It’s no secret that back pain is an epidemic in the United States, costing millions every year in medical costs and lost wages. In a recent survey, as many as 60 percent of U.S. respondents said they had experienced neck or low back pain in the previous three months, according to the National Center for Health Statistics.
Spokane’s Natalie Mugaria was one of those statistics. While she was in the Navy, her job as a firefighter required her to maintain top physical conditioning. After two knee surgeries forced her to abandon the running program she used while stationed on the Abraham Lincoln aircraft carrier supporting Iraqi forces, she took up swimming. Mugaria explains, “I would swim two miles every day, and when I swam, I would only turn my head to one side because it was difficult to turn the other way.” After five years in the Navy, Mugaria was honorably discharged; still, her back pain continued and became so bad that she could no longer continue swimming. It eventually started affecting her daily activities.
“I remember when I fi rst started working at the coffee shop following leaving the Navy,” says Mugaria “It was awful. I was always in pain and I had to take ibuprofen all the time. Plus I couldn’t ride my bike.”
The spine is made up of vertebrae that interact with each other through several individual joints at each level; any of those joints can become irritated, eventually winding up stuck and painful. That’s what Mugaria’s physical therapist, Lindsey Masiarek at Apex Physical Therapy in north Spokane, discovered had happened to Mugaria’s back.
The condition is typical of many people who develop back pain after repetitive activities with an occasional, seemingly minor trauma or two along the way. In Mugaria’s case, the repetitive motion of swimming with her head always turned one way, combined with a military life-style of high-impact activity — “She had done different types of training in the Navy where she jumped out of stuff and landed and rolled,” says Masiarek — had created a painful situation.
Masiarek located the problem joints in Mugaria’s low back and turned to a gentle technique known as Muscle Energy to help free them up. Masiarek explains that the techniques are based on the patient’s own effort combined with the therapist’s guidance, unlike massage or mobilization.
“Muscle Energy techniques use a muscle contraction to try to encourage a stuck joint to move in the direction it needs to,” she says. And just like your mother always said, posture is critical.
“We trained her how to move her body correctly so she could do the activities she would like to do,” Masiarek says. “I also taught her good positioning, especially in sitting.” Mugaria followed up with a home exercise program, always using a pain-free range of motion.
Strength and stability training followed when Mugaria’s back had gained adequate range of motion. A key concept in back rehabilitation is the neutral spine, a position in which the natural curve of the low back is maintained even while the rest of the body is in motion. One way to learn about neutral spine positioning was to have Mugaria lie on her back. “I had her visualize that she was resting a cup of water on her stomach,” Masiarek explains, “so that as she was lifting her legs or moving her arms, she was keeping her abdominal muscles tight and really working on not spilling the water.”
Mugaria later advanced to exercises on her hands and knees, such as lifting one arm or leg, or opposite arm and leg, all while maintaining a “neutral spine.”
Although Mugaria still occasionally experiences back pain, she says she is able to do some of the muscle energy techniques on her own to help relieve pain.
“I feel these exercises have really helped me,” she says. “It has been a challenge, but it is really worth it. I can walk and stand for seven hours comfortably while working. And I just went for a 20-mile bike ride without any problems.”
Marie Cole is a physical therapist and instructor in the PT assistant program at SFCC.