What should I do if the treatment doesn't make me feel better?

What should I do if the treatment doesn't make me feel better?

This is a tough question because every situation is different. If you are suffering from acute pain and it is very new you probably need to give treatment a little more time, especially if you have just started Physical Therapy. This holds true for chronic pain and recent initiation of treatment. It takes about 4-6 weeks for muscles to make lasting changes in strength, length and endurance. So if you have just started a lumbar stabilization exercise program you need to give it 4-6 weeks before you start to measure results.

Also, sometimes pain is not a good measure for progress. If you are able to tolerate more, perform more advanced exercises and resume more day to day activities but your pain is about the same you are actually demonstrating progress. You are doing more without increase in symptoms. That is sign of progress!

In addition your symptoms may change indicating progress. For example, if you have had nerve symptoms into your legs, known as radiculopathy, and that pain moves into your low back, this is also a sign of progress. Even if you pain has intensified in your low back, the centralization of pain, or concentration into your low back indicates decrease in neurological symptoms and is a sign that you are improving.

If you have been participating in Physical Therapy for more than 3 months and you continue to have significant pain without any relief, you may need to take a closer look at the situation. Have you truly committed to the lumbar stabilization process? Have you been faithful with your home exercises? Have you given your best to improve strength in your low back? If the answer is truly yes to all of these questions, you may need to have further diagnostic testing such as MRI and consult an orthopedic surgeon or neuro surgeon for further treatment. Otherwise, you may need to re-establish your commitment level to the process and really give lumbar stabilization and Physical Therapy the effort to improve.

What treatment do I need?

What treatment do I need?

Treatment for acute low back pain

Acute low back is symptoms that has lasted less than 3 months. If your low back pain has just recently started these tips can help:

Immediately after you back pain starts for the first day or two, try to rest in a comfortable position. Lying on your side with a pillow between your knees, on your back with 2-3 pillows under your knees maybe the most comfortable you can get. Try no to stay in one position for too long. Get up every 2 or 3 hours and move in a pain free way, either a short walk or gentle stretches while standing. Try to stay up and moving around for 15-30 minutes. Then resume a comfortable resting position.

Certain over the counter medications can help control your pain and reduce some symptoms associated with an inflammatory response. Take ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve) to address pain, swelling and irritation or take acetaminophen (Tylenol) to control pain. Follow the directions on the bottle for dosage amount.

Heat and Ice can help to control symptoms as well. Try using a heating pad on a low or medium setting, a warm shower, hot bath or sitting in a hot tub for 15 to 20 minutes every 2 to 3 hours. Or try using an ice pack for 10 to 15 minutes every 2 to 3 hours. You may also want to try switching between heat and cold.

Resume normal activities as soon as you can. Staying sedentary for longer than 1-2 days can actually cause more back pain and problems. Movement helps your muscles stay strong.

If you have low back pain for more than 3-5 days, call your doctor and get into Physical Therapy to address remaining symptoms and strengthen your low back. Once you have back pain you are more likely to have a reoccurrence of low back pain. Getting the proper strengthening and stretching exercises quickly can help reduce that risk.

Treatment for chronic low back pain

Chronic low back pain is symptoms that has lasted longer than 3 months. As low back pain continues beyond 3 months, it becomes very important that you get the help you need to resolve your injury. Going to see you doctor and getting the diagnostics done that may help to explain continued low back pain Furthermore it is important to undergo Physical Therapy treatment to address symptoms, strength deficits, spine joint restrictions and general movement pattern disruptions. With the proper lumbar stabilization regiment you can improve your low back pain and restore function without more invasive measures.


Other therapies to consider in addition to tradition Physical Therapy:

Acupuncture: When you have pressure on the nerves, acupuncture can help relive that pressure and help to reduce pain. When the acupuncture needles are put in certain places in the body, you will relieve the pressure on a nerve. By relieving that pressure on a nerve, the muscles begin to relax, the blood begins to flow into an area, and pain is reduced. Also accupuncture releases endorphins which also adds in pain reduction.

