A Healthy Back: Worth the Work : Medicine: Strong and flexible back, leg and abdominal muscles and good body mechanics are the best insurance against back problems.

Kathleen Ellsworth can’t ignore the reminder she always gets when she slacks off on exercises for her back, leg and abdominal muscles.

Her back pain returns.

She tires more easily and suffers “all the nagging little symptoms of a bad back.”

Most of the time, though, Ellsworth works at being pain free and is successful when she does her exercises every day.

Ellsworth, a 41-year-old landscape architect from Costa Mesa, has a herniated disc. She learned the conditioning program in a six-week class called The Y’s Way to a Healthy Back at the Newport-Costa Mesa YMCA. She also swims and bicycles to keep in shape.

Ellsworth learned that maintaining a healthy back is hard work, but worth it.

And, she’s part of a dramatic change in how back injuries are being treated today. The progress of sports medicine has shown the value of certain exercises in returning back patients to normal function.

A few years ago, patients were often told to rest in bed and given passive treatments such as massage, hot packs and ultrasound therapy. But treatment today often includes exercise to increase strength and flexibility of back, leg and abdominal muscles and an education program geared to avoiding re-injury.

The medical community is also sending a message to people who have yet to experience back problems: Strong and flexible back, leg and abdominal muscles and good body mechanics are the best insurance against back problems.

Many back injuries are self-inflicted by bad habits. Eight out of 10 Americans will experience some back pain during their lives. For one out of 10 people, back injuries are severe enough to make them miss work. For some, it’s disabling.

People who have a sedentary job, are more than 20 to 30 pounds overweight, are in poor physical condition, lift incorrectly or subject their backs to unnecessary strain and twisting are at considerable risk. And weak hamstring and abdominal muscles pull a spine out of proper alignment and cannot provide sufficient support to the spine.

The main categories of back injuries are lumbar sprain/strains (injuries to muscles and ligaments), disc herniations (injury to the fibrocartilage between the vertebrae) and fractures (injuries to the spine).

Sprains and strains are believed to represent the vast majority of back problems, and computerized equipment is increasingly being used in diagnosis.

Most people with back sprain or strain should have rest and medication for two or three days and then “need to get into a rehab program of some kind,” says Dr. Michael Gordon, a Newport Beach orthopedic surgeon.

“When we send people to the machine, we know they have lumbar sprains. We just have no way of saying how bad it is or how much it interferes with function,” says Gordon.

Software for the computerized isokinetic equipment, however, shows which muscle groups are involved and quantifies the injury by comparing function with people of similar weight, height and age. A physician then has a percentile rank for that person’s function level.

“That’s the kind of information we want,” Gordon says, to provide a better idea of what kind of therapy a person needs and how long rehabilitation might take.

Disc herniations and fractures could potentially require surgery. But only 1% of disc problems require surgery, according to Dr. Vert Mooney, a professor of orthopedic surgery at UC Irvine. Instead, many patients take the exercise therapy and education route.

Muriel Pike, a Costa Mesa preschool director, says moving a heavy table brought on excruciating back pain. But she also says years of bending incorrectly and lifting children were probably contributing factors. Her condition was diagnosed as a deteriorating disc, and she says she felt like “I’m just losing it all and I’m going downhill real fast.”

By attending Back on Track, a four-week class at Hoag Hospital, Pike, 57, learned she could take charge of her back problem. She exercises, walks and swims and practices good body mechanics.

She still has a few restrictions and some pain but says, “I’m hoping that I can continue to do my exercises and live reasonably well without having to have surgery.”

Greg Ruzicka, a Newport Beach attorney, is also working hard to avoid surgery. He has a protruding disc and took the class at Hoag on the advice of his physician.

Ruzicka, 35, found the class helpful and does the exercises he learned every day. “I’m still not over the problem, but it’s made a lot of headway,” he says. “At least now I know the proper procedures. I’m not continuing to exacerbate the condition. . . . It’s slowly improving instead of staying static or getting worse.

His motivation?

“Once you go through one of these episodes, you make yourself a sworn oath that you won’t let it happen again,” he says.

Myra Drul, a 23-year-old flight attendant from Santa Ana, did require surgery. She says she suffered a herniated disc when she was knocked into a metal post and hit by a drink cart when her plane hit some turbulence. But surgical removal of the ruined disc and a spinal fusion were only the beginning of her rehabilitation.

