How to Take Care of Your Back Today and in the Future

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I am Deborah Howell, and today's guest is Dr. Jason Liauw, neurosurgeon at Saddleback Memorial Hospital. Welcome, Dr. Liauw.

Jason Liauw, MD: Thanks for having me.

Deborah Howell (Host): Such a pleasure. Today we're going to learn how to take care of our back. What good posture is, the long-term effects it can have on your body, and minimally invasive treatment options. Let's get going right away with the basics. Why is posture so important?

Jason Liauw, MD: Yeah, absolutely. So, you know, as we age, we develop some arthritis. And a lot of times as we kind of slowly settle down in our spines, we start to stoop forward. You see a lot of people who lean forward and who are either in a hunched forward position over their walker or kind of just walking with their heads down. And what that does is the reason why that's important to prevent is because when you look down, your body doesn't really like that. Human beings like looking straight. And so they use their back and they tilt their back backwards to try to get their eyesight level. And when they do that, it can be pretty tiresome on the back. And a lot of back pain itself, people don't realize they always think it's all skeletal. But a lot of times back pain is actually due to muscle fatigue. So when you're straining your back to improve your eyesight, to improve your posture, that can be taxing. And at the end of the day, that's actually what causes a lot of back pain.

Deborah Howell (Host): Interesting. So your mom was right, stand up straight. And sit up straight.

Jason Liauw, MD: Yeah. Absolutely, posture. You start off when you're young with really good posture. And then as you age, you just start to notice these small changes and people ignore them. But a lot of times people don't really strengthen or develop their back. A lot of times people when they work out even, they really just focus on their arms and their chest, for guys especially, and they don't really focus a lot on posture. Now that's kind of changing these days with Pilates, with yoga, and a lot of things that are focused on getting our natural positioning of our neck and our back, but that's not something that people generally pay attention to nor do they know the consequences of.

Deborah Howell (Host): Well let's dig down even further. What exactly is good posture?

Jason Liauw, MD: So good posture, what we call a neutral position for the back, is essentially where the shoulders are brought back, so that your head and your neck are essentially, well your eyesight is parallel to the ground. So overall, I would say it's easy to remember what bad posture is. And bad posture is simply just stooping forward or hunched forward. So closing down the chest, putting your shoulders in front of you. That's what poor posture looks like. So if you can just remember that, you kind of will remember what good posture should look like is just sticking your chest out, bringing your shoulders back.

Deborah Howell (Host): Shoulders back and down, correct?

Jason Liauw, MD: That's right. Shoulders back and down. And away from your ears. Yeah, anything to keep your head in an upright position. So just anything so you're not, you know, when people walk, a lot of times they kind of just look down and especially these days with cell phones, iPods, and everything else like that, people are always looking down when they walk, they're texting when they walk. And over time that kind of adds up. It adds to an unnatural posture. And what happens is as you age, your joints get more stiff, your muscles start to contract, and then you get stuck in that posture. So people can actually, if they're not careful, they can get stuck in positions. And so a lot of times that's why stretching is so important and why not just that, but developing the muscles of your back are very important. Because when you develop the muscles of your back, it brings your back in a better posture. And your muscles contract naturally so that it actually forces you in a better posture.

Deborah Howell (Host): You've actually in the last couple of minutes, you've had me sitting up straighter and saying to myself I'm going to get back into doing Pilates because it's so important to strengthen the back.

Jason Liauw, MD: That's right. Yeah, and also strengthening and working out in the right way. Because if you look at for example bodybuilders or anything else like that, they're working their front, their chest so much that they actually get, they work themselves into a bad posture. And a lot of my athletes actually are probably my worst patients because not only do they not really regard the effect of shock and of forces on their back, they just wear out their backs. So making sure that you do things that are less impactful, especially as you get older, is pretty important. Lifting things that are too heavy, those all tax the health of your back.

Deborah Howell (Host): Can you help explain the mechanics of proper lifting?

