May 5, 2025 • 41 mins
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Back pain affects 80% of people at some point in their lives, but the good news is that approximately 90% of cases improve within 6-12 weeks with proper care and movement. Understanding the causes, treatments, and prevention strategies for back pain can help you navigate this common but often debilitating condition.
• Most back pain is "non-specific" with muscle strain being the most common cause
• Common types include lumbosacral strain, SI joint dysfunction, and disc herniations
• Imaging (X-rays, MRIs) usually unnecessary in first 4-6 weeks unless "red flags" present
• Many people with no pain have abnormal findings on imaging
• Brief rest is okay but prolonged inactivity makes recovery worse
• Heat, over-the-counter pain medications, and lidocaine patches can provide temporary relief
• Physical therapy with core strengthening exercises significantly improves outcomes
• Your core includes abs, obliques, back muscles, pelvic floor, and diaphragm
• Good posture means stacking head, shoulders, spine, and pelvis vertically
• Common posture mistakes: tech neck, slouching, crossed legs, improper work setups
• Movement is medicine - think of your body as cement waiting to harden
• Seek medical attention for numbness, weakness, loss of bowel/bladder control, or persistent pain
If you learned something today, pass this episode along to a friend or neighbor who's dealing with back pain. You can sign up for our email list to receive written content and updates about future episodes.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ed Delesky, MD (00:10):
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area, and I'mNicole Aruffo.
Nicole Aruffo, RN (00:24):
I'm Ed Delesky, a family medicine
doctor in the Philadelphia area,and I'm Nicole Rufo.
Ed Delesky, MD (00:26):
I'm a nurse and we are so excited you were able
to join us here again today.
I've got a few notes.
Oh, I love how you smile assoon as you hear that.
You get the little sense thatsomething's happening, something
is brewing.
So we've had ourselves a reallynice weekend.
Nicole Aruffo, RN (00:42):
Yeah, because someone finally didn't have to
work.
Ed Delesky, MD (00:45):
Yeah, I mean back to the old days where I
actually had to work a lot onthe weekends three in a row, but
not this one and so we got tospend time doing some really
nice things.
We went and had a date night onFriday.
We went to one of our favoriterestaurants I think we've talked
about it before Giuseppe andSons.
I would say the wholeexperience was made by our
(01:06):
waiter, Waiter, Server, what arewe?
Nicole Aruffo, RN (01:08):
doing these days.
He was great Eric.
Ed Delesky, MD (01:10):
He was awesome.
He was down to earth, he waswarm but funny.
He went upstairs after I waslike can I have a Grey Goose,
dirty martini?
I was feeling bougie and I waslike can I get some blue cheese
olives?
And he says I'm sorry, we don'thave the blue cheese.
So he comes back with yourdrink and mine.
And this man went upstairs to aseparate bar and got the I
(01:35):
guess it's Gorgonzola, I don'tknow.
He went up and got the bluecheese and he stuffed those
olives for me and that wasreally nice.
Nicole Aruffo, RN (01:44):
It was a good martini.
Ed Delesky, MD (01:45):
And it was a good martini.
They like pulled the mozzarellaright in front of you.
I don't know You're better atdescribing that to me.
I still don't really understandhow that works.
Nicole Aruffo, RN (01:55):
We don't need to get into that now.
Ed Delesky, MD (01:58):
So, all in all, we had a nice dinner We'll spare
you the details, I suppose andthen the next day we had the
Rittenhouse there was like afair down the street on Walnut.
Nicole Aruffo, RN (02:10):
I do have something that we need to talk
about.
Ed Delesky, MD (02:12):
Is it an intrusive thought, like you want
to talk about it right now?
Yeah, okay, what is it?
Nicole Aruffo, RN (02:19):
It's an epidemic that is plaguing our
nation, and do you know what I'mgoing to say?
Ed Delesky, MD (02:23):
I have no idea what you're gonna say.
Nicole Aruffo, RN (02:24):
It's this is like totally an intrusive
getting into ubers and thedrivers keep the windows open.
Oh, because this has happenedto us twice now.
Okay, yeah, let's hear it.
Actually I guess it was left,because we get like double
credit card points or whateveron left actually five times.
Oh really, yeah, oh okay that'swhy I don't care all right, I
(02:44):
guess it might be worth thewindows open, but if we weren't
getting five times points, thishas happened twice now in the
last like two weeks yeah itreally has the one?
what well?
The one was on friday becauseit was pretty hot and we took an
uber to the restaurant.
And we get in the car, thisgirl has all four windows open
and I'm like, oh my god, like itis 85 degrees out, like I just
(03:08):
diced in my hair, like I got a500 blowout and now it's ruined
by the humidity and with yourwindows open, whatever, yep, but
then the, which was like, fine,whatever it was like a local
city drive, yeah, so it wasn'tthat big a deal but two weeks
ago or whatever, we took an uberto dylan's wedding and, like
we're obviously all dressed upand this guy has his windows
(03:31):
open and we're flying down thehighway yep, like a crisp
Ed Delesky, MD (03:35):
65 with windblown hair, showing up to
this wedding and, like you, hadspent a while working on yours
me equally or more you show upwindblown and yeah, so that I
think, um, we'll see it nexttime.
I we got back.
There was a ride we took fromto and from a brewery for our
friends engagement and they hadthe windows closed.
(03:57):
Oh yeah, they did.
So it's not exclusive, but ithappens more than I would think
and they're probably trying tosave gas, you know, like not
having the air conditioning onthe whole time.
Nicole Aruffo, RN (04:08):
I don't care.
Ed Delesky, MD (04:09):
I know we are paying for a service, you know,
yeah, that's a big one.
I'm glad you brought that up,good thought, good thought.
I was thinking about the.
On Saturday, unbeknownst to us,you like sent me like this
instagram story about this likeevent happening.
It was like a whole writtenhouse thing on walnut street and
(04:29):
it was cute.
It was like a bunch of likevendors but like local stores
and restaurants that we all knowand love and they have their
little thingies.
And like the philadelphiapickle fish town pickle project
which we had like a big pickle,that was so good yeah, that was
cool.
Like there's nothing like alarge pickle on a stick for you
to walk around a fair scene justmunching on that thing.
(04:51):
What it was good, it was crisp,it was refreshing, it's good.
And then we were walking bybecause we had like done a nice
run together and we eyed up thislike long hot, long has been a
lot like long hot peppers havebeen a big part of our life.
Recently Was so on dinner onFriday and I was really trying
to recapture that with thewilder tent.
Nicole Aruffo, RN (05:12):
I don't know what it was, but it was
delicious Porchetta or panchetta.
Ed Delesky, MD (05:17):
I don't even remember, not sure what it is,
but we definitely ate it, weenjoyed it.
And then went to get ice cream.
Oh God, all right, so1-900-ICE-CREAM, delicious ice
cream.
I had a conniption.
I'm not sure what was going on.
Kind of a long line and there'stwo people working inside.
Whatever, what have you?
(05:37):
Excellent ice cream.
Usually only get hard ice cream, so we finally get inside.
20 minutes waiting, not a hugedeal, and you know you get your
like.
Was it chocolate?
and vanilla swirl with a cookiebutter dip.
Yeah, that was delicious andI'm like okay, I know that I
(05:58):
won't be able to handle a conebecause it will start dripping
down the sides and it was like80 ish degrees outside so it'll
drip down the sides.
I have to like speed it.
I just avoid it entirely.
So can I get this in a cup?
I'd have you know this was thethinnest cup for soft ice cream
I've ever seen in my life verynarrow base and we get outside
(06:23):
and immediately I have to raceto eat this ice cream.
And then I start stressing out.
And then we're walking and thepressure of the situation rises
and my fist is tightening andnow there's ice cream dripping
down the sides on my hands, downmy hands, down my arm, now it's
onto my shirt and my shoes.
(06:43):
And I'm continuing to walk,continuing to grip tighter.
And what do you say?
What did I say when you tell meto relax?
Nicole Aruffo, RN (06:52):
oh yeah, I did, I did, I did do that.
You said okay, because you weregetting more frustrated that
the ice cream was melting andthen because you were getting
more frustrated, you had atighter grip on the cup, which
just made it come out faster,because it was such a narrow
base there was like four inchesof ice cream above the base,
above the end of the cup, and Ihave to rush through it.
Ed Delesky, MD (07:15):
So then, here I am, pouting in Rittenhouse as
people are like galloping aroundwith ice cream on my shirt,
like a toddler, and ice cream onmy lip because I was.
Nicole Aruffo, RN (07:26):
He got like on the very edge, like on like
the hem of his t-shirt got twodrops of chocolate ice cream and
he was pouting sitting there.
Ed Delesky, MD (07:35):
He's like I wanted to wear this shirt for
the rest of the day I was pissed, and then I came back and I
like didn't cook the steak toperfection.
And then yesterday I was justtaking myself or whatever day
that was.
Nicole Aruffo, RN (07:48):
Let's talk about the steak.
Ed Delesky, MD (07:50):
I was just.
Nicole Aruffo, RN (07:50):
I took myself way too serious Because I'm not
in the boys chat with Mike andKarthik, so they better be
listening.
I know Mike does when he likedoes stuff in his basement.
