Local look: Back pain

Carlea Lastrapes, Certified Stott-Pilates Instructor, Fitness Plus

I am a Stott-Pilates personal trainer at SFMC Fitness Plus. I know from personal experience and from working with many of my clients that back pain is real, however, I do believe that thought processes and other factors can affect how one responds or reacts to pain. In my experience, Pilates for chronic muscular back pain is very effective.

Pilates is an exercise discipline created by Joseph H. Pilates that stresses perfectly controlled movements rather than high repetitions. During WWI, JHP utilized his exercise regime to rehabilitate wounded British soldiers. After immigrating to this country in the early 1920's he taught his technique to elite athletes.

The technique addresses the underlying structural imbalances that often lead to back pain such as poor core support, pelvic instability and lack of body awareness. Pilates exercises strengthen the deep postural muscles that support and align the natural curves of the spine. A healthy spine can curve forward and backward, twist and move from side to side. As core strength develops, the back muscles learn to work in harmony with the abdominal muscles forming a protective support that increases potential range of motion of the spine. This retraining of the core muscles leads to reduced pain, improved posture and re-injury prevention.

I do not recommend that people with back pain buy Pilates DVD's and books or join a large group Pilates mat class. Learning the exercises correctly and tailored to the individual with one on one instruction, while more expensive, can be well worth the investment as exercises performed incorrectly can make a back problem worse.

Back pain has many causes and Pilates may not be right for all of them. If an individual chooses Pilates, it is important to work with a fully certified instructor. In Cape Girardeau, the only fully equipped Pilates studio with a fully certified instructor is Absolute Pilates at Fitness Plus on the SFMC campus.

Dr Justin Franke PT, DPT

Select Physical Therapy

Every sensation (including pain) must be interpreted by the brain. In this sense, all pain can be considered mental. Whether or not pain originates from the brain as opposed to actual sensation of brain is extremely difficult to test with scientific research.

Surgery is a good remedy for the actual cause of the pain but it needs to be followed up with a treatment for the behavior that led to the cause of the pain. The most appropriate patient for a surgery is someone who is already actively trying to correct the reasons that led to them needing surgery in the first place. Bad lifting/ carrying and postural behaviors that continue following surgery will lead to the need for more surgery. The people who address their back strength and posture/ body mechanics following surgery are most likely to prevent further injury and find themselves the most satisfied with their surgery.

All products that claim to alleviate back pain cost money and are not as effective as the most important products that don't cost anything. Motivation to exercise, discipline to follow good body mechanics for lifting and awareness of good posture techniques cost nothing but are priceless. No product that can be built is better than the human body for repairing itself with the proper instruction.

Jacob Pattengill

Pain is very difficult to quantify or measure. As a health care provider we can only report pain as something a patient describes. Discomfort or pain may be described as anything from sharp, dull, achy, burning, numbness, tingling and occur at nearly any location in our bodies. These descriptions help your health care provider have a general idea of what is causing your pain but amazingly, pain is always processed in our brain. How we cope with the pain and report it varies from one patient to another.

In regards to recommending surgery, I always recommend that patients exhaust all conservative treatments prior to pursuing surgical intervention. If avenues of physical therapy, medication, and possible injections have been pursued without improvement surgery may be a viable option. Surgery is always based on each surgeon's expertise and training but in general terms, I would recommend considering surgical intervention if symptoms included progressive numbness and tingling in the upper or lower extremity, loss of deep tendon reflexes, difficulty controlling bowel or bladder, and noted weakness in the extremities that may demonstrate muscle wasting or atrophy.

In regards to outcomes after spine surgery, the variables are too diverse to universally say that the patients are "happy" or "unhappy" with their decisions. It depends on the patient's age, dietary habits, smoking habits, expectations for regaining their prior level of function, expectations of their surgeons after the given procedure, and on the severity of the initial symptoms listed above.

Potential candidates must know there are inherent risks with surgical intervention and that the actual procedure is just the beginning and a component of regaining their prior level of function. Please encourage your readers to pursue all conservative treatment prior to surgical intervention and make every effort to understand what they are getting into if they are deemed a surgical candidate. Questions to ask may include: How often do you perform this procedure? How long should I expect to be out of work? What is your protocol after the surgery is complete? Will I wear a back brace? Will I have permanent restrictions that won't allow me to lift, carry, bend, or twist?

Many times, these conservative treatments are part of the rehabilitation process even after surgery.