Jason Liauw, MD: So proper lifting is basically you want to use as many joints as you can so that it's not just fully focused, the forces when you lift are not fully focused on your back, and that includes using your knees. It also includes keeping your back in a sort of upright position as much as you can. And then just not really lifting anything too heavy. I mean as you age, you just have to be more conscious of that. Because not just you can also strain your muscles and ligaments, but you can also actually cause a disc herniation and what happens in that case is you start to develop not just back pain but also leg pain or arm pain.

Deborah Howell (Host): I guess those are called long-term effects of bad posture or spine issues, right?

Jason Liauw, MD: Yeah, that's correct. There are long-term effects and then there are exacerbations which are whenever you kind of lift things that are too heavy.

Deborah Howell (Host): At what point is surgery necessary for spine and back issues, doctor?

Jason Liauw, MD: So initially, surgery should always be the last resort. The first things I usually refer my patients to are for injections and physical therapy. And even chiropractic or acupuncture, which are really less traditional but they have their utility and those things are to alleviate pressure and to distract the back to open it up. So you start with conservative therapies first and pain injections are basically medications they inject around nerve roots to quiet down inflammation. If you throw out your back, you probably have a pinched nerve root and the nerve root is inflamed. You can also inject for arthritis. So a lot of times arthritic joints in the back, your back is actually made up of quite a number of joints. So a lot of times those joints can be arthritic just like your knees, just like your arms. And that can cause back pain. So sometimes you can use injections or physical therapy to try to get some of that inflammation down. Your spine is made up of muscles and ligaments and so physical therapy can help strengthen your core and also prevent pain. But surgery is the last resort, but if all those fail, sometimes a lot of your nerves that are pinched are due to physical problems and surgery can help decompress those nerves or it can help to stabilize the back to give it more strength.

Deborah Howell (Host): And in this day and age what surgery options are available to patients?

Jason Liauw, MD: So the surgical options depend on the origin of the pain. So that's usually why physicians or primary care physicians send me patients, is so that I can kind of find out and diagnose what exactly the origin is. Is it a nerve compression? Is it arthritis? Or is it muscle fatigue? Muscle fatigue is due to poor posture. The nerve compression is due to a herniated disc or some sort of compression on the spinal cord. And arthritic pain is just due to arthritis of the back. So depending on where the pain falls into, dictates the treatment of it. And the treatment can be anything from a minimally invasive decompression of a nerve root for any kind of pain shooting down the legs, which is called sciatic pain, or the treatment can even go up to as complicated as a fusion, where you have basically a lot of arthritis in your back and those joints rubbing on each other, the bone on bone rubbing, causes a lot of pain. And so you hold it still with a fusion. So that's kind of in a nutshell how we look at how do we treat different types of spine pain, which is not an easy thing to treat.

Deborah Howell (Host): Sure. And what should patients know when they're considering spine surgery?

Jason Liauw, MD: Well, you want to start with the smallest possible surgery, of course. And then the patient should have a good understanding of their imaging. When a patient comes to my clinic, I look over all the imaging with them and explain to them why I think their pain is coming from where it is and why I think the treatment should help it. So they should really understand, they shouldn't just consent for a surgery or anything like that without understanding why they're getting the surgery. And then they also should understand that as you get older, you have to start to think of maybe having smaller surgeries, you know, instead of having a big surgery, a smaller surgery can help treat some of the pain, it's just a safer thing.

Deborah Howell (Host): Got it. Any other tips people can use to help their spine health?

Jason Liauw, MD: So, you know, just bone health is important too. So the simple things is people tell you to drink milk with vitamin D and calcium. That actually helps a lot because when you have osteoporosis, which is a condition I see in a lot of patients that I see, they can get fractures because their bones essentially are very soft. And so mineralizing your bones with vitamin D and calcium, taking supplements for improving the health of the joints in your spine can all help. So nutrition is important.

Deborah Howell (Host): Wonderful. Thank you so, so much Dr. Liauw for being with us today. It's been great to have you on the program.

Jason Liauw, MD: Oh, great to chat. Thanks so much.

Deborah Howell (Host): I learned a lot. To listen to the podcast or for more info, please visit memorialcare.org. That's memorialcare.org. Sit up straight. I'm Deborah Howell. Thanks for listening and have yourself a wonderful day.