Keeping the core strong reduces back pain

04/25/2014 4:20 PM

04/25/2014 4:21 PM

An avid hiker who founded the American Hiking Society, The Florida Trail and Big City Mountaineers, Jim Kern knew instantly something was terribly wrong with his hip while on a hike in the woods in 2011.

“I felt something painful in my left leg,” recalled Kern, a Miami resident for 40 years who moved to Saint Augustine in 1993. “I hobbled back to the car. It was quite severe.”

Over the next year, Kern’s hip “started to go downhill.”

“I knew I was in big trouble,” said Kern, now 79. So he scheduled hip-replacement surgery in Jacksonville in 2012.

But the surgery left Kern worse, and five months later he could barely get around with a cane, let alone hike. He finally found relief with a second operation done at the University of Miami by Dr. Maria Schneiderbauer to repair the original, botched surgery. Kern, a real estate broker, is now back to hiking and planning a trip to the French Alps this summer.

“I have my life back,” he said.

Kern’s experience is not unique. Millions of aging baby boomers are finding that they almost universally experience some form of joint, spinal or hip pain as they hit their 70s and 80s. Many wind up undergoing unnecessary surgery, say doctors, who are increasingly urging alternatives, especially if the patient is overweight or has other health issues.

“Aging brings on problems with all joints,” said Schneiderbauer, an orthopedic surgeon. “I tell patients, ‘You will have aches and pains, especially in your back.’ The fact is, everyone will experience back pain in their lifetime. We are just sitting a lot more than we should these days.”

Like other doctors, Schneiderbauer recommends lifelong exercise — particularly to strengthen the core abdomen muscles — as the No. 1 method of staving off or minimizing back and joint issues in later years.

“It’s important to train your core muscles, whether with Pilates or swimming,” she said. “That will avoid problems down the road.”

Dr. Warren Grossman, an orthopedic spine surgeon with Memorial Regional Hospital in Hollywood, agrees. “It’s a two-sided system,” he said. “You want to keep the back and belly strong.”

Grossman recommends low-impact exercise for his elderly patients, including swimming, the stationary bike, the elliptical machine, Zumba, Pilates and light weight-lifting.

“The most common reason people come to me is back pain,” Grossman said.

Dr. John O’Connell, a physiatrist, or rehabilitation physician, with the Cleveland Clinic in Weston, sees a variety of age-related back, spine and joint issues. Most prevalent are degenerative changes to the spinal discs that prevent them from doing their duty to cushion the spine.

Elderly patients also suffer from sciatica, a shooting pain down the leg; bone spurs, which can pinch off nerves to the leg; arthritis where the spine meets the pelvis, which causes back pain and stiffness in the morning; osteoporosis, a weakening of the bones that can lead to compression fractures; lumbar stenosis, a narrowing of the spinal canal that can cause a pinched nerve; and loss of muscle mass in areas that support the spine.

O’Connell, like most specialists who treat back, spinal and joint pain, starts with non-surgical treatments in an effort to give patients relief. Those treatments include physical therapy, medication for pain control, steroids injected in the spine to reduce inflammation, and radiofrequency ablation, in which an electric current produced by a radio wave is used to heat up nerve tissue and break up spasms.

One treatment that showed promise in the past decade but is now falling out of favor with doctors is cement injections, called vertebroplasty, intended to shore up the bone after a compression fracture. By one estimate, the number of such procedures performed in the United States doubled between 2001 and 2007.

But two major studies conducted in 2009 and published in The New England Journal of Medicine showed the procedure provided no benefit compared to sham therapies.

“It’s been controversial,” said Grossman. “It’s being tempered by doctors now.”

Another treatment that has proven to be controversial in the medical community is glucosamine, a capsule of natural, amino sugars that is purported to ease joint pain and osteoarthritis. While millions of bottles of the supplement have been sold over the counter and at health food stores, Grossman says no scientific evidence has offered proof the substance works.

For O’Connell, the goal is not to make patients pain-free, which he calls “a tall order,” but rather to make them highly functioning with as many pain-free days as possible.

“I want to give them a better quality of life,” he said, adding that the clinic operates on fewer than 10 percent of patients for such problems.

Schneiderbauer, too, calls surgery “a last resort.”

“I may be an orthopedic surgeon, but I talk more people out of surgery than into surgery,” she said, “especially if they are overweight.”

All orthopedic surgeons have stories of patients who wound up worse after back surgery, had unnecessary back, neck or hip replacement surgery or needed a second operation to fix the original, botched one.

“People should not freak out if there are changes on their X-rays or MRIs,” Schneiderbauer cautioned. “Everybody at a certain age has arthritis in certain joints.”

One surgery that Grossman does favor however, is a minor operation to “unpinch” lower back nerves that cause pain in the buttocks and legs.

“Some people come in and say they used to walk all the time and suddenly they can only walk a block or two without looking for somewhere to sit,” Grossman said. “That is something we can help with surgery.”

The good news, says Grossman, is that the vast majority of patients complaining of back pain improve within six weeks simply with Tylenol and a little physical therapy.

“I have many active octogenarians and nonagenarians,” he said.

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