Spine Care Frequently Asked Questions

How do you know what type of doctor or therapist to see first?

Always start with a physiatrist first, not a surgeon. This is similar to if you have a heart problem: you would see a cardiologist first and not a cardio-thoracic surgeon.

Conditions (Arthritis, Spinal Stenosis and Herniated Disc)

I have arthritis in my lower back and deterioration and scoliosis. It’s hereditary. What can I do? Are there herbs I can take?

You may not necessarily want to take herbs. Make sure that your B12 and D3 levels are normal. Your primary care physician may have already checked these (if not, they should). Also, you should be evaluated, so that we know what the degree of the curve is and make sure you are doing exercises to strengthen the spine muscles.

What can you do for arthritis of the neck and shoulder area that has a sharp pain?

Arthritis is rarely the cause of the pain. Make sure you get evaluated for the real cause (usually disc herniation or stenosis) and get treated for that.

Is there a treatment for osteoporosis?  Could a back problem cause a balance problem climbing up an include so that one falls backwards?

Yes, there is treatment for osteoporosis. It starts with your primary care physician and a baseline bone density test. Based on that study, your treatment may be simple exercises or medications, if needed. It is unlikely that a back problem causes you to fall backward. This will need a neurology evaluation.

I have spinal stenosis. My foot or leg drags when walking. My leg sometimes gives out. If I go down a down a step, my leg collapses. What are my treatment options?

Stenosis is treated with exercise, then epidural steroid injections, then spacers, and then a more invasive decompression surgery. If you have weakness, this needs to be evaluated now by a specialist.

What is the latest treatment for herniated disc?

Exercise will reduce disc material. Your exercise program would be followed by fluoroscopic (guided epidurals). If surgery is required, you would also do post-op exercises.

I have spinal stenosis and degenerative discs.  Bad balance problems. Any help for me?

Yes there is help and you should start with a Physiatry evaluation or a PT.

What are your feelings regarding spine decompression treatment for herniated disc?

Independent research does not show that spinal decompression works better than the traction physical therapists do. Better treatments are available.

Can symptomatic spinal stenosis get better without surgery?

Yes, with the right exercises or epidurals most people get better.

I have severe pain in the lower back first think in the morning.  I take ibuprofen (3 tabs) and sit for about 15 minutes, and the pain goes away for most of the day.  I am told that it is osteoarthritis.  What can be done to get rid of daily pain?

This is not arthritis. It should be evaluated, so you can get the right exercise and not have to take a pill.

If you have weakness in the leg going up and down stairs, does this symptom always require surgery or could there be a problem that could be corrected without surgery?  I have a diagnosis of sciatica and l5-s1 problems. 

Sometimes difficulty with stairs is simply weakness of your gluteal muscles. Physical therapy can help.

I used to do yoga years ago but for various reasons, gave it up.  Because of both knee replacements, what can I do now?  What about inversion therapy?

We would not recommend inversion therapy. You can see a physical therapist for exercise recommendations and even go back to yoga or tai chi.

I have spinal stenosis and haven't had any luck with physical therapy.  What is the next step?

After physical therapy, the next step is an epidural.

I have seven herniated discs. I have refused surgery and use a heated pool with some relief.  I also take muscle relaxer.  I walk with a walker or cane.  What do you suggest for the best therapy?

See a physical therapist or physiatrist for a specific evaluation and exercise program.

 I have spinal stenosis and had prototherapy for my lower spine.  I have no back pain, but the muscle stiffness is horrible and my posture is bad.  Is prolotherapy done frequently today?

Unfortunately, prolotherapy is not covered by insurance and has not been shown to be effective for most back pain except unstable SI joints.

The day after I shampooed my rugs, I could hardly lift a spoon to feel myself.  After 3-4 months, I still have occasional neck pain, but also my left arm is tingly.  Should I be concerned? 

You probably herniated a disc and should see a physical therapist or physiatrist

Physical Therapy

What can be done about back pain that wakes you up during night? What is the best time to see a physiatrist? When pain is acute or after the acute pain has subsided?

See a physiatrist as soon as possible.

Can physical therapy help a moderately severe (side-bending) scoliosis?

Yes, physical therapy may assist in management of scoliosis through stretching on the shortened side of the curve and strengthening on the opposite.

For spinal stenosis, other than an epidural, will physical therapy help stenosis?

Physical therapy exercises involving flexion of the spine and stabilization exercises have both been shown to be effective for management of stenosis.

I have lower back pain that radiates down both legs. The chiropractor no longer helps. Could physical therapy help?

Yes, physical therapists trained in the McKenzie approach will be able to identify exercises based on your directional preference. Directional preference are directions of movement (exercises) that cause leg symptoms to centralize, or move closer to the spinal segment where the problem originates.

When is the best time to exercise? 

Stretching and strengthening exercises should be deferred until the person is “warmed up,” meaning not immediately after getting out of bed. Some walking first thing in the morning is recommended, and then specific exercises can be done later in the morning or any other time during the day.

What exercises are good for a healthy back? 

A balance of daily stretching in both the forward and backward directions, as well as side to side directions is important. Some type of aerobic activity, be it walking, biking, or swimming should also be part of a healthy back program. Strengthening through stabilization exercises or weights is also critical for bone and muscle health and should be performed 2-3 times/week.

What can be done to lessen lower back pain when walking on paved hiking paths 3-4 miles?

Back pain while hiking may have several sources and should be examined prior to recommending specific exercises. In general, strengthening of the core (abdominal) muscles may be helpful.


Is a lumbar support cushion helpful or necessary?   

Sitting with a lumbar roll has been shown to place the spine in its normal, lordotic (inward curve) position. Slouched sitting increases pressure on the disc and places muscle, ligament and joint capsules on stretch, which can be painful. People have difficulty maintaining this upright position because our muscles have not been trained to maintain this posture.

Is it harmful to crack your back or joints?  Or is it “just air” releasing?  Does it cause arthritis? 

There is no evidence that "cracking the joints” causes arthritis. The cavitation sound is most likely due to gas escaping from the joint space, and in some instances, it may set up a pain relief mechanism. The need to “crack the back” may stem from a lack of spinal stability.

On a long bus ride, how do you keep from getting neck pain?  Do you recommend the neck collar pillow they sell?  What type of pillow do you recommend? 

Sitting with the low back in an erect posture places the head and neck in its correct position. For long trips, the neck pillow you seen sold at airports is fine. 

Is it best to sleep on your side or back? 

Whether to sleep on your side or back is a matter of preference. If sleeping on your side, you need to be careful about curling into the fetal position. This would place the spine in prolonged flexion, which can produce strain.

What type of mattress is best for back support?

A firm or semi-firm mattress is generally recommended.

Is sitting in a recliner a bad thing?

In general, yes. The spine is not maintained in a good posture while in a recliner. You will get pain relief in the recliner. Sometimes, people sleep in a recliner. If you sleep in a recliner and don’t have back pain in the morning, then it is probably fine for you.

At night, I have low back pain and my shoulders fall asleep.  What should I look for in a buying a mattress? 

A firm mattress is best.

Companies are trying to sell everyone the back brace.  Do they really help and are they worth the money? 

Bracing is often recommended following a spinal fusion or when the spine is not stable. In both of these cases, it is worth the money.