WHAT IS DORSALGIA? 

Chances are, you or someone you know has had lower back pain. Each year 15% of the population has their first episode of low back pain, and over the course of our lives, 80% of us will have lower back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, poor posture, arthritis, opioid use, multiple surgeries, severe pain, and a lifetime of disability are far too common.

Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

MEDICATION

Low back pain is the #1 reason for opioid prescription in the US, however, in 2106 the CDC recommended against the use of opioids for pain relief in favor of “non-drug treatment like physical therapy.”

IMAGING

Having an X-ray or MRI for back pain is common, however, it’s rarely needed or helpful. Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes in imaging are common.

  • 90% of people aged 50 to 55 have disc degeneration when imaged, whether they have symptoms or not
  • In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge.
  • Just getting an image increases the chances that you’ll have surgical treatment by 34%.

SURGERY

The US has sky-high rates for dorsalgia surgeries – 40% higher than any other country and 5x higher than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are terrible! A patient (worker’s comp) study looked at 725 people who had spinal fusions VS 725 people who didn’t. The surgical group had:

  • A 1 in 4 chance of a repeat surgery
  • A 1 in 3 chance of a major complication
  • A 1 in 3 chance of never returning to work again

Physical Therapy

  • Current clinical practice guidelines support manual therapy and exercise.
  • Research proves that early PT leads to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids.
  • A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60%
  • Unfortunately, only 2% of people with back pain signals start with PT, and only 7% get to PT within 90 days.

Despite the data showing that conservative therapy, PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for neck or back pain, and PT isn’t one of the first treatment options, ask for it! A Physical Therapist is a specialist trained to be able to assess your lower back and neck pain and refer out to an MD or request imaging if appropriate, so often you may save time and money by seeing your PT first!

The different types of Dorsalgia:

Simply termed, dorsalgia is severe pain in the back. It takes root from two words: “Dorsal” which means back, and “algia” which means pain. However, dorsalgia is more than just simple back pain. If we talk in specific terms, the pain involved in dorsalgia comes from the spine. Accordingly, the section of the spine that is responsible for the pain makes for a particular type of dorsalgia.

In all, there are six known types of dorsalgia. These are listed here:

1. Cervical dorsalgia

Sometimes, cervical dorsalgia is also medically termed as cervicalgia. In this type, the cervical spine is involved. The pain you feel is in the neck region and occurs due to some injury or otherwise as a result of degeneration of the cervical spine.

2. Cervicothoracic dorsalgia

As is evident in the term, this type of dorsalgia involves cervical and thoracic regions of the spine. The cervical spine is the uppermost part of the vertebral column that exists in the neck region. Whereas the thoracic spine is the second portion of the vertebral column. It is located between the cervical spine and lumbar spine. Hence, the pain in cervicothoracic dorsalgia comes from both of these portions.

3. Thoracic dorsalgia

As compared to cervicothoracic dorsalgia, this type of back pain comes from only the thoracic vertebral segments. Typically, this type of dorsalgia is a rare occurrence.

4. Thoracolumbar dorsalgia

Thoracolumbar dorsalgia involves both the thoracic and lumbar spine. Usually, this type involves both upper and lower back pain.

5. Lumbar dorsalgia

The lumbar spine is located where the thoracic spine ends and continues down to where the sacral spine starts. As this part of the back is the most used of all in our daily movements, lumbar dorsalgia is more common among patients with this disease.

6. Lumbosacral dorsalgia

This type involves back pain that roots from both the lumbar and sacral spine.

Symptoms of Dorsalgia

Varying between the six types, the symptoms of this disease are usually common across patients. You may feel a sharp or stinging pain in your back or only your neck. This pain also carries a burning sensation. You may have difficulty changing your position like climbing the stairs or rising from a chair or bed. In addition to that, there will also be pain or difficulty while bending down.

Overall, a change of posture is painful for patients with dorsalgia. In some cases where nerves are compromised due to a bulge of spinal discs, the symptoms usually also include numbness in the upper and lower extremities. Sometimes, a stinging sensation is also experienced. Both of these problems make it difficult for the patient to carry out everyday activities with ease.

