When my grandma, at age 90, started curving over like a limp banana, she laughed and joked about her humpback like she did about most things. I didn’t think much of it. She was 90, after all, and most of the other people her age seemed to be shrinking, bending, and slouching, too. A lack of spine health seemed normal.
But last year, when my mother started walking with her back bent at a 90-degree angle, no one was laughing. In her 60s, my mom has exercised her whole life, walked and stretched every day. She’s trim and active and healthy. But here she was, with almost unbearable pain in her back. Diagnosed with spinal stenosis, she had to have a very difficult surgery.
Spine conditions, it turns out, definitely have a genetic component. In some ways, there’s not much I can do to avoid what grandma and my mom experienced.
Common Spine Conditions
While you can get a herniated or slipped disc and a number of other injuries to the spine, degenerative disc disease and spinal stenosis top the list of common spine conditions that can be, if not prevented, at least managed by good spine health.
Stenosis, the condition my mom had, refers to a narrowing in the spinal canal, where the nerves live. This could be caused by discs wearing out, bulging, bone spurs or thickening of ligaments.
“Usually spinal stenosis shows up when people are 60, 70, 80,” Shen explains. “People might talk about leg heaviness, or leg cramping, having difficulty walking, they need to lean forward a lot. They find it easier to walk while leaning on a grocery cart.”
Can you avoid spinal stenosis?
Hassanzadeh says no. “Spinal stenosis, arthritis, you can’t do anything to stop it. The only option we have is to slow down the process and address the symptoms. For that, it’s really a healthy back, good balance, posture, muscles, all connected to each other.”
Degenerative Disc Disease
Shen sees people like truck drivers and football players with this condition — people who do repetitive activities, bear a lot of weight, or smoke. While somewhat genetic, this arthritis of the spine happens when the spine’s discs wear out.
The Keys to Spine Health
Shen encourages his patients to:
- Stay active
- Keep weight down
- Not smoke
- Practice good posture
- Strengthen your core
Building Your Core
Hassanzadeh points out, “Back pain is part of the reason our muscles are not strong enough to carry our torso. Core muscle strength is key for treating a spine or back condition. Core muscles are also very crucial in slowing down degenerative conditions. They help with preventing surgery.”
But Shen points out that many people only focus on their core, neglecting their back and pelvis muscles. He also recommends working on pelvic and hip musculature. “They’re all connected. Address all of them, they work together,” he says.
Hassanzadeh agrees, saying the goal toward spine health should include “balance between front and back muscles. A good analogy: If you’re pulling multiple ropes, and one is loose, you have to pull that one significantly harder. That one rope gets tired and tight. If all the ropes are equally tensioned, it’s easy to pull them all together.”
Bone softening can result in compression fractures and accelerate scoliosis. Shen advises patients, especially women, to “be aware and talk to your primary care provider on whether or not you need to be on calcium, vitamin D or a prescription. Especially if you have a family history of it.”
Spine Health at Work
“In general, any predominantly sedentary-type job does increase the rate of back pain,” Shen says. “The studies are pretty clear, even as far back as the 1960s. The pressure in your spine is higher when you’re sitting; when you stand you actually lower the pressure in your disc.”
In general, Shen recommends that office workers stand up every hour and a half to two hours. “Get up and walk and stretch. This prevents blood clots and helps circulation.”
He also encourages workers to take advantage of advances in office furniture. “A lot of companies and businesses have standing desks,” he says. “A lot has changed to help facilitate physical health – ergonomically designed things, lumbar support chairs, etc.”
He advises everyone to be conscious about the little things in one’s posture. He notes that the rise of handheld devices results in heads being cocked down. “Even the way you hold your head over time can make a big difference” in your spine health.
Mattress and Shoe Choice
Soft or hard? Does it matter? “We tend to sleep better on a firmer mattress than a softer mattress,” Hassanzadeh says. “If a mattress is soft, you constantly move, making micromotions, even if you are asleep.” These constant adjustments tire your muscles.
The same principle applies to shoes. “If you’re standing for a long time, you want a hard sole; your muscles will be able to relax and hold steady. You want a softer sole if you walk a lot.”
Moderation and Balance
“I think for a healthy back, it’s important to have well-balanced muscles and to modify activity, preventing harmful routines in our day-to-day life, good balance in our muscles — that’s really the key to slowing down spinal issues,” says Hassanzadeh.
He emphasizes moderation. “Exercise and running are always good but the other extreme is people trying to run marathons every day – do things in moderation.”
What to Do if You Have Back Pain
See a Chiropractor?
Whether or not seeing a chiropractor is a good idea depends, Hassanzadeh says. “It can be a great thing for some adjustments and mild changes, but tricky when you have a real issue that causes compression of the spine. Then manipulation could cause more harm, especially to the cervical spine or neck. I tell my patients if it provides good relief, I have nothing against it, especially if someone is good.” So, to be safe, talk to your doctor first before seeking chiropractic care.
Pilates and Yoga
Back Pain: See a Doctor
If you do have back pain, don’t ignore it. A compressed disc, for instance, could lead to progressive weakness, numbness, infection. You need to get it checked out.
Make an appointment at the Spine Center.
Hassanzadeh says, “Pilates and yoga are great, if they don’t cause pain. They’re great for building core muscles, abdominal, hip, shoulder, chest. They can help with spinal stability that takes pressure off discs and nerves, which is really beneficial.”
Exercise in Water
“My happiest patients go to aquatherapy,” Hassanzadeh says. “Water exercise decreases gravity, puts no pressure on joints. You can build more muscles without exaggerating joints. Taking gravity away, you can work harder and build more muscle mass.”
Do You Need Surgery?
Usually not. Hassanzadeh says the majority of his patients, “probably 90 percent, need physical therapy. Back pain is not an indication of needing surgery. A lot of people are afraid that’s what it means, but surgery is really the last step in a very long process of evaluation.”
What to Look for in a Spine Specialist
Whatever kind of specialist you see, Baldwin advises people to carefully consider who you allow to treat your spine. In his experience, you can tell whether or not “the treatment you will get is going to meet with your wishes or expectations” by looking at three key pieces of your experience.
Were You Treated Well?
The first, he says, “is the way the office personnel treat you. Were you dealt with in a respectful manner, given a reasonable appointment time, and given any needed instructions regarding what to bring with you?”
Do You Feel Heard?
Another indication of quality is how the actual visit goes. “You want to be heard and feel that your concerns are being addressed,” Baldwin says.
Were You Given Options?
How you feel when you leave the appointment? Baldwin suggests that “you should feel that you understand your condition, what your treatment options include, and what are the next steps to be taken.”
If you’re not feeling confident about these three aspects of your interaction, seek a second opinion. Take time to find the right doctor.