Kalb Back Pain

A Safe Self-Help Guide to Alleviating Back Pain with Dr. Zachary Kalb

Originally posted on WilliamsonSource.com

Eighty percent of people will develop back pain at some point in their life, according to Zachary Kalb, D.O., an interventional spine specialist at Bone and Joint Institute of Tennessee. But the good news? Dr. Kalb notes through exercise and over-the-counter pain and anti-inflammatory medications, individuals suffering from low back pain can manage and aid in the healing of some back injuries without extensive assistance.

Using Exercise to Alleviate Lower Back Pain

Exercise is one thing an individual can do for themselves to alleviate or manage back pain, but exercises for one person’s back pain may not be the best for another. There are physical therapists at Bone and Joint Rehabilitation Services who teach those suffering from back pain exercises specific to their particular problem. Dr. Kalb explained there are two general methods of back exercise depending on the type of back pain. The first is the Williams Method or flexion-based exercises. This method is best for those who feel better when sitting and feel worse when standing, as is the case in spinal stenosis.

“The most common reason for adults to seek back surgery is spinal stenosis,” said. Dr. Kalb. “Patients with spinal stenosis – or osteoarthritis of the small joints in the back – tend to be over the age of 55 and have low back pain that may or may not radiate into the legs with prolonged standing.”

The Williams Method features exercises that help people with spinal stenosis and osteoarthritis by strengthening the glutes, quads and abdominal muscles and stretching the hamstrings and erector spinae. Exercises include posterior pelvic tilts, knee to chests, sit-ups and seated trunk flexion. These are easily repeatable at home and can be completed in 10 to 20 minutes each day.

“The space for the spinal nerve roots is too narrow for those with spinal stenosis and the small joints in the back bear more weight when standing versus sitting,” Dr. Kalb said. “The space for the nerves increases and the joints are offloaded when doing Williams Method exercises. They strengthen the core while maintaining a flexed position, which reduces pressure on the nerves and joints and relieves the pain.”

The other group of exercises belong to the McKenzie Method. Per Dr. Kalb, these are best utilized by those who feel better while standing up and experience pain while sitting down or bending forward at the waist. Exercises include prone on elbows, press ups, standing backward bend, bridging, and prone opposite arm leg lift. These exercises can easily be found in yoga and pilates routines.

“The goal of the McKenzie Method is to offload the disc because it is the painful source,” explained Dr. Kalb. “The way you do that is to maintain a more upright, extended posture and avoid slumping forward while exercising. The McKenzie exercises strengthen the hamstrings and erector spinae muscles, while stretching the abdominal, quadricep and iliopsoas muscles.”

Whenever starting a new exercise routine, Dr. Kalb says to take it slow and do not expect a quick fix. Muscle takes time to strengthen. Also, pay attention to any pain. If doing an exercise causes acute pain, stop doing that exercise.

“Your body will tell you if it doesn’t like what you are doing,” said Dr. Kalb. “It’s important to understand the difference between acute pain and soreness. Patients often say, ‘One to two days after physical therapy they hurt and it doesn’t feel good.’ That is because they are using muscles they aren’t used to using. Any muscle strengthening program is going to cause soreness. This is not a reason to stop physical therapy.

Although there are two general groups of exercise for low back pain, not all will fit perfectly into one of those two groups. There are ways to individualize the Williams and McKenzie based methods, and a well trained physical therapist is your best resource to help develop a specific exercise regimen while ensuring the exercises are done correctly to avoid further injury.

Using Over the Counter Pain Relievers

“The goal of over the counter pain relievers should be pain control, not pain elimination,” said Dr. Kalb. “Pain is a normal part of the healing process. You want to make the pain tolerable and keep it from hindering your daily living.”

Pain medications are a way to give your body time to heal itself without the need of a physician. Most muscle strains, sprains and even disc bulges and herniations will heal on their own and the symptoms will resolve in four to six weeks.

There are two types of common over-the-counter pain medications: acetaminophen and non-steroidal anti-inflammatories (NSAIDs). There are many variations of these drugs and it is often hard for patients to figure out what is best for them, how often to take them, what dosage to take, and what length of time to take the medication. Another factor that must be taken into account are any contraindications with current medications or medical conditions.

“The optimal drug of choice will depend on one of three things,” explained Dr. Kalb. “One, the patient’s pre-existing comorbidities. This includes if they have a condition such as diabetes, heart disease, liver dysfunction or kidney dysfunction. These are key considerations when deciding what type of medications they can take. Second, the potential for adverse effects of a medication. Lastly, drugs the patient is using concomitantly with the over-the-counter medication.”

