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Back pain and dieting

Back pain is one of the most common musculoskeletal complaints. It is a major cause of disability in the world. Oddly enough, for such a big problem less than 20% of back pain has a specific cause (Ehrlich et al. 1999). Fortunately, back pain is typically a self-limiting condition that can resolve itself with conservative management within 2-4 weeks. That being said, can back pain turn your life upside down? ABSOLUTELY. What concerns me is how people respond to back pain. The natural response is to be less active and/or stay off of your feet. As a result, days become weeks. Suddenly people become socially isolated, dependent on short cuts for symptom relief, and deconditioned. Back pain is an expected experience in life so learning how to approach it is critical.

Fortunately, most back pain no matter how bad it feels is typically not dangerous i.e. spinal cord injury, fractures, etc. This is one of the reasons why imaging is often “negative” or “normal.” This is reassuring but it can be frustrating at the same time for people with back pain. The most common and appropriate question asked by patients: “Well what is it then?!?”

The truth is it could be a number of things like a disc, nerve, bone, tendon, ligament, joint, muscle related problem, or all of the above. Advanced imaging like Magnetic Resonance Imaging (MRI) and Conventional Topography (CT) can rule out a lot of these things. The problem is that imaging (if it’s not broken) is a very poor predictor of what actually hurts and how bad. Large disc herniations (see image) can be non-painful and small ones excruciating. So in a lot of ways we really do not know. Spraining an ankle or breaking a bone is a lot easier to understand when compared to back pain. Often times we either just wake up with it or it happens during something that you’ve done a million times before. Again, another source of frustration.

The truth is it could be a number of things like a disc, nerve, bone, tendon, ligament, joint, muscle related problem, or all of the above. Advanced imaging like Magnetic Resonance Imaging (MRI) and Conventional Topography (CT) can rule out a lot of these things. The problem is that imaging (if it’s not broken) is a very poor predictor of what actually hurts and how bad. Large disc herniations (see image) can be non-painful and small ones excruciating. So in a lot of ways we really do not know. Spraining an ankle or breaking a bone is a lot easier to understand when compared to back pain. Often times we either just wake up with it or it happens during something that you’ve done a million times before. Again, another source of frustration.

Back pain is part of the human experience and learning how to take care of it is an important skill. Over 80% of people will experience at least one severe episode of back pain in their life (Rubin 2007). To master any skill you need education, practice, consistency, flexibility, and creativity. The term “weight loss” is really about “weight management.” You start off in life with a certain weight and it’s your job to manage it. Some people are born with a predisposition to being more slender than others. It can go up and down and has multiple variables that affect it. Now think about back pain in this same model. You start off in life with a certain type of back and it’s your job to manage it. Similarly, there are folks who are prone to having back pain. Much like weight management, back pain can be approached in the same fashion.

When it comes to treatment, the typical treatment includes exercise, chiropractic care, massage, physical therapy, acupuncture, medications, injections, and surgery. All of these have been shown to provide some effectiveness but there is not a “best” treatment. In addition, these are not cures they are tools for a SHORT TERM GOAL: pain control. We have all seen the various fad diets, exercise equipment, weight loss drugs, and at the extreme folks are having weight loss surgeries. Again these are tools not cures. Do any of these interventions teach you how to manage your weight in the future. No!!!! Does a pain medication or an injection teach you how to take care of your back. Definitely no!!! The LONG TERM GOAL is to learn how to manage a flare up and develop health back habits (I’ll save for a separate blog.) Here is the major problem. At the end of the day, there are no shortcuts to controlling your weight and the same applies to back pain. You have to develop back maintenance skills.

These skills are not handed to you. Once you have back pain you must learn what it feels like and how your body responds. Patients commonly tell me that the back pain came out of nowhere. However, as I interview them I often pick up a very slow insidious decline in physical activity and increase in pain. Once you are educated, you will recognize the signs and symptoms of an impending flare up and know how to manage it before it gets out of hand. Maybe all you need is some ibuprofen, a massage, or a spinal adjustment. You have to build yourself a reference for back symptoms. Otherwise, if you don’t take the time to experience portions of your back pain your reaction will always be intense and unfocused. Kind of like if your workplace caught on fire panic and chaos is a natural reaction. But if you recognize the smell of smoke, hear the fire alarm, and know where the the nearest fire exit is it’s generally a “better” situation. Managing weight is no different. It is a struggle but if you want to be successful you have understand your bodies relationship to food, exercise, and stress management. People often regain their weight after having a dramatic loss or even after a gastric bypass surgery. Why? There was no plan to keep it off! Treatment for back pain acts the same way. Injections and surgery can only manage short term goals but you still have to learn to take care of your back.

Sometimes one of the “worst” things that can happen is for the pain to go away COMPLETELY after an injection or a surgery. Sounds weird coming from a doc, right? Having a silver bullet (i.e. injection, surgery, etc) is great but it’s not realistic when it comes to back pain. If someone is lucky enough to have an episode of severe back pain completely resolved by a silver bullet two things are reinforced:
1) back pain has an interventional “cure”
2) back pain has a definitive solution.

This is the wrong conclusion and can often set you up for unintended consequences. I have had patients have excruciating pain have amazing results after a simple surgery. If they end up with a 2nd episode of back pain, they almost always conclude that anything else but surgery is a waste of time. It can be very hard to convince them otherwise. The chances of re-operation after a lumbar surgery ranges between 15-20% in most studies. So it’s important to consider all options even if the one thing you tried worked like a charm. If it goes away completely with any single intervention then very hard to convince yourself that anything else needs to be done!

When you come upon your first episode of back pain, find a method of pain control and then take the opportunity to learn how to manage it. Silver bullets don’t work for ever so you must have a game plan in case symptoms are not responding. When the pain does go away, stay vigilant. Hoping that the back pain (like weight gain) won’t come back is not enough.

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WORK HISTORY

April 2016 – Current

Director of Sports Medicine

EVMS MEDICAL GROUP, NORFOLK, VA

I currently work in the Department of Physical Medicine and Rehabilitation. I also serve as assistant professor at EVMS working with residents and medical students.


August 2012 – March 2016

CLinician and managing Partner

REBOUND ORTHOPEDICS & NEUROSURGERY, VANCOUVER, WA

I loved living in the Pacific Northwest! Aside from clinical care, I was involved in holding monthly spine conferences and helping develop a multidisciplinary spine center.


EDUCATION

2011 – 2012

Spine and Sports Medicine Fellowship

SPINE AND SPORTS PHYSIATRISTS, ELMHURST, IL

A year dedicated to diagnosing and managing a variety of musculoskeletal injuries. I also had the opportunity to give a variety of lectures to various residents in the Chicagoland area.


2008 – 2011

Physical Medicine & Rehabilitation Residency

NORTHWESTERN UNIVERSITY / REHABILITATION INSTITUTE OF CHICAGO, CHICAGO, IL

Outside of residency, I became very involved within the field at a national level serving as president of the Resident Physician Council for the American Academy of Physical Medicine & Rehabilitation. Helping develop the largest and longest running physiatric medical student programs in the country is one of my proudest achievements.


2003 – 2007

Doctor of Osteopathic Medicine

ARIZONA COLLEGE OF OSTEOPATHIC MEDICINE, GLENDALE, AZ

A challenging yet exciting part of my life. This is where I started to create my vision of musculoskeletal medicine. My skills as an osteopathic physician have truly complemented my sports medicine practice.


1997 – 2001

B.S. Biology

GEORGE MASON UNIVERSITY

Aside from studying, I became very involved in the Filipino-American community on campus. This is where I realized my passion for leadership and mentoring.

NAVIGATION