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MiuraMan

A Good Read on Lower Back Pain

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23 hours ago, MiuraMan said:
backpain_lead.jpg

A review of 80-plus studies upends the conventional wisdom.

 

A good article. One thing i think is necessary to understand albeit unfortunate is the often negative connotation towards we physicians in this matter among others.

I’m a family medicine physician. The demand over the last 20 years for ‘customer satisfaction’ is overwhelming. People want immediate results and if not achieved they give us a bad rating and our jobs become in jeopardy.

So often proper treatment requires active participation from patients. I will not call them customers. Compliance to proper treatment is often very difficult to achieve. Look at weight loss. Diet and exercise? No. I want a pill that will melt away the fat. I want a procedure to make me thin. 
 

All too often our efforts are met with dissatisfaction due to the requirements of the treatment by the patient. I struggle to get patients to go to PT for what I know isn’t a surgical case. ‘ Isn’t there a good pain medicine for this? I don’t have time for PT.’ 
 

The article presents good therapy. But it’s easy for those who don’t practice medicine to assume we doctors are just writing scripts and sending them away or just referring them out. They don’t know that when we mention ‘yoga’ or ‘exercise/stretching’ the patients roll their eyes at us and leave unsatisfied.

Im all for least invasive therapy at all times. Just wanted to mention that patients often have a responsibility in their healing and it’s not always a matter of provider failure.

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Excellent point "Vinsk".

What you describe has been my personal experience. At age 67 I took my son out to Bandon Dunes early Sept. Out there you have to walk all courses. After coming home I started to have pain in my left hip; I always walked at home so I was surprised at this; I could no longer walk without pain, could not sit at my desk for longer than 15 minutes; riding a cart was OK; but I had subconsciously modified my swing to avoid posting too hard on my lead leg. Even before that I had bouts of back pain where I would suffer a spasm from not bending at the hips properly or twisting around to pick up an object, while under load. These bouts would always subside after a couple of days, but were miserable at the time. Back to the hip, First trip was to PCP; he took an X-Ray nothing showed up on that so he recommended a visit to orthopedic Dr.. Earlier in my life I had seen an orthopedic Dr. about my left shoulder. In my early 20's I suffered a severe dislocation - going to bed in the barracks late one night in the dark and flopped down on the bed, only the bed wasn't there and I extended my left arm to break the fall. After that my left shoulder would dislocate easily - making a left arm only golf swing; it would dislocate at the top of my finish. So I moved on with life; whenever it dislocated I would pull it back in place. In my 40's I was surfing; walking back in carrying the board under my left arm, when a rouge wave caught me by surprise and ripped that board from my grasp. Now a simple dislocation became a major big deal - couldn't play golf etc. At this point in my life I had Medical insurance so I went to Orthopedic Dr.. After reviewing my X-Ray he described the injury to me and said yes he could operate to try and fix the issue or I could try a series of exercises targeting the rotator cuff to strengthen it and help stabilize the joint. That worked, after a while I do not have an issue with that shoulder!! Back to my hip - after the PCP I decided to try a physiatrist (sp?); he did an ultrasound on the hip to see if there was a labral tear or some other cause, then ordered an MRI. So a 67 year old with hip pain guess what the diagnosis is from the MRI - mild arthritis. He offered pain meds(declined) and said if the pain gets too much go see an Orthopedic Dr.; they can replace your hip. I know a number of golfers who have had hip replacement surgery and it was successful - but not for me. I signed up with a golf specific trainer and started working with him; I worked with him once a week for two years. I learned a lot about how muscular imbalances and repetitive movements can cause issues., and what to do to counteract the adverse 

Now I am pain free in the hip; much stronger in the core; no back spasms; no sciatica; no knee pain. Play golf 5 days a week and hit a lot of golf balls in my garage setup. Have played 54 hole tournaments; swinging just as well on the 54th hole as the first hole.

Recently I had started having soreness in my trail shoulder after playing golf - after some research on the internet I have addressed that issue and my shoulder mobility and strength are vastly improved.

Hope I did not bore you with the long story; but I tell that story in the hopes it will help other individuals. I play with a lot of older golfers and see these issues all the time - sore backs, painful hips, shoulders and knees. I always suggest they first check with medical professionals to ensure there is not a serious medical issue that needs to be addressed; then tell them my story and suggest they get with a golf specific trainer. Despite that I know two golfers who had hip-replacements; another with shoulder surgery; another talking about knee surgery. The list goes on.

If you are still practicing medicine, then god speed and stay safe during this pandemic. 

