Health Blog

Put An End To Back Pain

Physical therapy often offers best path to relief.

Back PainAlmost all of us at some point have incurred a musculoskeletal injury that has slowed us down and kept us out of the game. If the statistics hold true, 80 percent of you reading this article will experience some sort of low back pain that will require medical intervention during your lifetime.

The total cost of musculoskeletal injuries to America’s health care system has beenestimated at $14 billion per year, with low back pain accounting for a large percentageof that total. The cost is not only in medical expenses but also in time loss, decreased productivity, and co-morbidities associated with chronicity. Many of the changes in health care that cut costs involve “pathways” to care—meaning getting you to the right practitioner at the right time using the least intervention to solve your problem.
For almost all musculoskeletal issues, including back pain, a physical therapist should be the first medical professional you see. In a now classic study done with Virginia Mason and Aetna, workers for Starbucks who complained of back pain were triaged to a physical therapist for their first medical appointment. Many times thephysical therapist not only treated the patient quickly and with minimal intervention but also produced better results. During this study, the cost savings were approximately $11 million, much of that from the avoidance of unnecessary imaging.

It can be powerfully argued that seeing a physical therapist first for musculoskeletal issues is one way to save our health care dollars.

Normal pain
When you see a physical therapist, what will they do? For starters, they’ll assess theissue and request further testing or consultation if needed. They’ll also:

  • Give you a treatment plan and an exercise regimen to help you regain your
  • function and reduce your pain;
  • Guide you through the process of healing; and
  • Educate you on posture and prevention.

The fact of the matter is that low back pain and musculoskeletal issues are normal parts of an active life. If I were to take an MRI of all of the WAC members who work out on the 4th Floor and don’t complain of low back pain, I expect a quarter of them would have a herniated or bulging disc. This sort of anatomical deformity is normal. It’s not always necessarily degeneration as much as it’s a natural maturation of the system. (Yes, that means getting old.)

The overriding message for those with low back pain and any musculoskeletal injury is to stay active. Several comprehensive literature reviews have been advocating this for many years. During the acute stage of an injury—the first three days—it’s typically best to keep moving and mobilize yourself within your comfort zone. The worst thing you can do is sanction yourself to bed rest. This, however, does not speak to a serious situation where you have loss of sensation or strength in your limbs.

Most low back stiffness or spasms are due to a disc event of some kind, such as a strain, bulge or herniation. These events are self-limiting and will usually last for three to seven days. Typically, a patient will describe bending forward and twisting—then feeling a pain or a pop. They will not feel particularly injured but will have difficulty getting out of bed the next morning.

What actually happens here is the outer portion of the lumbar disc, called the
annulus fibrosus, tears a bit and creates a pathway for chemicals in the inner portion, the nucleus pulposus, to leak into the body. These chemicals, called glycosaminoglycans, are very irritating to the tissue outside the disc and cause pain and swelling.

The disc repairs itself quickly as the chemicals that were released dissipate. It’s very important to get active as quickly as you can after this stage of healing, return to your normal activity, and stay consistent. It also may be time to focus on core exercises, weight management, and nutrition as part of your recovery. If symptoms persist or you feel stuck in your recovery, you should seek advice from a medical professional. That could be a general practitioner, a rehabilitation specialist, or a physical therapist.

A state of therapy
In Washington state you have direct access to any physical therapist. Many insurance plans don’t even require a referral. This often means you can see a physical therapist faster and in turn experience a quicker recovery.

So what do you do if an injury such as low back pain is keeping you down? First,
modify your routine but stay active, ice yourself, and take anti-inflammatories as you feel necessary. Second, return to your normal activity and see if you can get back to 100 percent within a week. Third, if you are having trouble getting back to your previous functional level, seek medical care, preferably from a physical therapist.

We’re here to help. Persistent pain shouldn’t be a part of life.

Follow these tips when you experience a back injury:

  • Walk distances that don’t increase your pain.
  • Use ice for pain relief. Five to 10 minutes on the area of pain at a time, several times a day.
  • Be careful with your sitting posture.
  • Stand up slowly from a sitting position.
  • Use a pillow to prop up your knees when sleeping on your back. Place the pillow between your legs when sleeping on your side.
  • Seek medical advice.

Originally published in the Washington Athletic Club Magazine, August 2013

Stuart Eivers, PT, DPT, OCS, FAAOMPT
Physical Therapist
MTI Physical Therapy – WAC