Participants: Don Mackintosh (Host), Phil Mills
Series Code: HFAL
Program Code: HFAL000212
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00:01 The following program presents
00:03 principles designed to promote good health 00:05 and is not intended to take the place of 00:06 personalized professional care. 00:09 The opinions and ideas expressed 00:10 are those of the speaker. 00:12 Viewers are encouraged to draw their own 00:14 conclusions about the information presented. 00:49 Hello and welcome to Health for a Lifetime. 00:50 I'm your host Don Mackintosh, and today 00:52 we're gonna be talking about Back Pain. 00:54 I know everyone watching today has 00:56 either had back pain or knows someone 00:58 that is maybe experiencing it right now. 01:00 And we hope that as a result of today's program 01:03 you're going to have some real helpful tips. 01:05 Talking with us about this is Dr. Philip Mills. 01:07 He is a specialist in Rehab Medicine 01:10 and you've been doing that for about 20 years 01:12 and I imagine one of the big things that you 01:13 see day in, day out is people with back problems. 01:16 Back Pain is so endemic. In fact, less than 01:21 20 percent of people will go through life without 01:25 a problem sometimes in their life with their back. 01:28 Well that's job security for you. 01:30 It is job security for anybody 01:32 who takes care of backs. 01:33 And that's just about every doctor, because 01:35 the problem with back cuts across 01:37 every medical specialty, virtually anybody 01:41 who sees patients will see someone with 01:44 back pain it is just everywhere, in fact 01:48 statistically 40 percent of the people 01:51 listening to this program are suffering 01:53 from back pain right now. 01:55 You don't have any pain 01:56 do you in your back right now? I don't. 01:57 And neither do I, so we're not in the 40 percent. 02:01 Why are people so susceptible by this though, 02:03 it seems like just you know like you said, 02:05 I mean 40 percent are having it right now, 02:07 just all kinds of people, why is this like a flaw? 02:11 Why are people so susceptible to it? 02:13 No, it's not a flaw. The back was designed 02:17 in a very elegant fashion, okay. 02:20 But, if you look at the basic back kinesiology, 02:25 you realize that there is a lot of weight 02:28 yet there has to be some movement. 02:30 So God had to design the back in a way that 02:33 would provide motion, you could just have a pipe, 02:37 right just, and then you wouldn't have 02:39 any back problem, but you wouldn't have 02:41 any back movement either. 02:43 So, the back was design to have this mobility 02:47 but also provide great strength. 02:49 And so that puts it at some risk. 02:52 Now the way God designed to decrease 02:55 the risk is the back is buttrest with guy wires, 02:59 that's the muscles that come from our abdomens, 03:03 that's muscles in the back, muscles down the side, 03:06 those function as back supports. 03:09 So it's a very wonderful system 03:12 that we call the back. So whether you're sitting, 03:15 you're standing, you're walking, you're lying, 03:17 you're running, you're jumping, you're laughing, 03:18 you're sneezing, whatever you're doing 03:20 you need to use your back? Yes, and in fact, 03:22 most people don't know this, but the greatest 03:25 pressure on your disk is when you're sitting, 03:29 is when you're sitting? Not when you're 03:30 standing or when you're lying. 03:32 The least of all is when you're lying, 03:34 but the greatest is when you're sitting. 03:37 So it's must better to stand up or walk 03:40 if you have back problems. 03:41 Well, you wanna have good support when you're 03:43 sitting and you also want to move from time to time. 03:47 So, you said that this back is a very 03:49 amazing you know thing. 03:51 It's got guy wires and all this stuff, 03:54 could you explain to me, give me a little 03:56 anatomy lesson on the back. 03:57 Well, its not so easy to do, it's taken 04:00 some of the very best minds to figure out. 04:04 All the physical things, the physics and that, 04:07 what's called the Kinesiology, 04:08 that's the movements of the back, it's taken, 04:11 as I said some of the best scientists, 04:13 some very sophisticated computer modeling 04:15 courses that have helped elucidate these 04:22 the way it works and I've always wondered 04:25 if it takes our best minds just to kind of 04:27 understand what's going on, what must it would 04:30 have taken as far as a mind to design. 