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Get Your Back on Track

August 24, 2014

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According to a recent survey conducted by the American physical therapy Association, nearly 70% of Americans experience back pain, but 37% of these do not seek professional help. More than one third of adults say low back pain has affected their ability to perform everyday activities, exercise sleep, or engage in intimacy with a significant other. Of those surveyed, 72% say they have managed or temporarily relieved their back pain symptoms with treatment.There are multiple causes of lower back pain, many of which are not serious, but can cause significant discomfort. Low back pain may also be a result of osteoarthritis of the spine, or a bulging or herniated disc. Your spine is made up of 33 vertebrae stacked upon one another and separated by a piece of cartilage, known as an inter-vertebral disc. The disc acts as a cushion, with a rubbery outer portion (annulus) and a more gelatinous inner portion( nucleus). As we age, our discs begin to lose some molecules which attract water and nutrients into the disc. In some, the nucleus can push outwards towards the exterior and lead to a herniation.

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Who is at risk for developing a herniated disc? The most common risk factors associated with disc pathology include age, obesity, smoking, occupation, and low levels of physical activity. Most herniated discs occur between the ages of 30 through 50 as the disc degenerates. After age 50, the low level of fluid in the disc decreases the risk of herniation. During this time, the outer layers of the disc weaken, but the nucleus maintains its more gelatinous state. The bar graph below shows how your different daily positions affect pressure on your lower back. Adults with jobs that are more physically demanding, particularly those that involve repetitive tasks such as pushing, lifting, pulling and twisting also increase the risk of developing a herniated disc due to additional stress on the disc. People who are less physically active and those who may have less strength and stability, are also prone to developing herniated discs due to their inability to handle physical demands for certain activities.

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If your back hurts, how do you know if it is something serious? What exactly does a herniated disc feel like? First of all, there are some “red flags” to be aware of when assessing your low back pain. Such red flags include night pain unresolved with rest or medication, fever/chills, unremitting or throbbing pain, changes in bowel or bladder function, or pain not alleviated with positional changes. If you are experiencing any of these symptoms, it is best to discuss your pain with your physician prior to seeking physical therapy. If your disc is herniated, a portion of the disc will push outside of its normal boundaries and press upon spinal nerves or even the spinal cord. In this instance, you may experience symptoms of “radiculopathy”, or pain. Some adults experience numbness without a loss of sensation or significant weakness of the leg(s). Surprisingly, in situations where the amount of damage to the nerve is not that severe, the disc can heal itself over time with proper conservative care. A diagnosis of disc injury or disc disease shouldn’t be looked at as a catastrophic event. Disc symptoms are often exacerbated by activities or positions such as sitting, bending, or reaching. Pain may also appear to be more pronounced upon waking, or after you’ve been inactive for a long period of time.

So if you think you may have a disc bulge or disc herniation, is it time to go under the knife? Not necessarily. Studies have shown that up to 60% of patients who do NOT have symptoms, show disc pathology on MRI. Not all discs are alike, and not all disc problems are cause for concern. If you do have symptoms, how can physical therapy help you? Physical therapists are trained to help maintain and improve your everyday functional activities. After assessment, your physical therapist will help by teaching exercises that focus on specific movements to relieve nerve pressure and decrease pain. They will also work with you to improve flexibility and mobility of the joints and muscles that affect the motion of the spine. This can reduce stress on the already weakened disc. Strengthening is also a key component of treatment, designed to increase trunk muscle stability and extremity strength. Therapists are trained in a variety of manual techniques, posture, and movement assessments. They can also use modalities to calm down the nervous system. With an acute problem, ice, traction, electrical stimulation and heat, may offer a sound first aid approach to reduce the pain, and help you become active again. Physical therapists can guide you through the recovery process if you are dealing with a disc problem. More importantly, they can teach you how to prevent or decrease your risk of developing a disc herniation through postural education, proper biomechanics, and maintaining a healthy weight and lifestyle. Watch the link below for a simple core exercise that requires no equipment at all, and is easy to do at home.


Don’t miss out on what you love to do because your back pain is keeping you down. You can seek the help of a physical therapist in 46 states and the District of Columbia without a physician’s prescription. Don’t wait any longer to help get you back on track!

References

1. Fernando de Oliveira R, Liebano RE, Costa L, Rissato L, Costa L. Immediate Effects of Region-Specific and Non-Region-Specific Spinal Manipulative Therapy in Patients with Chorinc Low Back Pain: A Randomized Controlled Trial. Phys Ther. 2013; 93: 1-9. Available at: http://ptjournal.apta.org/content/early/2013/03/20/ptj.20120256. Accessed on October 9, 2013.

2. Wendel E. Most Americans Live with Low Back Pain – and Don’t Seek Treatment. American Physical Therapy Association Website. 2012. Available at ______. Accessed on October 21, 2013.

3. El Barzouhi A, et al. Magnetic resonance imaging in follow-up assessment of sciatica. N Eng J Med 2013;368:999-1007. http://search.proquest.com/docview/1316941106?accountid=41004. Accessed on October 9, 2013.

4. Low Back Pain by the Numbers. Move Forward Physical Therapy. Available at: http://www.moveforwardpt.com/LowBackPain/Infographic/Default.aspx. Accessed on October 9, 2013.

5. Bise C. Physical Therapist’s Guide to Herniated Disk. Move Forward Physical Therapy. Available at: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=79ef56df-780e-4ad0-963f-94364404125a. Accessed on October 10, 2013.

6. Chou R, Qaseem A, Owens D, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society [corrected] [published erratum appears in ANN INTERN MED 2008 Feb 5;148(3):247]. Annals Of Internal Medicine [serial online]. October 2, 2007;147(7):478. Available from: CINAHL Complete, Ipswich, MA. Accessed October 29, 2013.

7. New England Journal of Medicine, 1994, July 14: 331 (2):69-73.