Massage Therapy: Massage improves blood circulation, which aids in recovery of muscle soreness from physical activity. Massage relaxes muscles for an improved range of motion. Massage leads to increased endorphin levels. Endorphins are the chemicals the body produces that make you feel good, which is very effective in managing chronic pain.

Aquatic Therapy: Water exercise also known as aquatic therapy takes advantage of the unique properties of water to mobilize joints, increase range of motion and to develop balance and stability. If a back injury has short circuited your regular workout routine, a water exercise program might be a good alternative during the healing period. In addition, water offers an excellent core strengthener to help prevent back pain.

Do I need to have any tests?

Do I need to have any tests?

The most common test for low back pain is a Physical Exam.  Physical Exams are typically performed by Primary Care Physicians or Physical Therapists to identify the cause of low back pain.

If the Physical Exam results in any findings outside the norm, typically you will be referred for diagnostic imaging.  You may also be referred to an orthopedic surgeon or Neuro surgeon, who are the specialists in spine health.

Common imaging tests include X-Rays, MRI, CT Scan and Bone Scan.  These tests can further determine the cause of back pain.

X-Rays:  Spinal X-Rays are pictures of the spine used to find injuries or diseases that affect the bones or joints in the spine. X-Ray help to diagnose spinal fractures, dislocations, bone spurs, disc disease, osteoarthritis or scoliosis. 

MRI: Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to allow physicians to assess a patient’s spinal anatomy and investigate an anatomical cause of the patient’s back pain.  MRI gives specific detail to determine spinal alignment, disc height and hydration, vertebral body configuration, intervertebral disc space, nerve integrity or abnormalities in the spine that may cause spine pain.  MRI can help diagnose degenerative disc disease, spinal dysfunction, nerve root compression, and degenerative changes in the spinal column.  

CT Scan:  Also known as CAT scan, it combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. Using CT, the bony structure of the spinal vertebrae is clearly and accurately shown by CT scanning, as are the intervertebral disks and, to some degree, the spinal cord which can help to diagnose cause of back pain.

Bone Scan: A bone scan is a nuclear scanning test that identifies new areas of bone growth or breakdown.  A bone scan can often find a problem days to months earlier than a regular X-Ray test.

What is causing my low back Pain?

What is causing my low back Pain?

There are various causes of low back pain, however most low back pain is triggered by some combination of overuse, muscle strain, and injury to the muscles, ligaments, and discs that support the spine. Many experts believe that over time muscle strain can lead to an overall imbalance in the spinal structure. This leads to a constant tension on the muscles, ligaments, bones, and discs, making the back more prone to injury or re-injury.

The most common causes of low back pain are: Injury or overuse of muscles, ligaments, facet joints, and the sacroiliac joints.

Pressure on nerve roots in the spinal canal. Nerve root compression can be caused by a herniated disc, often brought on by repeated vibration or motion (as during machine use or sport activity, or when lifting improperly), or by a sudden heavy strain or increased pressure to the lower back.

Osteoarthritis (joint degeneration), which typically develops with age. When osteoarthritis affects the small facet joints in the spine, it can lead to back pain. Osteoarthritis in other joints, such as the hips, can cause you to limp or to change the way you walk. This can also lead to back pain.

Spondylolysis and spondylolisthesis, vertebra defects that can allow a vertebra to slide over another when aggravated by certain activities.

Spinal Stenosis, or narrowing of the spinal canal, which typically develops with age.

Fractures of the vertebrae caused by significant force, such as from an auto or bicycle accident, a direct blow to the spine, or compressing the spine by falling onto the buttocks or head. 

Spinal deformities, including curvature problems such as severe scoliosis or kyphosis. 

