in your day to try and relieve the tension through your spine and actually activate those muscle groups again.

JOSHUA HARPER:   How do you advise to do this?

JOHN PETROZZI:   Well, the best thing to do would be to try and actually think of some exercises or go get some professional help from your chiropractor, physiotherapist, osteopath, massage therapist, doctor—whoever you want to go to—to ask them for some exercises to do during the day. But generally, the things you’d be looking at would be getting off the chair, having a walk around every 30 to 40 minutes to try and activate those muscle groups again. If you can integrate your exercise routine into the lunchtime of your day, then that’s better for you, because that means that your spine and muscles don’t get de-conditioned throughout the day.

JOSHUA HARPER:   And can something as small as going for a walk every half an hour just be that much better for you?

JOHN PETROZZI:   Yup, exactly.

JOSHUA HARPER:   Yeah.

JOHN PETROZZI:   Yeah. It’s only small things, Josh, that we need to do.

JOSHUA HARPER:   Right.

JOHN PETROZZI: You don’t have to sort of do some back flips to activate the muscle groups again, but just small things every day would help a lot. Other things that produce trauma and problems to the spine would be obvious things like falls and accidents, car accidents, sporting injuries, falls downstairs, walking and sort of missing the gutter, missing a step going up and down stairs and ladders. They are all obvious things.

Then you got the sort of subtle things like picking up the kids. Picking up the kids and holding them on one hip would mean that your spine and your pelvis and your body leans over to one side, which means one-half of the spine gets stronger and one-half gets weaker. So over time, your spine will start to produce some curvature instead of being nice and straight. So, these are small subtle things that can cause back pain over time.

JOSHUA HARPER:   Like the survey we did on bags, school bags.

JOHN PETROZZI:   Yeah, exactly right.

JOSHUA HARPER:   Just slung over one shoulder would be a bad thing.

JOHN PETROZZI:  Yeah, exactly. So we’ll talk about things you can do at the end of the episode, in terms of trying to maintain a healthy spine. Other things that produce back pain would be weight gain, especially weight gain over a short period of time. So let’s say you go overseas, you go for a holiday and you put on 8 to 10 kilos, the body structures aren’t designed or basically not strong enough to hold that amount of weight over that short period of time. So you might start to develop back pain as a result.

JOSHUA HARPER:   Is that because your spine isn’t strong enough to hold it?

JOHN PETROZZI:   Yeah, exactly. The muscles aren’t strong enough to hold it and the spine is just not used to it as well. Other things would be not doing enough exercise, and also having a bad mattress and a bad pillow. So ideally when you’re lying down on your mattress, you should either lie on your side or on your back. If you’re lying on your back, the lower back should be supported. So you really should be able to get just your hand underneath the small of your spine, so that we know that your spine is being supported. If your spine is bending down like a big banana, then it’s not good to your back.

JOSHUA HARPER:   Really?

JOHN PETROZZI:   Yeah.

JOSHUA HARPER:   Wow.

JOHN PETROZZI:  Also pillows are really important. Don’t use two pillows.  Use one pillow, but make sure that when you’re lying on your side, your nose is actually in line with the mid-part of your chest – the sternum. When you’re on your back, your ear should be in line with the shoulder tip. So these are the sort of things that would produce back pain over time.

[Break]

JOSHUA HARPER:   Welcome back to Living Is Easy with John and Josh on 89.7FM Eastside Radio. Today, we’re talking about lower back pain. We’ve already spoken about the signs and the causes, but John, how do we treat it?

JOHN PETROZZI:   Well, there’s lots of different treatment approaches. All you need to do is do a Google search on back pain and you come up with hundreds of different sort of varieties of treatment methods for back pain. So when you’re looking for someone to help you out with back pain, the most sensible thing to do is, first, you try to figure out what caused it. If you think it was an obvious cause like a sporting injury or a fall, then you need some sort of manual therapy to try and help you get through that episode. So the sorts of practitioners you should be keeping your eye out for would be obviously a chiropractor, osteopath, physiotherapist, massage therapist, your local GP. They are the main ones that you’d be going for.

In terms of qualification and things, they’re all highly qualified, so just make sure you find someone who’s part of an association, because at least you know that they’ve gone through the training and they follow certain protocols and ethical procedures as well. When it comes to times when you really don’t know where the back pain is coming from, still go and see these guys. But also, start to think outside the square and start to think of areas in your lifestyle where you think you may have caused the pain.

Think of your work station for instance. Is there something in your work station that’s causing your back pain? Do you use the laptop all the day?  Is your monitor off to one side? Is your body twisted while using the computer? Do you have a job while you using the mouse all day? Is your chair at work too high or too low? Is it unsupportive? Is it uncomfortable? Are you too short for your chair?

Think of things at home as well. What’s you mattress like? Is your mattress too soft or too hard? Is it too old? Is your pillow too high or too low? The sort of things that you could be doing at home would be, with the kids for an instance, how are you holding the kids? Are you holding them on one hip? Do you hold them a lot? Do you put them on your shoulders? What do you do with the shopping bags? Do you carry them always on one side?

What do you do with your handbag, for instance, for the ladies? Is it always on one shoulder? Do you wear high heels? And for the guys at work, it’s more to do with computers. It’s got to do with carrying things as well. What do you do when you stand up? Do you stand up more on one side so you lean on one leg? There are so many different things you should think about really.

