Be Kind to Your Spine

The global burden of low back pain is greater than cancer, stroke, heart disease, diabetes and Alzheimer’s disease combined. Spine Health Awareness Month in October aims to draw attention to the huge problem of spinal disorders around the world and in our own backyard—and to the importance of spine health and wellness, including good posture, regular physical activity and spine-friendly working conditions.

For some, spine-related pain can be severe and disabling, interfering with their ability to work. But there are plenty of actions you can take to protect your spine at every age and stage. Topmost among these? Stay strong, quit smoking and keep moving!

When asked to respond to patients’ FAQs, Dr. Nasser Ayyad, an assistant professor of clinical rehabilitation medicine at Weill Cornell Medicine and an interventional spine and rehab specialist at Weill Cornell’s Center for Comprehensive Spine Care, starts by listing the three most common spinal conditions he encounters in his practice:

• Acute muscle strain or spasm
• A pinched nerve in the neck or lower back, resulting in pain that radiates down the arm or leg
• Lumbar spinal stenosis—a narrowing of the spinal canal in the lower back—irritating the nerves that go to the legs

What steps do you take to diagnose a spine issue?

My first step is to take a thorough history of a patient’s chief complaint. I strive to understand the patient’s medical, surgical, social and exercise history.

Next, I conduct a complete physical examination that includes how a patient stands and walks, and a neurological exam during which I check muscle strength, sensation and range of motion.

Sometimes, imaging is required to confirm or further define a patient’s diagnosis. The first image I order is usually an X-ray of the spine, followed by a CT or MRI to evaluate the spinal cord, nerves, joints or particular aspects of the spine.

What are the various treatment options for spine-related pain, discomfort or dysfunction?

Let’s start with the milder forms of therapy and work our way up to surgical treatment.

• If a patient doesn’t have urgent surgical indications such as weakness or other neurological problems, the foundation of any treatment plan is an exercise program that may or may not include working with a physical therapist.
• The most basic exercise is walking. Walking builds muscle endurance, increases blood flow, decreases stress on the lower back—especially caused by sitting—and releases those all-important endorphins that improve mood and reduce back pain.
• Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and nerve medications can be used to ease acute pain and allow a patient to engage in mild exercise or physical therapy. The goal is not to be on pain medications long-term but to use them as a bridge to therapy while the body is healing.
• Sometimes, we can add pain-alleviating procedures to a patient’s treatment plan, including epidural steroid injections or joint injections to block pain, among others.
• Surgery is indicated when a patient experiences weakness, a significant loss of sensation in their legs or arms or instability of the spine that has been identified on a CT or MRI.

Are there any promising treatment advances on the way?

One exciting development in the field is orthobiologics, which is part of regenerative medicine. Orthobiologic treatment uses tissue found in human blood—fat, bone marrow or blood cells themselves—to treat an injury.

This novel approach may be able to ease musculoskeletal pain and discomfort and promote the body’s ability to heal. Two orthobiologic treatments of great interest at Weill Cornell are platelet-rich plasma injections (PRP) and bone marrow aspirate concentrate (BMAC). Both of these have shown promise in treating such disparate conditions as arthritic knee pain, multiple sclerosis and erectile dysfunction.

However, orthobiologic treatments haven’t fully “arrived.” To ensure that they fulfill their promise and to maximize safety, we need to develop a deeper understanding of the basic science of stem cells and educate ourselves on the risks and benefits of cell-based treatments.

You offer a “whole patient” approach to care. Please describe how that works.

A holistic approach to care entails building a partnership with a patient, taking into account all the variables that influence their health and wellness. That includes their mind, body and spirit along with their specific activities and life goals. The “whole patient” model gives me all the information I need to shape their treatment plan, which may incorporate any or all of the following:

• Nutrition
• Therapeutic exercise
• Complementary health practices such as acupuncture and medical massage
• Mind-body approaches such as meditation and tai chi
• Procedures to control pain when necessary

How do patients’ attitudes affect their perception of pain?

Pain is a many-faceted experience—one that’s related to a specific injury or issue but that is also influenced by a person’s genetic, developmental, familial, psychological, social and cultural background and history. A patient’s mood, for example, can significantly alter the intensity of their experience of pain. Treating pain requires an accurate diagnosis of the patient’s injury or condition, as well as a clear picture of all the possible contributing factors.

What can patients do to take care of their spine health and avoid problems down the road?

Aerobic exercise

Cardiovascular exercise such as brisk walking or moderate running improves blood flow, promotes the health of your discs—the shock absorbers of your spine—and strengthens all the muscles that support your spine.

Light-to-moderate strength training

Strength training improves bone mineral density, which, in turn, decreases the risk and rate of fracture.

Yoga or Pilates

These modalities help build both strength and flexibility.

Avoid smoking and limit alcohol

Become nutrition-conscious

Calcium, magnesium, iron, vitamins B12 and D3, and adequate amounts of protein are among the nutritional elements required for a healthy spine. Choose a diet rich in green leafy vegetables, colorful root vegetables (for example, beets, carrots and yams), lowfat dairy products and foods rich in vitamin D such as fish, portobello mushrooms and eggs.

And remember: “Motion is Lotion.” Stay strong and flexible, and move as much as possible!

If you’re having spine-related pain or other problem, make an appointment to see a Weill Cornell spine care specialist.