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24 minutes ago, MiuraMan said:

Excellent point "Vinsk".

What you describe has been my personal experience. At age 67 I took my son out to Bandon Dunes early Sept. Out there you have to walk all courses. After coming home I started to have pain in my left hip; I always walked at home so I was surprised at this; I could no longer walk without pain, could not sit at my desk for longer than 15 minutes; riding a cart was OK; but I had subconsciously modified my swing to avoid posting too hard on my lead leg. Even before that I had bouts of back pain where I would suffer a spasm from not bending at the hips properly or twisting around to pick up an object, while under load. These bouts would always subside after a couple of days, but were miserable at the time. Back to the hip, First trip was to PCP; he took an X-Ray nothing showed up on that so he recommended a visit to orthopedic Dr.. Earlier in my life I had seen an orthopedic Dr. about my left shoulder. In my early 20's I suffered a severe dislocation - going to bed in the barracks late one night in the dark and flopped down on the bed, only the bed wasn't there and I extended my left arm to break the fall. After that my left shoulder would dislocate easily - making a left arm only golf swing; it would dislocate at the top of my finish. So I moved on with life; whenever it dislocated I would pull it back in place. In my 40's I was surfing; walking back in carrying the board under my left arm, when a rouge wave caught me by surprise and ripped that board from my grasp. Now a simple dislocation became a major big deal - couldn't play golf etc. At this point in my life I had Medical insurance so I went to Orthopedic Dr.. After reviewing my X-Ray he described the injury to me and said yes he could operate to try and fix the issue or I could try a series of exercises targeting the rotator cuff to strengthen it and help stabilize the joint. That worked, after a while I do not have an issue with that shoulder!! Back to my hip - after the PCP I decided to try a physiatrist (sp?); he did an ultrasound on the hip to see if there was a labral tear or some other cause, then ordered an MRI. So a 67 year old with hip pain guess what the diagnosis is from the MRI - mild arthritis. He offered pain meds(declined) and said if the pain gets too much go see an Orthopedic Dr.; they can replace your hip. I know a number of golfers who have had hip replacement surgery and it was successful - but not for me. I signed up with a golf specific trainer and started working with him; I worked with him once a week for two years. I learned a lot about how muscular imbalances and repetitive movements can cause issues., and what to do to counteract the adverse 

Now I am pain free in the hip; much stronger in the core; no back spasms; no sciatica; no knee pain. Play golf 5 days a week and hit a lot of golf balls in my garage setup. Have played 54 hole tournaments; swinging just as well on the 54th hole as the first hole.

Recently I had started having soreness in my trail shoulder after playing golf - after some research on the internet I have addressed that issue and my shoulder mobility and strength are vastly improved.

Hope I did not bore you with the long story; but I tell that story in the hopes it will help other individuals. I play with a lot of older golfers and see these issues all the time - sore backs, painful hips, shoulders and knees. I always suggest they first check with medical professionals to ensure there is not a serious medical issue that needs to be addressed; then tell them my story and suggest they get with a golf specific trainer. Despite that I know two golfers who had hip-replacements; another with shoulder surgery; another talking about knee surgery. The list goes on.

If you are still practicing medicine, then god speed and stay safe during this pandemic. 

That'll be $350 for the office visit unless you have Medicare...

Way to go with the physical therapy.  Two torn tendons in my elbow and the PT was the only thing that helped it.  Tried virtually everything else out there, except acupuncture, and nothing worked.  Spent more money this last year on my elbow than I do in the same amount of time on golf.

Edited by Double Mocha Man

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58 minutes ago, MiuraMan said:

If you are still practicing medicine, then god speed and stay safe during this pandemic

I am and thank you. Very glad to read your story. Great job on your behalf and keep it up! 

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Mobility is a big thing.

I try to get out of my work chair every few hours at a minimum and use my standing desk for a few hours of the day. I go for walks daily. I stretch every night before bed. I find that my lower back mobility is the best its every been. If my back does flare up, its usually not too long and I don't need much in the way of drugs. 

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9 hours ago, saevel25 said:

Mobility is a big thing.

I try to get out of my work chair every few hours at a minimum and use my standing desk for a few hours of the day. I go for walks daily. I stretch every night before bed. I find that my lower back mobility is the best its every been. If my back does flare up, its usually not too long and I don't need much in the way of drugs. 

I used to have SI joint issues all the time. Mobility and stretching really helped as did core strength. Since I retired in April, I don’t sit that much anymore and my SI doesn’t flare up as much. Sitting really can cause issues.

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