 Back Pain - What's a body to do?
 I wonder what God is thinking about what we've done to His marvelous creation, the back. Is He crying that man would wreck the spine by sitting most of the day? Or is He laughing at the complicated schemes the American health system has devised to care for back pain?
Back pain is one of the most common reasons to visit a doctor. Sooner or later it's going to get you, and surprise-- it r-e-a-l-l-y hurts! If the pain isn't enough to bring you to a doctor, then you may be prompted by anxiety that “You never know what really might be wrong with you” (that caregivers often promote). Yet, for over 90% of back pain, “what's really wrong” is anyone's guess. Treatments are almost always the same, regardless of cause, and 90% of the time all the symptoms are gone within 6 weeks (even if you take care of it yourself).
Most back pain is triggered by an obvious event---like trying to bench press like a college kid, jerking bamboo out of the garden, wrestling the big screen television closer to the couch. Those who ask “But why should it hurt--I haven't done anything but sit 12 hours a day for the past 45 years?” are answering their own question. But most of the time, I don't know why! If you just have to have an explanation, there are a lot of groups out there who will oblige, but there is scant scientific evidence backing them up.
Of course, I'm always happy to see you, There are plenty of treatment options for acute low back strain. But the bottom line is this: in 6 weeks, almost everyone is better, no matter whom you see and what you do. Evidence on what speeds healing is scarce. Keep moving. Keep your back straight. Keep walking. Don't be a couch potato! This is one of the few recommendations backed by evidence
What do I personally do for my back pain? Play ice hockey! (no kidding). Talk about spinal manipulation!
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 Dr. Rant is right in saying that most lower-back problems “heal” in two to six weeks. But they should still be seen by a doctor. During that time patients may suffer considerable pain. They may need to get into cars or bend at work and interventions like physical therapy, manipulation and prescription medications may be needed.
There are times when back pain does indicate more serious trouble. It is important to see a doctor for: injuries on the job, trauma, a bad fall, back pain in those over 65 or under 18, multiple occurrences of back pain, back pain with fever or associated with numbness/pain in the legs, persistent back pain lasting longer than six weeks, or if back pain worsens after 4 to 7 days. All these situations merit a doctor's care. How can a patient with little health training distinguish whether patience or immediate help is needed?
I have a lot to offer. I quickly place patients on the path to healing. I direct them to a physical therapist. I reduce their pain with medications. I teach them helpful exercises. And by eliminating the possibility of more serious problems, I ease anxieties.
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 If you don't know the cause of your back pain, or if it fits the warning signs enumerated by Dr. Rave, see a doctor. A huge percentage of the patients visiting me, however, know exactly what caused their pain. For the simple back strain, x-rays have no value in directing your care (they might alter your DNA...).Everyone seems to want MRIs (magnetic resonant imaging), but these are useful only if you plan back surgery, to show your surgeon where to cut. Physical exams shed little light on these problems. In the end, I'm likely to prescribe that you just keep moving and that you wait it out. Of course you are not likely to get out of my office without some pain medication. I think physical therapists help reduce pain and the good ones can show you some great self-help techniques. Some patients swear by chiropractors. I buy that their manipulation sometimes helps the pain. But most of the rest of the package some offer, like vitamins, immune system boosters, and frequent visits, seems like snake oil to me. Drugs aren't great either, but they can help make the pain more bearable while you wait it out.
Preventing recurrence back pain is 80% about moving and physical conditioning. Don't sit longer than 20 minutes without taking a 2-minute “stroll around the office” break. Learn about proper body mechanics. If you want to do your own thing, a cheap and valuable source of information and exercises is the book Treat Your Own Back , by Robin McKenzie. Books by Duane Saunderson also have a lot of useful information.
Good back hygiene includes good lumbar support (like chairs that keep you from slumping) and lifting properly. An occasional person may benefit from a chair with good lumbar support, but you usually don't need expensive equipment. Remember the adage that “the secret to a healthy back is a strong stomach”? It's true—so keep working on your “six-pack”...
Who are Dr Rant, Dr. Rave, and Dr. Reason?
 Dr Rant represents reductionist science, research, evidence, and fiscal responsibility.
 Dr Rave voices views from the medical-industrial complex and macro-business realities.
 Dr Reason is a practicing doctor in the real world where differentiating fact from self interest requires constant vigilance and reflection.
Medikal Tips: Flu Shots – Benefits do outweigh risks
If you are debating about whether or not to get the flu shot, think again: http://www.cdc.gov/flu/keyfacts.htm
While there is no Avian flu vaccine available yet, there is hypothetical data to suggest that those immunized annually against other flu seasons might gain some relative protection against Avian Flu, or at least reduce the mortality rate.
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Cholesterol reduction has well-recognized preventive health benefits but it only works if you know you're at risk and if you want to do something about it. There is a very inexpensive way to get a complete cholesterol profile. The INOVA Reference Lab will do one for $15.00. You can just walk in (preferably fasting) and say that you'd like the “walk-in” testing done. They also offer many other convenient tests at a much reduced rate. Give it a try if you want to work on a little prevention. The closest site to our office: INOVA Reference Lab 110 E Maple, Suite 110 , Vienna VA 22180 Tel. (703) 938-4039.
Link of the Month: Calculate your heart disease risks
Once you have you cholesterol numbers, calculate your cardiac risks and get strategies to reduce them at:
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