By Tatum Wilson McCain, MSPT
Brace yourself. Almost 80% of people suffer from back pain at some point in their lives. Fortunately, most back pain can be treated with basic treatment programs and a little common sense. But beware of relying too heavily on painkillers to fight off an attack of back pain. While there are many conditions that can be treated through exercise and core strengthening, it is also important to note that in some cases, it may be appropriate to refer patients to a spine surgeon, if your facility does not have one in-house.
For those suffering from back pain—no matter what the cause—a physical therapist's advice to start moving again may seem cruel and aggressive. But studies have shown that activity is best for those suffering acute back pain. The "olden time" treatments of bed rest and limited mobility actually serve only to prolong patients' pain and, in some cases, cause additional problems like muscle atrophy. After days of inactivity, muscles weaken and become less flexible, making movement more and more painful. This makes recovery even more difficult and can make a therapist's work even more time-consuming.
AVOIDING BACK SURGERY Not all back conditions require back surgery. Many patients recovering from an injury or dealing with spinal stenosis or degenerative disc disease require a strong body core to support the back and reduce discomfort.
Through manipulations, various treatments, and patient exercises, the therapist may be able to relieve pressure on nerves causing pain, as well as strengthen the body core to provide increased support. But treatment does not end in the therapist's office. Encourage patients to take treatment into their own hands as well as continuing proper body mechanics at home, and making smart choices that will further their recovery.
The stability ball is a popular tool for patients to use to help strengthen their core. Specific examples of exercises performed with a stability ball include abdominal crunches, ball squats, bridges, and tabletops. The ball is a great way to provide dynamic stabilization and make it fun for patients to work out.
Weight machines are also great for overall body strengthening and conditioning. Emphasis is usually placed on lower weights and higher repetitions. It is important to be careful with overhead weights, as they can compress the spine by loading more weight onto the body. Proper form and technique are encouraged for any patient with a weight-training program.
Other popular exercises for the back include Pilates and yoga. The exercises involved also help with core strengthening. It is important to modify positions accordingly for patients with neck or back problems. A key exercise in Pilates and yoga includes activation of the transversus abdominis. To activate the transversus abdominis, lie on your back with your knees bent. Take a deep breath in, and as you let all of the air out, draw your belly button down toward the mat. Hold this position for 5 to 10 seconds and keep the pelvis steady.
Are you treating a patient suffering from back pain? Offer these self-treatment tips:
"BACK ATTACK"….JUST WAITING TO HAPPEN? Is the patient middle aged? Do they have a job? If so, then they are at high risk for a back attack. Back pain affects all demographic and occupational groups—some more than others—but most people are at risk for back pain between 35 and 55, prime working age. Men and women seem to experience back pain in equal percentages, but there is some indication that women are at a greater risk for lower back pain after menopause. And back pain is a side effect of pregnancy for many women as well.
For some, back pain is not too serious, while others find that it does affect their quality of life and ability to work and play, even reducing their capacity to work and earn a living. There are a number of factors that may place a person at higher risk for back pain and potential injury, most commonly, cigarette smoking, being overweight, poor work habits, and lack of ergonomic work situations. Physical fitness is not a predictor of risk for lower back pain; however, physically fit people are likely to recover from pain more quickly. Also, those who have previously experienced back pain are more likely to have it again at some point in their lives. Therefore, prevention is key. When your back hurts, it seems like every move you make is torture. If your patients are looking for relief, offer these tips:
POSTSURGICAL TREATMENT OPTIONS A ruptured or herniated disc is probably the most common, serious source of back pain. It can be a result of traumatic injury, but is more often the result of degeneration. The disc resembles a jelly donut. When the pressure becomes too great, the outer edges weaken and allow the jelly to ooze out. People with ruptured discs often complain of leg and hip pain because the jelly-like material touches and presses on nerves that send messages to the leg.
A herniated disc also can cause tingling and pain in the foot. This is normally corrected by removing the disc material that affects the nerve. Although re--covery from this surgery may require 3 weeks to 3 months, most people—depending on job and lifestyle—return to normal activities and are not restricted in any way.
After many kinds of back surgery, patients are usually faced with several common conditions, including pain sensitivity, decreased flexibility, structural or functional changes, a reduction in endurance, altered body mechanics, and postural changes. Some patients may even experience psychological changes or depression.
Successful lumbar surgery rehabilitation is dependent on cooperation between the therapist, the patient, and the surgeon. It is critical for any postsurgical therapy program to include neuromuscular reeducation and core muscle strength training. As core strength is rebuilt, the therapist should then begin to focus on increasing flexibility, muscular strength, endurance, and coordination in the postsurgical patient.
KEY PLAYER Physical therapists play a key role in the treatment of back and neck pain. They work closely with physicians to develop treatment plans unique to each patient's specific needs; physical therapists provide invaluable assistance to both surgical and nonsurgical patients by working one-on-one and in small groups.
No matter what spinal dysfunction disorder a patient may have, a physical therapist should carefully evaluate each patient, examining complaints of pain, strength (or lack thereof), range of motion, coordination, and balance. Regardless the problem you are treating, it is always important to recommend several key treatments to each patient, including:
Overall, education is the most important part of any treatment plan. Teach patients good posture, how to move correctly, how to best perform daily activities like lifting and bending, and how to deal with limitations. Patients assume responsibility for continuing their own exercise and therapy programs by learning techniques they can do at home or at the gym.
Tatum Wilson McCain, MSPT, is a staff physical therapist at the Texas Back Institute, Plano, Tex.
