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Patient Discussion Handout 4:  When activity and time is not helping 
  By now, your health care provider has made every effort to seek a medical reason for your continued activity limitation.  You are well into the exercise program intended to condition your back for the activities you need to do.  Unfortunately, for some people success is less easy and slower to achieve.  If this is the case, there are many things to consider. 
  Age is important.  Few middle-aged persons have a back that is as strong as it was at age 18.  Medical science presently cannot reverse the aging process that limits activities requiring both speed and strength.  Young people may find it hard to accept these limitations.  Older people commonly find it difficult to give up or alter activities they have been doing for a long time. 
  Some people continue to look for a "cure" when progress is slow.  Such efforts rarely succeed.  Consider a basketball star like Larry Bird.  Money was surely no object in seeking a cure for his back problem.  He could afford the most expensive medical care and conditioning programs. Nevertheless, he was forced to retire at age 34.  His back could no longer tolerate the physical stress of basketball. 
  How many athletes in strenuous sports can compete beyond age 35 or 40? Very few!  Most of us must adjust our activities as we age, regardless of occupation or level of physical conditioning, many by age 30, most by age 40, and just about all of us by age 50.  Some people can continue strenuous activities into their older years, especially if they are able to do it at their own pace.  Others may need to consider change. 
  Be realistic.  Ask yourself three key questions about your daily activity requirements: 
-    Can a reasonable exercise program overcome my back problem? 
-    Will it be possible to continue a more time-consuming exercise program and my usual daily requirements long term? 
-    Is there any way I can change my activity requirements now or in the future? 
  If a reasonable exercise program is not helping you, there are several options: (1) You can choose to put up with discomfort and expect some setbacks.  (2) You can begin a more time-consuming conditioning program. (3) You can change the pace of doing difficult activities.  This may include a job change.  People may use a combination of the three approaches. 
  Considering a job change is difficult, especially if back problems continue to limit your ability to do your work.  Again, ask yourself this important question: "Is my activity goal realistic, or do I need to look at my options?" A review now might help you avoid a similar dilemma in the near or distant future, when increased age may work against you.  Being a few years older sometimes makes a big difference in the chance of changing jobs.  Some creative planning could benefit you now, or in the future, especially if your job activities present a problem. 
  When considering a job or career change, it is important to gather information from many sources.  Some possibilities include private career counselors, local or State employment offices, and veterans' or consumer groups.  You may also want to talk to someone working in the field. 
  Information is your ally.  Whether or not you explore job opportunities alone or with professional help, remember this important point: 
Only you can find a way to adjust your life, your job, or your plans in a way that is right for you. 
Not seeking information about options is insane considering the risks to your future. 
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