Is It a Simple Strain or Is It a Herniated Disc? Dr. Andrew Peretz Announces Tips for Promoting Back Health

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Leading orthopaedist Dr. Andrew Peretz explains causes and treatment of back pain that troubles millions today.

Everybody gets it. Well, almost everybody. Estimates are that 80% of people suffer back pain at some point in our lives. Approximately $50 billion is spent a year in search of relief. Back pain is second only to the common cold as a cause of lost days at work and it is one of the most common reasons to visit a doctor's office or a hospital's emergency department. The good news is that most back pain will go away in a few weeks with some basic self-care. But if pain is severe or lasts more than a couple of weeks, medical evaluation is called for. “Back pain is not a disease but a symptom with many possible underlying causes,” says Dr. Andrew M. Peretz, a leading specialist in spine surgery with Somers Orthopaedic Surgery and Sports Medicine Group. Dr. Peretz offers tips for promoting back health.

“The most common causes are strains and sprains, which occur when the muscles and ligaments that support the spine are stretched or torn, often as a result of sports and activities like shoveling snow – or lifting a heavy object,” adds Dr. Peretz. Generally, rest, ice and over-the-counter anti-inflammatory medication are sufficient to improve the symptoms of strains and sprains. And some simple measures like back-strengthening exercises, weight control and proper lifting technique (bend at the knees!) can help prevent these injuries.

Herniated disc – also known as ruptured or slipped disc – in most people is precipitated by years of wear and tear. Discs are shock-absorbing cushions between the vertebrae in the spine. Each disc has a strong, fibrous outer ring and a soft, gel-like center, called the nucleus pulposus. A herniated disc – medical name: herniated nucleus pulposus (HNP) – occurs when a tear in the tough outer layer of cartilage allows some of the soft inner material to protrude out of the disk. This is more likely to happen as we age and the discs weaken and become more prone to tearing.

The lower back (lumbar region) of the spine is the most common location of a herniated disc. If the disc presses on the main nerve that travels down the leg, it can cause sciatica — sharp, shooting pain through the buttock and back of the leg — as well as tingling or numbness in the legs or feet and muscle weakness. The pain often starts slowly. It may get worse after standing or sitting, at night, or when sneezing, coughing, or laughing. Sciatica, which usually occurs on just one side of the body, is the most common symptom of a herniated disc in the lower back.

A herniated disc in the neck (cervical) area accounts for fewer than 10% of cases and produces symptoms in the upper body: pain near or over the shoulder blade, pain that radiates to the shoulder, arm and – sometimes -- the hand and fingers, and neck pain or spasm. Discs in the mid-back (thoracic area) are rarely affected.

Most herniated discs resolve on their own or with conservative treatment, which includes rest, anti-inflammatory medication, and physical therapy. Some people find that ice packs or moist heat applied to the affected area provide some relief. “A day or two of rest is recommended,” says Dr.Peretz, “but no more unless you have severe pain. Staying in bed too long can weaken the muscles and make the problem worse. Moderate walking and light activity may help. And it's important to do the exercises your doctor or physical therapist recommends; they will help keep your back muscles strong.”

For those who do not respond to conservative treatment, an injection of a cortisone-like medicine into the lower back might help reduce swelling and inflammation of the nerve roots, relieving symptoms and improving mobility. These injections are referred to as epidurals or nerve blocks and their effects sometimes last months. Surgery is generally advised only for those who do not respond to other treatments, whose symptoms get progressively worse, or who experience progressive neurological decline.

It isn't always possible to prevent the degeneration that induces a herniated disc but there are steps you can take to reduce risk. These include general best practices for good health: weight control, regular exercise and not smoking. There are also some specific things you can do to promote back health:

Use proper lifting techniques. Do not bend at the waist. Bend your knees while keeping your back straight and use your strong leg muscles to help you support the load.

Practice good posture when walking, sitting, standing, and sleeping. For example, stand up straight with your shoulders back, abdomen in, and the small of your back flat. Sit with your feet flat on the floor or elevated. Sleep on a firm mattress and sleep on your side, not your stomach.

Stretch often when sitting for long periods of time.

Do not wear high-heeled shoes.

“Most back and leg pain will get better gradually – usually within six weeks -- by taking simple measures,” Dr. Peretz concludes. “People with herniated discs generally respond well to conservative treatment and are able to return to their normal activities.”

Somers Orthopaedic Surgery and Sports Medicine Group, founded in 1988, is one of the most comprehensive and specialized practices in the region. Highly trained physicians specialize in diagnosing and treating all orthopaedic, rheumatological, and pain management problems in adults and children. All surgeons are board certified and experienced, having completed rigorous training at the finest medical institutions in the country. The staff includes fifteen physicians, five physicians' assistants, three physical therapists and a supporting staff of over 100. The group's physicians perform all types of arthroscopic surgery, ACL reconstruction, minimally invasive joint replacement, computer navigation, revision joint replacement, sports care, spine surgery, fracture care, hand, ankle, and foot surgery. State-of-the-art facilities include digital radiology, MRI and ultrasound.

Dr. Andrew M. Peretz, M.D., a board-certified orthopaedic surgeon specializing in spinal surgery, joined Somers Orthopaedic Surgery in 1997 to treat spinal disorders in both adults and pediatric patients. His current hospital affiliations include Putnam Hospital Center, where he is the Director of the Spinal Institute and serves as Chairman of the Department of Orthopaedic Surgery; Northern Westchester Hospital; NYU School of Medicine/Hospital for Joint Disease Orthopaedic Institute, where he is a clinical assistant professor of orthopaedic surgery.


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