JOSHUA HARPER:  Yeah. If we go to a chiropractic, can they just tell us how to fix this?

JOHN PETROZZI:   Yeah, pretty much. I’m also taking a thorough case history, doing a set of examination procedures, trying to figure out what the tissue is that’s actually producing the pain in the first place. Is it the disc, the joint, the nerve, the muscle? Is it referred pain from internal organs? Then secondly, what’s the best treatment program for them as well? So all those sort of things you’ll definitely be able to get from a heath care professional specialising in these things. But don’t hesitate to send in your questions on to our program.

JOSHUA HARPER:   The address is eastside@eastsidefm.org.

JOHN PETROZZI:   That’s right. It takes us to our next section on “What is health?” Health is actually a combination of emotional well-being, physical well-being and chemical well-being. Basically what that means is to be healthy, your physical body needs to be running smoothly, you need to be getting enough exercise, and you need to be exercising your body throughout the day, making sure that you don’t have excessive amounts of force going through the body and spine. Basically anything that produces too much force on the physical body means that the body goes past it normal limits and normal barriers which will produce damage and, over time, diseases.

Emotional stress is another important factor in keeping your body healthy. Stress is a normal part of life. Without stress, the body actually won’t function optimally.  By that I mean, stress in terms of mental stress is important, because it activates different parts of the cortex in the brain to push you through different barrier and actually get more performance out of your body.

Another sort of stress is going for a brisk walk or a run. That’s stressful on the body, but the body needs that to clear out and eliminate toxins from the body and allow the body to regenerate and repair. But there are also emotional things that, compounded on the body, aren’t good for the body, because the body starts to break down and can’t maintain that homeostatic balance that it normally maintains.

The other part of homeostasis of health is chemical balance. When we talk about chemical balance, we really talk about the sort of foods that you are eating, the sort of chemical reactions and hormonal reactions that are produced and created in your body from the sorts of food that you are eating, the vitamins that you are taking, pesticides you’re eating through foods. There are so many things involved in the chemistry of the body. So it comes right down to even the sorts of food you eat for breakfast, Josh. What are those chemicals that have been sprayed on the fruit for an instance? What kind of hormones has been given to the chickens you ate for dinner last night?

JOSHUA HARPER:   Yeah.

JOHN PETROZZI:   What kind of chemicals are in the chewing gums that you have been eating? How much caffeine have you had? Whenever a chemical is put into the body, the body reacts with an opposing reaction. So if it is too much, let say caffeine for argument sake, your body has to try and eliminate that caffeine. It uses caffeine for a certain amount of physiological functions, but as soon as it had too much, it seems to try and eliminate that as quickly as possible to maintain homeostasis or well-being.

JOSHUA HARPER:   What does it do?

JOHN PETROZZI:   Well first, they have to go through into the stomach. It actually passes into the blood stream quite quickly. It is actually a neurotoxin; caffeine is a neuron toxin. But what that means is it gets sort of heats certain preceptors in the brain, particularly in the brain, to produce certain chemical responses. One of the things that caffeine does is basically sparks up the cortex and makes your work faster.

JOSHUA HARPER:   Yeah.

JOHN PETROZZI:   There’s actually a cool scientific experiment they did on spiders and caffeine. What they did is basically in a population of spiders, they gave it the equivalent of a short black. What they found is the webs that they made, they made 20% faster and they made 20% more.

JOSHUA HARPER:   Really?

JOHN PETROZZI:   Yeah. Then they gave them another dose of caffeine which is the equivalent of two coffees or two short blacks, and they found that they increase their rate of production by 50%. So they made double the amount of webs in half the time. So fair enough, they’re thinking, “Okay, caffeine must be the “be all and end all” of performance enhancement drugs. Then they gave it a third caffeine hit, so the equivalent of three short blacks, and they found that the spiders couldn’t make their webs anymore without falling off their webs. They couldn’t weave anything anymore. Basically they hit a saturation level which is causing a dysfunction and poor performance.

So like everything, there’s a certain balance that we need to try and maintain in the body. We need to try and find the balance of good exercise and physical well-being. We need to try and find the balance of emotional well-being and also a chemical well-being.

The best place to go and find out and read more about this would be– you can find out lots of information on the internet. Chiropractors over the last probably 10 to 15 years have been educating themselves a lot on balanced preventative medicine and wellness medicine.

Over time, I’d say over the next sort of 10 to 15 years, preventative and anti-aging medicine is going to be a huge part of everyday medicine and the sorts of things that people would be looking for to maintain health, mainly because it gives you an overall education on lifestyle and life. It’s not just a matter of “Let’s find the symptom and eliminate the symptom with a medication,” or “We want to lose weight; let’s just target exercise or diet.” It’s a matter of actually taking a global outlook on your lifestyle and implementing small things throughout everyday to try to and improve your health, not just for today or tomorrow but for the next 10 to 15 or 20 years down the track.

Unfortunately, that’s all we have time for today. So we hope you’ve enjoyed the show and gotten more of an appreciation of lower back pain and back health. If you have any more questions, you can just check out my website. It’s www.petrozzihealth.com.au. Our phone number is 02-9518-0096.

JOSHUA HARPER:   Thanks for joining us this week. We’ll be back next Wednesday at 6 o’clock for more of the same. I’m Joshua Harper.

JOHN PETROZZI:   And I’m John Petrozzi. Until then, stay well and stay happy.