Episode Transcript
[00:00:00] Speaker A: From Riverside Health System. This is the Healthy youy Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
I'm really excited to have with me today in the healthy youy studio, Dr. Javier Amadeo.
Dr. Amadeo is a board certified neurosurgeon and we are going to be talking about easing lower back pain, right?
[00:00:41] Speaker B: That's right.
[00:00:42] Speaker A: Welcome to the Healthy youy the podcast where you explore everyday health topics and meet the people who keep your communities well. I'm your host, Frankie Myers, and today we're talking about lower back pain, which is the number one reason adults miss work, as well as one of the most common reasons for physician visits. Welcome.
[00:01:03] Speaker B: Thank you. Happy to be here.
[00:01:05] Speaker A: Glad to have you here.
All right, I want to first start by asking you, how did you end up in this field of medicine?
[00:01:14] Speaker B: That's a great question.
My father was a surgeon and from a pretty young age, I wanted to be a surgeon. I wanted to.
[00:01:23] Speaker A: So it's legacy for you, right?
[00:01:25] Speaker B: Yep. Help fix people.
[00:01:26] Speaker A: Yes.
[00:01:27] Speaker B: Hands on.
[00:01:28] Speaker A: Okay.
[00:01:28] Speaker B: And he was a chest surgeon.
But I was always fascinated by the nervous system.
[00:01:36] Speaker A: Okay.
[00:01:36] Speaker B: And majored in, I guess what today would be known as neuroscience.
[00:01:41] Speaker A: Yes.
[00:01:42] Speaker B: As an undergraduate and I was fascinated by how the nervous system is wired and neurosurgery brings together surgery and the nervous system and the spine.
[00:01:55] Speaker A: Yes. Well, thank you for what you do.
All right, before we dive, let's look at the scope of the problem.
According to the American spine registry in 2025 in their annual report, lower back pain remains one of the most common reasons adults seek spine care in the United States, contributing significantly to surgical and non surgical treatment volumes.
How do these statistics show up in our community?
[00:02:30] Speaker B: It has a huge impact in terms of lost work hours, disability, lack of productivity, and sometimes hardship for people that really do want to work and are not able to work.
[00:02:48] Speaker A: Yes. Yes.
Would you discuss a little bit for me how common complaints are? Is it related to age? What is the age range? Are there certain occupational factors or emotional factors that contribute to this?
[00:03:07] Speaker B: Sure.
So we sort of see, I would say, a broad range of ages and the specific conditions that we see are clustered in different age groups. For example, herniated disc, which is one of the most common conditions we treat, actually tends to cluster a little bit younger, 30s, 40s, sometimes 20s, things like arthritis, spinal stenosis, narrowing in the spine.
[00:03:39] Speaker A: Right.
[00:03:40] Speaker B: Tends to cluster a little bit later towards middle age and senior patients.
[00:03:45] Speaker A: Absolutely.
I used to always hear what you do when you're younger may come back to hunt you when you become a little older and not using proper body mechanics and all of those things. And those things set in, so. Sure, absolutely. I'm a nurse, so I suffer with lower back pain and I know it's probably ergonomics and a little bit of arthritis and all those things. Sure.
[00:04:10] Speaker B: And we certainly, in our community, you had asked about occupation, which I didn't mention, but we have a lot of people who do a lot of physical work. For example, the shipyard and other physical occupations that can really be. Take a.
They demand a lot, let's say, of your spine. Absolutely. Nursing, CNAs, construction, electricians.
[00:04:35] Speaker A: Absolutely.
[00:04:37] Speaker B: And surgeons, believe it or not.
[00:04:38] Speaker A: Yeah. From standing. Yeah.
[00:04:40] Speaker B: In awkward positions.
[00:04:41] Speaker A: Yes, absolutely, absolutely. Now let's start with the basics. What really happens when someone says, I'm experiencing lower back pain?
[00:04:51] Speaker B: So there's so many possibilities.
And so usually because this is so common and back pain in general rarely requires surgery.
So most of those complaints, if they're persistent, are managed by primary physician, urgent care, sometimes the emergency room, if it's severe enough.