I don't know if Karthik does,but we're going to find out,
because we went to whole foods,got some steak.
Eddie came back, cooked it.
I like my steak cooked a littlebit more than he does, like a
solid medium is how I like it.
(08:12):
He cuts it.
He's like oh no, this is moremedium rare here, try it.
I was like no, I don't like itthis way, blah, blah, blah.
So he like cuts off a piece,puts it back on for me, yada,
yada, yada.
So then he proceeds to go tothe boys chat with mike and
carthick being like don't youhate when a woman doesn't like a
perfectly done medium raresteak?
(08:32):
Da, da, da, da, da.
Then come to find out once hegot done, having his second
hissy fit of the day, thatactually his steak was rare and
how I had it when I put it backon was medium.
Yeah.
Ed Delesky, MD (08:48):
So the idea of the steak you know not to be
done with a prime rib was to cutit into slices and then take
that and put it aside somenoodles that I made and I chose
the wrong steak for slicecutting and I didn't get the
chance because I was so wrappedup in the amount of time to put
it on the cast iron and it wasso wrapped up that it was like
(09:09):
an event and I was downstairs,no one was watching me.
I'm like huffing and puffingover this steak and I forgot to
touch it to gauge.
And if I touched it I wouldhave recognized that I just put
the whole whole hock back onthere.
But no, I didn't.
Now I know for next time, we'vebeen doing more sirloin this
time, like recently, and so thiswas a little out of the realm.
(09:30):
Maybe a flank steak next time,who knows?
But yeah, I did.
I did text them because I wasupset and then I was wrong and I
can openly admit that.
Nicole Aruffo, RN (09:42):
I recognize that there's no well, because
you like, they're like yoursecond girlfriends, or maybe I'm
your second girlfriend, I don'tknow.
But we sat down to eat and hislittle thumbs are going quick on
his phone and I'm like, oh mygod, he's like rage, texting
mike and carthag how mad he isabout this steak.
So what are?
Ed Delesky, MD (10:03):
we going to talk about today, Nick.
Nicole Aruffo, RN (10:08):
Let's see, let me see here Today we're
talking about low back pain.
Ed Delesky, MD (10:13):
Is that relatable at all?
Nicole Aruffo, RN (10:15):
Yeah, all of our backs hurt.
Let's talk about it.
Ed Delesky, MD (10:18):
Yeah, it's true.
About 80% of people experiencelow back pain at some point.
Let me sit with that for asecond.
80%, that is four out of everyfive people that you know, eight
out of every 10, 80 out of ahundred people experience low
back pain at some point.
Thank you, I really try hard.
(10:39):
Oftentimes, luckily, it's notdangerous, but of course it can
significantly interfere withdaily life.
But there's good news to all ofthis and that's why we're going
to take care of you guys heretoday and talk about it.
When I talk about daily life,one thing up front that I want
to say is that back pain usuallygoes away, which is a good
(11:04):
thing.
Usually goes away, which is agood thing, and by this I mean
approximately 50% get better inone to two weeks.
I'm in that category.
Recently you were 90% of themget better in six to 12 weeks.
That's really good news.
That is a month and a half tothree months that's really good
(11:27):
news.
That is a month and a half tothree months.
Nine out of 10 of these getbetter and the hiccup with this
is that about 85% of them recur.
About 85% of them recur inapproximately one to two years.
So that is a troubling piece.
That's a little frustratingthat for the vast majority of
people it goes away, but it canbe a relapsing, remitting type
(11:48):
of thing.
And I mentioned daily lifebecause back pain actually tends
to have a really big impact onpeople's function and return to
work.
If someone misses approximatelysix months because of low back
pain, there is about a 50-50chance that they go back to work
.
Nicole Aruffo, RN (12:07):
Six months is a long time.
Ed Delesky, MD (12:08):
Six months is a long time.
If they missed about a year ofwork from low back pain, there
is a 25% chance that they goback.
That's a long time.
So that's a long time.
Most of these get better.
But it's important that weunderstand what's going on when
we have low back pain, what yourdoctor's probably thinking
(12:28):
about when you go in with aconcern of low back pain.
Or maybe you're just at homeand you have low back pain and
are wondering what the heck wecan do.
So hopefully today we're goingto tell you more about what are
the causes, what you can do,when to seek help and how to
prevent it.
Nicole Aruffo, RN (12:45):
Tell us about causes or I guess the most
common causes of low back pain.
Ed Delesky, MD (12:50):
Yeah, this, I think, is going to be a little
bit of a frustrating answer, butit really like Wizard of Oz
pulls back the curtain for whatyour doctor is probably thinking
about.
The most common cause of lowback pain is really unsatisfying
.
It is a non-specific low backpain and by this I mean that
(13:11):
there tends to be noidentifiable cause.
Of those unidentifiable causes,a muscle strain is most common.
There are a lot of deep musclesin the back and they're very
important.
We're going to talk about themlater in the episode a little
bit.
But they often go unnamed, Likeunless someone is really into
(13:34):
anatomy back there, or like bysome random chance a spine
surgeon is listening or aphysical therapist perhaps.
But these muscles often gounnamed.
But there are so many layers ofthem in your back that help you
stand up straight, and veryfrequently when there's an
injury to someone's back, it isbecause one of these muscles is
(13:56):
injured.
There are other common problems.
I usually pitch it to people asthere's three really common
types.
There is a lumbosacral strain,which is what I just described.
There is SI, joint dysfunction,which is where the pelvis.
The joint where the pelvis andthe spine meet up, has a lot of
(14:19):
ligaments and tendons and thosecan become injured from abnormal
movements, chronic changes overtime.
And there's also discherniations, which is the lumbar
radiculopathy.
We'll define some of theseterms in a little bit as well.
(14:42):
Lumbar radiculopathy is where adisc, which is kind of a firm
but squishy material that livesbetween the bones of your
vertebrae, allowing absorptionof the compression and the
stress of the spine in thevertical axis.
In certain situations the discitself can go out of place and
(15:07):
pinch a nearby nerve, whichcauses back pain that often
radiates down the leg.
Does that sound familiar?
So there are disc herniations,there's also disc bulging, there
is also arthritis or breakdownof the joint or joints in the
spine, and then there is aconcept called spinal stenosis,
(15:29):
which is a narrowing of thespine.
What does that truly mean?
If the spine is considered to bethis hard, bony structure,
there are holes that allow forthe softer structures or the
nerves to exit the spinal cordand exit the cage of the spine
and go out and do their function.
(15:50):
But as we age there can be aprocess where these holes, these
passageways narrow, leading topinching of the specific nerves,
which can also lead to problems.
When it comes to back pain.
We talked about some of themore common ones just there, but
there are more rare but seriousones that we probably won't
take as much time to cover today, but these include infections,
(16:13):
tumors and a pinching of thelower parts of the spinal cord.
That's so significant that itcauses different symptoms,
including numbness in the groin,dysfunction in bowel or bladder
function, and this is calledcauda equina syndrome, which is
something that needs to beevaluated very seriously and
(16:36):
very quickly.
Surgeons will become veryinterested in you in that case.
Nicole Aruffo, RN (16:41):
Okay, let's talk about everyone's favorite
thing.
Ed Delesky, MD (16:44):
Yeah, honestly.
Nicole Aruffo, RN (16:46):
When um, let's talk about when typically
you would need to get imagingfor your low back pain.
Ed Delesky, MD (16:52):
Yeah.
So I think this is a hot buttonissue and I'll say clear and
plain here is that imaging isoften not helpful, at least in
the first four to six weeks,unless there are red flags that
are present.
And these red flags includeassociated unexpected weight
(17:14):
loss, a history of cancer,trauma, prolonged high doses of
steroids, a serious, significantfever or, say, neurological
symptoms.
And I think everyone, or Ithink a lot of people, go
forward and they want the MRI,which is the thing that people
(17:38):
really want, and there's acouple different hurdles that
have to happen before people getthe MRI.
And even then the MRI may notbring all of the illumination to
what's going on that someonemay be hoping for.
After four to six weeks andfour to six weeks of like,
(17:58):
continued thoughtful treatmentand there's no improvement,
clearly most insurance companieswill need an x-ray first before
they even consider approving anMRI.
Now, clinically, this alsorings true that someone with low
back pain really probablydoesn't need x-rays or an MRI in
that first six weeks, unlessany of those things are present,
(18:22):
because it's not going tochange what we do.
It doesn't change what theperson should do to help treat
themselves, and that's one keypiece that maybe you've picked
up from listening to all theseepisodes, like if you're not
going to do anything with thetest, it's not going to change
what you do.
Maybe you shouldn't do it.
And another thing is a lot ofpeople walking around on the
(18:46):
street who have no pain at all,and this number has been tossed
around 25%, 40%, many, manypeople with no pain at all.
If you were to take an MRI oftheir back would have bulging
discs or herniated discs andthey would have no pain
whatsoever.
(19:07):
And so what I say there is thateven if you got this MRI of your
low back to help get a betterdescription and make sure
everything was quote okay, itmay be out of place of what the
pain.
It may not be the pain generatorthat is causing your symptoms,
and so that as a whole layer ofconfusion to this issue.
