• Injured workers who must travel 20 miles or more roundtrip for medical care are entitled to collect $0.55 per mile. Special consideration also is given to employees who are totally disabled.
• Chiropractic treatment is allowed for workers’ compensation patients, if the employer or the employer’s insurance company grants permission. As many as 20 visits are allowed, if medically necessary. If additional visits are needed, the chiropractor should request this authorization from the Industrial Commission.

If youv'e missed any of the previous tips, find them here.

However, many people are surprised that post-surgery, the pain doesn’t subside as quickly as they would like and that the return back to normal life doesn’t happen automatically.

Of course, if your symptoms worsen or you do not experience any improvement after surgery, see your doctor.

Depending on the type of surgery a patient undergoes, the recovery time can vary from days to weeks to months.

Incisions, muscles and nerves need time to heal after surgery as your body tries to build back its strength.

Your doctor will give you an estimated timeframe for your recovery and will also discuss with you appropriate activities following back surgery. Remember that a plan that gradually allows you to return to everyday activities helps prevent reinjury to your back.

Connecting with friends and others who have had similar back injuries and undergone surgery surgery is a helpful way to learn the “real deal” on recovery. Other back patients may also be able to offer helpful tips from the perspective of someone who's been there, done that and most importantly, gotten through it.

Unexpected problems or questions can arise after surgery. You may experience moodiness or even depression. And you may find that you have questions about how to do things that you once took for granted. Many people who have had surgery to treat a back injury find themselves asking questions like, “How do I take a shower?” and "What's the best way to get sleep at night. "

Learning from others who have been through a similar situation can help you get through the recovery process. There are many online groups, discussion boards and blogs that can provide greater insight into how to cope with your recovery. You can find links to back injury support groups at the Deuterman Law Group Web site and elsewhere on the Internet. The Back Pain Support Group is a good one.

You can find list of other back injury and chronic pain support groups and resources at The American Chronic Pain Association Web site.

A healthy mental attitude as well as a healthy lifestyle will bring you closer and closer to your goal of returning to a normal life free from back pain.

Remember, the information in this blog is meant for education and is not a substitute for treatment. If you are experiencing back pain, see a doctor. Do no attempt to treat yourself.

This entry concludes our Back Health Blog, but we invite you to post comments and questions for our staff and our attorneys. If there's another topic you'd like covered in our Back Health Series or on our North Carolina Workers' Compensation Law blog, please contact us, and we'll do our best to honor all requests.

Today, we take up where we left off with a discussion of other surgical treatments for back pain, namely spinal fusion, artifical disc replacement and radio frequency ablation.

Spinal fusion is surgery that is performed to prevent movement between vertebrae by fusing the two vertebrae together.

The fusion happens through stabilizing screws, a bone graft or a combination of both placed between the two vertebrae that need to be immobilized. The graft then “welds” the two vertebrae resulting in something similar to one larger vertebra.

When the vertebrae are fused, the pain that resulted from the movement of the two vertebrae is lessened.

However the pain and recovery following the procedure can be more intense and longer than that with other surgeries. Bone takes a long time to heal, and the recovery can last as much as 4-6 months during which time your activities will be restricted.

Artificial Disc Replacement

Artificial Disc Replacement is a relatively new procedure, first used in 2004. As the name suggests, this procedure involves the removal of a disc which is bulging or herniated and in its place, inserting an artificial disc. The idea is similar to that of a hip or knee replacement surgery. 

The artificial disc then serves as the cushion between the two vertebrae and allows for greater freedom of movement than typically occurs in spinal fusion patients. Because the procedure is still considered experimental, patients are carefully screened to be sure that they are a good candidate for an artificial disc replacement.

Radiofrequency ablation

Although the name sounds more science fiction than medical, radiofrequency ablation simply involves the destruction (ablation) of a medial branch nerve in the spine.

Medial branch nerves are located on either side of the vertebrae. The surgeon uses high frequency radio waves to generate heat that burns the nerve. When the nerve is ablated, or killed, it can no longer transmit pain impulses. Therefore the brain never receives the “pain message” from the nerve.

Radiofrequency ablation is typically an outpatient procedure performed under local anesthesia. While pain may continue for several days after the procedure, most patients are fully recovered within a month.

Remember, the information in this blog is meant for education and is not a substitute for treatment. If you are experiencing back pain, see a doctor. Do no attempt to treat yourself.

Coming next: Our Back Health Blog has covered common causes of back pain and some of the more common treatments and surgeries. In our next installment of this series, we’ll review “life after surgery” and look at what you may experience while you recover from your operation or procedure.

Coming next: We’ll be discussing other types of back surgeries, including spinal fusion, artifical disc replacement and radio frequency ablation

These terms all refer to injuries to the muscles, ligaments and tendons. Most often your doctor will refer to this type of injury as a sprain or strain.

Typically these injuries are caused by damaged muscles, tendons or ligaments perhaps from over stretching or sudden movements. (This explains all those back injuries that people suffer doing everyday chores, like unplugging the vacuum cleaner.)

The healing process can last for many weeks and the pain can be quite intense from the inflamed tissues. Generally, surgery isn’t recommended for this type of back injury and treatment consists of anti-inflammatory medicines and, of course, rest.

