15 Questions to Ask Your Doctor About Lower Back Pain

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hey everyone, it's your host, Sebastian, with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. We are covering a simple 15 questions to ask your doctor about back pain today. I thought I would do a little Google search and see what you guys are finding with your lower back conditions. By the way, if you guys want some extra information that we put out on lower back pain, there's a webinar in the link description, as well as I have endless books, and we also have an online program too, which is really great.

If you guys are looking for a consultation, we do have consultations for a very reasonable price as well, and we're licensed in multiple states. So the webmd.com back pain questions to ask your doctor about back pain, I thought was a really nice place to start. So if you've been recently diagnosed with back pain, you might want to ask these questions to your doctor at your next visit. So I'm going to give just some quick answers on this and maybe circle it back to maybe what you guys could start doing. Number one, what's causing my back pain? You know, over the years, I think people have maybe learned the term of non-mechanical lower back pain.

And kind of like insinuating your back pain is not really related to anything mechanical. That's, I'd say, rarely true, but it does happen. Typically, back pain of various different types of diagnoses are related to mechanical factors, meaning it's the way you sit, it's the way you lift, it's how you treat your back, it's even imaging findings like x-rays and MRIs that show signs of wear or degeneration are oftentimes related to how you've been treating your back over time. You don't just wake up with arthritis, you get it over time because of how you've been using your back. And it doesn't necessarily mean hereditary either.

That's how you've been using your back, not how your father or your mother's been using their back. So, the typical diagnosis are going to be low back discogenic pain, sciatica, which is more from nerve root impingement. Oftentimes, sciatica is a symptom of many different types of diagnoses, such as piriformis syndrome or nerve root compression or even entrapment in different locations. So, but low back nerve impingement is a very common one. One that's overly diagnosed or often overly talked about is a muscle strain on low back. I've never, ever, ever in 15 years of practice have met anybody who's actually torn a muscle in their lower back.

Yeah, the muscles may feel tight and it may feel like they're strained, but remember, it's a strain, it's not a tear. So, they're treated in a very different fashion as well. So, some serious conditions that can be causing lower back pain. If so, which ones are, which ones and what are their symptoms and have they been ruled out? So, I think it's a pretty valid question. We tend to have like a red flag questionnaire that's in our history, which is like, have you had a recent fever, past history of cancer and things of that nature? I won't go into all these in particular. You can look up Google red flag questionnaire with lower back pain and find like basically we'll roll one out, but it's infections, tumors, cancers, things like that, which in even like systemic problems like organs could be creating lower back pain, ulcerative colitis and things of that nature.

So, usually people don't have a lot of these. I think it's very common to have many, many of these positives on your intake form unless you do have something a little bit more sinister. But that is part of your doctor's job is to roll that out. I wouldn't necessarily do that on your own, but you should certainly ask them, has it been ruled out? Because sometimes it'll remind them that they could be looking. And sometimes your past history, like smoking and past history of cancer and things that bowel and bladder function can help identify maybe what that problem might be, which is very rare. I think it's the status like two to 3%.

Number three, what will worsen my back and what can I keep it from? What can I do to keep it from getting worse? So this is super independent to each person. People who are younger tend to have worsened low back pain with poor lifting mechanics and with sitting with a slouch posture. But as you get older, say you're 80 years old and you have low back stenosis, which is a very common diagnosis up into that age range, actually rounding their back makes them feel better. And lifting, if not underweight, but picking up stuff with a rounded low back sometimes does feel better. Walking will make those people feel worse, while walking will make the younger crowd feel a lot better.

So Stuart McGill covers this in some of his literature about directional, kind of like directional preference or flexion or extension and tall and low backs. So younger people tend to experience more flexion and tall and low backs, meaning rounding their back in some form tends to make them feel worse. And laying on their stomach could make them feel great. While the older generations tend to feel that they're more extension and tall and low back. So laying on their stomach will make them feel terrible. But everyone can be anywhere in between. And that's why getting an exam is pretty important.

Number four, can stress be a factor? And what can I do about it? Oh, sorry. Let me rewind that actually. What can I do to make my back pain from getting worse? Well, I would identify what you've done in less trauma-based that is making your back pain present itself in the first place. If you've had reoccurring lower back pain, like you feel like it comes back every couple months has been a couple of years or, you know, you have resurfaced once a year, I think you can probably relate that to something you've been doing. You've spent more time at the gym. You've spent less time at the gym. You've picked up a new exercise.