(19:28):
So the real key isunderstanding your symptoms and
their timeline, kind of likewhat we were talking about
before, that 90% of them getbetter between 6 and 12 weeks
and not rushing into testsbecause they may just be more
expensive, more timely and maynot give you any benefit truly,
and I say that knowing thatthere is a group of people out
(19:49):
there who get benefit fromgetting the image, and so that's
why you need to specificallywork with your doctor to figure
out where you fall if you'redealing with this.
Are you someone who needs anMRI, or is there a lot of room
for you to improve and talkabout stability in your back and
your core or what lifestylechanges you can make to work on
(20:10):
these things?
Nicole Aruffo, RN (20:11):
Excellent.
So you know we, oh, what wasthat?
Ed Delesky, MD (20:15):
That was my name .
So we've done a lot ofpontificating about like types
of low back pain and imagingstudies and kind of laying the
background, but this part is thereally like the take home
tangible stuff for our audience.
What can you do at home?
Okay, so we're in my situation.
I was at the gym.
(20:36):
I was getting really excitedabout like doing an explosive
lift.
I feel like, oh, there it is, Idid something to my back.
What should someone like thatthink about doing?
Nicole Aruffo, RN (20:50):
There are a lot of different things that you
can do at home.
When this initially happens oryou kind of first feel that
twinge of back pain Most commonis probably going to be like
laying on a heating pad forcomfort or applying like ice or
cold.
Honestly, whatever makes youfeel better, do that one.
That's a key thing.
Yeah, um, some over-the-countermedicines you can take, like an
(21:14):
nsaid, so like an advil or analeve or some tylenol.
Um, if you know thosemedications are safe for you, to
take sure, lidocaine patchescan help numb you up a little
bit and provide some temporary,temporary relief I'm just gonna
jump in here real quick, is thatyou shouldn't put a lidocaine
(21:35):
patch on and heat, because itincreases the amount of medicine
delivered.
So don't do that, sorry notdoing that um the massage gun?
We love a theragun thatactually helps.
Ed Delesky, MD (21:50):
Look, I mean you're not going to find any
like literature about a massagegun out there, or maybe you will
, I don't know.
You can call us in the fan mail.
That was, I think, the mosthelpful thing.
Like you did that to me atnight and woke up the next day
and felt vast improvement.
Not that we're sponsored bytheragun or anything.
I kind of wish that would becool.
Yeah, and then there's a wholeclass of medications out there
(22:14):
that were pushed a while back.
I'm talking about opioids,plain and simple.
They are usually not needed forthis.
They may cause more no, noteven may they cause more harm
than benefit in this situation,and there is a time and place
for them.
It's in cancer patients, andacute pain, low back pain is not
the answer.
(22:34):
Please steer clear when you can, sorry.
Nicole Aruffo, RN (22:43):
And then the thing we're going to kind of
talk more about that you can doat home.
That's really important.
I feel like I actually have alot to say about this is staying
active Excellent, because youknow, like brief rest is okay
and taking a break from, youknow, going to the gym or
running or whatever kind ofactivity that you're doing you
know is safe to do right off thebat.
But prolonged inactivity willactually make your recovery
(23:06):
worse.
So much worse your recoveryworse, so much worse, because
you need to one, especiallytalking about your back, which
is what we're talking about,obviously, like you need to keep
all the muscles around yourlower back stronger and like
your core stronger, because ifthey're not, then you're just
going to keep getting injured oryou're going to take a really
(23:29):
long time to recover that's agreat point and like the longer
I was in pt.
One time and one of the pts wastalking to this guy who was like
in his 80s and was there forlike whatever, but like in great
shape, took really great careof himself.
And the guy was talking to thept, because the pt was I don't
know asked them like how, likeyou know, like what have you
(23:49):
done your whole life?
Like, how are you?
yeah this fit and whatever.
And the guy like the 80 yearold said to the PT and was like
your, our bodies are like cementand they're just waiting to
harden and it's you know kind ofthat old adage of like a body
in motion stays in motion but, Ithink that's really true in
this case too.
(24:09):
That's a nice analogy.
Like if you are just like layingin bed I mean, even if you're
like sick for a couple of daysand you're laying in bed or
laying on the couch, you don'tfeel good.
So if you have an injury toyour back and then you're not
moving and like keeping thingsmobile and like keeping
everything else around it mobileand strengthening it, then that
doesn't help and like keepingeverything else around it mobile
(24:32):
and strengthening it, then thatdoesn't help.
Ed Delesky, MD (24:36):
That is a great message and you even mentioned
like a key element in therewhere it can be great to stay
active and do exercises at home,and we're going to talk about
like a couple of different ways.
Nicole Aruffo, RN (24:42):
Yeah, pt is like really great for that,
especially with those little youknow all like the little
muscles in there and doing theselike little exercises that
you're probably like, oh this isstupid, this isn't doing
anything, but it actually, ifit's something that you take
seriously and yes continue to do, you know, like every day, or
whatever they.
Ed Delesky, MD (25:01):
However often they tell you to do stuff and
then it really can totally helpand, like you know, people are
busy and so going the threetimes a week that someone may
prescribe for physical therapymay not be so reasonable in
someone's busy life, or you maketime and space for it because
it's important to you but evennot even going like doing them
(25:22):
at home.
Nicole Aruffo, RN (25:23):
But doing it at home, even if you go once a
week and then, like they alwaysgive you stuff to do at home
that you have to keep doing.
It's not like you go in.
Your 30 minute pt session isgoing to cure everything.
Ed Delesky, MD (25:34):
It's something that you have to keep doing
exactly you really like youharped in on this when I was
down, you did and like therewere even subtle like pelvic
tilt motions that, yeah, I lovea pelvic tilt are tough to
describe and like I can onlyimagine like you were like hands
on, like showing me what to do,but then like, like I can only
(26:00):
imagine that, like if someonedidn't have someone like you not
that you're a physicaltherapist, but you have a lot of
experience like going throughstuff like this, that like
guiding them, like I was naive,I was like, oh, like cat cow,
yeah, that's what I'm gonna do,which sure, there's some of that
but like there were so manydifferent things and positions
that you showed me that I thinka physical therapist is very,
(26:21):
very helpful for, especiallyinvest in it like you're
investing in a skill or you'relearning knowledge, and then you
take that and do it at home,like you said.
Yeah, excellent point.
And one specific arm ofphysical therapy that has been
studied specifically for lumbarradiculopathy.
So when I say radiculopathy, Imean that pinched nerve in the
(26:44):
back with the shooting pain downthe leg.
One quick note here isspecifically the McKenzie back
protocol or the McKenzie method.
You can look this up online,but it is a focused effort for
repeated movements and theirspecific exercises that the goal
is to centralize the pain, andso I say a radicular pain and
(27:05):
you take that pain and the ideawith these exercises is to move
that up towards the back, wherethe initial pain generator is.
It's particularly useful fordisc-related pain or sciatica
but truthfully it's notappropriate for all types of
back pain.
It honestly works best when themovement improves the symptoms
(27:25):
and you know, in our future,like aches and pains types
episodes, we'll refer back tothis website.
But the UCSF sports rehabwebsite is has a whole for
patients section where you cango in there and you can see like
they have like shoulder stuff,but specifically they have core
strengthening and they have backprotocols that are especially
important to think about.
Nicole Aruffo, RN (27:47):
Your back muscles are part of your core.
Your core is not just yourfront.
This is a great transition tothis next part of your core is,
like you know, yeah, strengthen,you know, like your back
muscles and even working with,like your hips and like your
glutes.
But your core all around,including your back, is so
important for stabilizing all ofthose little muscles and
(28:11):
strengthening them and makingsure that you don't get hurt
again.
Ed Delesky, MD (28:14):
Oh my gosh, yeah .
So let's.
Why don't we like take a littletime to take our little
tributary away from this andtalk about the core a little bit
more?
And when we're saying this,we're not talking about six pack
abs.
You've hinted at the definitionhere.
The core is so much more thanthat.
It's abdominal muscles, it'sobliques, it's back muscles,
(28:36):
it's your pelvic floor and yourdiaphragm all of this is your
core right.
Nicole Aruffo, RN (28:42):
So your core is not just the front, it's all
the way around.
There's a lot of differentparts to it yeah, and.
And if that's if you know thecore, like the center of your
body, is weak, then you'll havepoor, then you have lower
stability in your body and,honestly, like you should be
(29:02):
kind of mindful of that andthinking about that just as you
age, not even having anything todo with back pain.
Ed Delesky, MD (29:08):
Sure.
Nicole Aruffo, RN (29:08):
So you can stand up straight when you're 80
.
Exactly, and so that you don'thave like balance issues when
you're you get to that age wherepeople fall.
Ed Delesky, MD (29:18):
Yep.
So tell us, since you talkedabout standing up straight, tell
us how posture impacts yourspine and opportunity for low
back pain, but also justlongevity altogether.
Nicole Aruffo, RN (29:31):
So poor posture.
So like slouching, leaningforward, neck forward.
It loads our spine unevenly,which we don't want.
Ed Delesky, MD (29:41):
Yeah.
Nicole Aruffo, RN (29:41):
You don't want an uneven load on your
spine.
Ideally, your head, shoulders,spine and pelvis should all kind
of like stack on top of eachother, not slouching sitting
rolled up like a pretzel on thecouch like I do all the time.