But the approach is to try to rule out something bad, something serious, rather than just assume, well, you know, you strained your back or you have arthritis. At least let's get some X rays.
[00:05:32] Speaker A: Okay.
[00:05:33] Speaker B: Let's start some basic treatment, home exercises, physical therapy, an anti inflammatory, if that patient's able to take it. If not, maybe a corticosteroid and. And manage the symptoms, at least ruling out that it's not something serious.
[00:05:48] Speaker A: Yes, yes.
That's good. That's good feedback.
What red flag symptoms signal something more serious?
[00:06:00] Speaker B: Well, I think severity and duration are big red flags.
Pain that just is unrelenting.
[00:06:09] Speaker A: Yes.
[00:06:09] Speaker B: Pain that is of just an outsized magnitude.
Pain that is accompanied by neurologic symptoms.
[00:06:19] Speaker A: Like radiating and shifting radiating legs, accompanied.
[00:06:24] Speaker B: By numbness, weakness, or in certain unusual instances, bowel and bladder dysfunction.
[00:06:31] Speaker A: Yes, yes. And I was told recently for myself after childbirth, sometimes some of the abdominal muscles can separate. For women they can.
[00:06:40] Speaker B: It can disrupt your core.
[00:06:42] Speaker A: Yes, yes.
[00:06:44] Speaker B: Because of the weight and the unusual balance or lack of balance, it really does stress the very bottom of your lower spine.
[00:06:53] Speaker A: Yeah, I never thought about that, but that was recently told to me.
So, Netflix, take a little closer look at everyday habits. Many listeners sit at a desk for eight hours or more each day. What small changes make the biggest difference?
[00:07:12] Speaker B: So one thing that I tried personally for my back health was using a standing desk.
[00:07:17] Speaker A: Yes.
[00:07:18] Speaker B: And I know that's not an option for everyone, but I struggled with a herniated disc some years ago and for me using a standing desk was a lifesaver. It made a huge difference.
If you're able. Some people I know use a treadmill desk and I know it's a little bit more difficult to get an accommodation, but if that's not practical or if your employer want to accommodate you, just good ergonomics, a chair that really keeps you upright, not slouching, not leaning back, not leaning forward.
You also want to be mindful of your neck.
[00:07:57] Speaker A: Yes.
[00:07:58] Speaker B: Because sitting for a prolonged period of time can also put you in a slouch neck position and that can be damaging.
[00:08:05] Speaker A: Yes.
[00:08:05] Speaker B: I think posture and ergonomics more than anything else.
[00:08:09] Speaker A: Absolutely good information. What lifestyle factors play a role as well?
[00:08:15] Speaker B: So I mean many different things.
I think people want to be active more and more.
We do see injuries from maybe over zeal or really high impact activity.
[00:08:32] Speaker A: Yes, yes.
[00:08:33] Speaker B: I'm not in any way knocking that. But you want to be wise and you want to listen to your body.
[00:08:40] Speaker A: Absolutely.
[00:08:41] Speaker B: So of course strengthening, stretching, trying to maintain the best possible body weight, that's key.
And, and you know something that will, something as simple as brisk walking is so helpful. It works your core, including back and abdominal muscles obviously has cardiovascular benefit and also has a benefit to preventing osteoporosis.
[00:09:06] Speaker A: Okay.
[00:09:07] Speaker B: So if, if that's the only thing you can do, brisk walking, 30 minutes a day is, is a great exercise.
[00:09:13] Speaker A: That'S good feedback because sometimes I know even at you, you know, for me going in the gym, I'm older, you end up hurting yourself because you're, you're not following the right form or you're doing too much. So I think just clarifying that brisk.
[00:09:28] Speaker B: Walking, brisk walking is great all encompassing resistance work.
As we get older, we do tend to lose muscle mass.
[00:09:38] Speaker A: Yes.
[00:09:38] Speaker B: So that's important. But again, you just want to be wise. You know, you probably don't want to be doing 200 pound deadlifts or squats. Right, right. If personal trainer is accessible to you, that's a great help.
But in general, good exercise mechanics, where you're not lifting with your back, where you're not incurring an overuse injury, where you're not twisting, twisting is the way that I've seen a lot of people hurt their back.
