Sprains, Strains and Pains

Staff Writer
Columbus CEO

At some point, an estimated 80 percent of people will experience back pain that limits their daily activities. That amounts to 31 million Americans at any given time.

The good news is this type of pain is usually not caused by serious conditions such as fractures, arthritis or cancer, but is simply due to poor body mechanics. According to the American Chiropractic Association, back pain is the second most common reason for visits to the doctor's office--behind only upper respiratory infections. It's the most common reason for missing work, and Americans spend more than $50 billion a year treating it. Professionals say there are myriad ways to alleviate the pain, heal injuries and avoid ailments in the first place.

Types of Back Pain

Dr. Milan Herceg, a spine surgeon with the Ohio Orthopedic Center of Excellence, says most cases of back pain he sees are due to sprains and strains. "Those injuries often happen when people spent the weekend painting the shed or raking too many leaves," he says. Patients may feel frozen, and although the pain is considerable, the injury is generally minimal. Activity modification and a short course of anti-inflammatory drugs usually do the trick, he says.

Other injuries last longer and can cause chronic pain, Herceg says. Discs act as cushions between vertebral bones, allowing the spine to do its work. Over time or through injury, the discs can sustain damage, press on nerves and cause debilitating pain. Disc herniation often takes people by surprise. Something as simple as a sneeze, a cough or bending over to pick up the newspaper may cause a sudden, stabbing pain. "You sometimes hear people say their back went out," Herceg says. "That's probably disc herniation."

Another condition, called spinal stenosis, is caused by the narrowing of the spinal canal. Bulging discs, bone spurs and thickening of the surrounding ligaments can narrow the canal on three sides, pressing in on nerves and causing pain, numbness and tingling. Herceg says spinal stenosis is something almost everyone will experience to some degree, although the symptoms may not be intense enough to be bothersome. In some cases, it runs in families.

Although degenerative disc disease has a strong genetic component that doctors don't fully understand, they do know there are some ways to lessen the damage, including not smoking. Herceg says nicotine (in cigarettes and smokeless tobacco, but also in nicotine patches and gum) can restrict blood flow to the discs, cutting off valuable nutrition to these essential structures.

Treatment Options

Dr. Donald Rohl, an orthopedic spine surgeon with OrthoNeuro, says surgery is typically the last resort. "In absence of neurological decline, and if patients can tolerate their pain, we recommend conservative treatment including physical therapy and short-term rest," he says.

Two days' bed rest is the maximum, Rohl says. Remaining sedentary for longer does more harm than good. The healing of the ligaments, joints and muscles is helped along by proper exercise, muscle relaxants and anti-inflammatory drugs--sometimes over-the-counter and sometimes physician-prescribed steroids.

"We try to get people into a good program that will maintain quality of life without surgery," Rohl says. "A large percentage will get better without it."

Sometimes, though, it is necessary to go under the knife. Surgery for a herniated disc can often be done in an outpatient setting. The surgeon trims as little of the bulging disc as possible and moves the nerve so it's no longer at risk for compression. Patients should be back to normal activities in four weeks.

Spinal stenosis surgeries may require a few days in the hospital, and the timetable for healing is highly dependent on the patient's pre-operative physical condition and mindset. Herceg says one of his patients completed Pelotonia and won a golf championship following surgery. "It all depends on motivation," he says.

Before most patients even think of meeting with a surgeon, they'll find themselves in the care of a physical therapist. Kelley Newsad of Accelerated Rehab is one of a handful of certified McKenzie Spine Specialists in Central Ohio. They employ a particular methodology that helps identify the source of the pain before any strengthening exercises begin. "We want to help patients understand what causes their pain and what alleviates it," she says. "If you strengthen a painful back without addressing what makes it painful in the first place, you just end up with a strong back with pain."

Proper assessment leads to shorter treatment time, which makes everyone happy, Newsad says. "With health-care costs rising, it is helpful to teach patients to understand what is causing their pain," she says. "They become accountable for their healing, the number of visits goes down, it costs less and the patient, the doctor and the insurance company are all happy."

Physical therapist Carol Albright, owner of Avida Physical Therapy, agrees that a thorough and insightful assessment is essential. "If someone has back pain, it is very likely that it will recur," she says. "If it recurs, it will probably come back with higher frequency and greater intensity over time."

The first visit with a physical therapist will likely include plenty of questions and some movement tests to find out what sorts of activities and positions provoke pain. Then the therapist can begin to build a regimen of exercises to address specific deficiencies.

Patients can expect therapy sessions once or twice a week, depending on the severity of their symptoms. They also will work on their own at home, using exercises prescribed by the therapist. Treatment may last three or four weeks, or several months if the source of pain is more difficult to pin down.

As treatment draws to a close, it is important to test the body all over again, Newsad says. "Once the pain symptoms have been gone for about a week, we test to see how stable the healing is," she says. "We move the patient into the positions that provoked the pain in the first place." The goal is to make sure the patient is well enough to do the activities that were painful before. To prevent reinjury, patients learn how to strengthen their bodies and change the ways they move.