Treatment for Dorsalgia

Nonsurgical Treatments

When surgery is not involved, treatment of dorsalgia is mainly relied on with pain relief medications along with physical therapy.

We all feel like life is spinning out of control at times, but if you have dizziness, that spinning feeling is for real. A physical therapist can help with many common forms of vertigo and dizziness. In this article, we’ll take a look at two examples of conditions that cause dizziness commonly treated by PTs.

BPPV

Benign Paroxysmal Positional Vertigo (or BPPV) is the most common cause of vertigo, a false sensation of spinning. BPPV is a mechanical problem in your inner ear that causes a feeling of spinning with certain head positions or movements. BPPV is caused when some of the small crystals normally embedded in gel in your inner ear get dislodged and end up in the semicircular canals of your inner ear. These canals are filled with fluid and sense head motion. The crystals disrupt the normal function of the canal, which sends an abnormal signal to your brain. Your brain interprets this signal as head movement, even though your head is still, causing you to feel dizzy.

Your therapist can take you through a series of motions to determine which is the problem ear and which canal the crystals are in. After that, a specific maneuver involving head motion allows gravity to pull the crystals out of the semicircular canal. Usually, symptoms can be greatly improved in 1 to 3 treatments, but some patients continue to feel mild dizziness or sensitivity to head motions even after the crystals are removed from the canal. Your therapist can also evaluate this and prescribe home exercises to correct this problem.

Cervicogenic Dizziness and Vestibular Rehabilitation

This is a condition that causes dizziness but is related to problems in the neck. This is a much more rare condition than BPPV and does not cause a true spinning sensation. There is no specific test for cervicogenic dizziness, so it’s important to get a thorough evaluation from a qualified professional like a PT to rule out other problems that may be causing your dizziness.

In most cases, the dizziness improves with treatment of the neck pathology alone using things like exercise, manual therapy, and education on proper posture. For the patients who don’t improve with treatment of the neck alone, adding vestibular rehabilitation often improves symptoms. Vestibular rehabilitation may include eye exercises, balance exercises, or graded exposure to what makes you dizzy.

Treatment of vertigo and dizziness is a specialized form of physical therapy that requires specific training. If you’re experiencing dizziness or vertigo, getting a full evaluation by a qualified PT is a great first step to stop yourself from spinning out of control. They can diagnose the specific cause of your dizziness and design a treatment plan to address it.

Think about the last time you made a big purchase, say $1,000 or more. Did you go out and buy the first thing you saw? Take one recommendation from somebody? Or did you research it, learn some things, compare it to other options, and select something that was right for you? Most people tend to be educated and research large purchases like cars, televisions, computers or the newest iPhone. So why do we so often fail to do this with healthcare?

By becoming more educated healthcare consumers we can go from passive patients who take the first recommendation that comes from a practitioner to an active consumer who weighs options and makes choices. Did you know that providers may make more money from you by directing you to other services at THEIR facility instead of providing you information on other locations that you may also obtain these services at a lesser cost or under more educated or qualified providers? Here are some questions to talk through with your practitioner the next time a healthcare decision comes up.

WHAT ARE THE BENEFITS OR EXPECTED RESULTS?

When a treatment or procedure is recommended, the patient often assumes that it will make them “better.” But what the patient expects and what the healthcare provider expects are often two different things. For example, a patient having back surgery expects to be pain free after surgery. The surgeon probably doesn’t expect that to happen. Outcomes from back surgeries are terrible. A large study of 1450 patients in the Ohio worker’s comp system showed that after 2 years 26% of patients who had surgery returned to work. Compare that to 67% of patients who didn’t have surgery. There was also a 41% increase in the use of painkillers in the surgical group.

