Madeleine Burke interviewing Dr. Michael Burke,
a chiropractor, about back pain.

Recently my 12 year-old daughter had a homework assignment in which she had to interview someone about a major health condition. When I jokingly suggested that she interview me about back pain she readily agreed. The recorded interview was later transcribed. When I read it I thought that visitors to this site might find it informative and even somewhat humorous. Aside from a few minor corrections of grammar and syntax, the interview appears here exactly as it occurred.

Madeleine: How is back pain caused?

Dr. Burke: While there are lots of different kinds of back pain, and of course there are many different causes for all of these different varieties of back pain, the primary type of back pain is caused by mechanical reasons. That means imbalance in the muscles of the body, shifts in the joints of the spine and other joints, and just generally faulty posture.

What causes these imbalances and faulty posture?

There are again several reasons for that. One major reason is that most people aren’t really taught how to have good posture. Good posture is not something that happens because your parents nag you to sit up straight and stand up straight. Good posture is a habit that is developed by training the proper muscles in the back and neck and other parts of the body to do what they are supposed to do. Another reason that imbalances occur is because of the aging process. As people get older their joints start to deteriorate, arthritis develops in the spine, we lose the blood supply to the discs, which are like pads between the vertebrae, or bones of the spine. We lose that blood supply by about age 25 and after that it’s all down hill. Although the more you can maintain good posture and train your muscles and keep your joints moving well, the less rapid that effect is going to occur.

The other causes of back pain amount to about 5% of all cases of back pain. Those are different kinds of diseases such as infections and cancer and other different health problems that can affect the spine, and those are a lot less common.

How does back pain affect your physical abilities?

Of course, when someone’s back is hurting they don’t want to do many things that they might normally do. You don’t want to lift things or participate in sports. Most people think that the best thing to do is to lie down but even though it seems contradictory, the best thing that someone with back pain can do is to stay as active as possible. That doesn’t mean to force themselves to do activities, but rather than resting in bed they should stay up and move around and try and do as much of their normal tasks and activities as possible. Research has shown that if you can stay active you are likely to get over an episode of back pain much more quickly than if you rest in bed. It has also been discovered that resting in bed actually will make an episode of back pain last longer and the recovery from the back pain will be less complete.

Can people die from back pain?

Well, the kind of back pain that people might be more likely to be seriously ill from or die from is not the kind of back pain that we’ve been talking about here, which is mechanical back pain. So, people could be very sick or die from a tumor in their spine or from an infection or from some other disease that is affecting the back, but the type of back pain most people have, which is mechanical back pain caused by postural imbalances, faulty movement, the kind of stuff we’ve already talked about, you will not die from. It is almost a trivial type of health condition compared to the more serious and life-threatening health problems.

But what makes back pain an important issue in our society is the fact that it is so widespread. Eighty percent of the population will be affected by back pain at some time in their lives, and I think the other 20 percent just don’t want to admit it. It affects all aspects of our culture. More people miss work from back pain than any other reason except for the common cold. So it affects our jobs, it affects work production, and the costs of treating back pain, as well as paying for disability for people who can’t work because of back pain, is very, very high. It amounts to billions and billions of dollars every year.

How is back pain treated?

There are lots of different treatments for back pain, and there is a big controversy about what, if anything, is the best treatment for mechanical back pain. As I said earlier, it used to be thought that rest was the best thing for back pain. I remember when I hurt my back when I was about 20 or 21 years old. I was in college, and this was back when the Earth was still cooling! It was quite a long time ago. So I went to the campus medical clinic and saw the doctor there who told me to rest in bed, and he prescribed Valium to relax my muscles. He also told me to put heat on my back.

Now it would probably be common for a doctor to prescribe a muscle relaxer. But as far as rest and heat, those things are just the opposite of what we now know to be helpful for back pain. That is, acute back pain. If you have acute back pain, something that comes on suddenly because of an injury or moving the wrong way, often one of the best first-aid treatments is to apply ice to the area. This is better than a hot pack. Even though a hot pack may sound more soothing, ice will get the inflammation down and allow movement to come back more quickly. There is a lot more agreement between different kinds of doctors and health care providers about treating back pain nowadays than there was even five or 10 years ago. Most health professionals agree that exercise is very good. Anti-inflammatory medications that you can buy without a prescription like ibuprofen, which goes by the brand names of Advil or Motrin IB, can be helpful in reducing inflammation. There is now quite a bit of research that shows that chiropractic spinal manipulation - or adjustments, as chiropractors like to call it - can help restore normal motion and get people better much more quickly.

Of course, there is no cure for back pain. It is not something that just happens and then goes away. It can be a recurring problem for a lot of people, and the best way to deal with it is by preventing it in the first place. As I said before, the best way to prevent it is to have good postural habits, to train your muscles, and to exercise. This is important not only to prevent back pain, but it is especially important for people who have had an episode of back pain or have recurrent episodes of pain, because that’s the best way to stay feeling as well as possible for the longest time.

For my last question, I’m going to ask you, do you a have any fun facts or interesting comments about back pain or the back in general?

I don’t know how fun these facts are, but I can tell you that there are 33 vertebrae in your spine and four of them fuse to form the tailbone and five of them fuse to form the sacrum, which is the triangular bone that sits between the two hip bones just above the tailbone. Then as adults we are left with 24 movable segments in the spine. The joints in the spine which are formed where each of the bones or vertebrae come together, each of them doesn’t have a lot of motion, but when you combine the motion of all 24 moveable segments we can bend over and touch our toes - or at least most of us can - and twist around to look behind you and do all these different activities because the joints in your back are moving. If some of them get restricted in motion, that’s what we call having a vertebra out of place. It doesn’t really go out of place but it sometimes feels like it’s out. What chiropractors do by adjusting or manipulating the spine is help to restore the normal motion in the joint. The popping isn’t because the bone is out and the doctor is popping it back in. The popping noise comes because of an exchange of gas and fluid inside the joint itself.

How many discs are there?

If I’m counting correctly there are 23 discs. You’d think there would be 24 or 25 even because each vertebra would have a disc above and below but there is no disc above the top vertebra in the neck and there is no disc between the first and second vertebra in the neck.

Many people like to crack their knuckles. It is a bad habit with many people. Is it bad to crack your knuckles, or just loud?

Contrary to what a lot of people believe, cracking you knuckles is not really harmful. You are making popping noises because of the exchange of the gas and fluid within the joints, which are what knuckles are, and you are probably stretching the ligaments that help to hold the bones together at the joints. But, overall, there is really no harm in this.

On the other hand, it is harmful to pop your back or pop your neck yourself. You see people cracking their neck and that is not a good habit at all. The joints in the spine are somewhat different from the joints in the fingers because they are weightbearing structures. The joints and bones in the neck, for example, have to hold up the weight of the head, and the bones in your spine have to hold up the rest of your body and hold everything together. When you start popping these joints repeatedly you stretch the ligaments and that makes the muscles have to work harder and harder to keep the joints and bones stable. When the muscles are working harder they get tight and then your neck feels tense and you feel like you need to pop your neck again. So it is a vicious cycle. It just gets worse and worse.

Do you know any good chiropractic jokes having to do with pop, pop, pop?

I don’t’ know how good these jokes are but I know a few.

What’s a chiropractor’s favorite cereal?

Rice Krispies?

Well, no, Captain Crunch.

How many chiropractors does it take to screw in a light bulb?

I don’t know.

Never let a chiropractor screw in a light bulb. He’ll twist it ‘til it pops.

Why is a chiropractor like a comedian?

Because he’s always cracking people up.

Oh, you knew that one already!