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Nonsurgical Care

Return to Activity | Diagnostics | Pain Relief | Time | Limiting Rest | Physical Therapy | Exercise | Types of Medication

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The primary goal of treatment is to get you back to your everyday activities. During your initial visit, the physician will assess your medical history and collect more specific information during the exam. In order to better understand your back or neck problem, the physician may gently move your joints and limbs. It is important to answer all the physician’s questions honestly, because your answers help determine a correct diagnosis.

Types of diagnostics you may encounter:

  • X-rays show bones and the space between bones. Although X-rays are of limited value to muscle-related back pain cases, your physician may conduct X-rays to detect possible fractured vertebrae or narrowing of disc space.
  • MRIs (Magnetic Resonance Imaging) and CT scans provide images of soft tissues and nerves in the spine, including discs and joints. This is valuable information to your physician in determining the cause of your pain. These tests provide a medical photograph of your body and are painless.
  • Pain-relieving injections can relieve back pain and provide important information about your problem.
  • Myelograms can reveal the amount of damage in the spine. They are used to determine if surgery is necessary. If it is, myelograms provide a surgeon with key information to ensure the success of surgery.

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Doctors who focus mainly on pain symptoms often recommend the exact opposite course of action that is optimal for recovery from a back problem. For example, years ago, doctors treated back pain with bed rest and heavy drugs in order to mask the patient’s discomfort. Patients became sedentary and increasingly dependent on drugs. It was later discovered that this treatment was actually damaging to the back, because it weakened muscles and caused more pain.

Pain is a signal from the body to the brain that something is wrong. Either a certain motion placed too much strain on the back, or the back is too weak or inflexible. Your specialist will help determine the origin of your pain and the best treatment for it. More about pain relief.

Give it Some Time

Time is your most valuable asset. In cases where pain is focused in the low back or when there are NO RED FLAG SYMPTOMS,take the time to help yourself. Check out the home therapy section of this site for ways to treat your neck and back pain yourself.

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Limiting Rest

In 1986, the New England Journal of Medicine released that the treatment of most back pain cases should involve no more than two days of rest and inactivity. After that, patients should start moving and exercising to strengthen back muscles and increase flexibility. The rehabilitative process requires a commitment on the part of the patient to work closely with a therapist during the first few weeks to ensure a successful long-term recovery.

While drugs and manipulation may relieve initial pain, neither of these alters the musculature of the back, which is essential for long-term recovery. Only exercise can strengthen the back muscles and make them more flexible and resistant to future strain.

Physical Therapy

Physical therapy increases flexibility and strengthens muscles that support the spine. Greater strength and flexibility will help prevent future back strain. A therapist may use ultrasound, electrical stimulation, heat or ice, mobilization and exercises to reduce pain and the likelihood of future injury. Click here to learn more about physical therapy.

Exercise

Years ago, the prescription for pain was bed rest. However, we know today that more than a few days of bed rest after an injury can be counterproductive to rehabilitation.

Exercise and movement actually help tissues in the back become stronger, more supportive of the back and resistant to additional injury. Specific exercises can be used to target particular types of back pain. Engaging in activity acts as a lubricant to the back muscles and joints, and it’s as necessary to recovery as oil is to the hinge in a squeaky door.

It is important to work with a therapist to make sure exercises are done properly. Never do any exercise that causes pain to your back. Click here to learn about specific back pain exercises.

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Injection Therapy

For years, spine physicians have used cortisone injections, epidural steroid injections, trigger point injections and nerve blocks to relieve pain in the spine. They are often provided in a series of three or four injections spanned over a couple weeks.

These injections are intended as a means to an end. The goal is to provide enough pain relief to bridge the patient from being inactive to being able to attend physical therapy, where they can better treat their back problems with special exercises.

There has been conflicting research about the value of injection therapy. Some studies have questioned the benefit of epidural steroid injections. In 1997, Britain's Royal College of General Practitioners noted in its back care guidelines that epidural steroid injections relieve low back pain with sciatica (leg pain) better than some other treatments. The Royal College is less supportive of facet joint injections and trigger point injections. It sees little evidence that these injections improve clinical outcomes. With that said, many spine specialty centers believe in the benefit of injections and continue to use them.

To come to a definitive conclusion regarding its proven benefit, injection therapy needs to undergo further testing. Some experts theorize that there may be some placebo effect associated with the relief that accompanies an injection. In any case, when a patient gains relief from an injection, it reinforces a physician's desire to use that treatment again.

Types of Medication

Medications can lessen swelling and reduce pain in the back and neck. The type of medication your physician recommends depends on your symptoms and your level of pain.

At home, pain can be relieved with Non-Steroidal Anti-Inflammatory Drugs (NSAID), such as ibuprofen products like Motrin or Advil. Aspirin may also be recommended to ease pain.


TriCities Spine in Bristol, TN is a by-product of discussions with case managers, rehab nurses and managed care experts on a local and national level who believe that spine care can be improved through a multidisciplinary team approach. TriCities Spine includes a board-certified neurosurgeon who specializes in spine, Dr. Jim Brasfield, teamed with a pain management specialist and spine-specialized physical therapy. TriCities Spine physicians already see a variety of complex cases from across Eastern Tennessee, Virginia, North Carolina and Kentucky. TriCities Spine emphasizes a nonsurgical approach to back pain, recognizing that in most cases spine surgery should be the last card to be played after nonsurgical options have been tried. About half of patients are referred to TriCities Spine by other doctors in the region. TriCities Spine also cares for those who injure themselves at the workplace. The strength of TriCities Spine lies in the medical expertise brought in by a variety of specialists who complement each other, including experts in physical medicine and neurosurgery. An internal pain specialist is often able to relieve some back and neck pain symptoms with special injections that enable a patient to bridge to therapy. Dr. Fred Terry specializes in pain relieving lumbar spinal injections and as well as myelograms, which may reveal the amount of damage in the spine. Therapists who specialize in spine use customized hands-on treatments to relieve pain symptoms, along with special exercises to help make the back stronger, more flexible and resistant to injury. If nonsurgical treatments are not successful, Dr. Jim Brasfield is trained and proficient in the latest techniques in minimally invasive spine surgery. Because of the minimally invasive techniques used by Dr. Brasfield, many patients are able to have their spine surgery and then return home the same day to recover in the comfort of their own home.