[00:10:11] Speaker A: Okay. That's great information.
Very important stuff. There thanks for sharing. Now, when pain strikes, many people reach straight for imaging or surgery.
What's your opinion on that?
[00:10:26] Speaker B: So, as I mentioned earlier, spine surgery is peculiar in the sense the vast majority of back pain is not amenable to surgery, is very treatable with conservative means, and there are very specific conditions where we are able to help with surgery. But even with those, a lot of times they respond to non surgical treatment.
The areas where we are specifically able to help usually involve a pinched nerve that can be difficult to treat without surgery. Yes.
A condition where there's instability, meaning the spine is moving in a certain way that it shouldn't be moving.
[00:11:14] Speaker A: Right.
[00:11:15] Speaker B: Which sometimes you can overcome there with physical therapy and strengthening your core, sometimes not.
And certain injuries, fractures, dislocations involving the spine.
And then there are more serious rare things like cancer affecting the spine, which we sometimes see.
But in general, the vast majority of back pain is non surgical.
[00:11:43] Speaker A: Is non surgical.
Okay. That's really good stuff. I meant to ask you, is there a certain way you should sleep that's more beneficial to your back? Some stomach sleepers. Back sleepers. Or is. Or is there no association?
[00:12:00] Speaker B: So I have to confess I don't have good data on that. I generally tell folks to try to sleep in a way that is mostly preserves the natural alignment of the spine.
[00:12:13] Speaker A: Okay.
[00:12:14] Speaker B: Generally for most people, side sleeping, as long as you maintain a neutral position in your hips, your back and your neck is pretty good.
Stomach sleeping does put a little bit of unusual extension stress sway on your back. So I generally don't recommend that with a few exceptions.
And for some people, sleeping on their back is fine.
Interestingly, for back sleepers, you want to use a pillow that maintains neutral neck position because sleeping on your back can put your neck in a bit of a scrunch, which is not healthy if you have a bulky pillow.
[00:12:59] Speaker A: Yeah. So moving from side to side, sometimes your arm will go to sleep, sometimes with side sleeping.
[00:13:05] Speaker B: So sometimes it's as simple as avoid that side, go to the other side. Go to the other side.
[00:13:13] Speaker A: Typically there's fears associated around spine surgery.
Lots of fears. What myths do you want to debunk today regarding that?
[00:13:23] Speaker B: So it's something that we have to debunk in the clinic all the time.
[00:13:28] Speaker A: Right.
[00:13:29] Speaker B: And I'll take it back a step.
I think the most.
This is something that I fortunately learned early on. The most important part of spine surgery is deciding who who needs surgery and who doesn't.
[00:13:45] Speaker A: Right.
[00:13:46] Speaker B: The second most important decision is what surgery to perform.
[00:13:50] Speaker A: Okay.
[00:13:51] Speaker B: How you execute the surgery Obviously is important, but that's number three.
[00:13:56] Speaker A: Gotcha.
[00:13:57] Speaker B: And the problem is if one is not selective, as I mentioned, the vast majority of back pain does not warrant surgery. If you're not selective, you, you're unfortunately going to operate on patients that really are not going to get better with surgery. And those patients are very unhappy and they're very vocal, understandably, because here you've put somebody through sometimes a major operation and they're not better and they were doomed to not get better because they didn't really need surgery.
[00:14:31] Speaker A: Absolutely.
[00:14:32] Speaker B: And so explaining to people carefully, this is my thought process. I take a lot of extra time explaining to people, this is why I think you would benefit from surgery or this is why I don't think you would benefit from surgery. And then walking them step by step, this is how surgery can, should help.
These are the risks. But this is why I feel the benefits outweigh those risks.
[00:15:00] Speaker A: And they don't have any unrealistic expectations.
[00:15:02] Speaker B: Exactly.
Managing expectations.
Not, you know, not to be cynical about it, not just to, you know, cover myself, but to, to I, I think it's just fair so that people walk into this eyes wide open.
[00:15:17] Speaker A: Absolutely. Absolutely.
