Can low back pain be treated without medication or surgical intervention?

 

Low back pain is one of the most prevalent health problems of our time, perhaps due to changing working conditions, especially office work that requires long sessions, which led to the prevalence of these diseases.

In Germany, for example, Professor Michael Rove told Leading Medicine Guide that 80% of Germans have experienced low back pain more than once in their lives, often due to carrying unaccustomed weights, as well as spinal setbacks.

According to Professor Horst Palling, who works at the Neckar Uden Wald Hospital in Baden-Witemberg, 80,000 lower back surgeries are performed in Germany each year.

In contrast to drug and surgical treatment, there is another medical opinion that says that the treatment of many of these diseases is done by adhering to a set of exercises that lead to much better results than these treatment methods.

We visited Dr. Mohamed Tohme, a specialist in orthopedic and spine surgery from the University of Bochum, at his clinic in Pforzheim to learn about these treatment methods.

What causes lower back pain?

We can talk about:

– Back pain is not of a specific cause; 

these pains cannot be attributed to a specific cause and can increase or improve by general things such as sudden bending that can increase them, as well as carrying heavy weights, and appear in the form of muscle spasm. Also, sitting for long periods in front of the computer (to work) or working for long periods standing (under the influence of the weight of the body), and sometimes severe psychological stress, or depression may cause back pain of unknown cause, i.e. not related to any organic cause. What we should know is that these back pains (of undetermined origin) do not pose a threat to a person's life.

– Back pain has clear causes; 

it can be hernia of the nucleus pulposus (disc), fractures, osteoporosis, narrowing of the spinal canal, inflammation of the spine such as ankylosing spondylitis or rheumatic pain. Back pain can only be localized and can spread to the lower extremities, as well as may be associated with numbness and numbness of the lower extremities or associated with urination disorders or defecation habits, as well as high fever, chills or sudden weight loss, tingling or pain when lying down, these previous symptoms require a competent opinion, because they indicate injury to the nerve root. This usually requires clinical examination and x-rays, CT or MRI in some cases.

The majority of people complain of unspecified low back pain such as muscle spasms after muscle exertion. This requires conservative treatment such as the use of painkillers known to some, such as ibuprofen, diclofenac or naproxen, and these painkillers are known as (NSAR) or through some sports movements and exercises.

What are the risks of surgery and when?

I worked in the largest spine center in Germany, we used to do 15 to 20 surgeries a day, the surgery is useful if the surgical incision is small, it is okay in the operation, and the entry is through the camera and the removal of the "hernia of the nucleus pulposus", but if it is large, the surgical procedure leads to bleeding and the formation of a blood mass "hematome" that presses on the nerve root, so its effect is more severe than the disc itself, so it is preferable to stay away from surgery, as well as drug treatment is not recommended due to side drug effects Except for short-term processing.

The preferred method is exercise, but in a medically thoughtful manner, and it needs continuity and not intermittent, and the patient must adhere to these exercises. They are simple exercises that only need 10 minutes in the morning and the same in the evening, and improvement will come with continuity.

Why and what are these exercises for?

When the disc presses on the nerve root, the muscle fed by the nerve root is affected and from it the pain appears, and the role of "medical" exercise is to affect the muscle and indirectly on the nerve root, it has an anti-inflammatory effect (perinerve edema).

How did you come up with this method of treatment?

By observing the results of hundreds of major surgeries, and studying multiple medical cases, I found that many of these operations in this field in general can be avoided through the exercises that I have compiled and reviewed scientifically and practically during my 20 years of medical experience in this field, as some surgical results may not be as the patient wishes, especially if the surgical incision is large.

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What are the most important findings you have reached by applying this to patients?

The most important thing in treatment is the patient's acceptance of it and trust in the doctor, so I used to deal with the patient with logic (I will not prescribe you medicine or take you for surgery), but on condition that you adhere to these exercises as medicine, with the permanence of those exercises as if you were taking medication on time.

I give you examples through my treatment of German patients, that a patient comes about to enter surgery - and this happened a lot - I ask him to start these exercises and continue for two months, and then we decide the surgery or not, the results are about 90% of patients did not need surgery because of the maintenance of exercises, and the rest are those who did not commit and may not be convinced because of the severity of the pain, the strange thing is that those who recovered through exercises became much better than those who preferred surgery.

You mentioned the use of painkillers. When does the doctor decide on it?

Low back pain patients avoid bending forward because the pain increases, and exercises depend on bending, and this leads to muscle spasm in some cases, forcing us to give the patient a temporary analgesic - either ibuprofen or diclofenac - preventively and often for a maximum of a week.

For example, patients who have "neurological irritation" need vitamin B12 because this vitamin works to repair the damaged nervous part.

What exercises do you recommend?

It is 3 exercises:

The first exercise: the knees are straight and do not bend and the feet are apart, bend forward as much as possible with the hands extended towards the ground and then bend back with the hands under the back and repeat the previous one completely 15 times, morning and evening, preferably 5 times every two days until you reach 25 times.

The second exercise: the feet are far apart and the knees are straight, the patient bends and extends his left hand to the left ankle if he can and not only touch the thigh or leg, and the right hand on the head and the head is pressed towards the chest as much as possible, the first day begins with a minute of pressure on the head and every two days increases half a minute until it reaches 2.5 minutes and continues it in the morning and evening.

The third exercise: the knees are straight, the feet are apart, and the hands are lower back with a bend back, then the right hand is raised on the forehead and the head is pressed back, it also starts with a minute and then increases 30 seconds every two days until it reaches 2.5 minutes in the morning and 2.5 minutes in the evening.

There are some observations to pay attention to:

• Don't wait for improvement overnight, just keep getting better and the pain is coming.

• If you do not reach the ground with the first exercise or the ankle with the second exercise, it is enough to bend as much as possible, you will reach the ground or ankle with repetition and continuation.

• Emphasize again that the pain may increase in the first days due to spasm of the back muscles, so as a prevention painkillers should be used in the first days.

• Avoid falling during exercises, especially patients with orthostatic pressure, so it is preferable in the beginning for the elderly to perform exercises in the presence of a family member.