Q:  I fell from a ladder and hurt my back. I'm out on worker's compensation with no hope of getting back to work the way I feel right now. I'm also quite a bit overweight. Is there any hope for me?

A: Your situation sounds like a complex one. It may take more than a few visits to your physician to find a management plan that works for you. Usually a team approach is best for cases like this.

By team we mean a physician to help you with pain management and a physiotherapist to help restore normal movement and function of the spine and surrounding soft tissues. It is also a good idea to seek the counsel of a nutritionist. He or she will help with good food choices and weight loss. And don't neglect or discount the services of a behavioral counselor. A good counselor can help with the psychologic/emotional aspects of injury, healing, and recovery.

If a three-to-six month all out effort on your part to follow the recommendations of the team don't net the results you need, then it might be time to ask about surgical options. Today's minimally invasive and less invasive techniques make it possible to perform lumbar fusion procedures on overweight-out-of-shape adults with good results.

In a recent study of patients just like you, researchers specifically looked at the ability of patients to get back to work. They found patients were able to get back to work within a year's time of the surgery.

On that positive note, it should be mentioned that none of the patients who were workers compensation patients returned to work. That type of trend has been noticed by other researchers. Further study is needed to understand this phenomenon. But for now, it sounds like your next step is to get a team of health care professionals behind you and give a rehab program a good, solid try before looking for other options.

Reference: Anjani K. Singh, MRCS, et al. Less Invasive Posterior Lumbar Interbody Fusion and Obesity. In The Spine Journal. November 15, 2010. Vol. 35.No. 24. Pp.2116-2120.