WHAT ARE THE RISKS AND DOWNSIDES?
Patients want to hear about the benefits of a treatment, but they often don’t ask or care about the risks. To be an educated consumer, you need to. If one treatment has a 3% edge over another, but has a high risk of making you itchy or causing frequent headaches, do you want it? Going back to the back surgery study from before, the researchers found a 1 in 4 chance of a repeat surgery and a 1 in 3 chance of a major complication. With surgery you risk infection, blood clots, complications with anesthesia, and a whole host of other things. These risks need compared with other treatments. In the case of back pain, physical therapy is a valid alternative with a much lower risk profile. You might have some soreness with physical therapy, you might sweat some and be challenged with exercise, but the risks of PT compared to surgery are minimal.

WHAT ARE THE ALTERNATIVES?
Don’t feel bad asking about alternative treatments. If you were looking at a certain car you wouldn’t go out and just buy it. You’d at least consider the competitors and probably even test drive them. You should at least look at the other options in healthcare too. Maybe the first recommendation that your practitioner makes is the right one for you, but if you don’t consider the alternatives you’ll never really know.

WHY THIS TREATMENT OVER THE OTHER ONES?
This is the question where the rubber meets the road. You’ve learned about all the options, now you can see if your practitioner is balancing the risks and benefits to make the right choice for you. Staying with the back pain example, research shows that more than 40% of people who seek care for back pain will not receive a treatment of known effectiveness. Back pain is also the #1 reason for opioid prescriptions, despite a 2016 recommendation from the CDC to avoid prescribing opioids for back pain, and opt for non-drug treatments like physical therapy. By asking for the rationale and carefully weighing options, you can avoid being one of the people who gets an ineffective treatment.

WHAT’S IT COST?
This last question is becoming more important as patients bear an increasing share of the cost of healthcare. Even if you don’t have a high deductible plan or hefty co-pays, by being financially responsible today, you’ll probably see smaller price increases in your premiums down the road. That back surgery that we’ve been talking about? It’ll likely cost between $60,000 and $80,000. So if we put the whole picture together, a patient who takes the first recommendation for surgery will have a $60,000 procedure that leads to a higher risk of disability, and a higher risk of long term painkiller use, while risking infection, and blood clots. Don’t forget the 25% chance that you’ll get to do it all again in a repeat surgery. Seems like a bad deal.

An educated consumer would learn that physical therapy is a viable alternative to surgery with comparable outcomes, much less risk and lower cost. In fact, a large study of 122,723 subjects showed that people with back pain who got physical therapy in the first 14 days lowered their healthcare costs by 60%. It’s easy to see why bargain shoppers love PT! If your provider is referring you to a specific PT, ask why – do they have a particular piece of equipment there that he likes or does he have some financial investment in that facility? Research places and providers to find the best fit for you, not for the referring provider’s income or boosted status among referral network of friends. Your increased knowledge will help protect your health and your wallet.

You know the drill: During your annual visit, your primary care physician will take your blood pressure to assess that it is in normal range. Combined with an assessment of health measures such as diet and exercise, the results of the will provide your physician with the information she needs to make a recommendation. If the results are positive, you might hear: “You’re doing great, keep doing what you’ve been doing!” If the results are unfavorable, then you’re more likely to be told: “I’d like you to walk for 20 additional minutes each day and I am going to start you on this blood pressure medication.”

Over time, high blood pressure levels put you in a high-risk category for heart disease and stroke. Similarly, the cumulative effects of poor posture or a muscular imbalance, for example, can take a toll on your body and inhibit your ability to move properly. That’s where a physical therapist comes in: Annual PT “checkups” can catch the musculoskeletal problems that put you at risk for injury or limit your ability to function down the line.

One of the best tools in a PT’s prevention arsenal is a muscle testing and movement screen. By testing muscle strength and analyzing your fundamental movements with a movement screen, PTs can get a better picture of what the future will bring for you. Based on the information gathered, a physical therapist can help you safely reach your fitness goals and teach preventive strategies that can be incorporated into your daily life.

Of course, it’s best to schedule your checkup before you’re experiencing a problem. That way, your physical therapist can establish a baseline based on your functional level at that time and use it to identify changes during subsequent annual visits. The effects of poor posture or a muscular imbalance may not be immediately apparent to you, but they will be to your PT.

