By Anne Aurand / The Bulletin
Published: March 21. 2013 4:00AM PST
Chris McDougall, a computer programmer in Bend, had such intense pain in his lower back last summer that he wound up in urgent care. He was given steroids to cut the inflammation and pain killers to get through the day. Then he signed up for a 10-week program with a neurologist and physical therapist at the Bend Memorial Clinic Neck & Back Clinic.
The clinic doesn’t do surgery, injections or medicine. It’s a twist on the traditional physical therapy clinic, although walking in the door of the NorthWest Crossing clinic, it very much looks like one.
However, here, patients work with a neurologist as well as a physical therapist to address the underlying causes of neck and back pain. The program is affiliated with Neck & Back Clinics of Minnesota, which has a 20-year history treating chronic neck and back pain.
It’s covered by most insurance plans, just like standard physical therapy programs.
The lengthy and intensive rehabilitation program requires commitment and motivation on the part of the patient. In fact, McDougall had tried it a few years ago but he didn’t keep up the ongoing exercises. He relapsed. He will not make that mistake again, he said. This time, a couple months after the program ended, he said he’s still exercising on his own and he’s feeling good. McDougall said he has better movement and strength in his back.
One study that looked at almost 900 patients with chronic low back pain who used the same exercises and equipment that the clinic uses said 76 percent of patients had “excellent or good” results while those in the control group had poorer results.
The source of neck and back pain is often hard to pin down, said Dr. Richard Koller, a neurologist with the Bend Memorial Clinic Neck & Back Clinic. Pain usually stems from the discs, bones, joints, ligaments or muscles. One or all of these could be problematic, Koller said.
Emphasizing core strength is the most efficient way to address neck and back pain no matter where it came from, he said.
Not many physical therapy programs focus specifically on core muscles such as lumbar extensors, transverse abdominis and oblique muscles, said Kevin Bourlai, a physical therapist who worked with McDougall.
When a person improves their core spinal and abdominal muscles, Koller said, it holds the spine in the optimal position. That, he said, relieves pain and pressure, regardless of the original source of pain.
Koller evaluates patients to ensure there are no pressing neurological conditions or potential risks from exercises. He chooses a protocol appropriate for the given condition. An elderly woman with osteoporosis will have a different regimen than a young male with back pain. Then he refers patients to one of the physical therapists in the clinic.
McDougall, 52, has a compressed and problematic disc in his lumbar spine. He’s not sure why, perhaps partly from a bike accident long ago. He believes his pain is exacerbated by sitting in a chair for eight-hour stretches while he works.
McDougall said there are certain pieces of equipment at the clinic that seemed to help his individual case the most, such as the “Roman chair,” which isolates a group of lower back muscles, or the lumbar extension machine, which usually requires the help of a therapist to climb into because there are so many belts and straps to adjust.
The equipment is medically designed, Koller said. Most pieces of equipment tightly restrain most of the body parts, so only certain, targeted muscles can move, which is different than most equipment found in gyms. The lumbar extension chair, for example, locks the pelvis down so “you can’t cheat,” as McDougall said. A cervical rotation machine locks the shoulders in place so the neck can rotate neck side to side, only engaging specific neck muscles in isolation.
Koller adopted this MedX equipment and protocol into his neurology practice after he used it to relieve what had been decades of his own chronic back pain, he said. In 1997, Koller established the Koller Clinic, which later became NorthStar Neurology when other partners joined. NorthStar Neurology partnered with the Neck & Back Clinics of Minnesota, which has a 20-year history treating chronic neck and back pain, and added the neck and back programs in 2009. BMC acquired the practice last year and changed the name to BMC Neck & Back Clinic.
The clinic still cares for patients with neurological diseases such as multiple sclerosis, Parkinson’s and Alzheimer’s. Some of those patients use the exercise equipment to improve their muscle function and strength, but they have different protocols than the neck and back pain patients — from people like McDougall to triathletes to golfers — who are trying to relieve pain and keep it from returning.
With neurology patients, Koller said, it’s often expected that conditions will worsen. The neck and back patients, on the other hand, typically get treated and are not seen again.
— Reporter: 541-383-0304, aaurand@bendbulletin.com
