Non Surgical

Most back pain resolves with non-operative treatment within six months. The treatment plan could include things lke physical therapy, chiropractice care, massage therapy, injections and . Please contact your doctor to discuss a non-operative treatment plan that is best suited for your condition or symptoms. Here are some non-operative items to consider.

Exercise and Your Spine

Overview

Exercise is to the spine, as water is to a plant. Just as too much water can cause damage to a plant, too much exercise can cause increased pain. However, plants always need water, and muscles always need some type of exercise. If you overwater a plant once, you do not stop watering the plant all together, but change the amount you water it in the future. Similarly, if you over-exercise, you need to adjust your program, but continue exercising. The key is finding the right exercises.

Why Exercise?

Muscles provide dynamic stability to the spine, forming the world’s greatest spinal brace. All muscles must be taken care of through regular and consistent exercise to maintain strength, flexibility and coordination.

No matter your condition, one of the key ways to improve your condition is through a regular and continuous program.

How to Exercise

A well-developed exercise program is seven-fold and should include all of the following:
- Aerobic exercises (Cardio)
- Core strength (Stability)
- Range of motion (Flexibility)
- Overall strength and coordination
- Good sleep
- Good nutrition
- Stress management

A daily home exercise program which incorporates all seven of these aspects is important to recovering and maintaining a healthy lifestyle.


Neck Stretches and Exercise

As we go through life, the discs in our spine slowly age and degenerate, often causing pain in our neck, shoulders and arms. It's similar to the tread on your tires wearing out. Like most people today, you probably spend long periods of time watching TV or sitting at a desk, and have difficulty finding the time to do neck stretches and exercises. Here are some simple stretches and exercises that you can do anywhere to relieve pain.

Check out Dr. Kim's instructional video on YouTube.

Flexion and Extenstions



- Interlock your fingers and place your hands at the back of your head
- Use your hands to put gentle pressure on your head
- Full range of motion both forward and back
- Do 10 repetitions

Rotation Stretches



- Place one hand on your chin
- Use your hand to put gentle pressure on your chin as you look to your right and left
- Do 10 repetitions

Side-to-Side



- Place your hand on your temple
- Use your hand to put gentle pressure on your head as you move your head side-to-side You may want to use two hands
- Do 10 repetitions

Chair Stretches and Exercises

As we go through life, the discs in our spine slowly age and degenerate, often causing pain in our low back, buttocks and legs. It’s similar to the tread on your tires wearing out. Like most people today, you probably spend long periods of time watching TV or sitting at a desk, and have difficulty finding the time to do low back stretches and exercises. Here are some simple stretches and exercises you can do with a chair to relieve pain.

Check out Dr. Kim's instructional video on YouTube.

Proper Sitting Position


- When you’re sitting for a long time, you naturally start to rest your muscles and sink into the chair
- As you do this, all the weight of your upper body bears down on the discs in your spine
- It’s important to make sure that you sit properly in your chair
- Make sure you have a chair low enough that you can plant your feet firmly on the ground so that some of the weight is redistributed to your feet
- Every 20-30 minutes, sit at the edge of your chair and activate those muscles surrounding the spine

Forward Stretching


- Bend all the way forward, put your head in between your knees, and place your hands on your feet or ankles to provide support
- Hold for 20-30 seconds and don’t forget to breathe
- Make sure to use your arms to push yourself back up to avoid straining any muscles

Rotation Stretches


- Another stretch is using the arms or back of the chair to gently turn your upper torso
- Hold for 20-30 seconds and don’t forget to breathe
- The intention is to stretch, but if your back “cracks”, that’s okay

Reverse Leg Lifts


- This set of exercises should be done standing up and using the back of the chair for support
- This activates the back and gluteal muscles
- Slowly lift your leg backwards and hold it for 1-2 seconds
- Do this 10-20 times
- You can do the same exercise sideways and at a 45° angle

Posture Exercises

Tadasana (Mountain Pose)
A regular routine including proper exercises and stretches can help ensure you maintain a healthy spine and an active lifestyle. This exercise helps strengthen the muscles in your back which enable you to stand up straight.

Image credit to YogaJournal.

Focus on the following:
1. Tighten quads to straighten legs.
2. Tighten gluteals (tilt pelvis forward)
3. Tighten lumbar paraspinal muscle
4. Pull shoulds and rib cage back.

Practice this exercise in front of a mirror every morning and any time you pass a reflective surface throughout the day to improve posture and back strength over time.


Types of Injections

Injections are performed by a pain specialist. The goal is to obtain diagnostic information about your pain generator while also providing therapeutic symptom relief. The key to lasting pain relief is to s trengthen the core muscles and essentially create a brace out of your own muscles during the period of pain relief after the procedure.

Trigger Point Injection
These injections are done without imaging, the steroid and anesthetic solution is injected into a muscle that is causing pain. A trigger point injection will provide some relief so that your exercise program can be ramped up to hopefully alleviate the underlying cause.

Epidural Steroid Injection (ESI)
The firs t type of ESI is a Transforaminal (TF ESI), where the anesthetic and steroid solution are injected into the epidural space of the spinal canal through the foramen (gap) of a targeted level. This is different than an interlaminar space and spreads over multiple levels.

Facet Injections
These injections target a specific joint to be treated (the source of pain) the facet is where two vertebrae meet. During a Facet Block, the solution of anesthetic and steroid is injected into the joint, whereas during a Medical Branch Block (MBB) the solution is injected just outside the joint. Radio Frequency Ablation (RFA) is for long-term pain relief, a probe is used to ablate/burn the tiny nerve endings so that they no longer send pain signals. The tiny nerves will grow back but this can take 6-12 months.


Back Brace

This back brace is a temporary solution to help decrease the amount of pain medication you need to take.

The long-term solution is your exercise program which will build the muscles surrounding your spine into the world’s greatest back brace. This brace should be used AS NEEDED, for example while you are doing yardwork or for a long drive, in order to prevent flare-ups.

Depending on your insurance, Spine Institute of San Diego may be able to fit you with a back brace. Please give us a call to find out!