Back In Place
Advance for Directors in Rehabilitation, by Paul Hoffmann, MD, and John Kelly, MPT

Lately, decompression therapy has been receiving a fair share of attention. And for good reason, as the incidences of back and neck pains are still occurring with alarming frequency.

Simply put, spinal decompression is traction applied in constant or intermittent phases to isolate mechanical impairment in the neck or back. Barring spinal instability, traction is a gentle approach to treat common spinal dysfunctions, to address nonfused, post-surgical discomfort or manage failed back syndrome.

At our center, traction plays an important role to treat spinal conditions, and successful intervention depends on accurate communication between a physician and physical therapist. In addition, a proper diagnosis, the administration of medications and injections, if warranted, and a physical therapy program are key components to maximize patient outcomes. This article will address the approach physicians and therapists should take with respect to spinal derangement, while incorporating traction or decompression therapy into a treatment regime. more

Treating with Traction
Physical Therapy Products, by Renee DiIulio

Back pain is the second most common neurological ailment in the United States—surpassed only by headache. Eight out of 10 Americans, or an estimated 80%, will complain of back pain at some point in their lives. Many will take a do-it-yourself (or a wait-and-see) approach to fix the problem, solution that, fortunately, often works. Most back pain dissipates on its own after a few days.

In some cases, however, it doesn't. Short-term or acute back pain lasts a few days or weeks; chronic back pain is experienced for longer than 3 months. The National Institute of Arthritis and Musculoskeletal and Skin Diseases recommends back pain sufferers seek medical care if the pain persists for more than 3 days.

Some of these patients will find themselves in physical therapy, where the goal will be to alleviate or manage the pain. Practitioners of the McKenzie Method of Mechanical Diagnosis and Therapy share these goals but take a unique approach, creating a patient-specific program designed to minimize the number of visits. This program emphasizes active patient involvement, employing personalized exercises whenever possible.

Sometimes, however, the patient is unable to take such an active role in rehabilitation, and the therapist must use additional means, such as hands-on and traction techniques, until the patient has recovered the strength and ability. "We try to do a lot of patient generator forces first to see if they can resolve themselves and then incorporate traction at a later point in time, after we have exhausted what the patient can do on their own," says Clint Lohr, PT, cert.MDT, clinical coordinator for Baptist Health Care in Pensacola, Fla. more

Back to Basics
Physical Therapy Products, by Renee DiIulio

Who would have thought that a man could lift 1,000 pounds? But he can. At least two men hold official records for bench pressing more than 1,000 pounds, and the Internet is home to numerous videos offering proof of more men. But just because records can be broken doesn't mean they always should be, particularly by the average gym-goer egged on by well-meaning friends.

Jim Arnoux, PT, owner of Arnoux Physical Therapy in Portland, Ore, has seen the results of these misguided efforts. He once saw three patients in a row with thoracic disk problems caused by incorrect bench presses. Neither gender nor age is immune; one of the three thoracic disk patients was a woman. Another patient with a more serious injury by the same cause was only 15 years old.

Of course, back pain is not felt solely by overzealous weight lifters; there is a wide range of conditions that can cause enough pain to require treatment. Certain causes can be alleviated with back traction, which uses force to open space between the vertebrae. The resulting effect can help to alleviate back pain and muscle spasms by decreasing pressure, increasing disk hydration, and stretching muscles. more

Spinal Dysfunctions
Advance for Directors in Rehabilitation, by Ben Crawford, MS, PT

The spine runs from the base of the neck all the way down to the torso, twisting, curving and supporting the body along the way. The stacked cervical, thoracic and lumbar vertebrae withstand a high amount of stress every day. A breakdown somewhere along the chain, at some point in peoples' lives, seems inevitable. For more than 80 percent of Americans, that's exactly what happens when back and neck pain set in. In most cases, a common spinal dysfunction is the culprit.

Do you know how to identify the problem and can you differentiate between these disorders? This is the initial step to providing relief to patients. Of course, the usual relief advice includes proper body mechanics, exercise and tips to maintain a healthy back, but it's important to stay familiar with common spine dysfunctions.

• Degenerative discs. Cervical discs are made up of about 80 percent water, which creates a sponge-like shock absorber that provides a cushion between spinal vertebrae. These discs are comparable to a jelly donut with a sturdy outer layer and a pliable inner core. more

Driving Force
Advance for Directors in Rehabilitation, by Jeremy Bruce, MPT

Like back pain, whiplash injuries have long been associated with malingerers, symptom magnification and the stigma of unfounded lawsuits. But for those who truly sustain a whiplash-associated injury, the pain for people is real, intense and debilitating.

In severe cases, back and neck pain can be just the start, as the injury manifests into non-spinal symptoms—severe headaches, paresthesia, tinnitus, dizziness and concentration problems. Many researchers view whiplash as a systemic illness rather than an acute injury. The overwhelming majority of whiplash cases arise from automobile accidents. Occasionally, sports injuries and other accidents can also force the neck beyond its normal range of motion, which results in hyperextension and flexion of the cervical spine.

Regardless of the precipitating event, whiplash still elicits clinical controversy. Some clinicians feel its etiology arises from facet joint damage, while others implicate intervertebral disks, ligaments or muscular pathology. Treatments are just as hotly debated—some clinicians recommend rest, while others advocate exercise. Still others swear by manipulation or steroid injections.

Because of these uncertainties and its frequency in rehabilitation clinics, it's pertinent to take a closer look at whiplash and evidence-based treatments that can bring relief. more

Disc Damage
Advance for Directors in Rehabilitation, by Diana Olsen

As a child, you were probably told to "stand up straight" when you slouched. The admonishment wasn't intended to make you uncomfortable, as you might have thought at the time.

The demand for proper posture was actually intended to increase your long-term back comfort. While the phrase is still commonly used from classrooms to clinics, it can be misleading, and it belies the natural curvature of the spine.

The spine is comprised of four curves, divided into four regions: cervical, thoracic, lumbar and sacrum. These gently sloping spinal arcs all play crucial roles in overall comfort and a person's ability to stand, walk, sit and enjoy a productive quality of life. Spine health shouldn't be taken lightly.

The curvature of the spine is designed to absorb shock during movement, and the elastic discs that cushion the vertebrae feel the brunt of the burden. It's no wonder that approximately 70 percent of people have some form of disc pathology, says Matthew Goodemote, MPT, Dip. MDT, founder of Community Physical Therapy & Wellness in upstate New York.

Long-term disc pressure or a sudden increase in pressure can cause the jelly-like disc nucleus to push against the disc casing. When this bulge extrudes into the spinal canal, the result is a herniated disc.

A herniated disc often indicates additional spinal pathology, such as another herniation in the neck. Because spinal regions are interconnected, pathology in one area can easily affect other areas. "Very rarely do I see someone who has just one level of herniation," says Goodemote. more