Here are a few brief answers to the questions frequently asked by many patients in the Spine clinic, especially in India.

What is the cause for my back/neck pain?

The most common cause of back/neck pain is strain or injury due to bad posture during the daily routine activities like sitting, bending forwards and lifting weights etc. Lack of regular exercise to the back and abdominal muscles, age related wear and tear changes in the discs and bones in the spine, obesity are other contributory factors. Severe wear and tear changes (degenerative changes) in the spine can lead to instability and pain that is worse on certain activities. Mechanical back pain usually gets better with bed rest.

A small percentage of patients have a serious problem like a fracture, infection or tumour in the spine causing the back pain. Any pain that is not relieved by rest or is worse at rest, pain that wakes you up from sleep should be considered serious and that needs a consultation with your doctor.

What should I do when I have significant back/neck pain?

If the back/neck pain is not very severe and is of a short duration, then complete bed rest for two to three days will help reduce the pain significantly. Applying ice packs and light massage with a pain balm/gel is helpful. Consult your doctor if the pain is severe, running down in to the legs/arms, not getting better with rest, night pain, if there is numbness/tingling sensation or weakness in the limbs, is associated with fever, or if the pain started after a significant injury/fall. Thorough clinical evaluation by the doctor will help identify those with possible serious causes of back pain and further investigations are advised accordingly.

Is my back pain due to a kidney stone/problem?

Possible. But not always.

Kidney problems, especially renal or ureteric stones can lead to pain in the mid and lower back, usually limited to one side, often pain radiating down to the groin or lower abdomen. There are certain indicators to differentiate pain coming from kidney or other organs in the abdomen from the pain originating in the spinal structures. In general, spine related pain is mechanical i.e., it is worse in positions where the spine is loaded like while in upright posture, walking or bending or getting up from reclined position and generally gets relieved by resting in reclined position.

Pain from the kidneys can start suddenly in any position, can be waxing and waning and may not change related to a particular posture. It may not get relieved by rest and can be severe even while reclined. These are only general indicators and it is always better to check with your doctor and get the right treatment advise.

I have back/neck pain even though my MRI says my spine is normal !! Why?

A very common cause of back or neck pain is bad posture related stress to the spinal structures that happens during the daily routine activities. Sitting/standing posture, especially at work, has a major role in producing significant pain and disability even though the X rays/MRI of the spine may be normal.

Bad sleeping posture can lead to pain in the neck/back. Sleep is important to allow the spine to recover from the daily stresses it undergoes while we are awake. Reduced sleeping time and lack of proper sleep can lead to accumulated stress in the spine and result in pain. Lack of adequate exercises to keep the spine flexible and muscles strong is another important factor leading to pain.

So, right posture and regular exercises are the two most important treatments to prevent such pain from troubling you.

Other structures close to the spine can also lead to back pain. So if the MRI of spine is normal, further evaluation might be ordered by your doctor depending on the clinical picture.

Is my back pain due to the spinal/epidural injection that was given in my back many years ago for an abdominal or leg surgery?

No. It is a common perception that the spinal / epidural injection that was given in the past for anaesthesia purpose is the cause for back pain. Many patients associate their back pain to that injection as they remember it as painful event and think that the present pain is related to that procedure. Spinal anaesthesia related back pain doesn’t usually last more than 3 to 4 days and almost never beyond one week. So the back pain that continues beyond one week or that starts much later after the spinal anaesthesia is not because of that injection and it needs evaluation by your doctor to find the right cause and treat appropriately.

Is my back pain due to my body weight / pot belly?

Overweight is an important factor contributing to back pain, especially in the lower back. Excess weight and a large belly lead to some changes in posture. The pelvis tilts forwards and the lumbar spine is also pulled forward and this posture can lead to back pain due to additional stress on the spinal joints and muscles. Lack of exercises weakens the back and pelvic muscles and contributes to the problem. Back pain due to other problems in the spine can get worse if overweight is associated. Weight reduction and core strengthening exercises in obese people are helpful in reducing the back pain.

I have back pain. Is it due to slipped disc/disc prolapse?

Not necessarily. Although disc is a predominant source of back pain, all back pains are not because of a disc prolapse. The other structures in the spine like the facet joints, ligaments, vertebrae(bones) or the muscles of the back can be the cause of pain in the back. Less commonly, pain related to abdominal organs like kidneys or pelvic organs can be perceived as back pain. Rarely, more serious conditions like infections or tumours in the spine can be the cause of pain. It is essential to see your doctor if there is significant persistent pain. There are certain red flag signs that the physicians look for to decide if further investigation is required.

Does the disc bulge/prolapse seen on my MRI get reversed again naturally?

No. The changes that happen in the disc that lead to the prolapse or bulge are not reversible. They are due to age related wear and tear changes and we all know that ageing doesn’t get reversed !. But usually, the symptoms and signs that are related to a disc prolapse get relieved with appropriate treatment, although the MRI picture may continue to be the same. So the treatment decisions are mostly dependent on patient’s symptoms and signs rather than in MRI picture alone. Only if the prolapsed disc is causing persistent symptoms and significant neurological deficits, a surgical intervention is considered.

Is lumbar disc prolapse a cause of erectile dysfunction/impotency? 

Rarely a large lumbar disc prolapse can result in severe compression of lumbar spinal nerves causing numbness and weakness in both lower limbs and loss of urine and bowel control – a condition called “cauda equina syndrome”. It is only in this condition that a disc prolapse can affect the erectile function. An erectile dysfunction in isolation, without other neurological symptoms and signs, cannot be caused by a disc prolapse.

Does the disc problem affect the ability to become pregnant in future?

No. A disc prolapse/bulge doesn’t affect the ability to get pregnant. But, there is a possibility that the back pain due to a preexisting spinal problem may get worse during pregnancy due to the extra weight that is carried and the relaxation of ligaments of pelvis and spine that occurs as a result of pregnancy related changes.

Does it help to sleep on the floor/hard surface without a bed to cure back pain?

No. It is not advisable to sleep on the floor when there is a back problem. Sleeping on the floor when there is significant back pain can actually make it worse as you need to put an extra strain on the spine while getting up from the floor. Sleeping on the regular cot with a firm mattress is alright. It is advisable not to sleep on a very soft mattress that doesn’t support the spine well and can aggravate the back pain. Do not use a thick pillow or multiple pillows while sleeping as it can cause or aggravate neck/upper back pain. A thin pillow  or a rolled sheet supporting the neck is an ideal kind of head rest.

I exercise only when I get back/neck pain. !

Many patients say this when asked about any exercise they do. It is not advisable to start exercise when there is significant back or neck pain. But it is essential to start exercises after the pain subsides, to prevent the pain from coming back again. Exercises can help strengthen your spinal muscles, increase flexibility and protect you from recurrent episodes of pain. So it is important to keep exercising when there is no pain, to keep the pain from coming back and troubling you. So do not start exercising when there is pain!!.

If you have more questions about spine related problems, please do post here.