DR. HOOK- Back story: No cheers for sciatica, pinched discs

Hayden Panettiere, the auto-regenerating cheerleader from Heroes, is Ms. Paparazzi Queen! You know you're hot stuff when you're filmed and photographed while getting a mani-pedi. On one episode, while painting her toenails, Hayden cut off her pinky toe to see if it would regenerate— which it did, just like a starfish!  

Now, I've heard of toe jam, but never toe bam! Unfortunately, in the real world we aren't indestructible like the Heroes cheerleader, and we don't re-grow body parts– unless you count the annoying hair that keeps coming back in your ears and nose after you've plucked it.

Can you imagine if professional athletes had the ability to heal immediately after an injury? It would take ski jumping to a whole new level! Boxers would go 75 rounds. Baseball players would beat each other up like little brats... oh, wait, they already do that. Hmm. If we could heal immediately, would acute lower back pain cease to plague the country?

Acute lower back pain (LBP) affects about 84 percent of American adults at least once in their lifetime. Back pain costs our country approximately $100 billion a year (though as in everything, it takes only a few party poopers to bring down the party. Fully three-quarters of this cost is due to only 5 percent of people with back pain).

Most people who experience acute LBP don't see a doctor. About 90 percent of acute LBP goes away after a month. For those who do see the doctor, 75 percent give up sports or exercise, 60 percent cannot do some daily activities, and 50 percent give up sex– all due to the back pain. (Though in my experience, almost everybody will give up exercise for absolutely any reason.)

The majority of the time, acute LBP is due to a strain or sprain. Especially for those who are out of shape, moving a couch or lifting a heavy box can throw out the back. Also at risk for acute LBP are those with osteoporosis, degenerative disc disease, vertebral arthritis, and spinal stenosis. These conditions usually lead to a trip to the doctor.

Less commonly, the nerves within or coming out of the spinal column are pinched, and that can require immediate attention by a neurosurgeon or orthopedic back specialist. 

For example, if someone has an abscess or tumor compressing the nerves, Cauda Equina Syndrome can happen. Saddle anesthesia occurs, so, for example, if John Wayne was sitting on a horse, the whole area touching the saddle would be numb or feel like pins and needles (unlike Mame Dennis, of course, who rode sidesaddle). Numbness all the way down both legs usually occurs as well as weakness. Bladder dysfunction can occur, so it's hard to pee, and eventually the urine will leak out like rumors from the White House. 

Sciatica is when one of the lower back nerve roots is pinched– often by a slipped disk. Numbness or tingling goes down the leg all the way to the foot, and foot weakness might occur. Often sciatica can be managed with medicine and physical therapy, but in really bad cases, surgical intervention is needed.    

Those more at risk for a tumor or abscess of the lower back have immunodeficiency (such as HIV+ or cancer), are IV drug users, have had prolonged steroid use, and are over 70. However, in general, those at risk for acute LBP are obese and out of shape. Other acute LBP risk factors include smoking, being female, older age, and doing physically strenuous work– but also sedentary work (you just can't win), and mental illness.

If I were an indestructible cheerleader, I don't think I'd become a back doctor. I think it would be too annoying to patients to see me totally destroy my back, immediately heal, and say, "I'm back! Tada!" while doing a back flip.

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.