Frequently Asked Questions
What are the symptoms of a back injury?
Back injuries tend to peak between the ages of 35 and 45 in people who are still active but less fit. The injury can manifest itself in a variety of ways, and most often affects the lower back. A back problem can present as a dull ache or an excruciating stab, shooting pain or tenderness to the touch. There may be stiffness and pain in the lower back, or a person may experience pain and/or numbness radiating from the back, down into the legs.
One person may endure back discomfort all day, while another may feel fine in the morning and start to ache as the day progresses. Some people find their backs hurt more in certain positions, such as when they are bending, sitting for a prolonged period, or walking.
What causes back pain?
Four out of five of us will experience back pain at some point in our lives. Poor body mechanics (e.g. bending at the waist when lifting) is a common contributor to many types of back pain. Sitting for prolonged periods can also put excessive pressure on the spine that results in injury.
A number of people hurt their backs on the job. Any occupation that involves frequent bending, lifting, reaching, sitting, standing or repetitive motion could make you vulnerable to an injury if you are not fit and not practicing proper lifting mechanics. In the home, lifting children or other heavy loads repeatedly or improperly can cause an injury.
While many people blame their back distress on one slip, twist or heavy load, the pain is often an accumulation of years of faulty movements and small irritations to the spine. Poor flexibility and lack of control fitness can also be a major contributor to back pain.
What should I do when my back hurts?
Avoid activities that could aggravate your back further. While your inclination may be to take to your bed, however, the latest research indicates that continuing to be active can enhance recovery from back pain. Bed rest and inactivity for more than one or two days may actually be harmful, because you lose strength, flexibility and endurance.
Try these first-aid remedies at the first sign of pain:
- Maintain physical activity, but be careful to avoid any movements which produce aggravated pain in the back.
- Take over-the-counter pain anti-inflammatory medication.
- Apply ice on the back for 15 to 20 minutes at a time, three to five times a day, to reduce swelling, inflammation and soreness.
- Pursue low-impact exercise like walking or water aerobics.
- When sleeping, find a comfortable position (perhaps on your side, with a pillow between the knees) and try to maintain it.
When should I see a doctor about the pain?
In 90 percent of people with acute lower-back pain, the symptoms disappear on their own within a few weeks. Your doctor may be able to recommend specific interventions to accelerate your recovery and may suggest measures to prevent recurrence of the injury.
If your pain doesn't subside in four or five days after following the recommendations above, you should call your physician. Also, call your doctor immediately if you have pain radiating down a leg, difficulty using limbs or raising toes, weakness in the ankle, inability to stand straight, loss of bladder or bowel control, leg numbness or tingling, loss of male erectile function, or pain accompanied by an infection and high fever. While rare, back pain can be a sign of other, more serious conditions, so pain that is not improving should be brought to the attention of a physician.
Your primary care physician may prescribe medication or a home exercise program, or refer you to a physical therapist for more intensive treatment. In situations where the back pain is not responding well, you may also be referred to someone with more specialized training in back care, such as a sports medicine specialist, a physiatrist, a pain management specialist, or a spine surgeon.
Will I need to undergo tests?
Your physician may be able to diagnose the cause of your pain simply by taking a careful medical history and performing a thorough physical exam. The physician may ask questions about your lifestyle and occupation, assess your movement patterns and posture, and determine what you were doing when the pain originated. For acute back pain, X-rays and diagnostic studies are not often helpful unless a serious accident or neurological problem has occurred. If a disc injury is suspected, your physician may order a magnetic resonance imaging (MRI) test if your pain is not improving as expected.
What kind of treatment is available for back pain?
Your physician may recommend that you see a physical therapist or certified athletic trainer to start you on an exercise regimen to accelerate your healing and prevent further injuries. Once the acute pain has diminished, a regimen of stretching, strengthening and stabilization exercises is critical to prevent a future injury.
Those with persistent pain may find relief with injections of cortisone or nerve-blocking anesthetics. A small percentage of back problems require surgery.
With treatment of acute pain, you should notice some improvement after two weeks. If not, modify your treatment plan or consider another therapy. After four weeks without progress, diagnostic tests may be indicated. Keep in mind that back injuries require dedicated time and effort to fully heal. With proper care and patience, most people will recover. The key to successful treatment is good communication between the patient, the physician, the therapist, and any consultants who are involved.
Will the pain come back?
If you simply ride out the pain and do not change the bad habits that led to the injury, the problem is likely to recur. Prevention is the cornerstone of back care, because once you've had a back problem, you're four times as likely to experience future back difficulties.
How can I prevent another back injury?
- Condition and strengthen your leg and abdominal muscles to give your back greater support and flexibility. Exercises which strengthen your trunk and lower extremities build support of the spine, which can deter strains and tears.
- Learn to move safely. Bend your knees when lifting, never your waist or back. Also, hold objects close to your waist, and pivot, rather than twist, when moving. Step closer or use a stool instead of reaching away from your body. If you're performing a task that requires repetitive motion, take breaks at appropriate intervals.
