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June 20, 2006 > Good News about Back and Neck Pain

Good News about Back and Neck Pain

When you’re in pain, it affects every aspect of your life – day or night, waking or sleeping. For many people, their back and neck are especially prone to chronic pain. In fact, the American Association of Physical Medicine and Rehabilitation reports 80 percent of Americans will suffer from back pain at some point in their lives. Of all forms of physical disability, lower back pain is the most common.


“People used to believe that the only way to treat acute or chronic lower back or neck pain was through surgery,” says Robert Miller, M.D., a Fremont-based physiatrist on the medical staff of Washington Hospital. “On the other hand, most of us would like to avoid surgery if possible. Now, we understand that back and neck surgeries can often be avoided through the use of interventional, hands-on physiatric care.”


On June 27, Dr. Miller will discuss the treatment of back and neck problems at a free community education class sponsored by Washington Hospital Healthcare System (see box for details).


Physiatric care by a physician trained in the field of physical medicine and rehabilitation focuses on restoring function to the body’s musculoskeletal system. Rather than viewing surgery as the first option, the surgical approach is seen as a last resort. Physiatrists first conduct a thorough evaluation of the problem followed by treatment with various combinations of therapy, exercise, medications and interventional techniques. If these approaches do not substantially improve the pain, the surgical option is considered.


People of all ages can suffer from back and neck pain. As children and teenagers, the condition is usually related to misalignment of the back that affects the way the body’s musculoskeletal system functions. Or, the child may have had some type of injury, such as in a car accident. Genetics can also be involved (for example, scoliosis).


“That is why a thorough family history is an important part of data gathering during the diagnostic phase of care,” reports Dr. Miller.


In adults ages 20 to 55, the most common causes of back pain are repetitive strain injuries, herniated spinal discs, strained muscles and work related injuries. Back pain in people over 55 is usually the result of spinal stenosis or transforaminal (nerve opening) narrowing, degenerative disc disease, lumbar strain, problems with movement and function of the lower back, ligament strain, lumbar paraspinal muscle sprain or vertebral fractures (in people over 65). As we age, osteoporosis and pre-osteoporosis (called osteopenia) are risk factors for back and neck problems.


“To make a definitive diagnosis of a patient’s condition, it is important to start with a thorough assessment, and a musculoskeletal evaluation is a key part of this,” adds Dr. Miller. “To examine areas of the body not seen on physical exam, we may arrange for imaging studies, including X-rays, CT scans, MRIs, nerve conduction studies and electromyography.”


Once a diagnosis is made, the doctor can prescribe various treatments to help decrease the pain, such as oral medications, pain patches, localized injections and the use of modalities (for example, cold, heat or ultrasound).


“In order to achieve the best possible rehabilitation, these treatments must first bring about a decrease in pain,” explains Dr. Miller. “Once that has occurred, we can begin physical therapy directed by the physiatrist.”


Physical therapy can include stretching; strengthening; additional use of cold, heat and ultrasound; and the correction of the way the back or neck moves or functions. The Washington Outpatient Rehabilitation Center in Fremont features the latest physical therapy equipment and a dedicated staff of registered physical and occupational therapists, certified athletic trainers, exercises physiologists, hand therapists, aquatic coordinators, and sports medicine specialists, all supported by the staff and facilities of Washington Hospital Healthcare System.


If pain relief and physical therapy do not improve a patient’s condition, the physiatrist will consider further measures, including localized injections with trigger point therapy, botox therapy or sucrose/saline therapy. Alternative treatments can include acupuncture, acupressure and chiropractics, when appropriate. If the patient still doesn’t improve, an epidural (spinal) injection may be utilized.


“If, after all these routes have been tried, the patient still doesn’t experience resolution of the pain, we will refer him or her to a surgeon for consultation and possible surgery,” says Dr. Miller. “So, you see that much can be done before we consider the surgical approach.”


During his June 27 presentation, Dr. Miller will also discuss some of the newer surgical approaches now being used to relieve back and neck pain, as well as preventive exercises people can do to help strengthen the back after rehabilitation to prevent re-injury.


For more information about physical medicine and treating back and neck pain, visit the web site of the American Association of Physical Medicine and Rehabilitation at


The Washington Outpatient Rehabilitation Center is located at 3575 Beacon Avenue near the Fremont Hub. For more information, call (510) 794-9672 or visit, click on “Our Facilities,” and select “Outpatient Rehabilitation Center” from the drop-down menu.


Do You Have Back and Neck Problems?

Tuesday, June 27

1 to 2 p.m.

Conrad E. Anderson, M.D., Auditorium, Rooms A & B

Washington West, 2500 Mowry Ave., Fremont

To register, call (800) 963-7070


What is a physiatrist?


A physiatrist (fizz ee a´ trist) is a physician specializing in the prevention, diagnosis and non-surgical treatment of musculoskeletal and other disorders associated with disability. There are two important aspects of the specialty:


·   Physical Medicine – diagnosis and treatment of musculoskeletal disorders using physical therapy, modalities (such as ultrasound), medications, exercises and procedures.


·   Rehabilitation – assisting a person with a disability to become “maximally able” again by applying rehabilitation principles and techniques.



A physiatrist can perform all the function of an orthopedic surgeon or neurosurgeon except operate. He or she supervises the physical therapist, occupational therapist and speech therapist. Physiatrists view themselves as the primary care physicians for people with disabilities.
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