You picked up a new habit. Usually, so we have a saying where usually the source or the trigger can be traced back about two, three months prior. So you started to do a new yoga routine and now you have lower back pain. So usually keeping on that trajectory may insinuate that you can make things worse, but usually well rounding out your lifestyle and habits and plugging in any holes in your exercise or lifestyle can be very helpful to make it from stop getting worse. But usually that's management. That's usually what our job is beyond examination treatment. It's managing and making sure that you have a well-rounded life and habits.

Number four, can stress be a factor and what can I do about it? Yeah, stress can be a factor associated to it, but I wouldn't necessarily say it's the top of the list. Stress is something that can definitely make people feel worse. There is a mental aspect to almost everybody's problem. What you can do about it is find what stresses you out and do less about it. So you can remove how much stress you have or you can manage stress better, which is going to be something like meditation or doing things that are a little bit more the opposite, the yin and the yang of it, if you will. Number five, what are your treatment options?

Well, if mechanical based, and like I said in question three, like what works in your lower back, then you could try to incorporate a rehabilitation program to help stabilize your lower back, help identify which exercises or movements are painful, you can strengthen your legs, you can stretch your shoulders, and so on. So there's lots of different things that you can do treatment-wise. Pain management-wise, injections can be helpful, if in the right scenario, deep tissue massage, adjustments, hip stretching, shoulder stretching, low back stretching, or not. So all these things that you've probably read about on the forums can be helpful, but it's all going to come down to your exact type of case.

For example, surgery will not help your case if it's not a surgical case. Stretching won't help if you don't have any limitations in range of motion. So it all depends upon how you test in your physical exam. Number six, are there things you can do at home or in life to reduce back pain? Yes, certainly. So if you can identify the things that bother you already, you can reduce the frequency of them. If you've identified that you're not doing something, but you feel better overall when you start doing that, such as walking or lifting or being more physically active, then start doing more of that.

So you can add or remove to parts of your life based upon what you've observed to make your back pain worse. Number seven, if you've recommended surgery, what are the risks and benefits? So benefits are if you've been having lower back pain and it needs a surgery and you need something like a microdissectomy or you need a fusion or something like that or a disc replacement, those can be very valid ways to make you feel better. But it doesn't reduce the risk factors associated to it coming back either. In my opinion, you've been treating your back this way for a long time, if not trauma-based and those lifestyles won't change.

So, but it will help reduce pain on coming from a damaged tissue. Surgeries, the risk of it, inactivity, stiffness in the spine and all the standard things go along with surgeries such as infections and blah, blah, blah. So you can look at those on your Google. I won't cover them too much. Is medicine needed to, number eight, is medicine necessary or are there alternative treatments? There's tons of alternative treatments. Medication can be helpful when there's an inflammatory aspect to it, but I've met a lot of people who take medication and doesn't even dent it. So it's all over the board with it.

It's kind of do what's right for you. If medicine is needed, how does medicine work? In my opinion, it easily addresses the inflammatory aspect. It doesn't take away the mechanical triggers. It doesn't change how you treat your body. It doesn't change your lifting mechanics. So I don't want to say it's not a helpful thing. It can be helpful to douse the fire, but it doesn't stop the fire from starting. So it's a dual-pronged approach if you are going to use medication, in my opinion. Number 10, how long can I take medication? What are the side effects? I can't really vouch for this. I can't speak about it because I'm not allowed to suggest medications based upon my degree.

So I will leave that for an MD. Number 11, how will having back pain affect me and can other problems develop? Yeah, this is a good question to ask. So how back pain affects people is very different. It can take a person who's very physically active and make them just a shadow of themselves, especially if they've been told they're not allowed to do certain things anymore. But also, too, it can really weigh on your spouse or your partner. And if you've had lower back pain to the point where you can't bend forward, imagine washing your feet, putting your shoes on, and you ask your partner to get it.

I know plenty of people who drop something and they don't want to pick it up. So who gets who's picking it up? The other person. And so it does affect other people. And sure, a good partner will put up with it for a long time and do everything they can. But also, there's a fine line of if you haven't looked for help and you're not willing to get help, how much are they enabling you as well. And so Mother Nature has its way of, like, you do need to move a little bit more. And a lot of times it settles back pain down. But in the beginning, yeah, you need to arrest certain movements because it can be very painful as well.