Um, you know who has reallygreat posture?
(30:01):
Alex, he does.
Yep, he does have great posture.
You said something to me whenwe like first met about my
posture, and I don't know if Iever told you this, but I was
like like consciously working onmy posture and that was such a
good compliment yeah, yourposture was so great at the time
.
Ed Delesky, MD (30:20):
It still is at the time now.
I'm just a troll no, I'm like,I look like I belong under a
bridge.
Nicole Aruffo, RN (30:28):
I know, when we took our engagement pictures,
you like said something aboutthat, about like having poor
posture.
Well, she like, and how she youlike wanted her to pose you,
yeah.
Ed Delesky, MD (30:38):
The quickest aside is that, like she was
great because she asked us likeour insecurities and I was like,
yeah, it's my posture and Idon't want to look like I live
under a bridge.
Tell us a little bit more.
What are some really commonpostural mistakes and easy
things for people to fix?
Nicole Aruffo, RN (30:57):
Well, number one is definitely craning our
necks to look at our phones.
Ed Delesky, MD (31:01):
Yeah, I feel like everyone does that big time
the tech neck.
Nicole Aruffo, RN (31:03):
Yeah, slouching in your chairs, like I
am currently right now, orsitting with your legs crossed
for too long.
Ed Delesky, MD (31:11):
Like, I, am currently Yep.
Nicole Aruffo, RN (31:15):
I mean and there are simple corrections to
these like having a chair withlumbar support, looking at the
height of whatever screen you'relooking at, whether that's your
like laptop or your phone, andthen foot placement, so
essentially, just not sittingfor a long time crossing your
legs.
Ed Delesky, MD (31:35):
Yeah, so like more specifically, I guess that
the screen should be at the eyelevel and feet should be flat on
the floor and, like you said,low back supported.
I think work from home setupsare a huge culprit because, like
you could be working for hoursand you can be on the couch,
like there are some days where,not that I like work from home a
ton, but like if I am,sometimes I'm laying in the
(31:56):
corner and I'm like 90% of mybody's flat and my neck is up.
Not that that's actuallyhappening that way, but you know
.
I feel like a lot of people havestanding desks, though but the
standing desk was something Iwas going to just get into that
that's.
That can be a really importantavenue for changing it up,
changing that posture, Buildingcore strength is another
(32:17):
opportunity for improvement andreally you don't need a gym or
crunches to build a strong core.
I mean, really you can just tryto hold a plank for 20 seconds
or do a few exercises calledbird dogs.
Try to hold a plank for 20seconds or do a few exercises
called bird dogs.
These movements specificallyhelp really build the stability
of your spine and really you getbonus points if you can breathe
(32:38):
deeply, because your diaphragmis also a part of your core that
like diaphragmatic breathing isreally important and you can
find a lot of um.
Nicole Aruffo, RN (32:53):
They like made me do this in PT, which at
this point was probably like 10years ago, but doing that and
like they had me do likedifferent, like pelvic tilts and
stuff, but to engage your deepcore because it's like you know,
the like eight pack or whateverthat's you know not visible for
plenty of us.
But then you know the like eightpack or whatever that's you
know, not visible for plenty ofus, but then you know like under
that and around that are allsmaller little muscles that go
(33:16):
all the way around, like thecorset that we were talking
about, so doing things to engageall of those deep core muscles.
And there are a lot of um likephysical therapists and stuff on
, like TikTok that you can likefind exercises for.
Ed Delesky, MD (33:33):
Totally.
Probably lots of YouTube videostoo, but it's also worthwhile
to go support them, likefinancially, like in person, as
a part of their practice as well, and so all of that ends up
being really important formanaging at home.
And none of this stuff happensovernight.
You really have to think aboutyour behavior change and making
it a habit and doing thesethings consistently, kind of
(33:56):
like we were getting at.
This is kind of like anadvanced thing.
This isn't just for when youare feeling unwell and you have
low back pain.
This is a step above that.
This isn't to prevention, thisisn't to body maintenance.
This isn't to like bodymaintenance and living better,
not just longer.
Specifically.
So there are several otheropportunities for treatment.
(34:18):
Some are more studied thanothers.
We'll kind of list them offhere, and some people get more
benefit than others and somepeople swear by this stuff.
So cognitive behavioral therapycan be really important for
someone, training to betterunderstand their body.
When it comes to understandingpain, some people love yoga or
(34:40):
Tai Chi and massage.
Like we talked about, themassage gun can help a ton.
Acupuncture helps certainpeople and chiropractic care can
help people as well, thoughit's not a sweeping
generalization that across theboard.
Everyone needs a chiropractor.
But sometimes people getbenefit and I'm sure there's a
(35:01):
lot of people who feel reallystrongly and, on the other end,
feel really strongly in anegative way about chiropractors
or the care that they provide,not the people.
So sometimes it works forpeople.
Sometimes you need to becareful and think about what's
going on and we'll kind of leavethat there.
Nicole Aruffo, RN (35:21):
I also think it's important when you're kind
of, I guess it's important toalso find like having back pain
is like really, reallyfrustrating and annoying.
For what did we say?
80% of people who have back painyeah especially, you know, if
you're a more active person andit can be annoying to have to do
something that you like to doless, or have to make
(35:42):
modifications, or maybe you justaren't doing something for a
while, but which which this likesounds dumb.
But if something hurts youdon't do it, you know, at least
until you, you know, kind oflike build back up to it.
It's kind of like that comic orlike that cartoon of a patient
and a doctor and the patientsays, when I do this, it hurts,
and the doctor says, so don't doit, like that's the same thing
(36:04):
here.
Yeah, that's an excellent pointwith the movement and how not
moving makes things worse.
But that can kind of besomeone's initial reaction of if
you're hurt, let me just rest.
Ed Delesky, MD (36:15):
Right.
Nicole Aruffo, RN (36:15):
Which rest is good, but not for a prolonged
amount of time.
direct comparison, but just forexample, if you like had surgery
or you had some likeorthosurgery or you had say you
had like you tore your ACL andyou had that fixed.
(36:36):
You're not just laying in beduntil that quote unquote heals
Like there are there.
You know you have to go to PTand there are movements that you
have to do.
And I mean, if you go back toyour surgeon and say you didn't
do any of this, they're probablynot going to be very happy with
you.
Ed Delesky, MD (36:53):
Right.
Nicole Aruffo, RN (36:54):
So movement is important.
Ed Delesky, MD (36:56):
Movement is medicine.
Yeah, excellent point.
And sometimes you know I thinkwe've taken a very large and
important cause.
Stay in our lane.
We know what we're here for isto talk about the things you can
do at home and how to haveimportant conversations with
your doctor.
But sometimes there are timeswhen you do have to call the
(37:17):
doctor and by no means are wetrying to help you decide when
and when not to.
But you should look out forthese things to seek more urgent
care.
So if you have back pain andnew numbness or weakness, you
should probably think aboutcalling your doctor.
And if you have loss of boweland bladder control and back
(37:41):
pain, don't pass, go Call yourdoctor.
They may tell you to go to thehospital.
There are also other concerningsigns.
We kind of mentioned thembefore, but we'll mention them
again for completeness sake andreally hammering home the point.
Fever, night pain, unexplainedweight loss, trauma, a history
(38:01):
of cancer and steroid use andback pain that's new and
different and worsening are allreally important things to call
the doctor and we had this likedemarcation of four to six weeks
If there's back pain that'slasting longer than four to six
weeks without improvement.
And you've been doing all theright things and that's such an
(38:23):
important piece and you've beendoing all the right things.
That deserves furtherevaluation.
We're not going to pretend herelike we can cover all of the
next layer treatments of backpain, including like injections
or surgeries that are oftenoffered.
Sometimes surgeries help,sometimes they make it a little
more complicated.
But that's really just a laterdown the line conversation.
(38:46):
We wanted to stick to ouragenda here today to have the
most fruitful episode possible,and so we really wanted to make
a couple main points as we kindof close out our episode here
this week.
And so, in summary, we justwant you to recognize that back
pain can feel scary, but formost people it gets better and
(39:08):
you don't have to go throughwith guessing.
You should keep moving, applysome heat, stay off the couch
for too long, know when it'stime to go get a check with your
doctor and if you learnedsomething today, pass this
episode along to a friend or aneighbor who's dealing with back
pain, and you know let's alltake care of each other.
(39:31):
Do you have any last thoughts?
Nicole Aruffo, RN (39:35):
I don't think so.
Ed Delesky, MD (39:36):
Okay.
Well, thank you for coming backto another episode of your
Checkup.
Hopefully you were able tolearn something for yourself, a
loved one or A neighbor with lowback pain.
Please, for this week, send usyour thoughts in the fan mail.
We really do want to hear andif the more we get, the more
(39:57):
we'll be able to sit down witheach other and kind of dive into
the conversation.
So you can find the fan mail.
Anywhere where the episodedescriptions are and we welcome
that goes right to my phone andI read them.
So if you got anything to say,put it there.
Hopefully it's nice.
Nicole Aruffo, RN (40:12):
Have we heard from our loyal listener?
Ed Delesky, MD (40:15):
We haven't heard from our loyal listener
recently, so we'll have tocommunicate with him and if you
learned anything from thisepisode, send it to a loved one
or a neighbor.
