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This is the bridging the gap physical therapy podcast keeping you active and pain free.
Charlie McDermott 00:05
Hey there! This is Charlie McDermott, producer of the bridging the gap podcast and I’m back in the bridging the gap studio and today I’m here with Dr. David Lee. Dr. Lee, how you doing?
Dr. David Lee 00:16
Good morning, Charlie thanks for having me on.
Charlie McDermott 00:19
Absolutely, you know we had a great conversation last week with Dr. Tio and he got into lower back pain specifically and I love the fact that you’re following up on that, because my goodness, that’s probably one of the top things that plagued us in society and it really reduces the quality of life and I’d love the different angle that you have here and just again the beauty of this podcast is just really to enlighten folks and help them improve the quality of life and if they need you, awesome, you’re there and we found out that firsthand, as you know I’m gonna embarrass you a little bit, but it wasn’t Barb’s lower back, but it was her shoulder and I kept saying her to her doctor Lee and you know this because you know, the story because I went through rotator cuff surgery and I’m saying Barb, unfortunately, you’re gonna have to go through that there’s just no way. I mean, she couldn’t do it this; she couldn’t lift her arm up. I mean, the quality of her life was terrible, because she’s very active and we got her over there in. I mean, it’s a year later, and then take a year, a matter of months; she was back to life again, after she’s teaching group exercise classes, so anyway, kudos to you. Thank you for that. Let’s get to lower backs. So, have you recovered from all that gushiness I just laid on you, are you okay?
Dr. David Lee 01:47
I think I might need a minute for that but yeah, I mean, that’s what we do here. We get people back to function, we get them doing what they love to do and we don’t want them to miss a beat in their life.
Charlie McDermott 02:00
So let’s talk about lower back pain. Let’s just start with the basics, how common is lower back pain in the US?
Dr. David Lee 02:08
Yeah, so great question. So, basically, this is like the number one thing that we treat here at bridging the gap. So, basically, it is the most common thing that we will see. The stats say that about four out of five people are about 80%. At one time in their life, we’ll have a low back pain episode, okay? So when people come to us and they’re like, oh, my gosh, I’m going to this low back pain and my world around me is collapsing and I can’t do anything and we just got to ensure them that this is a very common thing. A lot of people go through this. So, you are definitely not alone. You’re not the only one on the bus and it kind of calms them down and be like, okay, we’ve had to take the right measures and go through this process. So, basically, with low back pain, there’s about $100 billion dollars per year spent in health care cost from low back pain. So, it’s so common, it’s kind of like a pandemic, where everyone goes through it at one point in their life and you will basically, you probably know about five or six people off the top of your head that have low back pain so, yeah very common thing.
Charlie McDermott 03:22
And I would imagine, it’s one of those things that, probably more so in men, I’m just guessing, put men in a box where it’s like, you know I’ll power through this, I’ll toughen through and you see them kind of hobbling around and limping around and it probably, not a good shot, that it’s gonna get better on their own end or we’re suffering a lot longer than we, we certainly need to but you know and I know, we’re gonna get into kind of the treatment side of the equation later on here, but let’s start with the cause. I mean, what causes lower back pain? How do you even diagnose?
Dr. David Lee 04:01
Lower back pain is very hard to diagnose just because there are a lot of different structures in the area. So, you have your muscles, you have your tendons, you have your ligaments, you have discs, you have the joints, you have a lot of different things that can cause it. Also, if you look at the hips, that can, you know it’s kind of in the same area. So, basically, that can refer into the low back as well, too. So, there are a lot of different things that can cause low back pain. Also, you have to look at systemic stuff. So, if you have kidney stones, if you’re pregnant and you have a lot of weight in front of your body that can cause low back pain as well too. You can look at your neurological stuff like Parkinson’s, you can also think about spinal bifida, which is a condition where the spinal cord actually protrudes out a little bit into your low back. So, all these different things can cause it and also trauma you know like, if you fall and you fracture a bone, you know, that can cause the back pain as well, too. So, there are just so many different things and so many different structures that can cause low back pain. So, it’s very hard to diagnose and we want to make sure that we’re looking at all these different things and incorporating the right treatments and putting in the right strengthening things as well, too. So, if we’re looking at the hip and the pain is coming from the low back, or vice versa, we have to make sure that we address those things.
Charlie McDermott 05:38
And even something like kidney stones can cause lower back pain?
Dr. David Lee 05:42
Absolutely so, yeah, nowadays, what happens is that all of us physical therapists get our doctorate degree, so we’re able to really call it differentially diagnose these things. So, if something doesn’t, make sense in our assessment, we have to look at systemic stuff, kidney stones, even cancer, even, cysts that can be pushing on some of these nerves that can be causing low back pain.
