Better Posture and Stronger Core Key to Recovery

By Dick Broom , Courtesy Ellsworth American, Inc.

If your back hurts, the problem might be your belly. Especially if it’s a big one.

“The classic example of chronic back pain that we can very effectively manage is somebody who has lost some physical fitness and is getting a pretty big belly,” says physical therapist Tim Wakeland. “That rotates their hips and pelvis forward, which extends the spine and crowds the space for the nerves in the lower back. That can cause muscle and connective tissue pain.”

Wakeland, who has clinics in Ellsworth and Bangor, has a doctoral degree in physical therapy.

Wakeland was clinical director of two physical therapy practices before starting his own practice in 2005. From 1993 to 2005, he was under contract to provide physical therapy services for University of Maine athletes.

He says the treatment for someone who is having back pain because of a “beer gut” often targets more than one part of the body.

“If we give them such a long laundry list of exercises that it’s a huge chore to do them, then compliance is terrible.”

— Tim Wakeland, physical therapist

“We need to improve abdominal strength so they can pull that belly in,” he says. “They often have a lot of tightness in their hip flexors, so we need to improve the flexibility there. Also, we usually see some inflexibility in the muscle and connective tissue of the lumbar [lower] spine, so we need to stretch those out.”

Wakeland says that, with the increase in the prevalence of obesity, he is seeing more people with low-back problems.

“Also, later in life, if somebody is obese, we begin to see joint problems — hips, knees, feet and ankles,” he says. “Naturally, if you’re carrying around more weight, we’re going to see more degenerative changes in the joints of the lower extremities.”

Wakeland says chronic back pain can have many different causes including arthritis, fractures and other injuries, changes in posture, bulging and herniated spinal discs and the loss of disc height, which is a natural part of aging.

Therapy varies from person to person depending on a variety of factors including the cause of the problem, the person’s overall level of physical fitness, any serious medical conditions he or she might have and the nature of the person’s job. For example, sitting at a computer all day can be worse for your back than moving furniture if you have poor posture.

For many clients, Wakeland says, therapy involves “educating them as to the best position for their spine and then developing some core strengthening to hold everything in place.”

He says physical therapy doesn’t necessarily involve a lot of sessions with a therapist. In fact, most clients do most of the therapy work on their own.

“For me to be most effective in the clinic, I need to provide them with activities they can do at home to complement what we’re doing here,” he says. “So, when they do come in, I’m only providing them with the things they need me for, my manual therapy skills or my specific guidance and education. We don’t clog up our therapy sessions with things they can do independently.

“Our main role is simply to move somebody in the right direction, provide them with enough skills so they can manage on their own and prevent problems from reoccurring.”

In prescribing a home exercise program, Wakeland says, it is important to make sure it is rigorous enough to be effective but not overly demanding.

“If we give them such a long laundry list of exercises that it’s a huge chore to do them, then compliance is terrible,” he says.

Strengthening muscles and improving flexibility are often important components of physical therapy for someone suffering from chronic back pain, but there’s usually more to it than that, according to Wakeland.

“We need to work on body awareness and retraining to achieve the most appropriate postural alignment, trying to find the optimum, neutral position for the spine that’s least harmful. Strengthening plays a part in that. Flexibility plays a part. But the whole neuromuscular retraining is really important.”

Wakeland says one of the biggest changes in the field in the past decade or so is related to the emergence of the Internet. It is not uncommon for clients to tell him about a type of treatment they have read about online that they think might help their condition.

“There’s a lot of good stuff on the Internet; it can be a fantastic tool. But be wary and make sure you question your health care provider about things you see on the Internet,” he says.

“I appreciate it when someone asks me about something they’ve seen. I can either help them understand it better so they can make an educated, informed decision, or I can tell them that, in their case, the recommendation they saw would not be helpful and could be harmful. It’s really important to have trust in your own health care providers.”