Bill Klaproth (Host): Many people live day-to-day with chronic back pain. One of the options to help alleviate that pain is physical therapy. Here to tell us more is Nick McClary, a licensed physical therapist and clinical services manager for Tidelands HealthPoint. Nick, thanks for being on with us. Why is physical therapy so important when it comes to chronic back pain?

Nick McClary (Guest): Well, I think that physical therapy is really important, especially seeing a physical therapist. There are so many different possible causes for chronic back pain and I think it's important to see somebody who can try to figure out what those causes are. Physical therapy really the primary choice for conservative treatment and there are a lot of different treatment options that physical therapists have at their disposal to help people with chronic back pain.

Bill: So, you said it. There are many causes for back pain. So, you put a patient through a variety of tests to really determine and pinpoint what area is causing the problem, then?

Nick: Yes. What people do when they come in, or what I'll do with patients when they come in, is we typically go through about 10-15 minutes of medical history and trying to figure out exactly what started and when the pain started and what might have caused it. Then, we spend another 10-15 minutes really thoroughly examining the back and doing different types of special tests and stuff to pinpoint whether it may be a nerve issue, whether it may be a muscular issue, whether it's a strength issue, if it's a possible disc issue; we try and isolate out what we think it might be. So, I feel like, as physical therapists, we're pretty thorough in running a patient through a wide variety of tests to really try and pinpoint what the cause might be.

Bill: So, you mentioned lifestyle. So, you're trying to determine, too, if there's something this person is doing that's causing this, whether it be not exercising or sitting all day at work, or maybe something else at work, or what they're doing in their leisure time that could be causing this. So, you're looking for that, too?

Nick: Yes, exactly. That can sometimes give a lot of insight into why somebody may be experiencing pain and that's often been, just in our society today, we do a lot of sitting, and there's a phrase out there that “sitting is the new smoking”; that just may be as bad as sitting is for you, may be just as bad as smoking; living that sedentary lifestyle. Then, we also see people who are active, but perhaps they're doing the wrong things and that's where a lot of people may think "Well, I'm active; I'm moving. I don't need physical therapy. It's just exercise." Actually, physical therapy is a lot of different things. Exercise is one of our primary interventions but, sometimes, it could be that same thing that that person is doing that is causing their back pain, and so once they see us, we can figure out if that is what it is and give them some instructions on how to work around that.

Bill: Right. So, understanding what they're doing you know, in their leisure time, or at work, can certainly give you a bigger understanding of what's causing that pain. You know, Nick, when people hear physical therapy, I think most think "Oh, boy. This is gonna be a grind and not fun." Are you able to find a more enjoyable way to get people moving and work the areas that need to be worked?

Nick: Yes. I mean, there are so many misconceptions, I think, about physical therapy because most people think of physical therapy after surgery, after a knee replacement, after a shoulder surgery, rotator cuff repair but, in all honesty, the largest portion of people I see is back pain, who have not had surgery. That's probably 70% of my case load. I try and actually dispel the myth that physical therapy is always going to be tough and also that it's going to be painful. In fact, when I see a patient who has not had surgery, the thing that I say to everyone is, "You've heard the phrase 'No pain, no gain', but that doesn't apply here." I don't want to put people in pain. Our goal is to get them out of pain and a lot of times the thought that well, you've got to push through it to get through it, that doesn't always apply there. So, really, I try and encourage people that my goal is not to put them in pain. It's to get them out of pain and that we're going to work around and figure this out as quickly as we can so we can get them out of pain and back to doing the things they want to do.

Bill: And, it helps to have a patient that's really motivated, that will listen to you, and then do the exercises at home after you give it to them in therapy, right?

Nick: Yes, exactly. And, that's one of those things, too. Not every patient is given the same exercises and they're not all given the same treatment. Say, for example, one patient may need more core strengthening so they may have a more robust exercise program, but another patient may have some disc issues, and they may respond to what are called “extension-based exercises”. Then they can perform maybe two or three exercises like that, two or three times a day, and it won't be as tough. Or, we do have some patients who--people don't think of physical therapists like this often--but they come in and we may crack their back. We may put them in a position and perform what we call “manipulation”, and there are just a few follow up exercises after that, if that treatment is indicated, then that can be a relatively a quick fix, when the patient presents with the findings that shows that that would be indicated.

Bill: How long does physical therapy usually last? Is it a couple of weeks? A couple of months? There's probably a misconception on that, as well. I know it's different for each patient but, in general, is there a timeframe for physical therapy and how long it takes?

Nick: Yes. I think you hit it on the head, there. It is different for each individual. Again, if we had a patient that what is what we call a “manipulation candidate”, they're coming in to have their back cracked, if you like to call it that in layman's terms. Sometimes, those are very quick and it's one to two weeks of just a couple of treatments but then, sometimes, for the more robust core strengthening, we're looking at more four to six weeks. But, I would say, the majority of patients fall into the category of two to three times a week, for four to six weeks. Now, if the patient is more compliant and they're really doing their exercises, and we can usually tell, because the patients don't ask as many questions when they're doing them, then we tend to see results a little bit quicker and, also, you may only come in once or twice a week if you're really performing the exercises the right way and you're doing them consistently at home.

Bill: You know, I wonder sometimes if people may aggravate or promote back pain by not moving, because they're afraid to start exercising. So, how do you handle that?

Nick: Yes, I think that's where we come in and we do some of our best work. We see a lot of people who, they haven't been moving, they haven't been active, and they come in and they may be just weak, they may be tight because they don't move very much, so our job is to figure out what is what we call the “minimal effective dose”. What is the minimum that we can do so that we're not wearing the patient out; we're not turning them away because they think it's too tough, but we can get the effect that we want. We can help them to get out of pain and start to show them that exercise can be the, I guess you want to say the cure that they are looking for. It can be the thing that helps control their symptoms. So, that's, I think, where we do our best work; it's finding those maybe gentle and smaller exercises to start with so that you can progress to those more robust exercises.

Bill: Well, starting simple and easy at first certainly would help the efficacy right there. So, with physical therapy, are you able to usually alleviate all chronic back pain or just make it much more manageable?

Nick: I'd say it's a little bit of both. Again, I'd say it depends on the patient. I've had some great success stories; a patient who had tried a lot of other treatments and within three treatments, we had her out of there and she was pain free for the first time in five years. We've had some people that we see for six, sometimes even eight weeks, though usually not, and we're able to get their pain down from an 8 to a 4, you know? So, they're still in a decent amount of pain, but we've alleviated it a lot. So, it really depends on the patient. Again, there are a lot of different causes for chronic back pain and every individual is different. So, some can have very quick results and it can be a quick fix, and in others it may require a little bit more robust program and a little more time.

Bill: And, again, if you put the work in, you will see better results. I know. I've gone through physical therapy and the more you put into it, when you do the homework that they tell you to do, it works, that's for sure. Nick, thanks for being on with us. Why should someone choose Tidelands for their back health and physical therapy needs?

Nick: Well, at Tidelands Health, we've got a great team. We've got a great team of very well-trained physical therapists, as well as physical therapist assistants and especially for our program, we have pain management physicians down the hall. We have an orthopedic surgeon in our same building. We just have a team that can comprehensively take care of the low back pain needs that a patient may have. So, very well-trained therapists and physicians and we're just ready to help people in any way that they might need.

Bill: Well, Nick, that sounds great and thank you so much again for your time today. Very interesting conversation. For more information about Tidelands Health physicians, services, and facilities, visit www.tidelandshealth.org. That's www.tidelandshealth.org. This is Better Health Radio, I'm Bill Klaproth. Thanks for listening.