Gary Faulkner, a Little Rock business executive, has suffered bouts of back pain since his 20s.
"There was really no explanation for when my back would go out," says Faulkner, 63. "It could be something as minor as reaching in my closet for a shirt, and turning in the wrong position or bending over to lift up something not even necessarily heavy." Sharp pain would put him in bed for several days a couple of times a year.
Gradually, Faulkner's back began to go out more frequently. "Miserable just does not describe it when you literally cannot get out of a bed," he says.
A friend recommended he consult Kathleen Rea, owner of Regeneration Fitness in North Little Rock. Rea specializes in helping people recover from injuries through fitness. Under her guidance, Faulkner works through an exercise regimen that targets his trunk muscles, shoulder muscles and arm strength.
"The results have been amazing," he says. "In that period of time, over the last three years ... I think my back has bothered me on probably two occasions for less than a day."
If it seems like you know a lot of people with back trouble, it's likely that you do. According to statistics listed at the websites of the American Chiropractic Association (acatoday.org) and the National Institute of Neurological Disorders and Stroke (ninds.nih.gov), 31 million Americans, and about 80 percent of
adults, experience lumbar, or low-back pain at some point in their lives. Back pain is No. 2 among the most common reasons for missed work. (It's topped only by upper respiratory infections as the most common reason for doctor visits.) Americans spend at least $50 billion each year fighting back pain.
Dennis Beavers, who is team chiropractor for the Arkansas Travelers, sees patients whose back pain stems from "twisting wrong, bending wrong, doing activities that they're normally not used to, like raking leaves, moving heavy objects," or from sitting at computers all day with poor posture.
Desperate people try all kinds of cures -- not all of them crackpot. Alternatives to surgery, drugs and visits to physicians or chiropractors abound. Inversion tables, tai chi, yoga, Pilates and other exercises, acupuncture and therapeutic massage are just some of the methods touted to those with back pain. With so many possible solutions, it can be confusing to know where to turn first for help.
"I maybe am a little bit biased," says Dr. Alexandra Rivera-Vega, an assistant professor of physical medicine and rehabilitation in the University of Arkansas for Medical Sciences College of Medicine. "As physicians, we usually [go] with our typical, or more conservative, treatment, which is evidenced-based, hence, surgery or medicines." But other back-pain relief methods may be indirectly incorporated into medical treatment, or recommended as a complementary treatment.
Based on her review of scientific publications and studies, Rivera-Vega sums up the evidence for three alternatives:
• Acupuncture. So far, studies of acupuncture have found the treatment to be either positive or inconclusive in improving low-back pain, she says. "In other words, there are many studies, but for some of these studies, the quality is not the best."
But from what she has seen, "the complication rates and the side effects are not that much, because it's not that invasive."
• Yoga and Pilates. "The strength of the evidence [is] not that good because the studies were not the best," Rivera-Vega says.
• Massage. Rivera-Vega says some studies suggest that massage would be beneficial for those who have chronic low back pain.
Beavers, who has a west Little Rock practice, agrees when it comes to his field. "I think that the best thing for a patient with back or neck pain is a conservative approach first." But he also recommends things his patients can do at home to speed healing.
OH, MY ACHING BACK
The effectiveness and safety of alternate treatments depend on the age of the patient as well as the cause of the pain, Rivera-Vega says.
The most common causes of back pain -- pulling or overstretching of a ligament or a muscle, or a herniated disc -- are not likely to kill the patient, no matter how awful the experience is. (Herniated discs become more common with age, she notes.)
Causes that are less common but potentially life-threatening include infection, malignancy and severe degenerative conditions that compromise the spinal cord. Therefore, Rivera-Vega says, it's crucial to get a thorough medical history from the patient and figure out what's causing the pain before prescribing a treatment. Most back pain is benign, but not all of it is.
Rea, a biomedical engineer and certified fitness consultant who has taught biology and kinesiology to college students, sees a lot of people with back pain, and makes the most out of alternative ways to treat it. She believes the reason so many show up at her doorstep is because "it's an injury [for which] you might tend to look for someone like me rather than going to a doctor."
The people she's most prepared to help include someone who has strained his back while doing some unusual motion, like carrying a box up into the attic, or lifting a piece of furniture. Or someone whose tight hamstrings changed his posture for the worse, maybe resulting in bulging discs. Weak abdominal muscles, tight hamstrings and poor posture make it much easier to hurt one's back, and of course carrying extra weight puts "a lot of stress on those discs," Rea says.
"But what people need to know is, if they do hurt themselves there is a way to get back again."
Of the alternative methods, which seem to achieve the most success and which are most looked upon kindly by medical professionals?
LUMBAR OF THE BEHOLDER
Beavers, who sometimes uses in-office electrical stimulation therapy, might recommend cryotherapy (an ice pack) to get the patient better quickly. "A lot of people, when they get back pain, they want to put heat on it" -- which may feel good but causes more inflammation. Using ice -- 20 minutes on, 30 to 40 minutes off, as many times a day that they can -- helps with inflammation, he says.
He'll also recommend stretching for people with tight muscles, and heat can assist that process. "I probably recommend ice about 99 percent of the time and recommend heat about 1 percent of the time" if it's a muscle spasm, he says.
He also recommends such treatments as acupuncture and physical therapy.
Beavers says there are times "when I haven't been able to help a patient because of their condition or their symptoms." If red flags arise, or if his treatments produce no results, he will refer the patient to a primary care medical doctor or orthopedic specialist. If the patient needs some rehabilitation or strengthening of muscles, he'll refer him to a rehab specialist like Rea.
Rea starts with an assessment to determine the cause of the problem as well as a fitness assessment to evaluate strength, flexibility, range of motion and posture. She asks patients to walk back and forth across the room while she studies them from different angles.
Clients who have X-rays and MRIs from their doctors are encouraged to supply them; she looks at them with clients so they understand what their doctors diagnosed. She also administers ultrasounds in cases where she's seeing muscle spasms and strained muscles.
In some cases, she advises clients to discuss surgery with their doctors and, if the surgery is warranted, she'll help the patient plan for it. "Most of the time, though ... 90 percent of the people I see can avoid surgery," Rea says.
For cases that are beyond her expertise, she recommends a visit to the chiropractor.
After the assessment, Rea puts each client on a customized regimen. Typically these plans begin with stretching and strengthening exercises, some of which are yoga-based. Clients progress to the inversion table, a spinal decompression device long seen as a way to treat back pain, and for more advanced clients, back extensions on a Roman chair. In addition, clients of the center have access to three massage therapists, each with a different specialty.
"I think any time we can take a more holistic approach and also consider all avenues of treatment, I think that's going to be better for the patient, in my opinion," Rea says.
GET OFF YOUR BACK
Experts agree that prolonged rest after a back injury, which was once advised, is not helpful. Patients are now told to rest for the first hours, or the first day after the injury -- it's called relative rest, as opposed to complete or absolute rest -- and then gradually resume activities.
"Otherwise, it will be worse," Rivera-Vega says.
The best way to deal with back pain? Try to avoid it entirely.
"Get active," Beavers says. Walk, move, in ways that don't cause a problem to reoccur.
Rivera-Vega concurs, noting that low-back pain is not as common among moderately active people.
Staying active is her "main way of prevention at this time," she says. "I think that as long as the patient can [do] some kind of physical activity, definitely we are going to be avoiding a lot of things."
ActiveStyle on 02/09/2015