You can sign up for our emaillist, which I think you might
benefit from, because we'regoing to expand our content into
the written word and theremight be some other stuff coming
(40:35):
down the pike.
But, most importantly, stayhealthy, my friends.
Until next time.
I'm Ed Dolesky.
I'm Nicole.
Nicole Aruffo, RN (40:43):
Rufo.
Ed Delesky, MD (40:43):
Thank you, goodbye, bye.
This information may provide abrief overview of diagnosis,
treatment and medications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
Bye.
This information may provide abrief overview of diagnosis,
treatment and medications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
This is not medical advice oran attempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
(41:05):
guidance based on your uniquecircumstances.
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area, and I'mNicole Aruffo.
Nicole Aruffo, RN (00:24):
I'm Ed Delesky, a family medicine
doctor in the Philadelphia area,and I'm Nicole Rufo.
Ed Delesky, MD (00:26):
I'm a nurse and we are so excited you were able
to join us here again today.
I've got a few notes.
Oh, I love how you smile assoon as you hear that.
You get the little sense thatsomething's happening, something
is brewing.
So we've had ourselves a reallynice weekend.
Nicole Aruffo, RN (00:42):
Yeah, because someone finally didn't have to
work.
Ed Delesky, MD (00:45):
Yeah, I mean back to the old days where I
actually had to work a lot onthe weekends three in a row, but
not this one and so we got tospend time doing some really
nice things.
We went and had a date night onFriday.
We went to one of our favoriterestaurants I think we've talked
about it before Giuseppe andSons.
I would say the wholeexperience was made by our
(01:06):
waiter, Waiter, Server, what arewe?
Nicole Aruffo, RN (01:08):
doing these days.
He was great Eric.
Ed Delesky, MD (01:10):
He was awesome.
He was down to earth, he waswarm but funny.
He went upstairs after I waslike can I have a Grey Goose,
dirty martini?
I was feeling bougie and I waslike can I get some blue cheese
olives?
And he says I'm sorry, we don'thave the blue cheese.
So he comes back with yourdrink and mine.
And this man went upstairs to aseparate bar and got the I
(01:35):
guess it's Gorgonzola, I don'tknow.
He went up and got the bluecheese and he stuffed those
olives for me and that wasreally nice.
Nicole Aruffo, RN (01:44):
It was a good martini.
Ed Delesky, MD (01:45):
And it was a good martini.
They like pulled the mozzarellaright in front of you.
I don't know You're better atdescribing that to me.
I still don't really understandhow that works.
Nicole Aruffo, RN (01:55):
We don't need to get into that now.
Ed Delesky, MD (01:58):
So, all in all, we had a nice dinner We'll spare
you the details, I suppose andthen the next day we had the
Rittenhouse there was like afair down the street on Walnut.
Nicole Aruffo, RN (02:10):
I do have something that we need to talk
about.
Ed Delesky, MD (02:12):
Is it an intrusive thought, like you want
to talk about it right now?
Yeah, okay, what is it?
Nicole Aruffo, RN (02:19):
It's an epidemic that is plaguing our
nation, and do you know what I'mgoing to say?
Ed Delesky, MD (02:23):
I have no idea what you're gonna say.
Nicole Aruffo, RN (02:24):
It's this is like totally an intrusive
getting into ubers and thedrivers keep the windows open.
Oh, because this has happenedto us twice now.
Okay, yeah, let's hear it.
Actually I guess it was left,because we get like double
credit card points or whateveron left actually five times.
Oh really, yeah, oh okay that'swhy I don't care all right, I
(02:44):
guess it might be worth thewindows open, but if we weren't
getting five times points, thishas happened twice now in the
last like two weeks yeah itreally has the one?
what well?
The one was on friday becauseit was pretty hot and we took an
uber to the restaurant.
And we get in the car, thisgirl has all four windows open
and I'm like, oh my god, like itis 85 degrees out, like I just
(03:08):
diced in my hair, like I got a500 blowout and now it's ruined
by the humidity and with yourwindows open, whatever, yep, but
then the, which was like, fine,whatever it was like a local
city drive, yeah, so it wasn'tthat big a deal but two weeks
ago or whatever, we took an uberto dylan's wedding and, like
we're obviously all dressed upand this guy has his windows
(03:31):
open and we're flying down thehighway yep, like a crisp
Ed Delesky, MD (03:35):
65 with windblown hair, showing up to
this wedding and, like you, hadspent a while working on yours
me equally or more you show upwindblown and yeah, so that I
think, um, we'll see it nexttime.
I we got back.
There was a ride we took fromto and from a brewery for our
friends engagement and they hadthe windows closed.
(03:57):
Oh yeah, they did.
So it's not exclusive, but ithappens more than I would think
and they're probably trying tosave gas, you know, like not
having the air conditioning onthe whole time.
Nicole Aruffo, RN (04:08):
I don't care.
Ed Delesky, MD (04:09):
I know we are paying for a service, you know,
yeah, that's a big one.
I'm glad you brought that up,good thought, good thought.
I was thinking about the.
On Saturday, unbeknownst to us,you like sent me like this
instagram story about this likeevent happening.
It was like a whole writtenhouse thing on walnut street and
(04:29):
it was cute.
It was like a bunch of likevendors but like local stores
and restaurants that we all knowand love and they have their
little thingies.
And like the philadelphiapickle fish town pickle project
which we had like a big pickle,that was so good yeah, that was
cool.
Like there's nothing like alarge pickle on a stick for you
to walk around a fair scene justmunching on that thing.
(04:51):
What it was good, it was crisp,it was refreshing, it's good.
And then we were walking bybecause we had like done a nice
run together and we eyed up thislike long hot, long has been a
lot like long hot peppers havebeen a big part of our life.
Recently Was so on dinner onFriday and I was really trying
to recapture that with thewilder tent.
Nicole Aruffo, RN (05:12):
I don't know what it was, but it was
delicious Porchetta or panchetta.
Ed Delesky, MD (05:17):
I don't even remember, not sure what it is,
but we definitely ate it, weenjoyed it.
And then went to get ice cream.
Oh God, all right, so1-900-ICE-CREAM, delicious ice
cream.
I had a conniption.
I'm not sure what was going on.
Kind of a long line and there'stwo people working inside.
Whatever, what have you?
(05:37):
Excellent ice cream.
Usually only get hard ice cream, so we finally get inside.
20 minutes waiting, not a hugedeal, and you know you get your
like.
Was it chocolate?
and vanilla swirl with a cookiebutter dip.
Yeah, that was delicious andI'm like okay, I know that I
(05:58):
won't be able to handle a conebecause it will start dripping
down the sides and it was like80 ish degrees outside so it'll
drip down the sides.
I have to like speed it.
I just avoid it entirely.
So can I get this in a cup?
I'd have you know this was thethinnest cup for soft ice cream
I've ever seen in my life verynarrow base and we get outside
(06:23):
and immediately I have to raceto eat this ice cream.
And then I start stressing out.
And then we're walking and thepressure of the situation rises
and my fist is tightening andnow there's ice cream dripping
down the sides on my hands, downmy hands, down my arm, now it's
onto my shirt and my shoes.
(06:43):
And I'm continuing to walk,continuing to grip tighter.
And what do you say?
What did I say when you tell meto relax?
Nicole Aruffo, RN (06:52):
oh yeah, I did, I did, I did do that.
You said okay, because you weregetting more frustrated that
the ice cream was melting andthen because you were getting
more frustrated, you had atighter grip on the cup, which
just made it come out faster,because it was such a narrow
base there was like four inchesof ice cream above the base,
above the end of the cup, and Ihave to rush through it.
Ed Delesky, MD (07:15):
So then, here I am, pouting in Rittenhouse as
people are like galloping aroundwith ice cream on my shirt,
like a toddler, and ice cream onmy lip because I was.
Nicole Aruffo, RN (07:26):
He got like on the very edge, like on like
the hem of his t-shirt got twodrops of chocolate ice cream and
he was pouting sitting there.
Ed Delesky, MD (07:35):
He's like I wanted to wear this shirt for
the rest of the day I was pissed, and then I came back and I
like didn't cook the steak toperfection.
And then yesterday I was justtaking myself or whatever day
that was.
Nicole Aruffo, RN (07:48):
Let's talk about the steak.
Ed Delesky, MD (07:50):
I was just.
Nicole Aruffo, RN (07:50):
I took myself way too serious Because I'm not
in the boys chat with Mike andKarthik, so they better be
listening.
I know Mike does when he likedoes stuff in his basement.
I don't know if Karthik does,but we're going to find out,
because we went to whole foods,got some steak.
Eddie came back, cooked it.
I like my steak cooked a littlebit more than he does, like a
solid medium is how I like it.
(08:12):
He cuts it.
He's like oh no, this is moremedium rare here, try it.
I was like no, I don't like itthis way, blah, blah, blah.
So he like cuts off a piece,puts it back on for me, yada,
yada, yada.
So then he proceeds to go tothe boys chat with mike and
carthick being like don't youhate when a woman doesn't like a
perfectly done medium raresteak?
(08:32):
Da, da, da, da, da.
Then come to find out once hegot done, having his second
hissy fit of the day, thatactually his steak was rare and
how I had it when I put it backon was medium.
