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Derek Cohn competes in stair-climbing races around the Midwest, including one contest climbing the 108-story Willis Tower (formerly Sears Tower) in Chicago.

That’s a stark contrast to three years ago when his back pain was so severe he feared one day he wouldn’t be able to walk at all.

The reversal is a rare development because people with back problems generally resign themselves to enduring the pain, sometimes for the duration of their lives. Surgery is iffy, drugs have side effects, injections don’t last long and exercise can make the pain worse.

The American Academy of Orthopedic surgeons estimates that the annual direct cost of treating back pain was $193.9 billion in 2004 and has risen steadily for a decade. Indirect back pain costs include missed work, lost wages, an underlying cause of drug abuse and obesity, and other factors.

Cohn is relatively lucky. He knows where his back pain started: a hiking trip in 1999 in Australia. Many people don’t know the cause of the pain and it’s never pinpointed.

“I jumped over a (culvert), and I felt something wrong,” he said. The wrong started hurting and got worse over the years. “I couldn’t sit or sleep or stand; I was always looking for a new position to (lessen) the pain.”

In 2011, two neurosurgeons and a magnetic resonance image diagnosed stenosis, which is a narrowing of the spinal column, and degenerative disc disease.

He rejected surgery, opting instead for physical therapy and exercise, because the doctor said the source of the pain wasn’t clear, and surgery could leave him with no relief.

Jonty Felsher is a physical therapist and co-owner of Rehabilitation Professionals Inc. where Cohn sought help.

Felsher said the back is prone to pain because it’s the central stress point of the body. “It is one of the most critical areas of our body in terms of our function,” he said. “Sports, work, or even sitting, body mechanics, we’re not taught that, and we abuse our backs.

“It’s an area that takes a lot of strain; it’s a complicated structure, vertabrae, nerves, ligaments, muscles.”

Sometimes conditions need different therapies, Felsher said. “Sometimes there’s (contradictory) treatments. Stenosis is one thing, disc degeneration may require an opposite therapy.”

While the worst back pain seems to start after age 50, Felsher says pre-emptive action can save younger people from a future of back pain.

“Watch the kids working on laptop computers when they may get stiff or sore backs,” he said. “You might want to usher them into a physical therapist who can give instruction on how to sit and work in way that’s less risky.

“Some schools do postural screens and try to head off problems with treatments or exercises. And parents should talk to their doctors and get a prescription for postural evaluation.”

Adults can work on exercising, standing more, improving their posture and other remedies.

“Sitting is still the worst thing people can do,” he said. Learn good posture, select more ergonomic chairs and equipment, learn to lift, or do whatever job you do in a way that protects the back rather than wears it out, he said.

As for Cohn, his physical therapy worked better than pain management shots, pain killers and other remedies. After the physical therapy, his therapist recommended Pilates.

He also joined a gym and tried the stair climber. He kept at it, doing only 10 or so minutes, then increasing as his endurance allowed. One day, he looked up, he was doing 3,000 steps per session. The back pain eased more.

Meanwhile, his weight started dropping. He was 223 pounds at 5-feet, 6-inches when he started.

“The doctor said my weight probably had nothing to do with the pain, but he said I needed to lose weight anyway,” Cohn said.

“I was already a vegetarian, but they call it a junk food vegetarian,” he said. “I went almost vegan, no cheese, no yogurt … It started coming off slowly, but over a year, I’m down to 160 pounds.” He has kept the pounds off for about a year.

The stair-climbing pulled him into a new hobby. His employer, Express Scripts, “has a stair-climbing team, and I joined them,” he said.

His first competition was the American Lung Association’s “Fight For Air Climb” in 2013, where he climbed the Metropolitan building one time. Last year, he competed in the event’s “ultimate climb,” going 40 floors as many times as possible in an hour. Climb up, take the elevator down, climb again. He made six rotations and plans to participate again in March.

Since then, he has scaled the AON Insurance Tower and the John Hancock building in Chicago. At the Willis Tower race, he finished 38th out of 2,000 competitors. He made the climb in 14 minutes and 8 seconds.

Competing will be a central part of his life, from now on, he said. He works out six days a week, including stair-climbing, stretching and Pilates.

At a recent checkup, his blood pressure was lower and his cholesterol had been cut in half.

“He told me if he didn’t know me, he’d think it was a different person.”

Do you know

a ‘How I did it?’

Suggest a candidate to:

Harry Jackson Jr.

St. Louis Post-Dispatch

900 North Tucker Boulevard

St. Louis, Mo. 63101-1099

Phone • 314-340-8234

Harry Jackson • 314-340-8234

Derek Cohn

Age • 53

Home • Clayton

Occupation • IT project manager with Express Scripts

What she did • After 15 years of back pain, he exercised, dieted and followed instructions from his physical therapist and Pilates instructor to relieve 90 percent of his pain. Now he competes as a stair-climber.

Harry Jackson is a health reporter for the St. Louis Post-Dispatch.