- Assess your work place in terms of tasks performed and your work station. Your chair should have good lower back support if you’re sitting a lot. Always stretch and shift positions if you're sitting or standing all day. Set up your work station – phone, computer, files, etc. – so movements are minimized from your head, neck, arms and shoulders. You shouldn't have to hunch forward to your work surface.
- Maintain a good body weight. Carrying excess weight, especially around the abdomen, strains muscles and can put undue stress on the spine.
- Learn relaxation techniques. Emotional stress causes back muscles to tense, which may results in painful spasms.
- Wear comfortable footwear. Heels higher than 1.5 inches throw the pelvis forward and can hurt your back. Your shoes should also have good arch support and cushioning.
About 75 percent of Americans have foot problems at some point during their lives. A complex structure of 26 bones, 40 joints, and an intricate maze of tendons, muscles, and ligaments, the average foot endures remarkable stresses throughout a lifetime. Yet, as much as we use our feet, we often take them for granted.
Although most foot problems are not life threatening, their presence can spoil many of life's enjoyable activities.
What are the common foot problems?
Many foot problems can be corrected by modifying shoes, by medication, or through a simple procedure to relieve pain and suffering. Some common foot problems are listed below.
Bunions are swellings or enlargements that develop at the joint of the big toe where it meets the foot. Women develop bunions about 10 times as often as men, and the prevalence of bunions increases with age. Left untreated, bunions may lead to bursitis (inflammation of the sac that cushions the joint), pressure and foot pain. Changing the type of shoe to accommodate the bunion will usually reduce pain. If this doesn't work, surgery may help.
- Corns and calluses
Thickened and hardened patches of dead skin cells, these cause pain as they transmit pressure to the bones of the feet. Corns usually develop on the toes, while calluses are more likely to occur on the soles.
People with diabetes are particularly prone to foot problems because of nerve damage associated with the disease. Pressure sores or infections often occur in people with diabetes. Because diabetes may impair the sense of feeling in the feet, people with this illness need to be particularly vigilant about foot care. Sores and infections may take much longer to heal, so any cuts should receive immediate medical attention.
- Fallen arches (flat feet)
This is a condition in which the arch of the foot has dropped, causing muscle fatigue and aching, pain or stiffness in the feet, legs and lower back. Custom-designed orthotics may be prescribed to alleviate the problem. Sometimes, surgery is indicated.
- Fungal and bacterial conditions
Athlete's foot and similar conditions can cause redness, peeling, blisters and itching of the skin. If not treated promptly, these can become chronic and difficult to cure.
A hammertoe is a painful deformation of the toe joint in which the toe curls downward, resembling a claw. Pain occurs on the top of the middle joint of the toe. Roomier shoes, splints, exercises and orthotic devices can alleviate pain. In more severe cases, surgery can provide relief.
- Heel pain
Pain occurring around the heel can often be attributed to nerve compression or inflammation of the tissues attached to the heel bone. Wearing well-fitted shoes, using orthotic devices or casts, stretching exercises, prescribed medications and, in severe cases, surgery, are all methods used to correct this problem.
- Ingrown toenails
The result of poor trimming of the nails or pressure from a nail deformity, ingrown toenails can cause infection and disabling pain. Once infected, they require medical attention.
- Morton's neuroma
This condition is the inflammation of a nerve in the ball of the foot. Pain sometimes extends toward the tip of the toe or to the ankle and lower leg. Your doctor may suggest roomier shoes, shoe pads, or cortisone injections. If these treatments don't work, surgery may be recommended.
- Ankle sprains
Patients can frequently injure the ligaments of their ankles with simple twisting injuries. About 23,000 ankle sprains occur daily in the United States. Most of these improve by themselves when treated with rest, ice compression and elevation. Some patients will need to see their physician for additional treatment, bracing or a physical therapy prescription. Sometimes, patients with chronic ankle sprains, or pain which does not improve with physical therapy or conservative treatment, may require operative intervention. This may incorporate arthroscopic procedures
or open procedures.
- Arthritis of the foot and ankle
Arthritis can affect any joint of the foot and ankle just as it affects the larger joints throughout the body. Forms of arthritis include inherited, traumatic, overuse and inflammatory. These can be treated with medication, modified shoe wear and physical therapy. Arthritic conditions of the foot and ankle may require operative intervention involving arthrodesis, also known as fusion, in which joints are screwed together. Arthrodesis is often performed to relieve pain and improve function. Ankle replacement surgery is a new and potentially promising form of therapy for patients with ankle arthritis.
- Plantar warts
These are viral skin infections found on the soles of the feet. Plantar warts require medical attention.
Who treats foot problems?
Orthopaedic surgeons are medical doctors who have received additional, specialized training to treat the bony structures of the body. You should see an orthopaedic surgeon to treat more complex foot and ankle problems. Orthopaedic surgeons specialize in Foot and Ankle Surgery. Doctors of podiatric medicine, or podiatrists, are medically trained specialists who diagnose and treat problems and diseases of the foot, ankle and lower extremities. They are recognized legally and professionally as full members of the health care team. Podiatrists can correct most minor foot and ankle problems.