Compression fractures: Compression fractures are more common among postmenopausal women with osteoporosis, or in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

Common Lower Back Pain questions

As a Physical Therapist, I get so many questions about what do about Lower back Pain. I have listed several of them below and will answer them as well. However, the list is long enough that I am not going to answer them all today. Over the next few Blogs, I will hit them all. I am sure that if you are experiencing back pain, you have asked one or more of these questions.

As always, when you have questions about your health, it is important to ask you Doctor.

Here are some common questions that I have been asked about Lower Back Pain:

• What is causing my back pain?
• Do I need to have any tests?
• What treatment do I need?
• What should I do if the treatment doesn't make me feel better?
• Do I need to stay in bed or rest?
• Can I still go to work?
• How long will it take for me to get better?
• What else can I do to make my back feel better?
• Are there any exercises that can make my back stronger?
• Are there any alternative or complementary therapies that might help?
• What can I do to avoid getting a backache again?
• Is it all right for me to drive?
• What is the difference between a herniated disc and a bulging disc?
• Are there any medications I can take for pain?
  
• I just injured my back, but it doesn't hurt enough to go into the doctor. What can I do?
  

Do any of these sound familiar? I am sure they do. Stay tuned for the answers in the next several posts.

Doctorate of Physical Therapy

Today I would like to discuss the degree of Doctorate of Physical Therapy. We received a phone call at the end of last week from an irate gentleman who seemed to think that there was no such thing as a Doctorate of Physical Therapy. This individual would not listen to anything let alone reason, so I decided this would be a good topic. There is indeed a Doctorate of Physical Therapy. It is an intense graduate program offered by several universities and I have one on the wall so I am certain that it exists.

The field of Physical Therapy is transitioning its accredited university programs so that all will offer the doctorate. Originally the profession required only a Bachelor's degree, next it moved towards a masters degree, but the profession is now moving towards the Doctorate. In addition to the degree, Physical Therapists must also have a license to practice. The Doctorate of Physical Therapy in an entry level degree. Similarly Medical Doctor and Juris Doctor are entry level doctoral degrees. In all of these cases, the profession warrants the knowledge required to practice within theses fields.

In addition, in the state of California, a law was passed in the past few years to allow Physical Therapists with a Doctorate degree to go by the title "Doctor". This was a tremendous step in the profession of Physical Therapists! I hope that other states will follow suit.

-Dr. Juliette Norman DPT

Posture

Somehow the posture post didn't get published on Wednesday...so here it is today!

Posture! It is the position in which you hold your body upright against gravity while standing, sitting or lying down. Good posture involves training your body to stand, walk, sit and lie in positions where the least strain is placed on supporting muscles and ligaments during movement or weight-bearing activities.

Good posture can help reduce the incidence of back pain! It is worth it!

Here are two great websites that will give you all the skinny on good posture, and steps to keep it good:

1) American Physical Therapy Association

http://www.apta.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=20457

2) Wikipedia - How to improve your posture

http://www.wikihow.com/Improve-Your-Posture

Be an expert on posture! Your back will thank you.

Back Healing Center

The Back Healing Center! It is a place to come get your back healthier! It works...I know because I helped design it. I am the one treating patients and I believe in improving lumbar strength, eating better and resuming a healthier lifestyle. That combination works to help decrease back pain. Making back pain better is something I am very passionate about. If you have been following this blog, I can imagine you have already picked up on that.

So what makes the Back Healing Center different? Truth be told it is the commitment and passion brought to the program by the individuals who have designed it. The reason it works is that the program incorporates a total approach to back pain including lumbar stabilization exercises, traditional Physical Therapy techniques, an emphasis on nutrition and wellness and Spine Six Biomotion Therapy. Quite frankly, the SpineSix Biomotion therapy is the piece that makes us a cut above. This is an amazing piece of technology that mobilizes the spine at each individual segment to promote proper spinal alignment, decreases soft tissue stiffness, and promotes healing of joint surfaces and soft tissue. So basically it helps to reduce pain and restore spinal mobility so that you may resume an active lifestyle.

So if you have low back pain, check out the Back Healing Centers.

www.backhealingcenters.com