Oh, my aching…

Tuesday, March 3, 2009

The back is one of the things we take for granted until it stops working and the new realize how much we’re dependent upon it fro almost every little thing. For athletes who make a living by exerting undue forces on their spine, a back injury may become devastating. For Allen Iverson, developing back pain at age 33 may be a sign that this body is slowly wearing down. After 13 seasons of pro basketball, the wear and tear on the body may make it harder to rebound.

Iverson makes his living as an athlete but in reality, his situation is no different than any other factory or construction worker who uses their body as a tool. After a while, the body wears out and while Craftsman has lifetime replacement guarantees, the same can’t be said for body parts.

Back injuries are especially frustrating. Chronic back issues lead to millions of missed work days each year and while most tests are negative, the pain is very real. Often the initial injury isn’t recognized or remembered but the patient presents to the doctor or chiropractor complaining of increasing pain. It’s up to the care provider to decide whether the pain arises from muscle, bone, compression of a spinal nerve root or a combination.

History remains an important part of making a diagnosis. When did the pain start? Is itworse getting out of bed or does it progress during the day? Does the pain radiate down a leg or into the buttock which is almost a sure symptom of sciatic nerve irritation? Is there weakness in a leg or falling? And then the two big questions which can turn a pain issue into a medical crisis where the spinal cord is at risk of failing: Are you able to urinate? Have you lost control of your bowels? This may signal cauda equine syndrome and the need for emergency MRI and potential surgery.

Physical exam is helpful in defining where the pain is located, if there is associated muscle spasm and whether inflammation of the sciatic nerve is evident. Muscle weakness or changes in deep tendon reflexes, where your ankle or knee jumps when hit with the little red reflex hammer, may push the care provider into imaging the back more quickly.

Unless there has been some recognizable trauma, plain x-rays of the back are not very helpful. Most people haven’t developed compression fractures of their vertebra unless they are very old or take medications like prednisone that can weaken bones. The bets way to image the back is an MRI, though the indications for the test are usually limited to patients with potential spinal cord injury, nerve compression or intractable back pain.

For most patients, back pain tends to resolve on its own. Activity as tolerated seems to work better than bed rest and progressing the activity as pain symptoms allow lets the patient get back to daily activities at a faster rate than immobility. Ice and heat, anti-inflammatory medications and muscle relaxants work together to get the back going again. Chiropractic manipulation and physical therapy may work to decrease the need for medication.

Ultimately, prevention is the best way to treat back pain. Back and abdominal wall muscles need to be strong and flexible, good lifting technique needs to be employed and one needs to listen to their body should the first signs of an injury begin with a twinge of pain.

All this is well and good for John Q. Public, but for elite athletes like Allen Iverson, who play a sport at break neck speed and 10 feet off the ground, even small amounts of back pain are devastating. After a normal MRI, Iverson is off to visit another back specialist for a second opinion. Perhaps the dozen years of competition on the basketball court override his body’s ability to heal. Perhaps 33 isn’t that old for a pro athlete. Come playoff time, we’ll see if he’s on the court.

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