May family members stay overnight?
Our hospital rooms are not designed to accommodate visitors overnight. Family members that wish to stay locally can make arrangements to stay at one of the area hotels. Visit www.jeff ersonhospital.org or call 215-955-7777 for more information. The Martin building on the corner of 11th & Walnut Street has rooms available at a special “Jefferson Rate.” Please call 215-955-6479 to make arrangements. Exceptions have been made in the event a patient is a minor or acutely ill. In the event you do stay, an overnight pass must be obtained and filled out by your nurse, and approved by Security. Please ask to speak to the orthopedic charge nurse if you have any questions.
When may family/visitors see the patient after surgery?
Patients assigned to the orthopedic units in the Thompson or Pavilion buildings may await their loved ones in their assigned rooms. Patients that are assigned rooms in the Gibbon building should verify through the receptionist in the surgical family waiting area that the room is indeed available before proceeding to the floor. After the procedure it may take anywhere from 2 to 6 hours for patients to arrive on the orthopedic unit. The recovery time for each individual is different and is oft en dependent upon their response to anesthesia and pain medications. Once your loved one arrives in their room please step out of the room momentarily so that the staff members can make their initial assessment and make your family member comfortable.
May I take my own medications?
Never take your own medication(s) while you are a patient in the hospital unless you are requested to do so by your nurse. You may have been told to bring your medication(s) to the hospital in the event that our pharmacy does not stock them. Once it is verified that we do carry your specific medication(s), your medication(s) will be returned to you. We ask that you please have a family member then take these medication(s) home.
How long will I be in the hospital?
Your length of stay is dependent upon your medical status and how well you’re progressing with your physical therapy. On average, patients spend about 2 to 3 days on the orthopedic unit aft er joint replacement surgery, and from 1 to 3 days after spine surgery.
Where will I go after surgery?
Our goal is for all patients to go home after surgery but some patients may require a short inpatient stay in an approved rehabilitation center prior to going home. Arrangements for rehab are provided by an assigned Case Manager that will contact you aft er a Physical Therapist has completed their evaluation. Once discharged from Jefferson, the rehab facility is responsible for all aspects of your care and discharge to home. If you incur an issue while at the rehab facility please bring it to the attention of the supervisor there so that they may have an opportunity to resolve it.
When may I eat?
Joint replacement patients receive clear liquids postoperatively and for breakfast the day after surgery. On the first day after surgery you will receive a regular tray for lunch. If you've had spinal surgery your ability to eat is dependent upon the return of bowel function. If you require a special diet, i.e. diabetic, cardiac, an appropriate meal will be provided.
What if I have to move my bowels?
Typically patients will not move their bowels for one to two days after surgery due to decreased bowel function that often accompanies anesthesia. We will provide stool softeners and assist you to use a bedpan or commode if necessary. Patients that have had spine surgery are not to utilize bedpans.
When may I shower?
Patients may shower once their dressing has been removed and your registered nurse verifies that you may do safely (usually 24 to 48 hours after surgery).
What is Coumadin?
Coumadin is a blood thinner used to prevent blood clots. Most joint replacement patients will be instructed to take Coumadin for 4 to 6 weeks aft er surgery. It is necessary to obtain blood samples daily (while you're in the hospital) to regulate your Coumadin dose. Once you are to home, arrangements will be made to have blood specimens drawn and a physician who monitors the results will adjust your Coumadin dose accordingly.
How often will I receive physical therapy?
You will receive an initial evaluation the day after surgery. For the next two to three days a therapist will see you twice a day. Patients scheduled to go home will be seen by an occupational therapist to review dressing and bathing. Your nurse can mobilize you and this activity is also considered to be physical therapy. Typically, hip replacement patients can get (out of bed to a chair) the day of surgery with the assistance of a nurse or therapist. Knee replacement patients are generally able to get out of bed the day after their surgery.
Where do I get the equipment I need?
Patients who are going home will receive equipment from the physical therapist. Typically, insurance companies only cover one device (walkers, canes, crutches). The occupational therapist can provide devices to assist you with bathing and dressing. Patients discharged to home after a rehab stay will receive equipment from the rehab facility based upon their evaluation.
Will I be able to use stairs in my home?
Your physical therapist will ensure that you can successfully navigate stairs prior to your discharge home. You will find that your endurance will improve once at home but it would be beneficial to have someone available to assist you for the first few days after discharge.
How do I get to the rehab facility?
Transportation can be provided by ambulance, wheelchair van or in a private vehicle. The method that is best for you is dependent upon the procedure you've had and your insurance. If you wish to verify insurance coverage you may contact your insurance company's member services and ask about nonemergency ambulance coverage. Medicare recipients do not have ambulance coverage (with few exceptions). Your social worker will discuss this information with you in more detail.