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I've Got Your Back

Posted by DietDetective on Sep 28, 2007 1:21:00 PM

I thought it would be interesting to ask a back surgeon a few questions about fitness, weight control and back problems. I contacted famed NYC Dr. Nathaniel L. Tindel. He received his medical degree from the University of Pennsylvania School of Medicine and completed his residency at Lenox Hill Hospital. He is a Board Certified Orthopaedic Surgeon who practices in New York City and Long Island. Dr. Tindel is affiliated with Lenox Hill Hospital and is an assistant professor of orthopaedic surgery at The Albert Einstein College of Medicine and chief of spinal surgery, at the Jacobi Medical Center. From 2001-2006, Dr. Tindel was the Director of the Spine Service in the Department of Orthopaedics Surgery at the Montefiore Medical Center. He has been honored by New York Magazine as a top doctor in the New York metropolitan area.


He is the Director of the New York Center for Spinal Disorders that offers comprehensive evaluation and treatment for all back and neck problems including back and/or neck pain, scoliosis, back related trauma, fractures, deformity, infection, cancer, osteoporosis, sciatica. (


Dr. Tindel's first book I've Got Your Back: The Truth about Spine Surgery Straight for a Surgeon was published in January 2007 by New American Library and is entering its second printing. The book is designed to help patients make the match between a particular back problem and the treatment option most likely to work for them.


Name: Nathaniel Tindel, M.D.


Your Location: New York City





Diet Detective: Hello and thanks for agreeing to do this interview! Back pain is a big problem for many of us. What was the biggest surprise you found in about back pain and a person' weight (aside from the obvious of carrying around more weight)?



Dr. Tindel: Despite many scientific studies looking at people who have back pain and a person's weight, the question of causality has not been conclusively established. Intuitively, many people assume that the evidence is clear, but it's not. That doesn't mean that there isn't a link between the two, just that researchers haven't found it, yet. A literature review of 65 of the best studies addressing the link between body mass index and back pain concluded that body weight can only be considered a possible weak risk factor for back pain, and the lack of good quality research precludes further commentary. What surprises me most about this important question (and I get asked by several patients every day) is how little high-quality scientific research has been conducted in this very important area and that we haven't figured out the answer.



Diet Detective: Is your weight one of the major contributors to someone having back pain, or is it just one of many contributory factors? And will weight loss "heal" or stop the back pain?



![!Dr]. Tindel: Scientifically, as I mentioned above, body weight can only be considered to have a weak link to back pain. But you asked an important second question that has been given some attention recently. Namely, if you are overweight and you DO have back pain, does weight loss help the back pain? With the rise of bariatric surgery, several researchers have looked at this and found that if you do have back pain and you do lose weight then there is a good chance the back pain will get better (but not necessarily "cure" it) but more importantly, that your overall functionality will improve, as well. So my answer is that if you do have weight issues and you also have back pain, losing weight may be of benefit for the back problem.



Diet Detective: How and why is your posture so important? Is there anything someone reading this can do other than "stand up strait" to help his or her posture? Something failsafe?



Dr. Tindel: Posture is important but constantly nagging for someone to "stand-up straight" doesn't seem to work. If you have ever asked someone to "stand-up straight" (whose mother hasn't told their child this?) you've probably noticed that it works for about 15 seconds, and then they go back to their natural position. I frequently get asked by the mom's of my adolescent scoliosis patients to tell them to "stand up straight." To the mom's dismay, I always take the side of the adolescent. We are all packaged differently and we all have different postures that are uniquely balanced and in equilibrium with our bodies. This is not to say that sitting posture and posture while walking and doing sports and physical activities isn't important: it is! It's just that everyday standing posture is so unique that it's almost impossible to change.



Diet Detective: What's your number one back suggestion for active people?



Dr. Tindel: Exercise in moderation and keep it going! Aerobic condition is the best for the back and it's also good for the heart and lungs.



Diet Detective: I often hear Doctors recommending physical activity to help alleviate back pain, but it seems that those that are physically active constantly have aches and pains - especially the back. Can you comment and offer a few (non-obvious) advice?