04:33 It's really wonderful. You don't think this 04:35 evolved, it did not evolve, noway. 04:38 This is not a testimony to the power of nature; 04:44 this is a testimony to the wisdom of God. 04:47 Okay so, take this into the mind of God here 04:50 a little bit and describe it if you can, 04:53 so maybe we can understand a little bit of it. 04:54 Well, your tough part of the back is your bones, 04:58 and they make up this skeletal anatomy, 05:01 that's where the muscles attach, 05:03 that's where you have good solid strong support, 05:09 but then between the bones there are what are called 05:14 disks and you can think of a disk as a liquid 05:17 filled golf ball and it's smashed down 05:21 like a plate it has a hard outer covering, 05:25 okay, and gelatinous inner core. 05:29 So it's like a doughnut maybe, this is the disk. 05:31 Well it's a filled doughnut, 05:33 filled doughnut, like a filled doughnut, okay. 05:35 And so except the hard outer core is 05:37 much stronger then a doughnut, 05:38 you wouldn't wanna bite into this doughnut, okay. 05:41 And so this gives it this movement and 05:44 flexibility and yet the disk itself has strength. 05:48 However over time, the outer layer of the disk 05:53 becomes brittle, it loses its elasticity 05:58 and become, anybody for anybody, 05:59 yes, overtime it becomes hard, okay. 06:02 And so because of that it becomes 06:05 more subject to tear, and there are certain places 06:08 that it can tear easier then others and certain 06:10 movements that we can make that put it at 06:15 more risk then others, because of all the 06:18 back problems that I see I am contumelious, 06:23 continuously aware of my back and the 06:27 importance to lift right and to move right, 06:30 so that I don't put the disk at a mechanical 06:34 disadvantage where it would burst 06:37 and cause a ruptured disk. 06:40 So, it kind of curves, you've got the, 06:41 what do you called these cervical ones, 06:43 what are they, seven of those 06:44 that I think I remember. There's eight cervical, 06:47 eight of those and then you've got the ones 06:49 in the middle anything different between the, 06:50 thoracic, you have the, thoracic vertebrae 06:54 and then the ones down at the bottom I don't know 06:57 what they're, I can't remember what they're 06:58 called but those going all the way down to the bone. 07:01 Did I say there are eight, seven cervical vertebrae 07:05 but there is eight nerves because you count 07:06 the top and the bottom of the nerves, okay, 07:09 but there's actually seven bones then you have 07:12 twelve one for each rib those are the 07:15 thoracic and then you have in normal people 07:18 there are variations of this you have five 07:21 lumbar vertebrae and then you have at the 07:25 very bottom you have the sacrum, which is the, 07:29 like the tail bone, tail bone, 07:30 and then the coccyx at the very tip. 07:33 Okay, and any part of that goes wrong and it 07:36 affects all of it? It affects all of you 07:39 if you feel it, because you need your back 07:44 to make virtually any activity even if you're 07:46 rolling in bed and so if your 07:49 back is bothering you, it's pretty apparent, 07:54 and I'm sure everybody out there that has back pain 07:56 and saying yeah, that you're stating the obvious. 07:57 Now you even said in your notes that I looked 08:00 over for this program that the abdominal 08:02 muscles are involved in this? Yes, your abdominal 08:07 muscles are very important and that's why 08:09 it's important to keep strong abdominal muscle, 08:15 do sit ups, sit ups, actually I prefer 08:18 sit backs, where you go from a sitting position 08:22 down to approximate 30 degrees and then back up, 08:25 if you have back problems and do a sit up 08:27 in some cases the first movement can 08:30 actually increase your discomfort. 08:33 So you're actually better to just sit from a sitting 08:37 position back 30 degrees back up to 08:40 strengthen these abdominal muscles. 08:43 Also, obviously if a person is obese then 08:51 that, it adds more weight, really it increases 08:57 a problem with that muscle pulling strongly, 09:01 I see right so it kind of knocks it out of kilter. 