Who has your back?

So often it's taken for granted, this intricate, delicate group of bones called the spine. We use it every day, all day long and really think little of it until suddenly something goes wrong and we are hurting. Your spine is part of the skeletal system, and it needs the muscular system and the nervous system to function well. Without all these systems working in unison, there can be trouble.

Sometimes your back pain is sharp and literally you can't move; other times it's dull and achy, the kind of nagging pain that you can't seem to shake. It may keep you up at night and then other times, it just agitates you all day long.

Back pain can often be associated with psychosocial issues, such as stress at work or home. Stress will often set off back pain. When stress is internalized, it will load up in our body and manifest itself in our musculoskeletal system. Our spine is a prime target, especially if there have been previous episodes of back pain.

According to the Oxford Journal of Rheumatology, there is a 59 percent chance that you will get some type of back pain in your lifetime; most often, it will occur between the ages of 45 to 59. It further stated that most back pain begins to decrease in the first month; however, the majority of people will continue to have symptoms on and off for at least a year, and only 21-25 percent will actually have complete resolution. Back pain that goes on for longer than three months will often have depression as a side effect. This is reason enough for a visit to your doctor, to ensure full resolution as quick as possible.

Risk factors for back pain often are mechanical in nature, such as twisting when loading the washer and dryer, heavy lifting, or repetitive lifting, even if the load is light, due to your back muscles fatiguing and lacking the proper endurance for such tasks. Other risks are more static in nature, such as prolonged work postures - sitting at the computer for hours at a time, prolonged standing as checker at a register, or prolonged walking. There is a tenuous link with obesity, and smoking also increases the likelihood of back pain.

Back history and examination are the medical model in order to obtain a diagnosis. Serious pathology should always be excluded, and it is important to determine if there is a possible inflammatory, neoplastic, and infectious or metabolic problem. Often when mechanical pain has occurred, there is disc prolapse, stenosis or instability. Sciatic pain can sometimes occur, which is where the nerve is actually compressed by mechanical injury, resulting in an inflammatory response and a possible obstruction to the veins, leading to perineural fibrosis. Frequently, there is sacroiliac joint dysfunction; its pain pattern will differ upon examination. Other issues occur when the facet joints are aggravated, which can produce another set of back pain patterns.

As you can see, back pain is complex. It is best to begin with a visit to your doctor, who can screen you to determine if further diagnostic testing is necessary such as X-rays, CAT scans or MRI's. (Imaging is not always indicative of pain patterns, especially with degenerative disc and joint disease. Many people have these degenerative changes and are completely asymptomatic). It is when there is neurological involvement that surgical intervention is often necessary, because prolonged nerve compression may lead to permanent disability.

Once the testing is done, the recommendation is that physical therapy be initiated, and supervised exercise and intensive physical retraining begin. Bed rest is to be avoided and mobility is the key to progress. The patient will be asked to be an "active participant" in the rehabilitation process. This progression is different for each person.

This idea has been studied in research. When this level of commitment from the person with back pain occurs, the rehab outcomes are far greater with less likelihood of long-term issues. That is why physical therapists start with mobility exercises and core strength training and then upon discharge, give a list of home exercises or a gym training regime, such as stretches for mobility (the spine needs rotation) and strength training for muscular endurance.

Your back is something you have to take care of all of your life. It all begins with you, and whether you decide to make it important to you. After all, how did Joe Montana, one of the most celebrated football quarterbacks of all time, return to football after sustaining a possible career ending back injury in the '80s? Well, it was because he made a commitment to rehab following surgery. This included a core trunk stabilization training program where you retrain all the systems to work again together in harmony. It is with this commitment to training the core trunk that your back is kept in top shape for prevention of chronic back problems.

So go ahead and seize the day! Plant your garden, rake your yard, build a firepit, work on your boat engine, climb Canfield with your neighbor and bike the trail with your kids, knowing that your spine is a gift and you need to take care of it. Make a plan to keep it healthy and come see us in physical therapy. We can help.

Carpe Diem!

Sheree DiBiase, PT, is the owner of Lake City Physical Therapy and she and her staff can be reached in Coeur d'Alene at (208) 667-1988 and in the Spokane Valley at (509) 891-2623.