Back Pain

Back pain seems to be a fact of life. Lower back pain affects as many as 80 percent of adults sometime during their lives. Even though back pain is common among adults, if your pain is severe or becomes more frequent, you should talk to your doctor.

Anything from injury to improper lifting to aging may cause back pain. Some of the common causes of back pain include:

• Stretched or strained muscles
• Injuries that damage the muscles, bones or tissue in the back
• Herniated (slipped) discs
• Osteoporosis
• Obesity and overweight
• Poor posture
• Pregnancy

How is back pain diagnosed?

Your doctor may use a number of diagnostic tests to determine the cause of your back pain. You may need an X-ray that shows problems like arthritis or bone diseases. X-rays, however, won’t reveal problems with soft tissue such as the discs or nerves. Your doctor may use a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) test. Other diagnostic tests may include a myelogram, which is an X-ray of the spine using a special dye.

What treatments are available?

Luckily, most back problems can be treated without surgery. Your doctor may suggest limiting your activity and prescribe some pain medications or anti-inflammatory medicines. You may start seeing a physical therapist for exercises designed to strengthen the back or for other treatments.

What about surgery?

If a severely pinched nerve, a compressed spinal cord or instability in the spine causes your back problem, then your doctor may suggest surgery. Surgery may be indicated if you have symptoms of nerve damage including pain radiating down the legs or arms; pain, numbness, weakness or tingling in the arms or legs; or a loss of bowel or bladder control.

Back surgery is used for these conditions:

• Herniated disk
• Disk degeneration
• Spinal stenosis (narrowing)
• Fractures
• Infections or tumors
• Spinal deformity

Back surgery techniques are improving. Today, your doctor may be able to use less invasive surgery techniques to treat your condition. It’s important for you to talk with your doctor about your options and which procedures are recommended and why.

Take Control

You can take these steps to prevent recurrent back problems:

• Exercise regularly to keep the muscles in your back strong and flexible.
• Stretch before exercising to help warm up your muscles.
• Avoid standing or being in one position for too long.
• Maintain your proper body weight since excess weight strains your back muscles.
• Use proper lifting and moving techniques.
• Get help if an object is heavy or an awkward size.
• Don’t twist when lifting.
• Avoid smoking.
• Remember what your mother said, “Don’t slouch. Sit up straight.”

Hip Fractures

Hip fractures send more than 320,000 Americans to the hospital each year. While hip fractures can be treated, the injury can lead to severe health problems and reduced quality of life. Approximately 20 percent of hip fracture patients die within one year of their injury.

Most hip fractures occur because of a fall, especially among adults over the age of 65. Women are more likely than men to experience hip fractures due to a higher rate of osteoporosis. In addition to advanced age and osteoporosis, other risk factors associated with hip fractures include being Caucasian or Asian, lack of calcium and vitamin D in the diet when younger, physical inactivity, tobacco and alcohol use, and certain medications. Environmental factors, such as loose rugs or a cluttered living space, also could increase the chance of falling.

A hip fracture causes pain in the outer upper thigh or groin area, as well as the inability to bear weight on the side of the injury. The hip area may become stiff, show signs of bruising or swelling, and a significant level of discomfort could occur after any attempt to rotate or flex the hip. Most hip fractures are diagnosed following an X-ray, which also shows where the fracture occurred in the hip.

Treatment is determined based on the patient’s overall health and age, as well as the location and severity of the fracture. Most hip fractures are treated surgically using one of three methods:

• Inserting metal screws into the bone, if it is properly aligned, to hold it together as it heals. This is called internal fixation.
• Replacing part of the femur, the long bone that extends from the pelvis to the knee. This method, called hemiarthroplasty, calls for removing the head and neck of the femur and replacing them with a metal prosthesis.
• Replacing the upper femur and pelvic bone socket with a prosthesis. This is called a total hip replacement.

Patients typically do better if they undergo surgery soon after the hip fracture occurs. They may be encouraged to get out of bed the day after surgery with help from a physical therapist, who also will work with patients to help them regain strength and start walking again. After a hip fracture, most patients are hospitalized for approximately one week and may then be either discharged home or referred to a nursing home if they are unable to live independently. Physical therapy rehabilitation usually takes approximately three months. 

People at risk for hip fractures can take steps to reduce their chances of falling.

• Women should have a bone density test to measure bone mass and make sure they get enough vitamin D and calcium in their diet.
• Engage in weight-bearing exercise to help strengthen bones and prevent falls.
• Avoid excessive amounts of alcohol and do not smoke.
• Take medications as prescribed to treat osteoporosis.
• Wear shoes with non-skid soles and avoid high heels and shoes like sandals and bedroom slippers that flop when you walk.
• Check your home for trip hazards like throw rugs, electrical cords and clutter.
• Make sure your home and outside walkways are well-lit so you can see where you are walking.
• Talk to your doctor or physical therapist about whether assistive devices may be needed to help you keep your balance.

