Hi, my name’s Randy Bauer, and have been a physical therapist since 1987. I did my physical therapy training at Mayo Clinic in Rochester, Minnesota and prior to that I did my post-graduate exercise science training at Cal State Fresno and I did my undergraduate in health education where I was, uh, athletic trainer at Utah State University.
One of the main factors that I see when I have a patient that comes through my door and I’m going to initiate physical therapy is are they a candidate for surgery? And, often times, the doctor is going to refer that patient to me, hopefully, to skirt the issue of having surgery and those people come to me quite concerned. They come to me because they’ve been experiencing pain, some amount of disability for months, years, maybe decades and it’s... takes an impact on their life.
So, one of the first things I’m going to do is find out what’s important to them. Do they want to be able to play with their grandkids? Do they want to be able to travel into their retirement years? Or, do they want to go out and play golf three days a week? Or, do they want to resume a high-level sport? I have to listen to them to tailor each program effectively for them to get back to those activities.
If I was to look at some of the major habits that influence back problems, I would go to sleep habits. You need sleep. Sleep is where our body recovers. You have to be able to assume a good position to sleep. Very important for me to spend some time on my patient education on sleep habits and whether it’s the mattress that they’re sleeping on or the position that they sleep. The other issue I see is nutritional habits and nutritional habits plays a major role because it dictates the nutrients that our body uses to help with injury, to recover from injury.
You also have problems related to carrying too much weight. You can’t carry around 10 extra pounds to fatigue your muscles, to irritate the joints and create pain and then get up and go on your journey the next day. So, diet is important. Fitness is huge. For the body to adequately provide oxygenated blood to the muscles and to the tissues, we need to be able to have some level of fitness.
Next, I would say it’s maintaining a neutral spine. It’s maintaining a chest-out positioning to where the muscles around the shoulders and neck don’t have to exert themselves. It’s having some adequate mobility in the hips. But, as soon as you see hips not being able to move and the mid-back becoming stiff, then what happens is all that stress is exerted down to the lumbar spine in that twisting movement.
As a physical therapist, in looking at some of the habits that I’m going to be improving in my patients, I need to look at not just the lumbar spine, I need to look at the big picture of what joints are moving or not moving, what their postures are, what their work habits are, what their lifestyle habits are and also what type of activities do they want to be engaging in in the long term. And, that’s where the importance of core muscles come into play.
Some of those muscles dictate very small rotational movements and create stability of isolated segments in the spine. In the lumbar spine those muscles create a little bit of rotation. They might create a little bit of side bend, they might prevent a little bit of sheer force. And then, you have your larger core muscles that are going to create more power and more strength exertion. So, if you emphasize just the big muscles of the core, you’re missing out on some of the finite stability that takes place at the local segments of the spine.