Charlie McDermott 06:12
Really pays to understand as much as possible about how the body works and wow, it’s first time I’ve heard that, how about the difference between chronic and acute pain when it comes to lower back pain?
Dr. David Lee 06:28
Okay, so with acute pain, that’s usually when it first, when you do something and you twist a certain way and you have low back pain, that’s what we call an acute. So, usually that lasts about anywhere, you’re anywhere from days to about six weeks, then we have your chronic condition, right? So this is something that you know you’ve been dealing with for years, months, off and on and you know things haven’t resolved. So, there’s different things that you do for acute and there’s the different things that you do for chronic, you know for the acute, we want to make sure that we’re taking stress off the back. So, if you get hurt lifting weights, you don’t want to keep lifting weights because that’s just not going to help your situation. So, that’s what you’re talking about before powering through it, right? You don’t want to keep powering through it because it’s not going to get better that way is it’s going to keep on irritating things. So, we encourage people to move, but you don’t want to move in the range of motion or the areas that keep causing you the low back pain and then we go into chronic. So, these are things that basically you’ve been dealing with for a very long time, a lot of stiffness type things, a lot of, you know if you feel like if you lift something and your low back just kind of gives out on you all the time. These are the chronic stuff. So, with this as well, you want to make sure that you’re moving frequently because that will help to lubricate your joints, help out with your dis situation, help out with strengthening the muscles, you want to make sure that you’re moving and strengthening consistently and a lot of times what we see in the clinic is people say that they’re working their core, but they’re really not working the proper core muscles. So, getting into professional and making sure that you’re actually doing things correctly because if you modify your technique, then you can a lot of times avoid low back pain as well.
Yeah, I would imagine probably pretty often just little things like a little tweak on where you’re focusing the exercise makes a big difference.
Dr. David Lee 08:49
Yeah, literally, it’s like millimeters emotions. If I twist just a little bit more to my left or you know bend a little bit more to my left. A lot of times what happens is that, you can work a different set of muscles and you can really take a lot of stress off the low back or wherever you’re having trouble with.
Charlie McDermott 09:09
How about when it comes to chronic pain, can you do anything to treat chronic low back pain?
Dr. David Lee 09:16
Yeah, like we said before, you know motion is key. I had a professor in PT school, I’m going to quote him because I got these two things from him that I use for the rest of my life is motion is lotion and he who rests, rocks. So, basically, the more you move, the more you lubricate the joints, the more you take tension off of your muscles. So, you want to move consistently and then you want to make sure that you’re not staying in one position for a very long time. So, if you or I, we don’t have any low back pain, but if you and I were to sit for two or three hours in one position and not move well, what will happen when you get up?
Charlie McDermott 10:02
Alright, we’ll take a while to get up number one.
Dr. David Lee 10:06
It’d be hard to straight now a lot of time. But what happens, do you keep moving and now you can get straight up again, right? So it just tells you how resilient the body is if you just move and if you just do the right things, a lot of times you can get back to normal. But it’s when we choose not to do those things, is when we start to compound the issue and then you go to this something forcefully and aggressively and then what happens? Then you start getting some pain…
Charlie McDermott 10:40
You get some yelling…
Dr. David Lee 10:43
So, you want to make sure that we’re treating our body good, we only have one body, so we want to use it for the rest of our lives. So, we want to make sure that we have it for the rest of our lives and it’s working at high capacity.
Charlie McDermott 10:57
Quality of life, it’s what it’s all about and I would imagine, human nature is, you know when you feel that pain is to kind of seize up just like, you know, not move right and that’s that you just share, it doesn’t really help.
Dr. David Lee 11:13
Yeah, it’s like, you go into protected mode and you think that if I don’t move, I will be okay but you know, a lot of times, it’s perception versus reality. So, I play golf and I think I have the best swing in the world. When I look at my video like that, yeah, a lot of times, we have to kind of go against what we think is right at that point and just do some things to help out the situation and you’re like, okay, well, I feel better now.
Charlie McDermott 11:45
Awesome, how about when it comes to arthritis, how does that affect low back pain?
Dr. David Lee 11:52
Yeah, so there are two types of arthritis. One is the systemic type, which is called the rheumatoid arthritis. Basically, that’s when your body attacks your joints and we have to control that by keeping low inflammation, stress diet, all those things and then there’s osteoarthritis, that’s the one that we deal with. So, with osteoarthritis, that’s kind of like the natural degeneration of your joint. So, we have to make sure that we’re doing things to help that situation out because yes, you can eventually feel pain with that posture of arthritis if it gets really bad. Now, a lot of us, you and I, we have arthritis and we don’t have any symptoms from that. But when it gets really bad, what we call like severe bone on bone and that’s where you can start to have some of the pain but a lot of times that takes years and a lot of abuse to get to that position and that’s probably the only time that we would recommend surgery if it’s so bad, that you cannot even move or you cannot even put weight on your body without excruciating pain.
