Transcription:
Keeping a Healthy and Strong Back

Melanie Cole, MS (Host): If you’ve ever groaned, “oh my aching back,” you're not alone. Low back pain and back pain in general can be debilitating. If you’ve ever suffered back pain, you know what I'm talking about. My guest today is Dr. David Brown. He’s the manager of the rehab services at Morton Plant Hospital, part of BayCare Health System. Dr. Brown, tell us a little bit about the prevalence and the economic impact of back pain in this country.

David Brown, PT, DPT, OCS, COMT (Guest): Well, back pain is a very common occurrence. What the data shows is that two-thirds of Americans are going to experience low back pain. Over any three-month period, about 25% of Americans will have low back pain. It’s the top cause of disability around the world. So, it’s really a very prevalent problem, and it’s something that we’re seeing in the U.S right now really pushed to the forefront of concern because about 72% of the people that have back pain use pain medications to address their low back pain. With the opiate crisis that we have in the United States, we already have a very expensive problem—low back pain coupled with a significant issue with opiates.

So that’s why it’s really always a highlighted item to consider when you're looking at folks either at the workplace or whether they tend to sit in the workplace or whether they stand in the workplace. We’ve seen a fair amount of people a seated job also report low back pain. So, it’s not going to just be the folks that are standing that are going to have low back pain either.

Host: And not to mention missed work as a result of back pain. So, what are some of the most common causes of it? And explain to the listeners a little bit, Dr. Brown, the difference between an acute incident of back pain like you threw out a disc or did something. You bent over and went “uh”, or chronic back pain that might be caused by a degenerative situation such as arthritis.

Dr. Brown: Well a common problem is going to be the low back pain. Really some of the best recipe for it whether it’s an acute exacerbation of low back pain or a chronic condition of low back pain, the best recipe is going to be to try and stay active. To try and maintain a normal routine. Trying to treat backpain with bedrests or trying to treat it with medication really is not yielding the results that we want to see for a condition. That’s one of the reasons why we see so many of chronic back pain is because it is being treated with medication and rest more than it probably should be.

Movement is really the best long-term plan for relief of back pain. The total cost attributed to low back pain when you're looking at either acute exacerbations or a chronic condition, it’s over $100 billion in the United States. Two-thirds of those costs are like what you had eluded to, indirect costs that are related to lost wages and lost productivity at work. Not just the cause of treating the low back pain medically.

Host: You're a physical therapist Dr. Brown. So, does treatment depend on diagnosis, or are there some things that we can start by recommending that people do to keep a healthy back? Or if their back is bothering them, things that you would like them to try before they maybe come in to see somebody.

Dr. Brown: Yeah, absolutely. When you talk about low back pain, and some of the mantras that we’ll use in physical therapy is motion is lotion, you really want to have a normal routine. You want to have a routine that you're doing on a routine basis to take care of your body in general. So, utilizing good body positioning at work, and also at home and with your leisure activities. That’s going to be important for protecting your spine over the long term.

When you're talking about some of the specific things, we’ll educate folks on doing, it will be activities such as if you're having to do any lifting to keep the load close to your body. If you're lifting anything heavy to ask for help. If you're working in the healthcare industry like my coworkers do here, to try and utilize different devices that we have available. You know, for example, in the hospital besides just having another person help you, we have different systems that we can use. Different slings for lifting or different devices such as an AirTAP or a Sara lift to help with transferring a patient to getting a patient up to standing. Another good mantra that we’ll always try and use when you're having to lift whether it’s an object or if you're helping to lift a patient is to really try and keep it close and try and keep it simple with those transitions.

Host: It’s definitely good advice and people want to know about things like lifting, proper lifting techniques when they're taking heavy items out of a trunk. That could be an awkward position. As a physical therapist, what do you teach people about doing these kinds of things? Even lifting up their children or getting up off the ground. What do you want them to know about the best ways to do that?

Dr. Brown: Yeah so like you said, there’s a whole complex amount of decision making that goes into the lifting that you're going to be doing depending on what you're going to be lifting, who you're going to be lifting, what activities that you're going to be doing. So, my advice is always to try and just ask people to slow down and think about it. Try and plan ahead before doing any heavy lifting. Doing some environmental scans first to ensure that you have a clear path, utilizing tools in the workplace that you might have to assist you in making this easier and safer is advice that I give. Lifting with your legs not with your back. If you're going to have to lift something, try not to have to lift over the object. Try and face the object that you're looking to lift and trying to avoid twisting. Trying to get as close as you can and keep your back straight and do the lifting with your legs.