Disc bulge, disc herniation and annular tear

All of these diagnoses refer to injuries to the vertebrae -- the smaller bones that make up the spine -- and discs -- the softer tissue that cushions the vertebrae.

These conditions are similar in that the soft tissue of the disc has extended beyond where it’s supposed to be. When the protective wall that surrounds the disc is torn or weakened, the tissue extends too far. For more on bulging discs and herniated discs, visit the Spine Health Web site.

The extended tissue can cause overcrowding, inflammation and compression of the nerves, which results in pain that may potentially spread to the legs.

Surgery is not always recommended for treatment because most patients respond well to anti-inflammatory medicines and physical therapy.

However procedures such as laminectomy or discetomy (which will be discussed in detail in a later blog) may be recommended to relieve patients of pain.

Spondylosis

This is basically arthritis of your spine.

Most people think of arthritis affects only the hands and knees, but arthritis can affect the vertebrae of your spine as well.

Common symptoms of spondylosis tend to be stiffness, not having a full range of motion, difficulty in walking or bending, weakness, numbness or even tingling.

Most people who suffer from spondylosis respond well to non-surgical treatments such as anti-inflammatory medication, physical therapy or chiropractic treatments. However,  sometimes if the pain is intense, corticosteroids, a powerful anti-inflammatory medicine, are injected into the spine.

Spondylolisthesis

This condition occurs when one of your vertebrae, which are normally aligned, slips out of alignment with the vertebrae below it.

There are different categories of spondylolthesis, graded on a scale of 1-5. depending on how and when the slippage occurred and the severity of the slippage,

You may not have any symptoms at all or you may feel pain in your lower back, thighs or legs; tightness in your hamstring; or difficulty with bladder control.

Some people may notice a change in their appearance such as a shorter looking torso or a swayback.

Treatments vary with each category and whether the vertebrae are continuing to slip or not.

If the vertebrae have stopped moving forward, then usually anti-inflammatory medications, physical therapy and possibly a back brace will help relieve the pain.  Physicians also may recommend bed rest or refraining from heavy lifting, twisting, or sports.

Remember, talking with your physician about your symptoms, diagnosis and treatment is the best source of information in managing your back pain.

But there are many resources on the Web that offer more information about spinal injuries and pain. Check out: SpineUniverse or the Southeastern Spine Institute for additional information and illustrations on spine health.

As always, please remember, this information is for educational purposes only. If you are suffering from back pain, please consult a doctor. Do not try to treat yourself.

Understanding the medical terminology doctors use in diagnosing and treating the causes of back pain can be confusing. While its always your right to ask your doctor for clarification, some patients may not feel comfortable asking a busy physician to take more time to explain things in simpler terms.

This series of blogs, entitled Back Health, is designed for injured people seeking more information about common back injuries, including symptoms and treatments. And we've attempted to explain things in simple terms, so you won't need a medical degree to understand what's going on with your back.

Read on for the first installment in our Back Health Series. This one focuses on the anatomy of the spine.

Please remember, this information is for educational purposes only. If you are suffering from back pain, please consult a doctor. Do not try to treat yourself.

The spine is made up of five separate and distinct parts: cervical (the area from the neck to approximately the shoulder blades); thoracic (the upper back area where the ribs are attached); lumbar (the lower back area close to the hips); sacrum (the pelvis area); and coccyx (commonly called the tailbone).

When these five parts are healthy and functioning well, your spine is able to support your weight, provide flexibility for bending and twisting, and protect your spinal cord. When your spine has been injured though, you may find that the most common of movements such as bending down to pick up a box or twisting to reach a file, can lead to intense pain.

Back injuries are surprisingly common. According to Prevention magazine, you have a 50-50 chance of suffering a debilitating back injury.

When you have a back injury, the pain may be concentrated in your back or it may radiate to other limbs, and it can range from chronic throbbing pain to sharp shooting pain.

Most patients experience back pain in the neck, the upper back and the lower back -- affecting the cervical, thoracic and lumbar regions of the spine. Depending on the type of injury or back disorder, some patients may experience more pain sitting down while others experience more pain standing.

There's no single cause of back pain. Spinal injuries may be the result of a traumatic event, such as a car accident or a fall. Or they can be the result of a long-term cause, such as repetitive movements, heavy lifting or even normal "wear and tear." You could even hurt your back doing normal household activities.

The pain in your back may be caused by disc or vertebrae injuries or damage to muscles, ligaments and tendons, the so-called soft tissues in your spine.

Coming next in our Back Health blog series: Understanding back sprains, soft-tissue injuries, bulging discs and herniated discs.

It's an interesting article that shows just how debilitating back injuries can be. The writer, a distance runner, outlines his long recovery and also highlights some of the realities of back injuries:

• The most common type of pain reported by adults in the United States, with more than one in four reporting some back pain lasting at least a day in the past three months. Eight of every 10 people in the United States will suffer from lower back pain at one point in their lives.
• The most common reason injured workers file for workers’ compensation claims, accounting for about one in every five U.S. claims for workers’ compensation.
• The leading cause of disability in the United States military.
• The leading cause of disability in people under age 45 and the third-leading cause in people older than that, after cancer and heart problems. One study found that two of every three people aged 20 to 60 reported some type of spinal pain in a given year.
• The leading cause of missed work time or doctor’s visits after headaches and cold symptoms.