Back to the right way

By Kathy Watts, Special to The Herald-Sun
September 4, 2002 10:28 pm

DURHAM -- I never understood what a pain it is to have back pain. Until my husband hurt his back in January.

He suffered no dramatic physical injury. In fact, it took retracing his activities to realize that he felt a little pop when he tried to push a 500-pound round bale of hay out of his truck one cold winter evening.

Now his physical therapist has told him not to jump up in the middle of the night to carry any of our four children back to their own beds. He really shouldn't roll bales of hay off our truck to feed our goats. He has to stretch before he eases out of bed in the morning. He sits with a towel roll in his chair at work. It takes him an extra minute to maneuver into the driver's seat of our van. And at least three times a day he does his back exercises, stretching his spinal column and resembling a seal in the process.

If you ask me, back pain is downright inconvenient.

If you ask my husband, he'll say, "It's excruciating pain. It's physically exhausting. It's emotionally exhausting. It forces you to restrict what you do. It's just debilitating."

"And mine's not even that bad," he added, which he's learned from talking with other people with back pain.

My husband is the perfect statistic. He's 38. He sits at a desk at work most days. In the evenings and on the weekends, he performs physical feats of home maintenance that would challenge even a much younger body.

Back pain is the most common cause of activity loss among adults under 45, according to the American Physical Therapy Association. An estimated 80 percent of American workers suffer back pain at some point in their lives.

Jon Weinberg, 37, a registered physical therapist and owner of Team Care Manual and Physical Therapy Co. Inc. in Louisburg and Oxford, estimates two-thirds of his clients come with back and neck pain. They range in age from 16 to their 80s.

In recent years, Weinberg has seen an increase in white collar clients as opposed to blue collar workers who are injured on the job. He described a typical office worker sitting at his desk with a phone wedged between an ear and a shoulder, using the computer mouse.

"You're putting yourself in a totally unnatural position," Weinberg said. "From a purely anatomical position, the position you spend much of your time at work in is a flexed position. If you kept your spine in the same position and stood up, it would be the equivalent of [being] bent over."

Although back injuries affect people of all ages, the type of injury often correlates with age, said Kristen Albers, 26, a doctor of physical therapy, at Duke's Center for Living. Younger patients tend to have strains and sprains; disc problems tend to occur mostly in middle-age people; and older age patients tend to suffer from years of wear and tear and degenerative changes that occur over time.

Sometimes back pain can be due to a one-time injury, Albers said, but it is "more commonly the result of an accumulation of months or years of wear and tear, poor posture, faulty body mechanics for activities like bending and lifting, loss of flexibility, overuse or general lack of physical fitness."

There's good news and bad news about back pain.

The good news?

"Most back problems can be prevented," Albers said. "Practice good posture. Practice good body mechanics -- lift with your legs."

Both Albers and Weinberg recommend that people stay physically fit and keep their weight down.

"Most of us lead horribly sedentary lives," Weinberg said.

In addition to these preventive measures, the American Physical Therapy Association reports that "most bad backs respond well to rest and conservative treatment."

In his treatment program, Weinberg uses the McKenzie approach, in which patients learn to take care of themselves.

"We want to show them that with the appropriate exercise program, they can control the pain," Weinberg said. "It puts the patient back in control."

Blair Pollock, director of public works for Chapel Hill, first felt his back injury after he dismounted after a horseback ride. "After two months, I'm recovering slowly but surely and steadily," he said.

"You have to take it easy and stay mobile and do mild exercise," Pollock, 50, said. "I find pool walking to be a tremendous boon and getting up out of the chair every hour and doing light back bends, a minimum of five every hour. Once you get a little more ambulatory, you still need to stay stretched out."

And the bad news?

"Once you've had back pain, you're more likely to have it again," Albers said.

In 1989, Don Benson, 55, of Creedmoor, fell while unloading some shelves from a tractor-trailer truck. He punctured his spinal cord, cracked a vertebra and ruptured a disk. Benson had his seventh surgery in late May. This time his pain recurred when he reached into the trunk of his car for his briefcase.

"I felt like I'd been hit by lightning," he said. After about a week, the intense pain subsided, but his fingers began to go numb. "It got so bad I couldn't even turn the steering wheel in my car with my left hand."

"A lot of people think you have to do something strenuous to hurt your back," Benson said, but he added the onset of back can be much less dramatic. His neurosurgeon's nurse told him that sometimes "You can just sneeze" and cause damage.

Benson, a territory manager for General Mills, used to play golf two or three times a week. Now he cannot golf, but when he's not recovering from surgery, he can shoot basketball.

"I've been fortunate and blessed: I can still walk and work," Benson said. "It's a long recovery time. You don't know how weak you are until your back goes out."

Albers said that there is confusion about the use of heat or ice after an injury.

The general consensus is to use ice for at least 48 hours, she said, then you may continue icing or switch to heat if it yields more relief. If pain continues, a person should see a doctor or physical therapist, she said. Pain for more than three months is chronic.

There are some warning signs that warrant immediate medical attention, Albers said. If you have loss of bowel or bladder control, numbness or weakness, or persistent severe pain that's not better with rest, you should see a doctor immediately, she said.

"The worst thing to do is to stay inactive," she said. "More than one or two days of lying flat on your back is going to make you stiff."

There are many different ways to treat back pain that can improve symptoms and quality of life, Albers said.

"I would encourage people to not just live with it and go have it checked out by their doctor or physical therapist," she said.

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