It seems there are always new products, gimmicks, exercise plans, and support groups that claim to offer the most effective, latest and greatest forms of weight loss. I see it on TV, in magazines, newspapers, and I even received a marketing piece in the mail the other day claiming to be the solution to my weight loss problem (which I incidentally don’t have).

I’m starting to hear and see a lot of the same about back pain. On the radio today they were promoting the newest “controversial” cure for back pain that is supposed to be highlighted on the 11pm news (I hope I stay awake long enough to see it). There are a slew of new products from braces, supports, pillows, and supplements. Not to mention, many, often contradicting types of exercise programs. Even the physical therapy treatments range from very aggressive, to passive and gentle. So how do you know where to start or what to invest in?

I wish there was an easy answer…and if there is, I unfortunately don’t have it. I don’t think there is a magic answer to back pain and for many reasons. Here goes:

1. Every body is different and will respond differently to each product and treatment available.

2. Mental /emotional pain and stress will often contribute to physical pain and if not addressed, the individual may not experience relief from a given remedy.

3. Motivation and commitment make a huge difference. If you are supposed to wear a brace for a certain number of hours a day but don’t, the results may not be as implied. Or if an exercise program takes an hour and you only find 15 minutes, you’re not going to get results.

4. It’s often difficult for me to bring up the topic with patients who are overweight, but finding a weight management program is often needed to find relief from back pain. As hard as it is to lose weight, it is so important to make lifestyle changes that include healthy, mindful eating and exercise.

5. The spine is complex structurally, with so many joints, ligaments, muscles, discs, and nerve, that there is lots of room for things to go wrong. Any imbalance can create pain and result in muscle spasm that can lead to weakness and loss of motion over even a short period of time.

6. If there was a magic answer, there wouldn’t be so many resources, products, and treatments available.

I encourage people to tackle back pain quickly to prevent a chronic problem from developing. If one treatment isn’t successful and you are consistently following through with whatever components were recommended (you have to be honest with yourself here), then discuss alternative approaches with your current provider or seek out complementary treatments. Evaluate your lifestyle and overall physical and mental well-being to see what other directions you may need to follow for treatment. Keep an open mind and open lines of communication between all of your providers so you can achieve the best outcome possible.

And who knows, maybe the 11 o’clock news tonight will have a miraculous break through treatment new to all of us that will put an end to back pain forever.

So we decided for the first time this year to forgo the flu shot. I’ve done it in years past when I worked in hospitals and then with young children we always opted for it. My kids are 4 and 5 this year and out of the high risk age range, so we skipped it since we’re generally healthy and I was feeling optimistic.

Well, live and learn. We got the flu (and I say this diagnosis with confidence because the pediatrician did a nasal swab on my daughter to confirm that it was in fact the flu) not once, but twice. Yes, we got two different strains of the virus this year, and it hit hard. High fevers, stomach upset, and a cough that was unlike any I’ve ever experienced. And this is how my injury came to be.

From my frequent, violent, coughing fits, I managed to send my entire neck into painful spasm, to the point where I couldn’t even turn my head. It was so excruciating and every time I coughed I had to brace myself and support my neck in anticipation of the pain.

Now, I’m an advocate of early access to treatment, so after unsuccessfully trying to treat myself (and actually making myself worse by trying to stretch the joints and muscles of my neck and upper back), I went to see a chiropractor and then a massage therapist. My pain gradually decreased as my motion also improved. I have regained almost full motion, and only have pain when I cough (which has lasted over 2 weeks now) and at the extremes of motion. Had I not sought immediate treatment, I don’t believe I would be feeling as well as I am today.

I can’t stress enough the importance of early access to treatment for any type of musculoskeletal pain. It helps to restore function and prevent secondary effects from stiffness and immobilization. Although waiting it out to see what happens is sometimes OK, in many cases, you will speed your recovery time and healing process by seeking out professional care from a doctor, chiropractor, physical therapist, and/or massage therapist within the first three days.

Within physical therapy and among physical therapists there is a a lot of variation in treatments that can be implemented. I’ve worked in hospitals and private clinics, and I have yet to meet 2 physical therapists who would approach a patient with low back pain in exactly the same way. A lot depends on the therapists level of experience, continuing education, and clinical training.

