I went to physical therapy but it didn’t work…

The most frequent prescription that I write is for physical therapy.  My standard scrawl on a prescription pad reads: “Low back pain.  Lumbar spine stabilization and core conditioning exercises.  Teach independent home exercise program.  Frequency: 2-3 times per week for 6 weeks.”  This translates into 12 to 18 visits over 6 weeks with a therapist, with each session lasting about an hour.  I have worked with a number of physical therapists over the years and the ones that get the best results are able to motivate the patients to do the core strengthening and conditioning exercises describe in our home remedy book.

    

Unfortunately, many patients are under the impression that physical therapy should feel like a spa session.  They are expecting the therapist to massage the sore muscles of the back, apply a hot pack to the lower lumbar spine, and magically take the pain away.  This does not work.  The most effective physical therapy programs emphasize ACTIVE rehabilitation, which means that the patient is the one doing the exercise.  Furthermore, this process has to happen outside of the the PT gym.  It is impossible to reverse years of neglect of the muscles that lend stability to the spine with only 18 hours of physical training over 6 weeks.  In my clinical practice I will often seen patient back after they have been going to PT for four to six weeks, and the patients who do well with physical therapy are the ones that put forth a genuine effort establish a routine that they incorporate into their daily lives.  It typically takes 3-4 months to strengthen the core muscles to the point where the patient will notice an improvement in their low back pain.  It takes even longer for the patient to notice physical changes in their body that they can be proud of.  I am fond of saying that I’ll have to quit practicing medicine on the day that the model from the cover of Men’s Journal comes into clinic complaining of back pain, because so far, it just hasn’t happened.  The patients that tell me that PT did nothing for them tend to have more in common with a jellyfish than the guy with six pack abs on the cover of the men’s journal.

jelly fish  mens journal

Take home message #3: physical therapy involves a lot of hard work, and if you aren’t willing to do the work, you won’t get any of the benefit.

next topic: lifestyle choices have a huge effect on back pain

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Makinde Oyedemi

3 years ago

My MRI report some years ago says:

There is partial loss of signal from the disc spaces, worst on L4/L5 and L5/S1
Herniation of the disc with significant canal stenosis is noted at the L5/S1 level, moderate disc bulge with mild canal stenosis is also seen at L4/5 disc space.
The demonstrated vertebral bodies are within normal limits. The paraspinal soft tissues are preserved.

Impression: L5/S1 Disc Herniation

I have been managing this situation since then, but still going through the pain. Please, I want to know what you can offer me.

I sit with computer as part of my routine job, this pain as taken me out of job, please what is your advice

SG-sliderSS1

Sohrab Gollogly, MD is a board-certified orthopedic surgeon and Fellowship-trained spine surgeon who also performs scientific research and participates in several volunteer surgical organizations.

Dr. Gollogly completed his undergraduate education in biology at Reed College in Portland, Ore. He earned his medical degree from the University of Washington School of Medicine.

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