09:05 So it's all just kind of designed for someone 09:08 that has optimal weight and everything, 09:10 when you add different things 09:12 that can really mess it up, yes. 09:13 So what causes actually the back pain and says, 09:16 those nerves you were talking about? 09:18 Well for most cases we never really know and 09:21 that's why there are so many wastebasket 09:23 categories when you see 09:25 a physician about back problems. 09:27 You have the wastebasket category of low back 09:29 strain, low back sprain, dyskinetic back. 09:34 All these are because we really, 09:37 there are so many components that in 09:41 very few cases can you really determine 09:47 which of the components it is? 09:50 Okay, so they just say this or say that, 09:52 but you're kind of specialty has been 09:53 actually talking to people and to see whether or not 09:56 it's really a significant problem or not and 09:59 you're always put on the hot seat about that. 10:01 Yes, the first thing of course you wanna 10:03 make sure of is there is no underlying significant 10:10 back disease maybe cancer, 10:13 okay, or a serious medical problem, 10:16 like a referred pain from your pancreas or 10:18 your kidneys or something else, that could be 10:19 a cause or you could actually have a 10:23 frag tumor in the back itself. 10:25 Now those are rare, that be less then one percent, 10:28 the majority of back problems are simple, 10:30 they're self limited less then six weeks 10:33 will go away, but in that one percent 10:36 you don't want to miss it. 10:37 That's generally a person who is older, 10:41 generally a person who has weight loss, 10:46 other medical problems and so that's 10:49 what you're going to be alert to so that 10:53 you don't miss a major problem while you're 10:56 thinking it's what's called a "simple back ache." 11:00 So when you say what causes back pain 11:02 what you're saying is you got to, 11:03 don't just say well it's just the 11:04 back strain or this or that, you got to check 11:06 all these things out if you really want to know 11:09 and rule out those significant things and 11:11 hopefully you're dealing with a more minor 11:13 problem that maybe you can help with. 11:16 Yes, the second thing you wanted to 11:18 eliminate is, is it a pinch nerve. 11:21 So if it's either a significant occult medical 11:28 problem I just talked about, right, 11:31 or the second issue is, is it a pinch nerve? 11:35 Now the way you can tell if it's a pinch nerve or 11:40 it might be a pinch nerve, is the distribution of 11:42 the pain, whether there is actual muscle weakness, 11:46 going down your leg, your arms or something, 11:48 if there is muscles weakness in a particular 11:50 pattern in your leg or if it's from the neck in 11:53 your arm or if it's in a particular 11:56 pattern of referred kind of pain. 12:03 So you look at the referral pattern, 12:06 you look at the sensory loss, 12:08 you look at the muscle weakness and that's how 12:12 you determine whether there maybe nerve injury, 12:17 if it's a nerve injury you'll probably want to 12:19 have other testing like electroneurodiagnostics, 12:24 where they actually see if the nerves to 12:28 particular muscles are working, 12:30 are working, and pauses going there. 12:32 Now you talked to me about those disk again 12:35 and you were telling me that the nutrition 12:38 that gets to the disk it's a very interesting 12:40 process what was it, the imbibition or something, 12:44 imbibition, imbibition yeah. 12:45 Well the word comes from, what is that? 12:47 Well the word comes from imbibe, okay. 12:49 Now if you were imbibing, and maybe some 12:53 substance you should or should not imbibing, 12:54 correct, you're imbibing. 12:56 That is you're bringing something in. 12:59 Now in most places of the body the way you get 13:02 nutrition is through circulation, but in the 13:06 disk is really no circulation, 13:08 no circulation, no, so not normally. 13:12 So, if you're going to get nutrition, 13:14 still needs some nutrition how does it get it, 13:17 it gets it like a sponge gets nutrition you 13:22 squeeze the sponge down underneath water 13:27 and then you let it up and it sucks up the water, 13:31 imbibes, it imbibes it, that's imbibition. 13:34 And in your back if you squeeze down 13:38 the disk and then they let up, they move down 13:42 just a little bit they led up then it takes the 13:46 nutrition from the cell fluids around it. 13:51 Now, the way you squeeze it down is exercise 13:55 walking is probably the very best way 13:58 because as you walk there is this rhythmic pattern. 