That definitely clears up some misconceptions. So let's talk about staying well, what can people do each day to keep their backs and strong and avoid future tissue issues? And we talked a little bit about some of those things already.
[00:15:35] Speaker B: Sure.
So I tell pretty much all my back and neck patients, think of a preventive maintenance program.
The same way that you change the oil in your car.
You do a 10,000 mile checkup. You want to do that for your back, but you want to do it every day.
[00:15:56] Speaker A: Okay.
[00:15:57] Speaker B: You want to do preventive maintenance every day.
And that can be as simple as a 15 minute stretching, core strengthening, and if you can work in again, something as simple as a little bit of brisk walking either at the beginning or the end of the day, that's, that's great.
We tend to get stiffer as we get older and variable.
[00:16:20] Speaker A: Yes.
[00:16:21] Speaker B: And so stretching becomes really, really important as well.
[00:16:26] Speaker A: You're seeing these stretch labs come up now. Yeah.
So that tells you how important it is.
What's your take home message for someone who is stuck in pain?
[00:16:40] Speaker B: So I think don't feel that you have to live with it.
Don't resign yourself to this is the way life is going to be.
[00:16:51] Speaker A: Yes, yes.
[00:16:52] Speaker B: But don't self medicate either.
I've seen people fall into traps through self medication and like anything, there's a solution.
It may be a Cure. It may be a treatment, but seek help.
[00:17:11] Speaker A: Absolutely.
[00:17:12] Speaker B: Your primary care physician is a great initial resource.
Even if they can't give you the answer, they can get you referred, get you routed to a pain doctor to do an initial screening or to us to do a more, you know, full in depth evaluation.
[00:17:32] Speaker A: Yes. And it's individualized because sometimes, you know, people hear what others experience have been and so they may not seek that care. So everything is individualized. It's very one size fits. All. Right.
[00:17:47] Speaker B: And I would encourage listeners to just when you approach back pain, wipe the slate clean.
[00:17:53] Speaker A: Absolutely.
[00:17:54] Speaker B: Try as much as you can to go in with an open mind.
[00:17:59] Speaker A: Yes.
[00:18:00] Speaker B: Because really there is so much we can do both on the surgical and the non surgical side to help.
[00:18:08] Speaker A: Yes, yes, yes.
So as we wrap up, is there anything else you would like to leave our viewers with?
[00:18:16] Speaker B: Well, I mean, I just want to say I've been doing this for 25 years. I've enjoyed it tremendously.
You know, walk patients through difficult times.
But again, I would encourage anyone who struggles with back pain to not, not let it dominate your life to seek help.
There are great solutions out there.
Stay as fit and healthy as you can.
Some really just basic, 20 minutes a day, stretching, core strengthening, walking can make a huge difference.
[00:18:53] Speaker A: Yes, yes, yes. If one of our viewers would like to reach out to you in your group, how would they contact you?
[00:19:00] Speaker B: Sure. I think the easiest way would be through the Riverside portal.
[00:19:04] Speaker A: Okay.
[00:19:05] Speaker B: Just to follow Hampton Roads Neurosurgical and Spine through the Riverside portal.
If you are obviously established with us, we encourage patients to reach out to their provider within our group through MyChart, which has been really incredibly helpful in maintaining contact with patients.
Or, you know, if you are seeking actual full evaluation, just get in touch through your primary provider.
[00:19:38] Speaker A: Absolutely. Dr. Amadeo, thank you so much for taking time out of your busy schedule to talk with us today. I appreciate it and I know our viewers do as well.
And thank you.
[00:19:48] Speaker B: Very welcome.
[00:19:49] Speaker A: Frankie, you're. Yes, absolutely. And you're welcome to come back anytime.
[00:19:52] Speaker B: Thank you so much.
[00:19:53] Speaker A: Yes. And thank you again for demystifying some of the thought processes out there around lower back pain and sharing breakthrough strategies to get listeners back into action and having a great quality of life to our audience.
If today's episode sparked some hope or offered you new strategy, share it with a friend and visit Riverside's blog for more expert tips. Until next time, stay healthy. Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today. And learn more about this topic. If you would like to explore more, go to riversideonline.com.