So that's going to be a little talk with your partner. And make sure you have the right help to guide you in the right direction. So it's number, like I say, the number 11, how it will affect you. And can other problems develop. Yeah, I mean, other problems develop associated to just inactivity and being worried. There's a lot of people who are worried about their back, which rightfully so. But if you worry and you don't move and don't do anything, you may end up developing other problems down the way. Hip flexor tightness, lower back stiffness, tailbone pain, inner knee is all very common associated to people who are afraid to move their back.

Number 12, where can I learn more about how to live with lower back pain? So I think if you're looking for people to help you manage this, I think it's going to come down to somebody who's experienced it on their own. But also who has had a lot of experience trying to empower people to become more active and figure out what their goals are. I know one person who their goal is they're 70 years old. They just want to be able to garden. That's fine. We don't need to give them so much as rehab and treatment if their activity and their goal is really, it's not as much as somebody who's a professional athlete.

So it's just going to take a little bit more. So I think the person you work with has to understand what your goals are and if they're reasonable or not. And if they're not reasonable, they need to tell you that as well. There's plenty of people who have very unreasonable goals based upon their spinal health. And it's always up to them to pick what they want to do. But we should always be advising about like the success that they'll probably have or the expectations, like realistic expectations. I spoke with someone before where they were a very flexible person, very flexible spine. They were lifting multiple times a day, not even just a week.

And so they wondered why their condition kept coming back. I said, look, this is the cost. So there's always risk and benefit. The benefit is you get stronger and bigger. The risk is that you're going to have this return. So we need to maybe modify your treatments and figure out a minimal effective dose of your lifting, figure out minimal effective dose to get to the goal you want. Like more is not always better. So if you guys want to help, if you guys want help with us, from us, that's what we specialize in doing. We work with people with lower back pain and help them figure out what their goals are and then figure out how to get them to it.

Physical and mental goals are very important. So number three, 13, what if any special accommodation do you recommend for school, home, or work? I think just the ability to move around. Standing desks would be great, but schools aren't going to do that. Being able to stand in the back of the room if you need be. Being able to take, like kind of stroll around and walk, if you will. Being able to move, a lot of times it shakes out some of the spinal stiffness and pain, but that's not always possible. Sometimes you're in a car and you're not going to be able to do that. So it always comes down to like if it's possible or not.

14, how often do I need to come in for a visit? Usually when things are really inflamed or irritated or in your in pain, usually once a week is enough to get by. If it's really intense, two days a week is enough. But usually about a month or two is enough at that frequency to get a big dent in it and making it so you can manage your own problem. We oftentimes have people come back once every two to three months just to make sure that they're doing a check-in because there are easy wins that we can identify to do lifestyle and rehab program changes that they can't identify on their own. Mainly because they haven't had this experience before.

So we're trying to make sure to catch things early to make sure to save the person any grief. And usually a shorter session once every two to three months is enough to do that. Number 15, what are the chances my back pain will result in permanent disability? Very low for most people. There's plenty of people with lower back pain who are not disabled, but there are some people who are. But usually the first bout of back pain is not like the end, like it won't disable the person. I think where it really gets into trouble is when people have motor loss or they have like the inability to do things like calf raises or move their foot or tripping and so on.

That's where disability comes in, especially if they wait too long. But pain is, as we say, pain is just pain. It's painful, but it's not like you can't move. But a lot of these people are in pain whether they're moving or not. And so if that is the case, then we need to find something which makes you more comfortable. And most people are, they're closer to being in much less pain than they think. And although it seems very unreasonable to feel better in about three to four weeks, it's super possible. We have countless people that we've helped get to that point where they're way more comfortable.

Now, are they going to need to come back? Probably. They've had years, decades of lower back pain. So, like, it's not going to be a magic show. So people will need to return because things have settled a little bit. We just have to make sure that we're on the right track of rehab and treatment and loosening things up. So, but that's pretty reasonable expectations for people. So if this was helpful to you guys, subscribe to the show and please listen in for more topics on this, as well as some of the guest hosts that we have. If you're looking to contact us, we have the description in the podcast player, which will get you access to that webinar, as well as how to talk to us for a consultation.

See you next time.