DECATUR — Sandy Calhoun didn’t want to have surgery, and she definitely didn’t want to take prescription pain medications.
Calhoun would pop an Advil when her lower back pain got too bad, but for many years she, “just kind of dealt with it.”
Finally, after a car accident, she had an X-ray. The accident didn’t do any damage, but the X-ray showed some signs of joint disease in her lower back.
Surgery was an option, but Calhoun opted to try physical therapy. So far, it’s working.
“I could tell a difference quickly,” Calhoun said. “And the more I do, the more it improves and I have less pain.”
Calhoun is one of the lucky ones. Back pain has sent hundreds of thousands down a path that has led to a physical addiction to opioid painkillers — drugs such as Percocet, Vicodin, OxyContin, Demerol, Dilaudid, fentanyl and morphine. They’re great at masking pain, but they’re also highly addictive. Patients commonly build a tolerance, and with the the crackdown in recent years on prescribing opioids, those who are already addicted have turned to street drugs such as heroin.
The state of Illinois has experienced one of the highest increases (8 percent) of overdose deaths in the country, many of which are opioid-related.
Physical therapy is a way to fix the pain before surgery and without masking it with medications, which can hide the root cause and keep a patient from being motivated to perform the exercises that can relieve the pain.
John Furrey, HSHS St. Mary's Hospital Pain Medicine Center of Central Illinois director, said physical therapy has become the No. 1 option for pain.
“The WHO (World Health Organization) came up with pyramid, and they recommend interventions like physical therapy as the first line,” Furrey said. “There’s hardly a patient who comes through who doesn’t get referred to physical therapy for pain for back and leg pain.
“And physical therapy does seem to help. When you increase mobility, it can actually help joints lubricate themselves and allows tissues to move more freely and be more pliable.”
Brian Freund, an Athletico physical therapist based in St. Peters, Mo., said a therapist’s job is to provide education and exercises to increase mobility, strength and flexibility, and to, “facilitate a healing environment for whatever tissue is injured.”
“We live in a society that wants immediate results,” Freund said. “We work as a team with the physician to set realistic goals, to explain the healing process and establish how long it’s going to take.”
Furrey said most patients are at least initially responsive to physical therapy for pain management.
“Pain is a good convincer — people want their pain reduced and are willing to do anything you ask of them,” Furrey said.
Freund said he can usually convince patients to give him a shot.
“There are definitely people who are skeptical, usually because of experiences a friend or family member has shared,” Freund said. “But the research is clear. The CDC (Centers for Disease Control and Prevention) recommend it as the first option for treatment and the risk is extremely low.
“I’ll say to people: Give me four to six visits. Give me an opportunity, because I know I can help.”
That was HSHS St. Mary’s Hospital physical therapist Karen Hill’s pitch to Calhoun, who considered surgery on her back.
Calhoun had been experiencing lower back pain and radicular symptoms — pain that runs down the leg from the spinal nerve root — for five or six years.
“I worked at a financial institution and sat all the time,” Calhoun said. “It was just one of those things you put up with — some days were worse than others — and I put up with it for years. There’s a lot of pain when you get older that you just deal with.”
Calhoun began physical therapy Jan. 5 and noticed an immediate difference. Hill said that’s common.
“Sometimes in physical therapy that happens — the pain immediately starts coming out of the leg," Hill said. "I’ll have them do the exercises and ask them how much pain they have and they’ll say they don’t have any. And this will be after they’ve had pain for months straight, then all the sudden they don’t have it.
“I’ve had people with hip pain get sent to me and I’ll tell them it’s their back and they’ll say, ‘No, I need a new hip.’ Then they’ll go through the program and they won’t have the hip pain anymore.
“But then I’ll explain to them: As quickly as it comes out of there, it can come back. It’s their postural habits that are making the disc bulge and rupture.”
Most back pain is the result of repetitive stress, either lifting or sitting incorrectly.
“It’s not just picking up one thing or one incident, it’s repetitive,” Hill said. “We have more forces when we sit. And we’re in that bent position that causes the disc to start moving backwards.”
Hill said the philosophy of physical therapy for back pain is to force the disc off the nerve root.
“We use exercises to try to physically force the disc back in,” Hill said. “What we do is try to push it in and have patients maintain good posture. When we bend forward, that disc has a tendency to move back and it keeps going through the outer rings until it ruptures. We’re trying to prevent rupturing and trying to get that bulge back in.”
Hill said the exercises focus on extension, which work well with relieving radicular symptoms. The main exercise is the press-up, in which the patient gets in the push-up position, relaxes their lower half and lifts their head and chest to create a curve in the lumbar spot.
“I’ll have them do those press-ups at home every two hours to start out with,” Hill said. “As they graduate and abolish the pain, they don’t have to do them as much.”
Hill said the motion can be done while standing, but lying on the belly is more effective. Hill said walking is also good for lower back and radicular pain.
“Walking is also an extension,” Hill said. “The back has poor blood supply, and moving is how it nurses itself. That’s why you have to keep moving. If you don’t, you get stiff, then you get more pain.”
Hill said there are times that it’s too late for physical therapy — “When the capsule around the disc has gotten so stretched that we can’t keep it in,” Hill said. But even after surgery, physical therapy can help patients get pain-free faster and, in turn, get off opioids faster.
“There are lots of times we’ll get referrals from our back surgeon post-surgery to help the patient tone it up and teach them good posture — how to sit, how to stand and how to lift — to prevent any further problems,” Hill said.
Freund said physical therapy is more effective when started early: Don’t wait for the pain to become unbearable to report it to a doctor.
“Any injury, if left untreated, can advance into chronic pain,” Freund said. “If you’re having any back pain, early treatment and early intervention are the key. If you get it treated early, you can prevent it from becoming chronic pain.”