Some of the other basics is try and keep your feet shoulder width apart and trying to maintain your balance so you can evenly distribute the weight that you're going to be lifting. That’s all going to be part of the education when you have a specific task to accomplish. But I still would want to highlight that the real key to protecting your spine over time is to maintain a regular physical fitness regimen, and really staying active can help prevent a lot of injuries as well.

Host: What kind of activity? I mean there’s cardiovascular, but then there’s also strength training and functional training. People wonder which kind would be the best for their back.

Dr. Brown: Yeah. So, the strength training, there’s certainly a value to making your back stronger. The reality is is that the muscles that you're typical trying to strengthen in your lower back are very small, they're very close to your spine, they're intimately attached to your spine. Those are a slow twitch muscle fiber that needs to be strengthened and be made to be more endurant as opposed to go to the gym and lifting heavy weights to make it bigger and stronger. These are very small muscle groups.

So, what you want to try and do is have a routine where you're hitting those muscle groups very regularly. These are the type of muscle groups that when you go to the gym or you're working on a home exercise program at home that you can do activity daily for them to try and keep them strong. You're going to help improve their endurance, their strength, their ability to circulate fluids and pump blood through those muscles by just hitting them on a daily basis with relatively light weight to no weight but just doing the activities the strengthen the small muscle groups in your spine.

Host: What do you tell people that have to sit for a living or have to stand for a living about maybe alternating between or the chairs that they have at work because all of these things… And you even see people sitting on balls now and working their spine while they sit there. What do you want people to know about workplace advise for keeping that healthy back?

Dr. Brown: Well one of the most important pieces of advice I try and give people at work is that have a clock. To have a clock. Use a clock on a wall, use a clock on a computer, but you don’t want to stay in one position for anything longer than about two hours. Because you can have the most expensive and most ergonomically setup chair, but the body is really designed to move. We don’t have all the different joint articulations that we have to just place them in one position. Because no matter what position we place them, when we place them there it can be the most ergonomically correct position that is possible, but it’s still not going to be a position that you body is designed to be in for any extended period of time. The body is really designed to be moved.

That’s how the different joint articulations get their nutrition. Cartilage gets its nutrition from compression, decompression, and gliding. So, if we stay in any one position for a prolonged period of time, we’re robbing the body’s ability for it to accomplish what it’s designed to accomplish. So, whether it’s a ball or whether it’s a well-designed chair, whether it’s sitting or standing, I always recommend that you take a break. So, if you're sitting for two hours, then get up and stand and walk around. If you’ve been standing for two hours, maybe sit down and take a break. You can do some exercises while you're sitting, such as hamstring stretching or some stretching for your shoulders while you're sitting. That’s going to give your body what it’s looking for throughout the course of your eight-hour day. So, two hours at max is the recommended time for just being in one position.

Host: Dr. Brown as you wrap it up for us, tell us what an appointment with a physical therapist might be like. What people can expect and what you would really like them to know about keeping a healthy strong back.

Dr. Brown: Well what we try and really focus on when you come to physical therapy is, we certainly need to, we’ll do an examination with you and we’ll try and determine what’s the cause of your symptoms. We try not to focus too much on just the symptoms itself. We want to get at the root cause of what your symptoms are. So, a physical therapist is going to do an interview with the patient. They're going to glean some information about what’s been going on and get a history. A physical therapist is really going to try and get to the source of the problem and develop a treatment plan that’s going to include a combination of exercises to strengthen the back. Typically, some manual therapy to improve the mobility of the joints, the soft tissues, and also education so the person can be actively involved in their recovery. So, we provide a fair amount of education about how to take better care of the back and how to relieve the pain over the long term.

So, it’s really a good scenario when the patient and the therapist can connect. The patient’s able to share all of the information they want to share with the physical therapist. And the physical therapist can help assist the patient to become actively involved in their rehab and performing activities that over the long term showed result and resolution of their symptoms.

Host: Thank you so much Dr. Brown for coming on with us today and explaining something that so many people suffer from. Back is so prevalent, as you said. Thank you for such great advice and tips on keeping that healthy strong back. You're listening to BayCare Healthchat. For more information, please visit baycare.org. That’s baycare.org. This is Melanie Cole. Thanks so much for tuning in.