Teacher discovers new twist to easing chronic back pain

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ST. LOUIS — Carly Richmeyer, 32, can move again without her back torturing her to be still. More than that, she's back to exercising, standing more than she sits and making plans for her June wedding.

Richmeyer as recently as six months ago had debilitating lower back pain, a common affliction. About 80 percent of Americans will have some degree of non-specific lower back pain over the course of their lives.

She said she started noticing lower back pain around age 25. "I've always been really active, fitness oriented; when I would do certain things, it would hurt, even day-to-day things," she said.

She had difficulty exercising, wrestling with her pets or even teaching her middle school classes at Holy Cross Academy in Webster Groves, Mo.

"I'd started teaching sitting down," she said. Her middle school students pushed her around her classroom in a chair.

"I didn't go to the doctor, because one day it would be OK, then it would start again," she said.

In July 2013, she returned from a vacation almost bedridden.

She went to a chiropractor who said her right leg was shorter than her left. "I went through all of this, physical therapy and adjustment and insoles for my shoes, and I still had back pain.

"I was very depressed. I'm a fitness-oriented person, and for me not to be able to work out … I couldn't do anything. I put on a good 20-30 pounds. I wanted to be able to lift my kids, play with them — when I have kids. And I wanted to be that active mom. This was like taking it away."

In March, she saw a television spot about a Washington University study aimed at relieving lower back pain and qualified for it.

The study is run out of the program for physical therapy at the university.

Linda Van Dillen, professor of physical therapy and orthopedic surgery, said the study is aimed at finding ways to relieve lower back pain that has no apparent cause, which includes the vast majority of such complaints. The study does not include people with back pain caused by injury and illness, she said.

The study approaches therapy in two ways:

Strength and flexibility focuses on building muscles that have been overloaded when people compensate for pain.

Motor skills therapy targets how people move around in ways that can cause lower back pain. "Then we show how to do that differently," Van Dillen said.

(Incidentally, chief researcher Van Dillen doesn't know which group Richmeyer is in and won't be reading this story until the study is finished three to four years from now.)

Richmeyer is in the motor skills group. "At my first appointment, they told me I was twisting my pelvis, my lower back constantly," Richmeyer said. "I used to sit on one leg and that would tilt my pelvis; I was crossing my legs too much, when I did certain tasks, I'd twist because it was more comfortable."

Her therapists learned that by placing adhesive sensors over her pelvis, back and upper body. Then she did simple movements. The sensors produced a three-dimensional picture on a computer screen.

"They didn't determine which came first, the pain or (the effect from) the twisting," Richmeyer said. "But everything I was doing was causing a twist, drawing in my abs, bending over, sitting at my desk reaching for things, everything."

That explained what an orthopedic surgeon had told her, that a disk had been worn down to half its depth. "The twist wore down my disk, which caused the pain," she said.

Next, a physical therapist watched her do household tasks. "Movements that seemed normal may have been contributing to my pain," she said. "Taking dishes from the dishwasher, I'd plant my feet and twist as I removed or replaced dishes.

"When I was sleeping in bed, all night long my torso was twisting."

The physical therapists in the program showed her how to sleep on her side with a pillow between her knees and how to sit and stand without using other muscles to compensate for the pain in her lower back.

"Once I knew the problem, the cause, I could adapt," Richmeyer said. Still, she had to break some old habits. "Once you move a certain way for 30 years, you just get used to it."

She experienced some soreness in the new muscles she was strengthening. "It was like going to the gym and exercising after being off a while," she said.

Three sessions after she started, the back pain had eased enough that she was getting back to the self she'd lost seven years ago.

Six sessions into it, "I was kind of excited," she said. "I asked the therapist when I could start exercising again; she said I could do anything I want that didn't cause pain."

Van Dillen said the study so far is finding a few things they expected. Either method works if the person does what they're told — easier said than done. The study takes people up to 60 years old. Bad habits could have been around for more than half a century.

Researchers are finding new things as well as putting older knowledge into context.

For example, "Activity is necessary," Van Dillen said. Change the load on your back about every half hour. "If you're standing, sit," she said. "If you're sitting, stand and move around. Change positions. You're changing how your weight is distributed on the spine."

Staying in one position can "change the tissue," she said. So muscles you avoid can become atrophied, and lower extremities can lose strength.

Another finding is that bed rest is not good for you when it comes to back pain. "There are a lot of physical issues associated with bed rest, and they're not good," Van Dillen said.

Richmeyer says she's still adapting. "The hardest thing to adapt to was the sleeping," she said. "I was so used to sleeping in that twisted position that my body didn't want to sleep any other way."

She has started exercising again, but slowly, with yoga and Pilates. But even with those she must be aware of moves that require twisting.

She's confident the bad old days are behind her. "I would go through six ibuprofen a day, just to deal with the pain."

By the fifth week of the program she wasn't taking any.

She has half a year left in the study, she said. And if some bad habits slip back in, she said: "I know what to do and who to call."

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