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Center for Physical Medicine and Rehabilitation
Dr. Curwen has spent much of the last two decades practicing medicine in Jackson, based out of Jackson-Madison County General Hospital. In 1996 years ago, he moved his outpatient practice to the Center for Physical Medicine and Rehabilitation, at 60 Lynoak Cove. For an appointment call
731-664-7744.
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Treating back pain starts with proper evaluation
Successful treatment of back pain involves the patient taking the responsibility to manage the pain through rehabilitative exercises and activity, said Dr. Davidson Curwen. Too many patients, he explained, are looking for that magic bullet – whether it be medicine or surgery – to get rid of the pain.The reality is that most likely the pain won’t entirely go away, he said. Through physical therapy and activity, the patient will lessen the pain as he or she improves function.
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| Dr. Davidson Curwen believes in a thorough physical exam to help pinpoint the cause of back pain. |
Dr. Curwen’s systematic approach involves a thorough patient history and physical exam and a routine set of x-rays. “With that I can properly evaluate and diagnose most back pain symptoms.”
He asks what he considers key questions during the patient history, with answers helping him to pinpoint the problem: Does changing positions affect the pain? Is the pain worse or better during sleep? Does the pain awaken you from sleep? What do you do to relieve the pain? What medications work? What medications do not work?
His physical evaluation starts with observing how the patient walks into the room. Is the patient walking as if he were in pain or is he exaggerating the pain? Dr. Curwen looks at posture; he palpates the back, looking for muscle atrophy and muscle spasms; checks the spine; and assesses the spinal range of motion.
He’ll also complete a sensory survey and check reflexes. He’ll do a neurological assessment, manually testing muscles and joints in the trunk and extremities. If a physician suspects a neurological problem, he explained, “I strongly recommend an EMG done by a trained physician.”
With each step, he says, “you are ruling out conditions to help pinpoint the cause of the pain.”
Some conditions may need further testing with an MRI or
another test. And, for some patients, surgery may be needed to relieve the pain.
For most of his patients though, Dr. Curwen emphasizes a rehabilitative approach to managing back pain. “I educate the patient to take responsibility for his or her therapy and treatment and to not expect some magic cure.” Though patients often think strong pain medication is the answer, Dr. Curwen adds, “medications are prescribed only to help patients get through specific phases of their rehabilitative program. We don’t give medications for a patient to sit on the couch at home.”
A rehabilitation prescription for a non-operative condition like disc disease may include the following...
• Flexion exercises.
• Isometric strengthening of trunk muscles.
• Pelvic traction.
• Lumbar rolls for sitting.
• Lumbar support for repeated or heavier chores. (Too much dependence on support can weaken the muscles.)
• Self administered heat, ice therapy and analgesic medicines when pain flares up.
• Patient education on good posture and body mechanics.
• Attendance at a “back school” or back skills program, if one is available.
“This prescription can be adjusted to fit other conditions,” Dr. Curwen said. For example, if a patient had a suspected disc herniation, he would change the flexion exercises to isometric.
“All patients benefit from flexibility training, pelvic tilt exercises and endurance training, such as daily walking.”
Obesity is another contributing factor to back pain. “Regardless of the initial cause of back pain, your body has to change to get better,” he said. That includes rehabilitative exercises, losing weight, having better posture and strengthening your abdominal and back muscles.
This rehabilitative approach, he said, will help with most back pain. “With rehabilitative medicine, we look at functional restoration.”
When working with a patient, he prefers to tie improvement and the patient’s expectations to function rather than to a lessening of the pain. “The pain goes away as your function increases. If you are so preoccupied with pain, you won’t do what you need to do to get better.”