Yeah.
Ed Delesky, MD (08:48):
So the idea of the steak you know not to be
done with a prime rib was to cutit into slices and then take
that and put it aside somenoodles that I made and I chose
the wrong steak for slicecutting and I didn't get the
chance because I was so wrappedup in the amount of time to put
it on the cast iron and it wasso wrapped up that it was like
(09:09):
an event and I was downstairs,no one was watching me.
I'm like huffing and puffingover this steak and I forgot to
touch it to gauge.
And if I touched it I wouldhave recognized that I just put
the whole whole hock back onthere.
But no, I didn't.
Now I know for next time, we'vebeen doing more sirloin this
time, like recently, and so thiswas a little out of the realm.
(09:30):
Maybe a flank steak next time,who knows?
But yeah, I did.
I did text them because I wasupset and then I was wrong and I
can openly admit that.
Nicole Aruffo, RN (09:42):
I recognize that there's no well, because
you like, they're like yoursecond girlfriends, or maybe I'm
your second girlfriend, I don'tknow.
But we sat down to eat and hislittle thumbs are going quick on
his phone and I'm like, oh mygod, he's like rage, texting
mike and carthag how mad he isabout this steak.
So what are?
Ed Delesky, MD (10:03):
we going to talk about today, Nick.
Nicole Aruffo, RN (10:08):
Let's see, let me see here Today we're
talking about low back pain.
Ed Delesky, MD (10:13):
Is that relatable at all?
Nicole Aruffo, RN (10:15):
Yeah, all of our backs hurt.
Let's talk about it.
Ed Delesky, MD (10:18):
Yeah, it's true.
About 80% of people experiencelow back pain at some point.
Let me sit with that for asecond.
80%, that is four out of everyfive people that you know, eight
out of every 10, 80 out of ahundred people experience low
back pain at some point.
Thank you, I really try hard.
(10:39):
Oftentimes, luckily, it's notdangerous, but of course it can
significantly interfere withdaily life.
But there's good news to all ofthis and that's why we're going
to take care of you guys heretoday and talk about it.
When I talk about daily life,one thing up front that I want
to say is that back pain usuallygoes away, which is a good
(11:04):
thing.
Usually goes away, which is agood thing, and by this I mean
approximately 50% get better inone to two weeks.
I'm in that category.
Recently you were 90% of themget better in six to 12 weeks.
That's really good news.
That is a month and a half tothree months that's really good
(11:27):
news.
That is a month and a half tothree months.
Nine out of 10 of these getbetter and the hiccup with this
is that about 85% of them recur.
About 85% of them recur inapproximately one to two years.
So that is a troubling piece.
That's a little frustratingthat for the vast majority of
people it goes away, but it canbe a relapsing, remitting type
(11:48):
of thing.
And I mentioned daily lifebecause back pain actually tends
to have a really big impact onpeople's function and return to
work.
If someone misses approximatelysix months because of low back
pain, there is about a 50-50chance that they go back to work
.
Nicole Aruffo, RN (12:07):
Six months is a long time.
Ed Delesky, MD (12:08):
Six months is a long time.
If they missed about a year ofwork from low back pain, there
is a 25% chance that they goback.
That's a long time.
So that's a long time.
Most of these get better.
But it's important that weunderstand what's going on when
we have low back pain, what yourdoctor's probably thinking
(12:28):
about when you go in with aconcern of low back pain.
Or maybe you're just at homeand you have low back pain and
are wondering what the heck wecan do.
So hopefully today we're goingto tell you more about what are
the causes, what you can do,when to seek help and how to
prevent it.
Nicole Aruffo, RN (12:45):
Tell us about causes or I guess the most
common causes of low back pain.
Ed Delesky, MD (12:50):
Yeah, this, I think, is going to be a little
bit of a frustrating answer, butit really like Wizard of Oz
pulls back the curtain for whatyour doctor is probably thinking
about.
The most common cause of lowback pain is really unsatisfying
.
It is a non-specific low backpain and by this I mean that
(13:11):
there tends to be noidentifiable cause.
Of those unidentifiable causes,a muscle strain is most common.
There are a lot of deep musclesin the back and they're very
important.
We're going to talk about themlater in the episode a little
bit.
But they often go unnamed, Likeunless someone is really into
(13:34):
anatomy back there, or like bysome random chance a spine
surgeon is listening or aphysical therapist perhaps.
But these muscles often gounnamed.
But there are so many layers ofthem in your back that help you
stand up straight, and veryfrequently when there's an
injury to someone's back, it isbecause one of these muscles is
(13:56):
injured.
There are other common problems.
I usually pitch it to people asthere's three really common
types.
There is a lumbosacral strain,which is what I just described.
There is SI, joint dysfunction,which is where the pelvis.
The joint where the pelvis andthe spine meet up, has a lot of
(14:19):
ligaments and tendons and thosecan become injured from abnormal
movements, chronic changes overtime.
And there's also discherniations, which is the lumbar
radiculopathy.
We'll define some of theseterms in a little bit as well.
(14:42):
Lumbar radiculopathy is where adisc, which is kind of a firm
but squishy material that livesbetween the bones of your
vertebrae, allowing absorptionof the compression and the
stress of the spine in thevertical axis.
In certain situations the discitself can go out of place and
(15:07):
pinch a nearby nerve, whichcauses back pain that often
radiates down the leg.
Does that sound familiar?
So there are disc herniations,there's also disc bulging, there
is also arthritis or breakdownof the joint or joints in the
spine, and then there is aconcept called spinal stenosis,
(15:29):
which is a narrowing of thespine.
What does that truly mean?
If the spine is considered to bethis hard, bony structure,
there are holes that allow forthe softer structures or the
nerves to exit the spinal cordand exit the cage of the spine
and go out and do their function.
(15:50):
But as we age there can be aprocess where these holes, these
passageways narrow, leading topinching of the specific nerves,
which can also lead to problems.
When it comes to back pain.
We talked about some of themore common ones just there, but
there are more rare but seriousones that we probably won't
take as much time to cover today, but these include infections,
(16:13):
tumors and a pinching of thelower parts of the spinal cord.
That's so significant that itcauses different symptoms,
including numbness in the groin,dysfunction in bowel or bladder
function, and this is calledcauda equina syndrome, which is
something that needs to beevaluated very seriously and
(16:36):
very quickly.
Surgeons will become veryinterested in you in that case.
Nicole Aruffo, RN (16:41):
Okay, let's talk about everyone's favorite
thing.
Ed Delesky, MD (16:44):
Yeah, honestly.
Nicole Aruffo, RN (16:46):
When um, let's talk about when typically
you would need to get imagingfor your low back pain.
Ed Delesky, MD (16:52):
Yeah.
So I think this is a hot buttonissue and I'll say clear and
plain here is that imaging isoften not helpful, at least in
the first four to six weeks,unless there are red flags that
are present.
And these red flags includeassociated unexpected weight
(17:14):
loss, a history of cancer,trauma, prolonged high doses of
steroids, a serious, significantfever or, say, neurological
symptoms.
And I think everyone, or Ithink a lot of people, go
forward and they want the MRI,which is the thing that people
(17:38):
really want, and there's acouple different hurdles that
have to happen before people getthe MRI.
And even then the MRI may notbring all of the illumination to
what's going on that someonemay be hoping for.
After four to six weeks andfour to six weeks of like,
(17:58):
continued thoughtful treatmentand there's no improvement,
clearly most insurance companieswill need an x-ray first before
they even consider approving anMRI.
Now, clinically, this alsorings true that someone with low
back pain really probablydoesn't need x-rays or an MRI in
that first six weeks, unlessany of those things are present,
(18:22):
because it's not going tochange what we do.
It doesn't change what theperson should do to help treat
themselves, and that's one keypiece that maybe you've picked
up from listening to all theseepisodes, like if you're not
going to do anything with thetest, it's not going to change
what you do.
Maybe you shouldn't do it.
And another thing is a lot ofpeople walking around on the
(18:46):
street who have no pain at all,and this number has been tossed
around 25%, 40%, many, manypeople with no pain at all.
If you were to take an MRI oftheir back would have bulging
discs or herniated discs andthey would have no pain
whatsoever.
(19:07):
And so what I say there is thateven if you got this MRI of your
low back to help get a betterdescription and make sure
everything was quote okay, itmay be out of place of what the
pain.
It may not be the pain generatorthat is causing your symptoms,
and so that as a whole layer ofconfusion to this issue.
(19:28):
So the real key isunderstanding your symptoms and
their timeline, kind of likewhat we were talking about
before, that 90% of them getbetter between 6 and 12 weeks
and not rushing into testsbecause they may just be more
expensive, more timely and maynot give you any benefit truly,
and I say that knowing thatthere is a group of people out
(19:49):
there who get benefit fromgetting the image, and so that's
why you need to specificallywork with your doctor to figure
out where you fall if you'redealing with this.
Are you someone who needs anMRI, or is there a lot of room
for you to improve and talkabout stability in your back and
your core or what lifestylechanges you can make to work on
(20:10):
these things?
Nicole Aruffo, RN (20:11):
Excellent.
So you know we, oh, what wasthat?
Ed Delesky, MD (20:15):
That was my name .
