May 17, 2022
Getting back on track
This past March, Breaux Gargano began suffering from intense low back pain, day and night.
“My back pain was debilitating. There were things I couldn’t do, and I was miserable,” said the 40-year-old Nashville, Tenn., resident. “I tried to change the way I was sitting and lying down, and I took over-the-counter pain relievers, but nothing fixed it.”
Gargano, who works as a sales manager at a waste management company, had been working from home since the COVID-19 pandemic started. He believes his sedentary job and makeshift home office set-up contributed to his back pain.
And with a baby on the way, he knew he needed to do something to get back on track. “I didn’t want July to come and find that I couldn’t take care of my new son,” he said.
Through his company health plan, Gargano had successfully used Hinge Health last year for knee and shoulder pain he experienced while running and weightlifting, so he thought it might help his back. “I didn’t want to go to the doctor without seeing if the Hinge exercises could help first,” he said.
The digital clinic for musculoskeletal issues offers people like Gargano a customized list of exercises along with a tablet and sensors to ensure they are doing their exercises properly. Each participant also is connected with a health coach and physical therapist who provide support.
Using Hinge Health’s exercises for his back 10 minutes a day did the trick, Gargano found.
“After 4-6 weeks, I noticed a reduction in the pain, and combining proper back support with the program expedited my results,” he said. “In 2-3 months, I noticed a serious difference to the point where now I go through the majority of my days with no pain. I’m like a whole person again.”
Imaging isn’t the answer
Low back pain is a common complaint among adults in the U.S.
“Our current lifestyles mean most of us are going to experience low back pain at some point,” said Dr. Jayson Carr, a primary care provider with Beth Israel Deaconess Health Care in Brookline, who notes that the condition is the second most common reason for a sick visit in adult primary care in the U.S., behind viral respiratory illnesses, at 13 million office visits a year.
An aging population, including a mix of fitness buffs and others who have sedentary lifestyles, and high rates of obesity create the perfect conditions for rising cases of low back pain, Carr said. Add the pandemic to the equation—with individuals like Gargano working from home at improvised workstations and many others gaining weight and not moving much during the day—and the trend line for back and joint pain continues to rise.
Because most low back pain is due to muscular strain that resolves in a few weeks, Carr said, the best treatment is often a combination of simple measures: moderate physical activity including the kinds of stretching Gargano did, over-the-counter pain relievers like ibuprofen or acetaminophen, ice and heat, medicated back patches, and a healthy dose of patience – rather than interventions such as an X-ray or an MRI or surgery.
“Patients usually want an image because they want an answer, but a careful review of your history and a physical exam usually can give you the answer,” Carr said.
In fact, he notes that imaging for most patients with low back pain can cause patients more harm than good.
“No one over the age of 40 has a normal-looking lumbar spine MRI,” he said.
“Abnormal” results can lead to more imaging, unnecessary exposure to radiation and an increased chance of needless surgery with a big price tag, delays in returning to work and regular activity, and more disabling pain.
“Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition,” the American College of Physicians advises. “In this area, more testing does not equate to better care.”
One study of nearly 2.5 million patients diagnosed with low back pain found “overimaging of low back or lower extremity pain is associated with a significant, avoidable cost burden” for a condition that usually resolves on its own.
If you do want to see your doctor, Carr recommends telling your clinician how your back pain started, describing your symptoms, and asking how you can expect your recovery to progress instead of asking for an X-ray or MRI. As always, he says, if your back pain gets worse or other concerning symptoms develop, it’s important to let your doctor know.
Movement as medicine
While there is no foolproof way to avoid low back pain, Carr says moderate physical activity on a regular basis, such as a brisk walk after dinner, often is the best medicine.
“I tell folks to try to get some exercise more days than not, and if they’re starting out, to make a three-week commitment to walk 30 minutes a day, three days a week. Finding something that fits into your lifestyle is important so it will be sustainable.”
Hinge Health Chief Medical Officer Dr. Jeff Krauss agrees.
Our program focuses on movement as a keystone habit. We want to try to help people make exercise a habit because we know that to treat most chronic musculoskeletal conditions, we need to get people moving — not stop them from moving — and educate them that it’s safe and important to move.
Dr. Jeff Krauss
Good posture and frequent breaks are important, too, notes Carr. “Being at a computer for hours at a time without position changes can lead to back pain and strain. People should aim to get up and move for a minimum of 15 minutes every hour.”
Carr also recommends sitting with proper back support with your feet under you and your head, shoulders and hips aligned, as well as doing 10 minutes of core exercises each day because “The core is the best friend of the back.”
Gargano and his wife welcomed their new son, Sam, in July, and he said he is excited to be able to pick Sam up with no pain, as well as be an active dad to his 7-year-old daughter Olivia. “I let her ride on my shoulders, and I pick her up, too. I’m just that kind of dad.”
He encourages anyone with back pain to start with exercises and proper back support like he did before jumping into treatments like imaging and surgery—even if they require a little more effort.
“I would suggest that anybody try something like this first. We’re a society of on-demand, but if you’re willing to put in the work and stick with it, it might save you back surgery,” he said. “I think it’s worth the time in the long run because you can build a healthy habit and have the tools to fend off back pain forever.”
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PHOTO OF DR. JAYSON CARR BY JOHN WILCOX