She has put in three months of several hours a day working on her own rehabilitation at the Physical Assessment & Reactivation Center and the PAR Work Simulation Center, both in Irvine. She is now “feeling 100% better almost” and hopes to return to work soon.

“There’s a changing concept in what is most appropriate for an injured back,” says Mooney. Thinking has changed, he says, because studies show “rest is a bad thing for connective tissue . . . because the absence of physical stress is such a destructive force to the soft tissues that it just causes deterioration.” Exercise is the only way to build up those muscles and ligaments.

The concepts at the PAR Center, part of the new Irvine Medical Center, are an extension of sports medicine. The PAR Center treats injuries of the back, neck, trunk and extremities. Exercise can reduce inflammation and ease pain because it stimulates healing by improving local nutrition to the injured area by the exchange of fluids, oxygen and glucose and by removing debris, says Mooney, PAR Center medical director.

The strong emphasis is on patients taking an active part in their care, with physical therapists acting as coaches.

Back patients at the center go through a rigorous training program, much like that of an athlete who is being rehabilitated. The first step is a thorough evaluation on computerized equipment, followed by a stabilization program that includes McKenzie exercises, which are special exercises to build trunk muscle strength.

Stretching and stabilization exercises are followed by manual therapy treatments such as postural positioning to control symptoms. Next comes a conditioning program on computerized isokinetic equipment that provides resistance for more effective conditioning. These machines also measure how a patient is progressing.

Patients are also put on a program of exercises to promote a healthy cardiorespiratory system to provide good ventilation for proper healing of tissue, according to Gary L. Jarvis, vice president of orthopedic services at the PAR Center.

The length of time that back patients spend at the center varies, depending on the nature of the injury, but Jarvis says the average is about six weeks, which costs about $2,100.

And for patients with jobs that might cause further back injury, there’s the Work Simulation Center, an intensive work-hardening program where patients spend several hours a day in tasks that simulate their work environment. They learn how to do the task in a way that will protect their backs and condition muscles to deal with repetitive tasks.

While poor physical condition is a major factor in back problems, ignorance is a close runner-up. Most people simply don’t know how to protect their backs.

“We cause our own problems and that’s why education is the key to preventing unnecessary back problems and often to correcting problems that already exist,” says Bill Cox, administrative director of Rehabilitation Services at Hoag Hospital. Hoag offers the Back on Track classes in addition to individualized treatment through Rehabilitation Services and the hospital’s Back and Neck Center.

Cox says with evangelical zeal that people need to understand what they are doing in their daily lives that is putting unnecessary stress on back structures and causing pain.

The Back on Track series of classes, which costs $160, is geared to do just that. For information on the class, call (714) 760-5645. Participants learn exercises to increase strength and flexibility, relaxation methods to reduce stress, structure and function of the spine, proper posture, techniques for using the body efficiently and tips on equipment such as lumbar rolls, inflatable pillows and other items that keep the back in proper alignment when sitting.

“Why didn’t somebody tell me this before?” is the reaction of many people when they hear how simple protecting their back can be, according to Cox.

Changing bad habits is another goal. Patients often say, “But I’ve always done it that way.” Cox responds by saying: “Yes, I know. That’s why you have a back problem.”

People fail to understand that repetitive micro-traumas over a period of time can add up to major pain and disability. Just because a movement doesn’t cause immediate pain, doesn’t mean it is not damaging your back, Cox says. Even something as simple as doubling over quickly every time you sneeze can cause injury.

“I think it’s actually the best for people who don’t have an extremely acute condition like I have,” says Ruzicka of the back school. “If you’re just starting to get back strain, I think that’s when you should go in. If you get in there before you really have a chronic condition, it can foreclose ever getting in my condition.”

Education and exercise are the components of The Y’s Way to a Healthy Back, which is offered at the Newport-Costa Mesa YMCA, $60 for members and $90 for non-members, (714) 642-9990, and the South Coast YMCA, (714) 495-0453, $30 for members and $40 for non-members, in Laguna Niguel.

“We get people in with severe problems looking for an alternative to surgery or medicine. We get people in that have very minor back problems that are looking for an exercise routine and then we get people that are preventive and want to know more about the back,” says Diane Berry, physical director at the Newport-Costa Mesa Y and instructor for the back class.

“I really believe the key to back problems is exercise,” Ellsworth says. “If you can get on a program and begin to tone up the muscles and keep the body a little bit limber and do a variety of activities throughout the day, you can pretty well be free of back pain.”