Acetaminophen – also known as Tylenol – when used in the setting of back pain is a pure pain medication, not an anti-inflammatory like Ibuprofen or Naproxen. Acetaminophen is processed by the liver, while NSAIDs are processed by the kidneys, meaning they don’t compete for elimination from the body and taking both in combination can provide better relief than one or the other used alone.

“Patients will often say to me that they thought they had to alternate Tylenol and NSAIDS,” said Dr. Kalb, “but you can take both on the same day as long as you’re following appropriate dosing protocols.”

Dr. Kalb tells patients to start taking between 500 to 1,000 milligrams of Tylenol per day and to increase as needed up to, but not exceeding, 3,000 milligrams in a 24-hour period. Those with liver dysfunction, however, cannot use the drug. Additionally, alcohol should not be consumed when using Tylenol. If there is any question about the patient having an unhealthy liver, they should seek lab work and the recommendation of a physician on how to proceed with these medications.

“Only one type of NSAIDS should be taken at a time,” explained Dr. Kalb, “so you do not want to be taking Ibuprofen and Aleve at the same time. If one doesn’t work, you can try another type, but only use one at a time. One may be more effective for one patient than another because different patients metabolize drugs differently.”

When deciding how often to take Tylenol or NSAIDS, Dr. Kalb says the fewer times the better, based on a patient’s personal habits. He suggests twice a day because most people will remember to consistently take their pills in the morning when they wake up, and in the evening when they go to bed.

Kalb explains that patients need to “start low on the dosage and increase slowly” on a daily basis until finding the dosage that works best for them. He suggests starting at 25% of the recommended daily dosage. The smaller the dose, the less the chance of any side effects possible at higher dosages. If there are any adverse effects, stop taking the medication.

“If there are no major contraindications, like kidney dysfunction,” said Dr. Kalb, “I recommend giving a medication one to two weeks before deciding it is not going to help and switching to a different one.”

Once pain-free for 24 hours, the patient can start decreasing the dosage. But if the pain returns, then they can go back to the lowest dose that stops the pain.

There are more than 30 NSAIDS out there. Dr. Kalb says most patients are going to stick to those most well-known. Those are Naproxen sold as Aleve, Ibuprofen sold as Motrin and Advil, and acetylsalicylic acid known best as aspirin.

“Patients with advanced age or kidney dysfunction should consult their physicians before starting NSAIDS,” said Dr. Kalb. “However, as long as their liver is healthy, Tylenol can be a very good option to help those folks with their pain.”

Those considering NSAIDS with advanced age, kidney dysfunction or a history of GI ulcer will need to be under the care of a physician and monitored for development of side effects. They need liver, kidney, GI and cardiac health screening prior to starting these medications.

The maximum dose of Ibuprofen is 800 milligrams three times a day. Naproxen is the NSAID of choice for patients with pre-existing cardiac dysfunction, and comes with a max dose of 500 milligrams twice per day. Aspirin is good for pain and it is an anticoagulant that can reduce the chance of blood clot and stroke. All NSAIDS can cause those on anticoagulants such as coumadin to bleed, so the best option for patients on anticoagulants is Tylenol.

As with any medical regimen, Dr. Kalb cautions a patient should first consult their personal physician before beginning a new exercise routine or medication regimen. The information he has shared is general information related to lower back physical therapy and the use of pain relievers by persons aged 18 or older. The above information is purely for educational purposes and not meant to act as a treatment protocol.

To learn more about non-surgical back care, contact Dr. Zachary Kalb at Bone and Joint Institute of Tennessee. Dr. Kalb can be reached at (615) 791-2630 or schedule an appointment online.

Dr. Kalb is a physiatrist, a physical medicine and rehabilitation specialist. His clinical practice focuses on non-surgical treatments for spine- and joint-related issues. His holistic, non-surgical approach to care is designed to reduce pain and improve function. Kalb often treats patients who wish to delay or avoid surgery or who have continued pain despite prior surgery. Kalb earned his medical degree at the Edward Via College of Osteopathic Medicine at Virginia Tech and completed his physiatry residency at Larkin Community Hospital in Miami, Florida. He then completed a fellowship in interventional spine and electrodiagnostic medicine at the OrthoCarolina Spine Center in Charlotte, N.C.