Back and neck injuries and degenerative conditions have the potential to be incredibly debilitating. They affect not just our recreational activities, but our daily lives as well, and can create a lot of fear and anxiety--especially so in people who are used to highly physically active lifestyles.

Back pain is a common problem. In fact, estimates show that 26% of adults in the U.S. have experienced some type of back pain within the past three months, and 2% of all doctors visits concern back pain complaints. While the vast majority of back and neck pain resolves relatively quickly (less than a month), in cases where it continues, people often face frustration and depression--not just with the pain, but with the decreased functional ability. Athletes and those who simply treasure intense physical activity often base a good amount of their identity on being fit and strong.

I’ve been treating back and neck conditions in the clinic for many years, and the most common questions among my highly active patients are, “When can I get back to my training/sport?” and, “Can I do everything I used to do?” While pain is of course a concern, it appears to be less so than in more sedentary people, as athletes are more focused on a return to prior performance.

Dr. David Rogers, an incredibly well trained and passionate physician, offers his insights and experience about recovery from neck and back pain, and getting past pain and dysfunction. In addition to the medical training and experience that he will discuss, Dr. Rogers also has athletic experience himself, with high school football, wrestling, and track, as well as boxing in college.

Dr. Rogers, first of all thank you for taking time out of your busy schedule to talk to the Performance Menu today. We really appreciate it. Can you tell us a bit about your background and how you came into your profession?

Yes, glad to contribute; I’ve actually just come off of a 12-hour day, so it’s been hectic! I attended Harvard both undergraduate and for medical school, residency at UCLA, and fellowships in Orthopedic Spine surgery at UCLA and Saint John's Health Center Spine Institute. Continuing education is very important to me, and I attend conferences at least monthly.

I’m currently in a solo practice here in Glendale, CA, though often consult and co-treat with various colleagues in orthopedic surgery and neurosurgery. I actually started on the path of becoming an orthopedic surgeon very early. I was six years old when I was struck by a car and sustained a left femur fracture. I was fortunate to have had a caring physician who took me through the process and it made a lasting impression.

Do you have different expectations for your patients based on their activity levels and lifestyles? Do have different approaches to how you would develop a treatment plan for the couch potato vs. a person who is highly active in exercise and sports?

Yes, I fully believe in providing a high level of customization in a patient’s care plan. My interview and consultation with a patient is very important, and gives me a sense of where we need to go for that particular patient.

By the time these patients come to me, they are typically experiencing a significant decrease in their quality of life and I often hear the phrase, “I just want to get my life back.”

It’s through the consultation, imaging, and my analysis of their needs that leads us to the best treatment options, whether it’s operative or non-operative. Every situation is going to be different and I need to find the best plan for that individual.

What do you consider the primary indicators for a surgical intervention?

Well, that’s definitely dependent upon a number of factors. Of course, if there is a concern about spinal cord compression along with progressively worsening neurological deficits, these are indications for surgery. (Author’s Note: “Hard” neurological signs include the following symptoms; significant muscle weakness indicating spinal cord nerve root or peripheral nerve damage, sensation loss, bowel/bladder dysfunction, deep tendon reflex loss or heightening.)

In people with pain, surgery may be indicated based on what we find in the imaging and in their history, but that’s a complex decision with a lot of factors.

Do you see patterns for who will have the best prognosis after surgeries?

Yes, absolutely. Generally, the best outcomes are with people that are highly motivated with positive energy. And that also have that in their environment and support system. I often meet with the family and friends of a patient and emphasize appropriate communication and education about the process and what to expect.
Patients that are compliant in the post-care precautions and in their post-operative rehabilitation do the best. I also make sure that they have realistic expectations about what is to occur in each step of the process.

What are the things patients need to avoid (both temporarily and permanently) after a spinal fusion procedure? What are the most helpful things a patient should do after a spinal fusion?

That definitely depends on the details of the particular procedure, its extent and type. Primarily there are the post-operative care precautions that should be followed, and after the fusion itself has healed, it’s very important to follow the physical therapy rehabilitation. (Author’s Note: Spinal fusion procedures can vary: in how many spinal vertebrae are fused together, what type of graft [either from the patient or from a donor,] the particular areas of the vertebrae that the graft will be adhered to with hardware, and whether the intervertebral disc is removed. These factors determine the time required for the fusion to heal and “set” and what type of stresses need to be avoided in both the rehab process and afterwards.)

Strengthening the surrounding muscles is very important, and I generally recommend to patients that they really should be exercising and strengthening these muscles 3 days a week for the rest of their lives.

In regards to a person’s particular sport, further specific rehab is likely needed and I emphasize listening to your body. Once the fusion has healed, you’ll need to figure out how much you can push and when you need to back off, so being very aware and vigilant of that is very important.

Following good body mechanics goes a long way in protecting your spine.

Do you have any parting advice for athletes that are dealing with spinal injuries and conditions?

Yes. I believe that caregivers have a privilege in improving their patient’s quality of life. I have so many patients that “just want their life back” and I work my best to make that happen.

It’s truly a team effort to get someone back; it’s the surgeon plus the postoperative care plus rehab professionals and the patient’s family and friends that combine to create the best outcomes.

Conclusion

Throughout the interview, Dr. Rogers emphasized how important communication and education about the patient’s diagnosis and the chosen treatment plan were in determining how the patient would succeed. He encourages a true open dialogue with patients and their family to make sure that everyone’s expectations about the process and what needs to happen were realistic and in sync. This, along with the person’s total environment (personal mental attitude, friend and familial support, and compliance to all post care and rehab instruction) is the key to success.

It was interesting that instead of speaking of specific movement limitations, he spoke of proper body mechanics and being intuitive about exercise and performance intensity. This instills the importance of proper coaching, which is of obvious importance for performance aspects but also essential for safety--especially for those that have undergone surgical procedures.

Going through back and neck injuries can be an arduous and frustrating process, but keep these insights in mind to help you on your way back to your active lifestyle.