When I graduated with my master’s 10 years ago, I could treat a patient with low back pain in a very basic way. I had done one of my clinical rotations at an outpatient clinic in rural Iowa, and I learned entry-level techniques, without a lot of emphasis on manual therapy for the spine. With my low back patients, I would do some stretching, strengthening, modalities (like ultrasound and electric stimulation), and basic soft tissue and joint mobilization. The lower back was certainly not the area I was most comfortable treating.

Then I attended a seminar where I learned muscle energy techniques, and it changed my approach to back pain (and how quickly my patients felt better). A year or so later I learned another type of joint mobilization and again my experience, approach, and effectiveness improved. I also learned myofascial release, a type of soft tissue mobilization, which added another hands on tool for me to utilize. I wonder had I not taken these particular courses, would I still dread evaluating and treating lower back pain.

I recently read an article that talked about how the approach to care for low back pain patients varies greatly. Some practitioners take a very gentle approach to working with these patients, doing aquatic exercise, gentle stretching, heat, ultrasound, and ice. Others use McKenzie exercises, which encourage a lot of back bending type exercises. Some prefer to do all spinal stabilization. Some therapists use only hands on techniques to restore alignment and muscle balance. This is in high contrast to others, such as the New England Baptist Spine Program which takes a very aggressive approach to strengthening and does not use any modalities or hands on treatment (which has very good clinical results for decreasing pain and improving function for patients with chronic back pain.).

I feel very strongly that each patient is unique and their experience of pain must be looked at very individually. My experience has shown that a combination of some manual therapy, stretching, strengthening, and pain management modalities (all specific to the patient’s body and needs) if necessary provides relief for most patients. If you are working with a therapist and not seeing results, it may be that a different approach to your condition may be what you need. If you notice you are only doing exercises and the therapist doesn’t do any hands on work, you may need some specific joint stretching done. If your therapist is only doing hands on work and modalities, you probably need to do exercises to maintain the changes that their hands are invoking. It’s perfectly okay and appropriate to let your PT know that you are concerned about a lack of progress. You can also ask for a second opinion. You may not feel comfortable telling your provider that you want a different PT to see you, but a good therapist should be open to at least getting a colleague’s opinion and suggestions if you aren’t improving. You can always seek treatment at a different facility as well. If you take that route, be sure to communicate with your new therapist about the specifics of prior treatment that weren’t effective so you can start in the right direction. (You will also need to talk with your insurance company as they may not pay for a second evaluation and you may have partially exhausted your benefit.)

There are many options for back pain treatment within and aside from physical therapy. The same treatment doesn’t work for everybody; if it did, there wouldn’t be anybody living with chronic pain. If you can be open to trying new things, be consistent with the requirements of the treatment (if you don’t do any of your exercises and aren’t getting better, that may be the problem), and be proactive in finding the best solution for yourself, over time you should find relief from your pain.

Your whole body is aching and you feel like you’re falling apart. Is it that virus going around that’s got you so sore? Is it from all the tension from the super bowl game the other night? (New England fans I’m sure can relate.)

Although multiple areas of aches, pains, or injury are possible (particularly if you have sustained a trauma), you may be experiencing more than a traditional musculoskeletal injury. Multi-joint aches and pains can be a sign of a systemic, or total body condition. You want to also make note of whether you have any changes in your sleep, weight loss or gain, rashes, night sweats, depression, fatigue, or other unusual symptoms. Several of the rheumatic conditions, such as rheumatoid arthritis, lupus, and scleroderma cause joint pain and swelling in multiple joints, but the treatment for these would be different than for a joint sprain or osteoarthritis.

It’s important to communicate with your primary care doctor if you have multi-joint pain so s/he can perform a thorough examination and run the appropriate lab work and diagnostic tests to allow for an accurate diagnosis. The earlier your condition is known, the sooner an effective treatment program can begin.

My first job after graduating with my Master’s in physical therapy was as an acute care physical therapist at the University of Michigan Medical Center in Ann Arbor. I worked with patients following such varied procedures as knee replacements, heart transplants, bone marrow transplants, and amputations. It was such a dynamic environment to learn about medicine, grow as a therapist, and observe patients coping with their hospitalizations.