Computer-guided Total Knee Replacement

You tried strengthening exercises for the pain caused by arthritis in your knee, but that didn’t work. Neither did medications, injections or using a cane while walking. So now you are looking at undergoing total knee replacement surgery. While the thought of surgery may be a bit scary, knowing that this type of operation is one of the most successful procedures in all of medicine is reassuring.

More than 600,000 knee replacements are performed in the United States annually. Some of these procedures are now being done with the assistance of computers. This type of computer-guided total knee replacement has shown to help improve the reliability of sizing and positioning of joint implants. 

Proper placement of a knee implant is critical to the long-term success of the operation. The ideal position of the implant allows for weight being transferred from the center of the head of the femoral bone down through the center of the knee joint and then to the center of the ankle. This imaginary line is called the mechanical axis. Any deviation from this line could result in more weight-bearing stress being placed on one side of the knee joint, which could increase the risk of the implant loosening.

With the use of special computers, orthopedic surgeons can confirm proper alignment of knee replacement implants. This computer-assisted navigation technology is especially helpful with patients who are obese or have knee deformity because that can increase the difficulty of the procedure.

A computer-assisted knee replacement procedure begins with the surgeon placing several small transmitters on the patient’s leg. An infrared camera is used to track the movement of the transmitters via a computer that analyzes the positions and creates an anatomical drawing of the knee. Using this real-time graphic display, the surgeon makes cuts in the bone to ensure proper alignment on the mechanical axis for the implant. The implant is then secured with bone cement, tested to ensure proper alignment, and the incision is closed with stitches. Using computer navigation during surgery may add about 15 minutes to the total operating time of one to two hours.

As with a regular total knee replacement, patients typically stay in the hospital for several days. Foot and ankle movement is encouraged right after surgery to increase blood flow in the leg, and decrease swelling and blood clots. Most patients are able to resume regular activity within three to six weeks after surgery.

More than 90 percent of total knee replacement surgery patients experience a significant reduction in knee pain and considerable improvement in their ability to perform regular activities of daily living. However, patients should not expect to be able to do more than they could before they developed arthritis. Walking, biking, swimming and other low impact activities are acceptable forms of exercise. High-impact sports that involve running, jogging or jumping should be avoided. Knee replacements can last for many years with appropriate activity modification.

The Importance of Physical / Occupational Therapy after Joint Replacement 

Physical / Occupational therapy plays an important role in helping patients return to everyday activities following joint surgery to replace hips, knees, shoulders, fingers or ankles. Making a full recovery takes a considerable amount of time and significant effort on the part of the patient, but is often possible with the help of a physical therapist.

Therapy following joint replacement surgery usually begins with a thorough assessment of your condition and the development of a treatment plan. During a quick screening, the physical therapist will check your heart rate, blood pressure, breathing, skin integrity, and range of motion and functional strength of other areas of the body. An evaluation of your overall ability to move may be done and you may be asked to complete a questionnaire to describe problems you could encounter with day-to-day activities, such as getting dressed. Finally, the therapist will make a recommendation of how many visits and for how long you will need physical therapy.

Your physical therapist will recommend certain exercises as part of your rehabilitation program. Exercise can help improve flexibility, decrease swelling, increase strength, enhance endurance, improve balance and coordination, and lessen difficulties in performing daily activities. The type and intensity of exercises you do will take into account the surgery that was performed, type of replacement joint and condition of the joint before surgery.

If you had a shoulder replacement, for example, your occupational therapy program would typically begin with isometric strengthening exercises. This would focus on muscles that lift and push the arm forward and backward, raise the arm, and turn the shoulder. As your therapy progresses, elastic bands would be introduced to further strengthen shoulder muscles. Approximately 12 weeks after surgery light weights can be used, beginning with one-pound weights and gradually progressing up to five-pound weights. Aquatic exercises also may be included in your physical therapy program.

As you go through therapy it is important not to overdo the exercises. If you notice any swelling, you may be doing too much, too fast. A small amount of muscle discomfort during therapy is to be expected, but if you experience pain, you may be irritating or straining the joint too much. Check with your therapist if you experience any problems with your exercises.

Physical therapy may feel uncomfortable at first, but exercises will help speed your recovery and reduce pain after surgery. If you had a total hip replacement, you will be asked to begin walking to increase circulation in your legs and feet, and to prevent blood clots. It may take months to make a full recovery. During that time your physical therapist will work with you to build endurance so your muscles will work effectively for longer periods of time. You also may be asked to start weight-bearing and postural exercises, as well as balance and coordination exercises.

Your physical therapist will recommend more advanced exercises as your condition continues to improve. During follow-up visits your therapist can make sure you are performing the exercises routinely and safely. Eventually you will be released to full activity, but keep in touch with your therapist to ensure that you achieve your optimal range of motion and make a complete recovery.

For a physician referral, please call 1-800-522-5292.