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Got chronic back pain? Try physical therapy

Participants who called during Saturday's Deseret News/Intermountain Healthcare Hotline had several specific questions about incontinence and low-back pain that are common to patients with those conditions.

Jake Magel, a physical therapist and director of the Intermountain Orthopedic and Spine Therapy Clinic at Intermountain Medical Center, said many older patients with chronic back pain have not had physical therapy to deal with their symptoms.

Magel said targeted exercises directed to specific symptoms have been shown to be beneficial for people with the condition.

"We're not talking about getting rid of the pain, but being better able to function with it," he said.

Some callers said they'd had MRIs showing multiple issues such as slipped discs in the spine or arthritic conditions that are part of the normal aging process.

"With specific exercise and some kinds of mobility modification and manual manipulation, studies have shown that this condition can be better managed," Magel said. "We're not talking about taking the pain away altogether. For low back pain, there is no quick fix."

People with acute low-back pain that doesn't extend below the knee and is less than 16 days duration are often most helped by spinal manipulation and exercise. If there has been pain below the knee, it often involves neurological conditions or nerve irritation, and spinal manipulation exercises are often the best intervention, he said.

Magel urged anyone dealing with low back pain to consider physical therapy.

"If people get proper care up front, they tend to use less health care in the years following," he said. "They visit physicians less, take fewer medications and miss less days at work."

Physical therapist Susan McLaughlin, a specialist in dealing with incontinence, said many callers were concerned about urgency with urination and about Kegel exercises they have tried for years that don't seem to help.

People who can't make it to a bathroom before leaking urine are often experiencing a reversal of brain/bladder function. Rather than the brain controlling urination, "the bladder starts taking control," McLaughlin said.

"When they have the urge to go or are going every 30 minutes, they're not allowing the bladder to fill completely," she said. "So it trains the bladder that when it gets to that (low capacity) level," they need to urinate.

McLaughlin suggests that patients learn suppression techniques, which means they avoid urinating when the urge first comes.

It can be helpful to sit in an upright position and put pressure on the urethra to suppress the urge, she said, or to use a pelvic floor contraction if the right technique is employed.

McLaughlin also encourages people to use "mental distractive techniques, mental self-talking regarding their ability to retain control, counting backward from 100," or whatever works best for the individual.

"They need to wait a few minutes, about five minutes after the urge to urinate has passed, and then go to the bathroom," she said.

People with urgency problems should never urinate at the height of the urge, McLaughlin said. Delaying urination is behavioral modification that retrains the bladder, but it takes time and mental energy.

Callers who said they have done Kegel exercises that haven't helped them are often "not doing the contraction correctly," she said.

"You need to train the muscle specific to its use and work for muscle for endurance, which means holding it for a certain amount of time," McLaughlin said. "That's why it's really important to assess strength and then training for the quick-acting part of muscle, which is helpful when you cough or sneeze."

People with questions about physical therapy for their condition may call the clinic at 801-507-2050.