Got chronic back pain? Try physical therapy

Participants who called during Saturday's Deseret News/Intermountain Healthcare Hotline had several specific questions about incontinence and low-back pain that are common to patients with those conditions.

Jake Magel, a physical therapist and director of the Intermountain Orthopedic and Spine Therapy Clinic at Intermountain Medical Center, said many older patients with chronic back pain have not had physical therapy to deal with their symptoms.

Magel said targeted exercises directed to specific symptoms have been shown to be beneficial for people with the condition.

"We're not talking about getting rid of the pain, but being better able to function with it," he said.

Some callers said they'd had MRIs showing multiple issues such as slipped discs in the spine or arthritic conditions that are part of the normal aging process.

"With specific exercise and some kinds of mobility modification and manual manipulation, studies have shown that this condition can be better managed," Magel said. "We're not talking about taking the pain away altogether. For low back pain, there is no quick fix."

People with acute low-back pain that doesn't extend below the knee and is less than 16 days duration are often most helped by spinal manipulation and exercise. If there has been pain below the knee, it often involves neurological conditions or nerve irritation, and spinal manipulation exercises are often the best intervention, he said.

Magel urged anyone dealing with low back pain to consider physical therapy.

"If people get proper care up front, they tend to use less health care in the years following," he said. "They visit physicians less, take fewer medications and miss less days at work."

Physical therapist Susan McLaughlin, a specialist in dealing with incontinence, said many callers were concerned about urgency with urination and about Kegel exercises they have tried for years that don't seem to help.

People who can't make it to a bathroom before leaking urine are often experiencing a reversal of brain/bladder function. Rather than the brain controlling urination, "the bladder starts taking control," McLaughlin said.

"When they have the urge to go or are going every 30 minutes, they're not allowing the bladder to fill completely," she said. "So it trains the bladder that when it gets to that (low capacity) level," they need to urinate.

McLaughlin suggests that patients learn suppression techniques, which means they avoid urinating when the urge first comes.

It can be helpful to sit in an upright position and put pressure on the urethra to suppress the urge, she said, or to use a pelvic floor contraction if the right technique is employed.