So we've done a lot ofpontificating about like types
of low back pain and imagingstudies and kind of laying the
background, but this part is thereally like the take home
tangible stuff for our audience.
What can you do at home?
Okay, so we're in my situation.
I was at the gym.
(20:36):
I was getting really excitedabout like doing an explosive
lift.
I feel like, oh, there it is, Idid something to my back.
What should someone like thatthink about doing?
Nicole Aruffo, RN (20:50):
There are a lot of different things that you
can do at home.
When this initially happens oryou kind of first feel that
twinge of back pain Most commonis probably going to be like
laying on a heating pad forcomfort or applying like ice or
cold.
Honestly, whatever makes youfeel better, do that one.
That's a key thing.
Yeah, um, some over-the-countermedicines you can take, like an
(21:14):
nsaid, so like an advil or analeve or some tylenol.
Um, if you know thosemedications are safe for you, to
take sure, lidocaine patchescan help numb you up a little
bit and provide some temporary,temporary relief I'm just gonna
jump in here real quick, is thatyou shouldn't put a lidocaine
(21:35):
patch on and heat, because itincreases the amount of medicine
delivered.
So don't do that, sorry notdoing that um the massage gun?
We love a theragun thatactually helps.
Ed Delesky, MD (21:50):
Look, I mean you're not going to find any
like literature about a massagegun out there, or maybe you will
, I don't know.
You can call us in the fan mail.
That was, I think, the mosthelpful thing.
Like you did that to me atnight and woke up the next day
and felt vast improvement.
Not that we're sponsored bytheragun or anything.
I kind of wish that would becool.
Yeah, and then there's a wholeclass of medications out there
(22:14):
that were pushed a while back.
I'm talking about opioids,plain and simple.
They are usually not needed forthis.
They may cause more no, noteven may they cause more harm
than benefit in this situation,and there is a time and place
for them.
It's in cancer patients, andacute pain, low back pain is not
the answer.
(22:34):
Please steer clear when you can, sorry.
Nicole Aruffo, RN (22:43):
And then the thing we're going to kind of
talk more about that you can doat home.
That's really important.
I feel like I actually have alot to say about this is staying
active Excellent, because youknow, like brief rest is okay
and taking a break from, youknow, going to the gym or
running or whatever kind ofactivity that you're doing you
know is safe to do right off thebat.
But prolonged inactivity willactually make your recovery
(23:06):
worse.
So much worse your recoveryworse, so much worse, because
you need to one, especiallytalking about your back, which
is what we're talking about,obviously, like you need to keep
all the muscles around yourlower back stronger and like
your core stronger, because ifthey're not, then you're just
going to keep getting injured oryou're going to take a really
(23:29):
long time to recover that's agreat point and like the longer
I was in pt.
One time and one of the pts wastalking to this guy who was like
in his 80s and was there forlike whatever, but like in great
shape, took really great careof himself.
And the guy was talking to thept, because the pt was I don't
know asked them like how, likeyou know, like what have you
(23:49):
done your whole life?
Like, how are you?
yeah this fit and whatever.
And the guy like the 80 yearold said to the PT and was like
your, our bodies are like cementand they're just waiting to
harden and it's you know kind ofthat old adage of like a body
in motion stays in motion but, Ithink that's really true in
this case too.
(24:09):
That's a nice analogy.
Like if you are just like layingin bed I mean, even if you're
like sick for a couple of daysand you're laying in bed or
laying on the couch, you don'tfeel good.
So if you have an injury toyour back and then you're not
moving and like keeping thingsmobile and like keeping
everything else around it mobileand strengthening it, then that
doesn't help and like keepingeverything else around it mobile
(24:32):
and strengthening it, then thatdoesn't help.
Ed Delesky, MD (24:36):
That is a great message and you even mentioned
like a key element in therewhere it can be great to stay
active and do exercises at home,and we're going to talk about
like a couple of different ways.
Nicole Aruffo, RN (24:42):
Yeah, pt is like really great for that,
especially with those little youknow all like the little
muscles in there and doing theselike little exercises that
you're probably like, oh this isstupid, this isn't doing
anything, but it actually, ifit's something that you take
seriously and yes continue to do, you know, like every day, or
whatever they.
Ed Delesky, MD (25:01):
However often they tell you to do stuff and
then it really can totally helpand, like you know, people are
busy and so going the threetimes a week that someone may
prescribe for physical therapymay not be so reasonable in
someone's busy life, or you maketime and space for it because
it's important to you but evennot even going like doing them
(25:22):
at home.
Nicole Aruffo, RN (25:23):
But doing it at home, even if you go once a
week and then, like they alwaysgive you stuff to do at home
that you have to keep doing.
It's not like you go in.
Your 30 minute pt session isgoing to cure everything.
Ed Delesky, MD (25:34):
It's something that you have to keep doing
exactly you really like youharped in on this when I was
down, you did and like therewere even subtle like pelvic
tilt motions that, yeah, I lovea pelvic tilt are tough to
describe and like I can onlyimagine like you were like hands
on, like showing me what to do,but then like, like I can only
(26:00):
imagine that, like if someonedidn't have someone like you not
that you're a physicaltherapist, but you have a lot of
experience like going throughstuff like this, that like
guiding them, like I was naive,I was like, oh, like cat cow,
yeah, that's what I'm gonna do,which sure, there's some of that
but like there were so manydifferent things and positions
that you showed me that I thinka physical therapist is very,
(26:21):
very helpful for, especiallyinvest in it like you're
investing in a skill or you'relearning knowledge, and then you
take that and do it at home,like you said.
Yeah, excellent point.
And one specific arm ofphysical therapy that has been
studied specifically for lumbarradiculopathy.
So when I say radiculopathy, Imean that pinched nerve in the
(26:44):
back with the shooting pain downthe leg.
One quick note here isspecifically the McKenzie back
protocol or the McKenzie method.
You can look this up online,but it is a focused effort for
repeated movements and theirspecific exercises that the goal
is to centralize the pain, andso I say a radicular pain and
(27:05):
you take that pain and the ideawith these exercises is to move
that up towards the back, wherethe initial pain generator is.
It's particularly useful fordisc-related pain or sciatica
but truthfully it's notappropriate for all types of
back pain.
It honestly works best when themovement improves the symptoms
(27:25):
and you know, in our future,like aches and pains types
episodes, we'll refer back tothis website.
But the UCSF sports rehabwebsite is has a whole for
patients section where you cango in there and you can see like
they have like shoulder stuff,but specifically they have core
strengthening and they have backprotocols that are especially
important to think about.
Nicole Aruffo, RN (27:47):
Your back muscles are part of your core.
Your core is not just yourfront.
This is a great transition tothis next part of your core is,
like you know, yeah, strengthen,you know, like your back
muscles and even working with,like your hips and like your
glutes.
But your core all around,including your back, is so
important for stabilizing all ofthose little muscles and
(28:11):
strengthening them and makingsure that you don't get hurt
again.
Ed Delesky, MD (28:14):
Oh my gosh, yeah .
So let's.
Why don't we like take a littletime to take our little
tributary away from this andtalk about the core a little bit
more?
And when we're saying this,we're not talking about six pack
abs.
You've hinted at the definitionhere.
The core is so much more thanthat.
It's abdominal muscles, it'sobliques, it's back muscles,
(28:36):
it's your pelvic floor and yourdiaphragm all of this is your
core right.
Nicole Aruffo, RN (28:42):
So your core is not just the front, it's all
the way around.
There's a lot of differentparts to it yeah, and.
And if that's if you know thecore, like the center of your
body, is weak, then you'll havepoor, then you have lower
stability in your body and,honestly, like you should be
(29:02):
kind of mindful of that andthinking about that just as you
age, not even having anything todo with back pain.
Ed Delesky, MD (29:08):
Sure.
Nicole Aruffo, RN (29:08):
So you can stand up straight when you're 80
.
Exactly, and so that you don'thave like balance issues when
you're you get to that age wherepeople fall.
Ed Delesky, MD (29:18):
Yep.
So tell us, since you talkedabout standing up straight, tell
us how posture impacts yourspine and opportunity for low
back pain, but also justlongevity altogether.
Nicole Aruffo, RN (29:31):
So poor posture.
So like slouching, leaningforward, neck forward.
It loads our spine unevenly,which we don't want.
Ed Delesky, MD (29:41):
Yeah.
Nicole Aruffo, RN (29:41):
You don't want an uneven load on your
spine.
Ideally, your head, shoulders,spine and pelvis should all kind
of like stack on top of eachother, not slouching sitting
rolled up like a pretzel on thecouch like I do all the time.
Um, you know who has reallygreat posture?
(30:01):
Alex, he does.
Yep, he does have great posture.
You said something to me whenwe like first met about my
posture, and I don't know if Iever told you this, but I was
like like consciously working onmy posture and that was such a
good compliment yeah, yourposture was so great at the time
.
Ed Delesky, MD (30:20):
It still is at the time now.
I'm just a troll no, I'm like,I look like I belong under a
bridge.
Nicole Aruffo, RN (30:28):
I know, when we took our engagement pictures,
you like said something aboutthat, about like having poor
posture.
Well, she like, and how she youlike wanted her to pose you,
yeah.
