Q: I have been diagnosed with a herniated disc in my lower back. I would like to know what kind of exercises I should do and not do. Also, should I have surgery? -- J.C., Port Orange, Fla.
A: I hope you have not been suffering from back pain for a long time. If you really take care of yourself from now on, you can expect to have little back pain in the future. Unfortunately, few people do that.
Almost everyone has back pain from time to time. Usually, this is caused by straining the muscles in the lower back along the spine. But sometimes a disc, the spongy material that acts like a shock absorber between vertebrae, will get pushed out (herniated) of its place, which puts pressure on nerves of the spinal cord.
There are telltale signals when a lumbar (lower back) disc is herniated:
Pain in the leg is present and is often greater than the back pain.
Numbness and weakness of the leg is present.
It hurts for someone to lift the opposite leg while it is held straight.
If all these signals are present, additional tests such as X-rays and electrical conduction studies only confirm what is highly likely in the first place. Depending on your course of action, these studies may not be needed at all.
The vast majority of people with low-back pain, including those with a herniated disc, will get better over a few weeks if they following a few simple rules:
Don't lift heavy objects.
If you lift anything, keep your back straight.
Keep active; bed rest rarely helps and may harm.
Use pain relievers sparingly.
Gently stretch your muscles several times a day.
If you continue to follow these rules from now on, even after you've treated your painful back, you may not have back trouble again, or you will at least minimize the problem. But it's hard to remember to keep it up after the pain and stiffness is gone -- a good reason not to eliminate all of your pain with pills.
Sometimes a herniated disc is so bad that it demands attention right away. Other times, it never quite resolves or the problem keeps returning. In those cases, surgery is a good option to consider. Certainly, this would be a good time to further document the location and extent of the disc herniation with further medical tests.
If you are considering surgery, please ask your doctor about alternative methods of doing the surgery. Also ask about the risks and benefits of each approach before deciding. And if you are unsure whether to have surgery, a second opinion from another doctor may help you.
Update on sickle cell anemia: The FDA has approved a new treatment for adults who suffer from sickle cell anemia. The drug, hydroxyurea (Droxia), was previously approved by the FDA for treatment of certain types of leukemia and other cancers.
Sickle cell anemia is an inherited blood disorder that causes chronic anemia and episodes of severe pain. About 91,000 people in the United States, mostly of African-American heritage, are affected by the disease.
Droxia has been approved only for people over 18 who have had at least three "painful crises" in the previous year. Although the drug is not a cure for sickle cell disease, it may help control the symptoms of the disease.
During a painful crisis, the sickle-shaped red blood cells get stuck in narrow blood vessels, blocking the flow of blood and oxygen to the body's tissues. These painful crises can cause pain and swelling of hands and feet, along with fever, fatigue, shortness of breath, eye problems and a pneumonialike condition.
Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, IL 60611.