Dr. Tindel: There is a big difference between having a chronic or intermittent back problem (whatever that might be) and having a little muscle ache after a work-out. Either way, if the problem persists, it should be evaluated. I've found that even professional athletes can have back pain because of improper technique and with the right coaching have cured their pain. You can start with your trainer and if that doesn't work, consider a physical therapist that specializes in sports medicine. I can't stress enough, though, that if your pain continues or gets worse, you should seek medical advice.



Diet Detective: If someone is physically active what are some things they can do to prevent back pain, assuming they already have it? Also, I've read research that shows that stretching doesn't not prevent injury, so is there anything we should be doing to prevent injury or re-injury?



Dr. Tindel: Being physically active is the best advice we give patients with back pain. But being "active" doesn't mean you are doing the right activities that have been shown to make the back stronger. Weight-lifting, per se, is very physically active, but hasn't been shown to help back pain. What works best is low-to-moderate aerobic activity. Walking, swimming, biking, hiking and yoga all are good examples.


The advice on stretching has gone full circle. What we know for sure is that it's good to stretch, at least a little and that overstretching is worse than not stretching at all. If someone is re-injuring themselves, it's worth taking a close look at their exercise strategy with a trainer or physical therapist. Often times, it's a simple solution.



Diet Detective: I used to enjoy getting massaged regularly-especially for my neck and back, however, it started to hurt more than help. I know the therapist was good and well trained-are there certain situations where massage is not recommended?



Dr. Tindel: Everyone loves a massage and I'm included. But, aside from a short-lived stress reduction and feel-good experience, there is no lasting effect of massage for back pain. Rarely, patients report worsening symptoms with a very aggressive massage, but that is not common. Overall, I recommend massage, but not as an alternative to exercise and re-conditioning.



Diet Detective: For those weekend or part-time athletes, are they at an increased risk for back injury / pain? Any suggestions (other than to your doctor.. J)



Dr. Tindel: Weekend or part-time athletes are at increased risk for back pain and a whole host of other joint and bone injuries including knee injuries, stress fractures, tendonitis, muscle strains and ligament injuries, to name a few. Instead of doing a few "hard" work-outs during the weekend, it's better to do a couple of easier ones, spread out over the week.



Diet Detective: I've heard that you should "work through" and continue being active if you have pain or injury. Does staying active help?



Dr. Tindel: Staying active is the most important message I tell my patients but "working through" the pain is a different story. Pain is very subjective so how one person experiences pain may be entirely different from another's experience. "Working through" the pain is a very individual experience and I don't generally advise it. More importantly, if you find yourself continually doing so, your pain should be evaluated by a medical professional.



Diet Detective: What about yoga in terms of back pain? It seems obvious that it's helpful, but can it hurt you? When shouldn't you be doing yoga or Pilates?



Dr. Tindel: Yoga and Pilates are two great ways to stay fit and they are at the top of my list for anyone, with or without back problems. The only downside that I come across is that many people unfamiliar with these type of activities do not realize how strenuous they are and how important a good instructor can be. I'm always happy when a patient of mine tells me they are doing this type of activity.



Diet Detective: Okay, enough of the medical stuff. I would like to ask you a few personal questions. If you could eat one forbidden or unhealthy food whenever you wanted without gaining weight, what would it be?



Dr. Tindel: Ice cream



Diet Detective: If there were one healthy food item (something you love) that you had to eat every day, what would it be?



Dr. Tindel: Bananas



Diet Detective: What's your favorite breakfast?



Dr. Tindel: Cupcakes



Diet Detective: Do you have a pet?



Dr. Tindel: Yes, a mixed-breed rescue dog names Sally.



Diet Detective: Last book read?



Dr. Tindel: The Master and Margarita



Diet Detective: What did you want to be at the age of 5? (as far as a career)?



Dr. Tindel: A brain surgeon



Diet Detective: What was your worst summer job?



Dr. Tindel: Fortunately, I loved all of my summer jobs, from fixing pools and being a life guard to summer camp counselor.



*Thank you!!!! *



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