Ed Delesky, MD (30:38):
The quickest aside is that, like she was
great because she asked us likeour insecurities and I was like,
yeah, it's my posture and Idon't want to look like I live
under a bridge.
Tell us a little bit more.
What are some really commonpostural mistakes and easy
things for people to fix?
Nicole Aruffo, RN (30:57):
Well, number one is definitely craning our
necks to look at our phones.
Ed Delesky, MD (31:01):
Yeah, I feel like everyone does that big time
the tech neck.
Nicole Aruffo, RN (31:03):
Yeah, slouching in your chairs, like I
am currently right now, orsitting with your legs crossed
for too long.
Ed Delesky, MD (31:11):
Like, I, am currently Yep.
Nicole Aruffo, RN (31:15):
I mean and there are simple corrections to
these like having a chair withlumbar support, looking at the
height of whatever screen you'relooking at, whether that's your
like laptop or your phone, andthen foot placement, so
essentially, just not sittingfor a long time crossing your
legs.
Ed Delesky, MD (31:35):
Yeah, so like more specifically, I guess that
the screen should be at the eyelevel and feet should be flat on
the floor and, like you said,low back supported.
I think work from home setupsare a huge culprit because, like
you could be working for hoursand you can be on the couch,
like there are some days where,not that I like work from home a
ton, but like if I am,sometimes I'm laying in the
(31:56):
corner and I'm like 90% of mybody's flat and my neck is up.
Not that that's actuallyhappening that way, but you know
.
I feel like a lot of people havestanding desks, though but the
standing desk was something Iwas going to just get into that
that's.
That can be a really importantavenue for changing it up,
changing that posture, Buildingcore strength is another
(32:17):
opportunity for improvement andreally you don't need a gym or
crunches to build a strong core.
I mean, really you can just tryto hold a plank for 20 seconds
or do a few exercises calledbird dogs.
Try to hold a plank for 20seconds or do a few exercises
called bird dogs.
These movements specificallyhelp really build the stability
of your spine and really you getbonus points if you can breathe
(32:38):
deeply, because your diaphragmis also a part of your core that
like diaphragmatic breathing isreally important and you can
find a lot of um.
Nicole Aruffo, RN (32:53):
They like made me do this in PT, which at
this point was probably like 10years ago, but doing that and
like they had me do likedifferent, like pelvic tilts and
stuff, but to engage your deepcore because it's like you know,
the like eight pack or whateverthat's you know not visible for
plenty of us.
But then you know the like eightpack or whatever that's you
know, not visible for plenty ofus, but then you know like under
that and around that are allsmaller little muscles that go
(33:16):
all the way around, like thecorset that we were talking
about, so doing things to engageall of those deep core muscles.
And there are a lot of um likephysical therapists and stuff on
, like TikTok that you can likefind exercises for.
Ed Delesky, MD (33:33):
Totally.
Probably lots of YouTube videostoo, but it's also worthwhile
to go support them, likefinancially, like in person, as
a part of their practice as well, and so all of that ends up
being really important formanaging at home.
And none of this stuff happensovernight.
You really have to think aboutyour behavior change and making
it a habit and doing thesethings consistently, kind of
(33:56):
like we were getting at.
This is kind of like anadvanced thing.
This isn't just for when youare feeling unwell and you have
low back pain.
This is a step above that.
This isn't to prevention, thisisn't to body maintenance.
This isn't to like bodymaintenance and living better,
not just longer.
Specifically.
So there are several otheropportunities for treatment.
(34:18):
Some are more studied thanothers.
We'll kind of list them offhere, and some people get more
benefit than others and somepeople swear by this stuff.
So cognitive behavioral therapycan be really important for
someone, training to betterunderstand their body.
When it comes to understandingpain, some people love yoga or
(34:40):
Tai Chi and massage.
Like we talked about, themassage gun can help a ton.
Acupuncture helps certainpeople and chiropractic care can
help people as well, thoughit's not a sweeping
generalization that across theboard.
Everyone needs a chiropractor.
But sometimes people getbenefit and I'm sure there's a
(35:01):
lot of people who feel reallystrongly and, on the other end,
feel really strongly in anegative way about chiropractors
or the care that they provide,not the people.
So sometimes it works forpeople.
Sometimes you need to becareful and think about what's
going on and we'll kind of leavethat there.
Nicole Aruffo, RN (35:21):
I also think it's important when you're kind
of, I guess it's important toalso find like having back pain
is like really, reallyfrustrating and annoying.
For what did we say?
80% of people who have back painyeah especially, you know, if
you're a more active person andit can be annoying to have to do
something that you like to doless, or have to make
(35:42):
modifications, or maybe you justaren't doing something for a
while, but which which this likesounds dumb.
But if something hurts youdon't do it, you know, at least
until you, you know, kind oflike build back up to it.
It's kind of like that comic orlike that cartoon of a patient
and a doctor and the patientsays, when I do this, it hurts,
and the doctor says, so don't doit, like that's the same thing
(36:04):
here.
Yeah, that's an excellent pointwith the movement and how not
moving makes things worse.
But that can kind of besomeone's initial reaction of if
you're hurt, let me just rest.
Ed Delesky, MD (36:15):
Right.
Nicole Aruffo, RN (36:15):
Which rest is good, but not for a prolonged
amount of time.
direct comparison, but just forexample, if you like had surgery
or you had some likeorthosurgery or you had say you
had like you tore your ACL andyou had that fixed.
(36:36):
You're not just laying in beduntil that quote unquote heals
Like there are there.
You know you have to go to PTand there are movements that you
have to do.
And I mean, if you go back toyour surgeon and say you didn't
do any of this, they're probablynot going to be very happy with
you.
Ed Delesky, MD (36:53):
Right.
Nicole Aruffo, RN (36:54):
So movement is important.
Ed Delesky, MD (36:56):
Movement is medicine.
Yeah, excellent point.
And sometimes you know I thinkwe've taken a very large and
important cause.
Stay in our lane.
We know what we're here for isto talk about the things you can
do at home and how to haveimportant conversations with
your doctor.
But sometimes there are timeswhen you do have to call the
(37:17):
doctor and by no means are wetrying to help you decide when
and when not to.
But you should look out forthese things to seek more urgent
care.
So if you have back pain andnew numbness or weakness, you
should probably think aboutcalling your doctor.
And if you have loss of boweland bladder control and back
(37:41):
pain, don't pass, go Call yourdoctor.
They may tell you to go to thehospital.
There are also other concerningsigns.
We kind of mentioned thembefore, but we'll mention them
again for completeness sake andreally hammering home the point.
Fever, night pain, unexplainedweight loss, trauma, a history
(38:01):
of cancer and steroid use andback pain that's new and
different and worsening are allreally important things to call
the doctor and we had this likedemarcation of four to six weeks
If there's back pain that'slasting longer than four to six
weeks without improvement.
And you've been doing all theright things and that's such an
(38:23):
important piece and you've beendoing all the right things.
That deserves furtherevaluation.
We're not going to pretend herelike we can cover all of the
next layer treatments of backpain, including like injections
or surgeries that are oftenoffered.
Sometimes surgeries help,sometimes they make it a little
more complicated.
But that's really just a laterdown the line conversation.
(38:46):
We wanted to stick to ouragenda here today to have the
most fruitful episode possible,and so we really wanted to make
a couple main points as we kindof close out our episode here
this week.
And so, in summary, we justwant you to recognize that back
pain can feel scary, but formost people it gets better and
(39:08):
you don't have to go throughwith guessing.
You should keep moving, applysome heat, stay off the couch
for too long, know when it'stime to go get a check with your
doctor and if you learnedsomething today, pass this
episode along to a friend or aneighbor who's dealing with back
pain, and you know let's alltake care of each other.
(39:31):
Do you have any last thoughts?
Nicole Aruffo, RN (39:35):
I don't think so.
Ed Delesky, MD (39:36):
Okay.
Well, thank you for coming backto another episode of your
Checkup.
Hopefully you were able tolearn something for yourself, a
loved one or A neighbor with lowback pain.
Please, for this week, send usyour thoughts in the fan mail.
We really do want to hear andif the more we get, the more
(39:57):
we'll be able to sit down witheach other and kind of dive into
the conversation.
So you can find the fan mail.
Anywhere where the episodedescriptions are and we welcome
that goes right to my phone andI read them.
So if you got anything to say,put it there.
Hopefully it's nice.
Nicole Aruffo, RN (40:12):
Have we heard from our loyal listener?
Ed Delesky, MD (40:15):
We haven't heard from our loyal listener
recently, so we'll have tocommunicate with him and if you
learned anything from thisepisode, send it to a loved one
or a neighbor.
You can sign up for our emaillist, which I think you might
benefit from, because we'regoing to expand our content into
the written word and theremight be some other stuff coming
(40:35):
down the pike.
But, most importantly, stayhealthy, my friends.
Until next time.
I'm Ed Dolesky.
I'm Nicole.
Nicole Aruffo, RN (40:43):
Rufo.
Ed Delesky, MD (40:43):
Thank you, goodbye, bye.
This information may provide abrief overview of diagnosis,
treatment and medications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
Bye.
This information may provide abrief overview of diagnosis,
treatment and medications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
This is not medical advice oran attempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
(41:05):
guidance based on your uniquecircumstances.
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
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