14:03 So in another words if you wanna have a healthy 14:06 back you better find a way to walk, find a way 14:09 to get that weight going down and up and down 14:13 so it can squeeze in and squeeze out. Yes, 14:15 you wanna have, have that imbibition take place. 14:20 Now, in the bones themselves when you're 14:24 doing activity and exercise most people 14:27 don't know it but bones themselves have some 14:29 squeezing down, in a healthy young person 14:32 a bone a can actually squeeze down by about 14:35 25 percent without breaking, 14:37 if you go more then that you'll have a fracture, 14:40 but there is, there is flexibility in the way 14:44 God designed the components of the back. 14:47 We're talking with Dr. Mills, 14:48 we're talking about back pain, 14:49 when we come back we're gonna talk about some 14:51 common causes of back pain and what you can do 14:53 about them, join us when we come back. 14:57 Are you confused about the endless stream of new 15:00 and often contradictory health information 15:03 with companies trying to sell new drugs 15:05 and special interest groups paying for studies 15:08 that spin the facts, where can you find 15:10 a common sense approach to health. 15:12 One way is to ask for your free copy of Dr. Arnott's 15:15 24 realistic ways to improve your health. 15:18 Dr. Timothy Arnott and the Lifestyle 15:20 Center of America produced this helpful 15:22 booklet of 24 short practical health tips 15:25 based on scientific research and the Bible, 15:28 that will help you live longer, 15:29 happier and healthier. 15:31 For example, did you know that women who 15:33 drink more water lower the risk of heart attack. 15:36 Or to 7 to 8 of sleep a night can minimize your 15:39 risk of ever developing diabetes. 15:41 Find out how to lower your blood pressure 15:43 and much more if you're looking for help not hike, 15:46 then this booklet is for you. 15:47 Just log on to 3abn.org and click on free offers 15:51 or call us during regular business hours, 15:53 you'll be glad you did. 15:55 Welcome back, we're talking with 15:58 Dr. Philip Mills, we're talking about back pain 16:01 and I hope that you will hear good news, 16:03 maybe you're going through back pain right now. 16:05 We're gonna talk about some of the common 16:06 causes of back pain you have them listed here. 16:08 What's the, what's the most common 16:11 cause of back pain? Well, the most common 16:13 cause is what's called a simple back ache 16:16 and we really don't know. So it's a sprain 16:18 or a strain or this, you don't know. 16:21 There are 80 percent of the back problems we are 16:26 unable to find a specific reason for them. 16:31 Now you say there is sometimes the strain is 16:32 caused by lifting bulky object or something, 16:36 30 pounds or more? What, what it is clear is that 16:42 people whose jobs entail repeated rapid 16:46 lifting of greater then 30 pounds have a 16:49 slightly increased risk of back problem, 16:51 the reason is simple. As you lift repeatedly 16:56 your muscles which provide some protection 16:59 for your disk begin to fatigue, 17:01 as they fatigue there's gonna be more 17:03 pressure on the ligaments. 17:06 And so if you do any lifting that's wrong you 17:10 have no margin of safety, no margin of error. 17:14 And so if you're in a job that is 30 pounds 17:18 and really fatiguing the back muscles day 17:20 after day that is a slightly increased risk. 17:25 Okay, we're going to look at some of the other 17:27 causes you have here, you say one causes 17:29 osteoporosis, is that when the bones of course 17:33 get pores, is that the, the issue there? Yes, 17:35 and that occurs with age and also nutritional 17:39 aspects, genetic factors, all have a part to play 17:44 with osteoporosis but if your bones get real 17:47 brittle then even slight types of movement, 17:51 slight types of pressure can actually 17:52 cause a bone fracture that's a bad thing. 17:56 Herniated discs, disk tears, herniated disks 18:00 can come particularly if you're bending 18:03 forward and sideways. So you have a forward 18:07 plus a twist and that is a, 18:10 a high risk back injury movement. 