Do you have a disc problem

By Suzanne Seff, MBA PT

Most back problems don’t start with picking up that stray piece of paper from the office floor, or putting that last grocery bag into your car trunk. Most often back problems start with bad posture, poor muscle tone in the abdominal musculature, and many years of abuse. Before you know it you’re walking into the doctor’s office with bent over posture begging for pain relief. Most often doctors will prescribe a muscle relaxant such as soma, or Flexeril. The doctor may order some x-rays and then send you for some physical therapy as a conservative measure. If after a month or so the pain continues most patients are then sent for an MRI for diagnostic purposes. Unfortunately everybody encounters changes in their spines after a certain age, so unless there is a clear presence of a herniated disc the information obtained from the MRI doesn’t really tell us anything of consequence.

In the past patients with back pain were admitted to the hospital and given bed rest, traction and physical therapy twice a day consisting of moist heat, ultrasound, and massage. This treatment is considered very passive because these methods were administered to the patient. This did nothing to fix the muscle weaknesses or imbalances that caused the back pain, nor did it really provide any long lasting relief. In addition many patients were given Williams Flexion Exercises which consist of double knee to chest flexibility exercises and crunches, both of which are actually detrimental for a disc problem. If given Williams Flexion exercises when sent for physical therapy I suggest that you not walk but run out of that office. Why do many practitioners still use these exercises? Because physical therapist get reimbursed for all but the moist heat even if they don’t get positive results.

The truth of the matter is that most back pain will resolve itself on its own after a few weeks, or until the next episode. The cause of the back pain does not go away, but the symptoms can resolve for a while only to reappear again sometime in the future. When you see a physical therapist for a back problem you want to get rid of the cause not just the immediate discomfort. If you don’t resolve the issue that is causing the back pain then chronic pain or surgery may be in your future.

Today we know that passive treatments in the form of pain killers and bed rest will often worsen a back problem. Getting a back patient out of bed as soon as possible is optimal for the healing process. Depending on the injury, extension or exercises performed on the stomach may be the right choice. There is no one size fits all for back ailments as each case is different. I often tell my patients that if we took a survey of 100 people over the age of 40, all of the MRI’s would likely show some disc and vertebral abnormalities. This does not mean that everyone has symptoms that are debilitating or that require treatment. Most often the reason for these flare ups may just be the proverbial straw that broke the camel’s back.

Therapy should begin with manual or hands on therapy and a good exercise program for stretching and core strengthening. I am not an advocate of sit-up exercises I prefer to prescribe an abdominal bracing or lumbar stabilization regime.

Patients often ask me when it would be a good time to stop exercising or how long should I continue exercising after I’m feeling better. My answer to that question is that after suffering a back injury the vulnerability never goes away even if the symptoms subside for a while. My suggestion would be to continue the back program as a preventative measure for the long run just like the patient that takes medication for a particular condition. In other words, it would be best to continue the program forever to reduce the risk of any further injury or those annoying flare ups.