An annual “checkup” gives your PT an inside look at your musculoskeletal system, which is comprised of your muscles, bones, cartilage, tendons, ligaments, joints and other connective tissues. It’s important that these essential internal structures are working together to support, stabilize and move your body. Just as taking an annual trek to the primary care physician helps to monitor your cholesterol levels—and prevent heart disease—yearly physical therapy appointments allow your PT to identify and address any changes in the way you move before they become something more.

The joys of a family vacation can be overshadowed by the ‘pain’ of hauling excessive luggage, sleeping in a different bed and extended periods of sitting. Here are our favorite tips to keep you feeling your best while traveling so you can enjoy your destination.

Take breaks while driving
Every hour or two, stop and walk for a few minutes. It’s also not a bad idea to do some standing back extensions. Sitting places your spine in a flexed position, so moving it the opposite direction can prevent pain.

Support your back
If you’re going to be sitting for extended periods, like on an airplane, using lumbar support can keep you more comfortable. A lumbar roll, or small pillow works well placed between the seat and the small of back. Using a rolled jacket or blanket is another good option.

Choose the right luggage
Suitcases with wheels let you avoid lifting and carrying. If you’re flying, check your bags to avoid the overhead lifting. A backpack that can be worn on both shoulders makes a great carryon and is easier to handle than a bag you can only use one hand on.

Dress to move
Comfortable shoes and clothes let you walk when you have the opportunity. If you have down time, like waiting at the gate at the airport, or waiting for your hotel room to be ready, use the opportunity to take a walk instead of sitting.

Pillow talk
If you have a long flight, train or car ride where you plan to sleep, use a neck pillow. This helps you avoid sleeping with a twisted neck, then waking up in pain. If you’re worried about the comfort of the pillows at the hotel, don’t be afraid to bring your own.

Listen to your body
Vague discomfort is often a warning sign that you need to move!

Don’t take a vacation from exercise
Maintain your usual activity level. Research local exercise facilities before you head to a new town, take your running shoes, and travel with your theraband and foam roller. The more you can maintain your activity level, the less likely you are to end up in pain.

With these tips, you should be able to arrive at your destination feeling ready to enjoy your time with your family instead of in pain, stiff, or sore.

It turns out that while our early ancestors spent their days out in the wilderness hunting and foraging for food, they may also have been keeping their brains sharp. Researchers at the University of Arizona have found a connection between the highly active lifestyle that was prevalent in those ancient days and the prevention and treatment of Alzheimer’s disease and other age-related diseases.

Some two million years ago, our ancestors covered long distances—mixing moderate and intense bouts of aerobic activity throughout the day—as a means of survival. In sharp contrast, today’s average American starts his day by getting ready for work or school, then travels by car or train to an office where he’ll likely spend hours in meetings or in front of a computer, only to retire home to catch up on the latest series on Netflix. For the most active among us, exercise might consist of an hour at the gym three or more days a week and perhaps a few short walks sprinkled in throughout the day. But contrary to popular belief, that level of activity doesn’t completely erase the damage we do to our bodies during the other 23 hours in the day—which are largely spent sitting in a desk chair or at the dining room table, reclining on the family sofa or sleeping.

An obvious connection can be drawn between today’s sedentary lifestyle and a host of prevalent modern-age health problems like obesity and chronic illness, but how do low levels of activity affect our cognitive abilities? The study’s co-authors hypothesize that the amount of exercise that our ancestors engaged in reduced the burden of a genotype that leads to a high risk of Alzheimer’s disease, cardiovascular disease and increased mortality. As a result, the researchers stress the importance of exercise as a potential disease prevention and intervention tool.

Beyond reducing the risk of disease, the role that movement and exercise play in a person’s cognitive performance cannot be underestimated. Many research studies have proven that engaging in regular physical activity keeps our brains in top form, helping us to focus, recall and think more clearly. And while it’s not exactly feasible to adopt a hunter/gatherer way of life in today’s world, perhaps the takeaway is that moving—more frequently and for longer periods of time—can help stave off disease and boost our brain function. Just some food for thought next time you settle in to binge watch Game of Thrones or pass up an opportunity to bike to the office.