18:15 So when you pick something up even if you 18:18 just bend over simply to pick up a penny, 18:22 pretend that it was a 100 object and you'll 18:25 pick it up right you'll bend right and so you 18:28 don't put your disk at as much risk, if you're 18:32 lifting to put something into a trunk that can be 18:36 a problem because you're 18:37 at a mechanical disadvantage. 18:40 So what you want to do is put your knees up 18:43 against the bumper, I see, to support you thighs, 18:47 so that when you're doing the lifting you're 18:51 lifting through your body rather than just your back. 18:58 Okay. You know you hear different things like 19:00 slipped disk, bulging disk, this and that 19:02 depending on who you're talking to, 19:05 what do these terms mean? Well, that can be 19:08 confusing to patients because they'll go to 19:12 their maybe their primary care physician 19:15 and he's concerned that they've injured 19:16 their back, he orders an MRI. 19:20 The radiologist sends the MRI report back 19:23 and says it's a herniated disk. Okay. 19:25 so he's told then that he has a herniated disk. 19:30 He's sent to a neurosurgeon or an 19:32 orthopedics surgeon, those are the ones that 19:34 usually do surgery on the back for disk and 19:38 he takes a look at the MRI, takes an examination 19:42 of the patient history and all and he tells him, 19:46 well this is a bulging disk, okay, and he 19:51 and so the patient is confused, one doctor 19:53 told him that it was a herniated disk 19:57 and one says it's a bulging disk, 19:58 and one says it's a bulging. 19:59 But it's the difference of perspective 20:03 any of these a disk doesn't just bulge 20:07 a certain amount come out boom, boom, boom 20:09 and discrete amount, but it can be any 20:13 amount along a continuum. 20:16 And so the question is at what point do you call it 20:19 a frank herniation versus a bulge. 20:24 And so, in my experience a radiologist use it 20:28 based on a measured amount and they'll say 20:31 this is a herniation because it passes 20:33 this amount, okay. But a orthopedic or a 20:38 neurosurgeon will say it's a bulge if he doesn't 20:43 feel it's one that would benefit from surgery 20:46 and if they think it's a surgical bulge 20:51 then they will say it's a herniation, 20:53 so in surgeons in my experience a surgeon 20:57 will differentiate the difference between 21:01 a bulge and a herniation on 21:04 the basis of surgical indications. 21:07 And so that can be confusing to patients 21:09 but really they're saying the same thing, 21:11 they're the same thing. There is no reason 21:12 to be or bulging saying the same thing, 21:14 then slipped, does that mean 21:16 they think one of the bones slipped? 21:17 No you can have slip, the slip disk can be a 21:20 bulge disk, okay, but now there is such a 21:23 thing as a slip in the back and that's actually 21:27 spondylolisthesis where your bones actually 21:31 have some movement and there if it's severe, 21:35 if it's causing nerve damage then you would 21:37 have to have a fusion or at least consideration 21:41 for a fusion, if this process continues. 21:44 Once they slip can they go back on their own? 21:47 In spondylolisthesis no, no, okay. 21:51 Now, in when you're stalking about these 21:54 spondylolisthesis that is where the bone 21:57 is actually moving relative to another 22:00 bone that's seen in a very high frequency 22:07 in professional football players. 22:09 So evidently football is very bad on backs. 22:13 Well I had one of those too, and I'm not a 22:16 professional football player, maybe it's just 22:17 because I am, look like one. 22:20 Okay, what are some of the, what are 22:22 some of the thing that we can do to avoid 22:26 having back pain, having back problems? 22:28 Well surprisingly enough smoking, stopping 22:32 smoking is an important way 22:33 to avoid back problems. 22:35 Smoking increases the risks of disk problem, 22:38 it increases the risk of arthritis in the back 22:41 and it also increases the risk of needing surgery, 22:46 but it has a much poor prognosis if surgery is 22:52 necessary and performed, just from 22:54 smoking, from smoking. 22:55 So the reason is probably related to oxygen 23:01 carrying capacity of the blood so you have 23:04 relative over a long period of time, 23:07 less oxygen then optimal to the back and 23:09 so it increases the problems again overtime. 23:12 So a person should not smoke, 23:15 if they want to avoid back problems. 