Getting In Shape

Physical therapist Lisa Johns, director of rehabilitative services for OrthoNeuro, says core conditioning is essential when healing, and in order to prevent reinjury. But a strong core isn't necessarily something that can be maintained without specific effort. "We see patients who have muscles everywhere, but their core is weak," she says. "Being a runner or a swimmer won't necessarily give you everything you need."

Cross-training in several sports may help keep core muscles strong, but targeted exercise is much more effective. Contrary to popular belief, crunches don't really strengthen the core. They help define the abdominal muscles, but don't do much in the way of adding stability and function.

Some therapists recommend pelvic floor exercises (also known as Kegels) and side leg raises, often in combination with elastic bands connecting the ankles. While it looks like a leg exercise, the activity actually does more to strengthen the hips--an essential part of a strong core. Other beneficial activities include Pilates and yoga, Johns says.

For a simple exercise that can easily be done at home, Johns recommends the plank, a yoga mainstay that's somewhat akin to a stationary push-up. It can be done with two arms and the abdomen facing the floor, or with one arm and the side of the body facing the floor. The effort of keeping one's body still and straight works muscles deep inside the core. Johns says a physical therapist or properly educated athletic trainer can help people learn more about body mechanics, which can lead to a stronger core and prevent injury.

Rohl also recommends exercise to his patients. He says it's not only important to have well-conditioned muscles, but also strong bones. "Weight-bearing exercise is very important to the health of the bones," he says. "The bone reacts to stress, so the more active you are, the stronger your bones are." Lifting weights and even walking around the block give the bones the little push they need to get stronger. Rohl says almost everyone over age 60 will experience some sort of back pain, and since we know it's coming, we should do all we can to prevent it. "I don't think it is ever too late to make a change," he says.

Part of that change comes in how we use our bodies. Albright says back pain, although it may seem sudden, can be the result of years of cumulative wear and tear. Our spine bears the brunt not only of carrying us around every day, but also the effects of the bad habits our mothers warned us about--poor posture and heavy lifting in particular.

"Forward bending can be the cause," Albright says. "Repeated forward bending can cause compression on the front of the spine and put pressure on the discs, which can press on the nerve roots. One day, someone may bend over to pick up a pencil, and that's enough to do it."

Undoing bad habits and replacing them with proper techniques is the key to a pain-free back. "We learn a lot of bad habits as we get older," Rohl says. "It's all about mechanics. Don't overlift, and get help when appropriate."

Johns agrees. "When we teach patients about lifting mechanics, they understand how to push and pull properly. As long as they practice those techniques, they will decrease their risk for injury."

Alternative Methods

There also are methods for treating back pain that go beyond traditional therapies. The Ohio State University Center for Integrative Medicine employs techniques not typically found in Western medicine. Nutrition, dietary supplementation, acupuncture and massage therapy are among the nontraditional treatments that patients use to find relief from back pain.

Dr. Glen Aukerman, the center's medical director, says it is imperative to begin treatment of back pain or any other health concern with a blood test. "You have to know where you are before you can know where you are going," he says. Many patients exhibit deficiencies of calcium, magnesium and vitamin D, which accompany a low level of the parathyroid hormone. "When you don't have enough calcium and magnesium, your body is going to try to take it out of the bones," he says. "You can manipulate that all you want, irradiate it all you want and talk about it all you want, but unless you put the magnesium and calcium back into the body, the bones will be full of holes."

The only way to get things back into balance is through supplementation, but it has to be done cautiously. Too much supplementation can lead to kidney stones and heart arrhythmia, Aukerman says. "You also need clean supplements," he says. "Most supplements are contaminated with lots of unnecessary ingredients, and then you have another problem of getting rid of the contaminants."

Dr. John Grandominico is a chiropractor at the Center for Integrative Medicine and also serves as a clinical assistant professor at the university. "We take a whole-body approach," he says. When he first sees a patient, he completes a thorough evaluation to rule out conditions such as fractures, neurological conditions or cancer.

If the patient has a strain or sprain, it can be treated through manipulation, through which a chiropractor uses manual pressure to realign the structures of the back. "I find areas of restriction and restore motion to those joints," he says.

Grandominico also talks with patients to learn about lifestyle, and may recommend an ergonomic assessment. The small stressors of standing improperly or using a desk that is too tall for its chair or a keyboard that is too far away can build up, causing chronic and debilitating back pain. Ergonomic professionals can make recommendations about furniture, and some larger companies will assist employees with the assessment, Grandominico says. Meanwhile, patients can use postural techniques and exercises.

"We try to give them as much information as we can so that they can manage on their own," Grandominico says. Initially, patients may visit four to eight times over the course of a month. "As they educate themselves and get to feeling better, they may not need to return," he says.

Kristin Campbell is a freelance writer.

Reprinted from the January 2012 issue of Columbus C.E.O. Copyright © Columbus C.E.O.