Charlie McDermott 13:11
So, then that leads me to, as we do age because like you said, you know, I’m sure I have arthritis, I don’t feel in yourself, you know are we destined for that, are we doomed for chronic low back pain and arthritis?
Dr. David Lee 13:24
Yeah, absolutely not, the thing is, I have people, even with a severe type of arthritis, we start doing the right things, meaning we get you moving, we get the muscles working around the joint, we get all these things go and we modify activities, so that you’re not pushing yourself through pain and what happens is that you give it a couple of months, you work hard at it and now wow, I can actually move without pain, like excruciating pain, you might have a little bit of pain here and there. But you’re able to resume your activities in life, that’s what we want is we want people to resume activities life, are you going to be perfect? Are we going to get rid of all your arthritis? Are you going to be 20 years old again? Probably not but you’re gonna be able to actually do the things that you want to do on a daily basis, you know as long as you know how to move correctly, as long as you know how to fire the right muscles, as long as you know how to activate things so that you’re safe about your movements and you’re using your whole body.
Charlie McDermott 14:30
Awesome so, to summarize here, when we feel the pain, it is not a time to just rest and do nothing it’s all about being active and it sounds like there is many more times than not a solution that doesn’t require surgery, which I’m sure is a big fear for a lot of folks. I mean, certainly again with Barb and her shoulder. That was my fear and her fear certainly when it comes to the back oh my goodness, it’s how many people have had back surgery and are still in crazy pain, right? So I absolutely love your angle of hey, if it’s bone on bone and you’re in constant pain, then you do what you need to do. But my goodness, there are so many ways to treat that. So, so again when it comes to low back pain, it’s not about resting, it’s about moving, getting some help, right, like the golf swing, right? Let’s have someone help you move the right way.
Dr. David Lee 15:35
I mean, the thing is, you have to get an objective point of view from, it’s like any sport, and everybody has coaches, right? So coaches to take a look at you to see if you’re doing something right or wrong because the perception in our own bodies way off a lot of times, so, we need to and then you need to make sure that moving in this direction, or this position is actually okay, it’s not going to hurt you, it’s not going to put long term damage on you. It might feel like that at the time. But if we do some gentle things and then we start moving again, it’s like, okay, well, then your body knows that it’s actually okay to move into that position. You know we have a lot of fear and apprehension, a lot of times when we have pain, you know, especially getting back to something. So, if you have low back pain and then you get back to a score, like that’s always gonna be in your head, right? So we need to ensure that the body can actually move that way and then doesn’t have to be painful. So, that’s what we do here is we make sure that you’re moving in that direction and it’s okay to move there and we just kind of encourage you to keep doing that insight, now, over time, your body’s like, it’s okay to move there. I don’t have pain here, yes, I can actually do this now.
Charlie McDermott 16:59
Wow, that’s such a great point because no one wants to have to go through the pain of that initial injury or the ongoing pain in that a confidence of having a professional say, hey, Charlie, it’s okay, this is actually good pain and it won’t set you back, it’s actually gonna help you move forward.
Dr. David Lee 17:19
And if it hurts a little bit, we say, keep going through it, if the pain increases, then we stop, a lot of times, you know, it’s just, it’s just the body kind of accommodate to that motion. So, you’re going to feel a little bit discomfort, but, as long as it’s controlled, as long as it’s slow, as long as it’s properly loaded, then it’ll be okay and usually, what happens is that it starts to feel better with more repetitions.
Charlie McDermott 17:44
How about imagery or imaging, when is imaging necessary for low back pain?
Dr. David Lee 17:51
Yeah, so basically, if we do some treatment and you’re doing everything that you’re supposed to be doing and feel like, it’s not getting better at all, well, a lot of times we’ll recommend, okay, we’ll get an x ray, get an MRI, just to see if we’re missing anything. I always say, you know, at least a month, if you don’t feel any improvement, then we might have to go a different direction because over here, what we’re going to do is we’re going to diagnose the situation, try everything that we can that we know underneath the sun, that’s going to help you out and if you’re following that to the tea, there’s no reason why you shouldn’t get better as long as it’s not something systemic, like we talked about before, it could be like a tumor or cancer or some like a broken bone or a ripped tendon or something like that. So, we want to make sure that at that point, it’s like, okay, let’s get some imaging. Let’s find out what’s going on here.