23:18 So yeah, because I guess the back gets bad 23:20 in the different way then vessels 23:21 so if it's really compromise that really, 23:24 really can affect the bones. 23:26 Well, we can explain it in an interesting 23:29 way out of your back you have blood vessels 23:35 that come straight off the descending order. 23:42 So these blood vessels come straight out and 23:44 that means the blood has to go through an 23:46 acute angle, not a smooth bend but a tight curve, 23:52 and so if there is any atherosclerosis, 23:56 that is if there is any deposits, can't get there, 23:59 that makes a real problem with the blood flow, 24:03 I see, and so your back is going to be the single 24:07 most senses, impact, sensitive 24:11 to vascular programs. 24:14 Wow, even more so than you, maybe your lungs. 24:17 You mentioned some other things that seem 24:19 pretty obvious, obesity, lose 25 pounds. 24:22 Now let me just stop you on that, a pound on the 24:27 stomach is four pounds on the back, 24:31 wow, the reason is there is a mechanical 24:34 lever affect your weight is out in front of you 24:40 and it's moving over a lever 24:42 arm so if you lose one pound, four pounds, 24:45 it's 25 to be 100, if you lose 25 pounds you've 24:48 actually lost a 100 pounds of pressure on your back. 24:52 Wow, well and you think about it the back 24:56 can handle about 1,400 pounds of pressure 25:03 and so obesity can add quite a bit of pressure 25:09 on the back and decrease again your level of safety. 25:13 So get rid of that weight, exercise, we've only 25:16 got about two-and-half minutes but we wanna get 25:18 some hope here so you say don't be angry 25:20 that would be interesting to talk about but angry 25:22 you say specifically related to back pain. 25:24 And the reason is people if they're angry 25:28 and their job involves lifting, they'll angrily 25:31 go down and lift something up they'll jerk, 25:34 okay, and because of that jerk they increase 25:38 their risk of back injury. And then age, you can't 25:42 do anything about that, but try and be healthy 25:44 with your nutrition and all those different things. 25:47 You can lower your speed of aging now. 25:51 Okay, what are some of the things just some 25:54 quick things in about the last two minutes that 25:56 people can do to have this back pain, 25:57 what should they do. 25:58 Well the first thing is walking, walk, 26:01 we've already mentioned that. 26:02 Walking is the single best treatment 26:04 for the back, okay, walk, another 26:08 good treatment for the even of its real 26:10 slow you can't walk very fast walk. 26:12 Well you're better off if you can have some 26:15 faster walking, okay, if you can't tolerate 26:19 walking because of some other arthritic or 26:22 neurologic problems swim, okay swim, 26:25 so these are good exercises for the back. 26:30 Okay, what about surgery you didn't mentioned that? 26:33 Well, surgery it has a very limited place 26:36 but it does have an important place that 26:38 would be if you have a very severe and increasing 26:42 spondylolisthesis that slippage or if you 26:46 have neurologic damage you need to 26:50 remove pressure on a nerve or if you have 26:52 what's called spinal stenosis, that is not 26:55 enough space for the blood, for the nerves 27:01 to go through in the back. 27:02 Posture, posture is an important one; 27:07 it's easier to take care of posture in younger 27:10 people then older because sometimes 27:12 you have fixed posture deficits 27:14 that we can't do too much about. 27:16 One of your favorite text you mentioned here 27:18 also in your notes about angels helping us 27:21 walk correctly, you want to share that? 27:24 Yes, every morning if we trust in the Lord it says 27:29 He portions angels to guide us, as we walk, 27:33 as we go around our daily task and we have angels 27:37 with us and to me that's a wonderful 27:39 blessing that we can trust God for. 27:42 Thank you so much Dr. Mills for joining us 27:44 and I'm glad the angels are with us, 27:45 they can help us not have those problems 27:48 and also the tips you've learned today 27:49 we hope that they're helpful for you and for 27:51 your back or those that you love and as a result 27:54 that you'll have health that lasts not just for 27:56 now, but for a lifetime, thanks for watching. |
Revised 2014-12-17