I encountered many patients who didn’t understand their condition, their prognosis, or what the treatment plan was. When I explored this further, I learned a lot of people didn’t ask questions because 1. they were too scared or 2. didn’t want to take up more of the doctor’s time or 3. didn’t think of it in time. Often people were confused about when they would go home, who was going to pay for the shower chair they needed, and whether or not a home health aid would be coming in to help them. Although shorter hospital stays, staffing shortages, and high costs of health care played a role, it seemed some patients didn’t understand their rights and ability to be involved in their care. A colleague and I both agreed that there was a definite need for people to understand the health care system and their role as an active participant and advocate within that system…a so called “Guide to What Every Patient Needs to Know to Survive the Health Care System.” (We never did write that, so here is an abridged version.)

When I transitioned to working in an outpatient setting with a focus on musculoskeletal injuries of the sports, overuse, and arthritic varieties, I saw some similar problems. Patients not understanding their treatment options, not getting to physical therapy until several weeks after their injury due to delays in getting appointments, and people exhausting their insurance benefit without realizing it was even a possibility. When I broke it down, it all seemed the fault of poor communication…maybe a provider not explaining clearly enough, or not explaining everything, or the patient not asking the necessary questions. The following 5 tips are a starting point for taking control of how your injury or health is managed and steps you can take to have the best outcome possible.

1. Find the Right Provider: If you get a bad haircut, you’d probably find a new hairdresser, right? It’s OK to search a little for a health care provider until you find the right fit for you. It’s well worth your time to find a health care provider you like, find easy to talk to/reach, and who provides you with care you feel good about. Recommendations from friends and family can be an excellent way to find a provider. In selecting a primary care doctor, you may want to have a phone interview or in person consultation to meet with the practitioner. You may want to ask if they have evening and weekend appointments, are available to answer questions/concerns via email, and about their philosophy or approach to care.
2. Don’t Delay: If you sustain an injury or illness, get treated early. Granted, you don’t want to run to the doctor with every ache and pain; but if a “minor” injury doesn’t improve after 5-7 days of modified activity, ice, and over the counter pain relievers/anti-inflammatories, schedule an appointment to see your doctor. It may be a more serious problem than you think, and treating it early will reduce your chance of developing a chronic problem. If an appointment isn’t available within a day or two of calling, you can request to be notified of a cancellation, request to speak with a doctor or nurse about your concerns, or firmly request an earlier appointment.
3. Educate yourself: With the Internet at your finger tips, you can investigate on a reliable website, such as webMD.com or wellnessprofessionals.com, to get an idea of what condition may be contributing to your symptoms. This is not in any way meant to replace a thorough evaluation by your doctor, but is a means to gain insight into what may be happening in your body. It will also allow you to learn about potential treatment options so you can engage in informed conversation with your doctor and have specific questions prepared to ask at your appointment.
4. Clearly communicate your concerns and preferences: Have your questions and main points to discuss written down when you meet with your doctor so you don’t forget to cover anything. If you feel rushed, it’s OK to let your provider know. Politely saying, “I know you must be busy, but there are a few more things I want to talk to you about/want clarified.” In addition, if your doctor recommends something that you’re not comfortable with, it’s your right to express that and explore other options. Let’s say for example that you go to see your doctor because you hurt your back, and he recommends bed rest and muscle relaxants for a week. If you can’t afford to be out of work or don’t like how these medications make you feel, you could say something like, “I understand that is one option. Is there anything else I could do because that doesn’t work well for my situation (and explain).” Or you could say, “What about trying physical therapy? I’d prefer to start on that right away.”
5. Understand your benefits: Contact your insurance company to see what your plan covers. For instance, if your doctor recommends physical therapy or chiropractic care, your plan may allow 30 visits per condition, per calendar year. Or it might cover treatment up to three times per week for two months, and at the end of the two months deny paying for further treatment. Some plans have limited networks of providers that they contract with, and it is most cost effective to see an in network provider so you don’t assume additional out of pocket expenses. Prior to scheduling an appointment, verify that the provider you choose is in your insurance network and confirm your insurance benefit with them.

Whether you’re in a hospital room and need help to get out of bed, or you are an active individual with a musculoskeletal injury, you have a say. You can speak up, be confident, and feel in charge of your body as you coordinate your care, treatment, and experience within the health care system.