Charlie McDermott 18:51
So, it kind of gives you a peek behind the curtain, structurally or what else, I love that, how about jumped to exercise again, because I’ve certainly over the years have had this pain in the low back during exercise always bad?
Dr. David Lee 19:10
So, that we discussed before, it’s like, okay, well, I’m starting off, you’ve been hurt for a while and then now you’re starting off like squatting again, right? So you might get a little discomfort and I always say that if you move through it and it feels better, keep going. That’s okay. If you feel that basically, you start a squat and it starts to get sharper, then there’s something off there. Either you’re in the wrong position or your muscles aren’t kicking in or your body can’t tolerate that load right now. So, what we do is we modify that and there’s always different modifications for every movement, like we have so many exercises that we can pick and choose from, that are actually going to steal load your body help the situation out but then keep you safe and then prepare you for that end goal. So, we just need to make sure that your body is ready for that and if you have a little bit of aching a little bit of pains, that’s okay, initially, I’ll give you a perfect example is when I had my back issue, you know I had a lot of low back pain and from herniated discs, what I did is I made sure that my core was firing correctly, I made sure that my glutes are firing correctly and then my body knew how to fire those things. So, that when I went to squat, I just went nice and so through it and it felt a little bit uncomfortable at first, but then my body was like, realizing that this is okay, as long as I go slow and controlled through it. So, I just did a lot more squats and it’s like, okay, doesn’t feel too bad now. It’s a lot of times when we go out of control, or too heavy or too many reps that our body can’t handle it, that’s when you start to get more pain and a little bit of just a little bit of damage, meaning just a little bit of inflammation that causes some of the pain that you have. So, nothing too crazy. Want to make sure that you’re just incorporating the right things at the right time. That’s the key thing.
Charlie McDermott 19:13
Well, terrific. I’m taking notes here, Dr. Lee, it was really helpful, you know before we end this episode, anything else you want to add when it comes to low back pain?
Dr. David Lee 21:36
Well, yeah, I want to kind of give people a thought about what imaging does. A lot of times you have low back pain and basically you’ll get an image, you’ll get, the X-ray or MRI and basically it says that you’re dying because it has so much damage and you shouldn’t be like on, you should be on the floor because you can’t you shouldn’t be able to walk at all right? So let me just give you a stat here where basically it says that degeneration is okay, we all have it. So, this study took it over 3000 asymptomatic individuals, so people without low back pain and then also this study over 30 studies have the same issue, basically. So, this is a really comprehensive study that was done. Basically, with disc bulges okay because everyone’s scared of oh, yeah, I know herniated disc, oh, yeah, I slipped my disc, whatever. So, basically, in your 20s, this is in your 20s where you’re young, healthy, usually you can do anything; you’re on top of the world, right? So it showed that 30% of people in their 20s had some kind of disc bulge. Now, when you’re in your 30s, it heads about 40%, 50s or 40s 50%, 50’s 60%, 60s 70. So, take this into consideration because these people don’t have pain. But they have all these things going on in the room, right? So what happens is that, oh, I feel tightness, oh, I feel a little pain in my lower back and then you go and you get an MRI and now it’s in your head that it’s coming from this disc bulge and a lot of times a surgeon can convince you to have surgery, if that pain continues to persist if you’re not doing the right things, right?
So, happens, we get all these people that come in and they show me their MRIs. I’m like, okay, you have a disc bulge. I mean, I can tell I have about five or six disposes myself, but it doesn’t really cause me any issue at this point and that’s why we do a complete examination to see if your pain is actually coming from symptoms of a herniated disc because they’re very specific, right? So we do all these different tests and if they come up positive for a herniated disc and it’s like, okay, you have a herniated disc, still not the end of the world. So, a herniated disc can actually recover, it can heal itself. So, what we do is we just do things to heal itself, right. So, we’re not going to go ahead and squat 500 pounds after if you’re suffering from acute herniated disc, I mean, that just doesn’t make any sense. So, we still have them move and he’s still having to do exercises, but it’s very low impact and it just helps out with the low back to get that movement in there. So, we had to do the right things at the right time. So, that’s the biggest thing. So, don’t let imaging scare you okay just because you have degenerative changes, just because you have stenosis, just because you have bone spurs, just because you have herniated disc. It’s not the end of the world, okay?
Charlie McDermott 25:08
Wow, fascinating stuff, Dr. Lee, thank you for sharing and thank you for making time. I know it’s always difficult for you to carve out a few minutes to talk, I really looking forward to the next episode. We got to get you out there more and more. So, I’m going to be on you to continue to carve out time here and share your knowledge.
Dr. David Lee 25:28
Yeah, sounds good, anytime.