image courtesy adobe stock
“Everyone has a back, and that’s the issue: We only have one. When we open it up to some kind of injury or strain, we don’t have a spare,” says Chris Guillo, a physician’s assistant at Semmes Murphey Clinic. “That can be a problem.”
The modern world is hard on spines. “As I’m sitting here talking to you, I’m slumped over in my chair,” Guillo says. “We have phones, and we’re looking down at them for who knows how long a day, so we get chronic tension on some of these muscles. Our body is very efficient and it gets used to doing what it does most frequently. It kind of defaults to those settings. so you get a lot of people with rounded, humped-over shoulders.”
You’ve probably had someone tell you to lift with your legs, not with your back. That’s good advice, says Guillo. But it’s not enough to avoid all back injury. Repetitive motion and bad ergonomics can also cause back pain. And some people draw the bad-back ticket in the genetic lottery.
“It’s a pretty good split, about 50/50,” Guillo says. “We’ll see injuries for sure, especially lifting injuries and twisting injuries — those are the big ones. Bending and twisting at the same time, that’ll get you. But then also we see degenerative-type conditions probably 50 percent of the time. These have gradually progressed sometimes over the course of months, but usually it’s been years. It’s not uncommon for me to talk to someone who says, I’ve had some kind of back pain, at least off and on, for 5, 10, 20 years.”
image courtesy adobe stock
Yes, people trying to lift heavy things frequently throw out their backs. But just as often, Guillo sees injuries caused by innocuous, everyday movements. “Watch those sneezes!” he says. “I see just as many people who injure their back bending over to pick up that sock off the ground and toss it into the hamper as I see from lifting a heavy box.”
It’s the mechanics of the movement more than the weight, for the most part. “It’s that complex dynamic motion,” he says. “That bending, stooping all the way forward. … I drop my pen and bend over to pick it up. That’s when we’re not guarded. We’re not prepared for those kinds of things. I see a lot of injuries happen like that. Maybe a load shifts, mid-lift, and you’re picking up and twisting. It’s that imperfection that’ll get you.”
When a new patient comes to Semmes Murphey with back pain, the first step is to determine their history. Guillo says specialists ask them, “What happened? How long has it been going on? Have you always had it, or is this is brand-new thing? What other symptoms are you having?”
Next is an exam, he says. “We’ll poke and prod, test strength and reflexes and all kinds of things. Is this a mechanical-type back issue — strains and sprains and things like that — or is this something different? Does this have symptoms of nerve irritation or nerve injury? Do you have numbness, tingling, and loss of strength? We’re trying to differentiate between those two main pathways.”
While the vulnerability of the back to injury can sound alarming, Guillo says, “The good news is the overwhelming majority of back pain and back issues are more on the mechanical side of things that are not affecting the nerves, not affecting the spinal cord.”
Many factors can affect the nature and severity of back and spinal problems, with some issues and diagnoses more predominant in men or in women.”
Guillo says pain radiating from the sacroiliac joint, “where the spine plugs into the pelvis,” is more common in women than in men. Sufferers usually describe the pain as coming from “the back of the hip.” That has to do with some of the muscle balancing, as well as the shape of the pelvis in men versus women.
“But honestly,” he says, “I see a greater difference, whether it’s men or women, in activities that cause the pain. You have people who have a sedentary job versus people who are lifting and bending and twisting. They each have their own issues and they each have their common problems.”
image courtesy adobe stock
In order to avoid a visit to the back doctor, Guillo says, “Whatever you’re doing the majority of your day, you should be doing it relatively intentionally. If you’re spending 6, 8, or 10 hours a day doing repetitive tasks or repetitive activities, that’s going to add up. What I see with people who have sedentary jobs, particularly most of us sitting in front of a computer, is a weakening of muscles. We’re not engaging those core muscles or those lumbopelvic muscles. We get opened up to injury with just minor things.”
Strengthening your back muscles is the key. “It can be yoga, it can be tai chi, it can be going to the gym and doing some exercises,” says Guillo. “Start low, and work your way up.”
Much of the physical therapist’s job is to strengthen the back. “You go through doing things correctly, rebalancing some of those muscles.”
Nine out of ten patients can find relief without surgery. “The majority of back pain will get better over the course of a few months. Most people just need a little help,” Guillo says. “But if we have to do surgery, we have a team of world-renowned experts.”
Neurosurgeon Dr. Kevin Foley is one of them at Semmes Murphey. “Neurosurgery, of course, includes not only surgery of the brain, but also surgery of the spine and peripheral nerves,” he says. “I’ve been doing back surgery for several decades and there have been huge advancements. I’ve had the opportunity to live through much of that and I’ve also had the opportunity to help create some of those advancements.”
“I was the inventor of something called spinal navigation, or spinal image guidance. It’s like GPS for spinal surgery. It lets us see underneath the surface without having to cut inside. Because of that, we can very precisely target what we’re going to do, and we can do it more accurately than we might otherwise do it.” — Dr. Kevin Foley
You’ve probably heard horror stories of people who tried to relieve their suffering with back surgery, only to make the problem worse. In the past, these operations have involved large incisions that inflict trauma on the complex web of muscles, ligaments, and nerves surrounding the spine.
“One of the themes of my career,” says Foley, “has been the development of minimally invasive spine surgery, with the goal of reducing suffering that would occur with big, open-back surgeries because big, open-back surgeries hurt, and sometimes the trade-off of that hurt isn’t worth having gone through surgery. Those would be the patients who say, ‘Oh, I had back surgery and I did so badly.’”
A negative outcome can be for several reasons, he says. “It can be that they never should have had back surgery in the first place. It really wasn’t indicated. It could be the back surgery wasn’t done so well. But it also can be that the back surgery caused so much surrounding tissue damage, for example, to their back muscles that those muscles never recovered properly, and are never the same.”
Foley pioneered an approach to spinal surgery where miniature robotic instruments are inserted through tiny incisions to clear out nerve pathways, or repair a bulging or ruptured disc. “Now, a procedure that used to require a hospital stay of several days, I can do that on an outpatient basis.
“I was the inventor of something called spinal navigation, or spinal image guidance,” he continues. A CAT scan, MRI, or ultrasound is used to create a 3D map of a patient’s spinal region. “It’s like GPS for spinal surgery. It lets us see underneath the surface without having to cut inside. Because of that, we can very precisely target what we’re going to do, and we can do it more accurately than we might otherwise do it. That was one of my innovations which has become commonplace now. It’s done all over the world. So I feel quite proud of that! But that actually started here in Memphis.”
One factor which frequently causes back pain in women is osteoporosis. People with compromised bone density are at risk of worse outcomes from surgery. Semmes Murphey now offers infusion therapy, which can shore up bone density ahead of any necessary surgery.
Foley says that, odds are, you won’t need surgery. “If you’ve got a spine problem, you want non-operative care first. No doubt. Often, patients get better with non-operative care, but the good thing about that is, even a lay person can figure that out. Be wary when someone points out something on an MRI and says, ‘Oh, you’ve got to have that fixed.’ Because if you feel well and you’re doing well, you don’t necessarily need anything surgical done.”
But if you’re one of the unlucky 10 percent who do need surgical intervention, your odds of relief are much greater now than they were at the beginning of Foley’s career, because of what he says are “really stunning things” happening technologically.
“The field continues to evolve, continues to get better, and it’s one of the things that keeps me engaged,” he says. “I love taking care of people, I love seeing people get better, and I love helping to improve the field.”
