Quick tips to better computer ergonomics 

I treat a lot of patients that have low back pain. Their pain can come from a variety of different things, but there is always one that sticks out to me the most. Bad posture and work station ergonomics. This one is the most frustrating one because it’s something that can be avoided if the proper steps are taken. But, it is also very easy for patients to go right back into their old habits again. So how can you start to help your back pain today? Here are a few tips that you can do starting today.

Let’s start with your chair: You want to push yourself all the way back into the chair. They make the seat that big for a reason so use it. You want your feet sitting flat on the floor adjust the height of the seat so that this can occur. Make sure your upper and lower back are supported. If the chair does not allow for that, then get a small towel roll or pillow to put behind our back. Allow for the natural lordosis of you lumbar spine to occur and keep it like that with the roll. Lastly you want your arms to be relaxed on the arm rests. Make sure your shoulders are not in a constant shrugged position.

Next, adjust your keyboard and mouse position: You want your keyboard to be the center of your workstation. Palm supports can help keep your wrists maintain the same position but are not necessary. Place the mouse as close to the side of the keyboard as possible. Lastly adjust the monitor. You want the monitor to be at eye level. You don’t want your head to be tilting up or looking down as you stare at it all day. Place your telephone at an easy reach so that you do not have to go far. An ear piece can come in handy so that you do not have to hold anything or tilt your head to one side.

Lastly, you want to take breaks as the day goes on. Every 30 minutes take a few minutes to refocus. After each hour of work take a break or change your task for at least 5 minutes. Always try to get away from the computer during your lunch break. You are there long enough during the day. Resting your eyes is a good idea as well. No, I don’t mean take a nap. Although, Europeans have it right taking a siesta for 2 hours during the day! If you are able to then I suggest that you do it. But if you are unable to take that snooze in a nap pod like those at google I advise you to rest your eyes by simply closing them for about 30 seconds. This helps reset and focus as well as giving them a break from the computer screen.

It’s very important to have some sort of plan as to how you are going to set up your work station. Developing bad posture at work will lead to back problems in the future. Make sure that you are always moving and getting up from your chair every 45-60 minutes. It’s not only good for your back but it helps with circulation throughout your body. Take these steps and you will feel better than you did yesterday!


What to do when you experience low back pain

I get this question a lot. “Nick I have no idea what I did to my back but here is what is going on”. “What should I be doing?” “What should I be avoiding?” Unfortunately, it’s really not that simple when it comes down to it. Without first evaluating someone I can’t just give out things to do, but I can suggest things that are pretty common in the treatment of low back pain. This can be a starting point to see if they get any relief. Once we have accomplished that, then we can look into more detail as to what the problem is. So what should you be doing if you start to experience low back pain? And what should you avoid so that the symptoms don’t get any worse?

Rest: how much is too much? In my opinion, rest with any injury is needed to allow for the inflammatory process to subside as well as for the tissues to start to heal themselves. Now, when I say rest I don’t mean bed rest. I am talking about rest from activities like running, lifting, carrying or any activity that seems to irritate your low back. And the length of time is important as well. 1-2 days is plenty because I then want you to slowly get back into your routine. Light walking, lifting, carrying activities.

Ice or Heat: I always advice ice for the first 48-72 hours. At that point you can mix the 2 back and forth if you want to. Some people, like myself, love ice. I hate being hot and ice always makes me feel better. So after that initial few days I say whatever makes you feel better is what I would recommend.

Change positions: you want to change positions frequently. If not you will tend to stiffen up or cause yourself more pain. When you are in pain your body and muscles are most comfortable tight. This, in turn, will cause you more pain and discomfort. If you sit for your job I suggest to not sit for more that 45 minutes before changing your position. Move in your chair, or get up and take a walk to change the position of your spine. This will decrease stiffness and load the spine and injured tissues so that they do not get stiff.

Light stretching activity: a light stretching program can help as long as you are not causing new symptoms to occur. Stretching also keeps the spine loose as well as the structures that surround it. As I said above your muscles like to stay tight when your body is in pain and this will help combat that. Sometimes back pain is accompanied by leg pain and we don’t want that. I always suggest to see your physical therapist to get evaluated and determine what best suits your back when you have these types of symptoms.

Avoid lifting heavy: If you work in an environment that you do a lot of heavy lifting this should be avoided for at least 2 days. Like I said about rest, it’s good for a short amount of time and then we need to start to load these tissues in order for them not to continue to get weak.

See your physical therapist: I suggest that you see a physical therapist right away when you experience low back pain. Our profession is so underutilized in this aspect considering that only 7% of patients with low back pain are referred from their physician to come to physical therapy. Where are the other 93% going? Or better yet are the other 93% not even doing anything about it? These are great questions and should be thought about in order to fully understand what it is that you can do when experiencing low back pain.

Why is form so important with exercise?

I have people ask me this question a lot especially if I am correcting them as they do a specific exercise. Why do I have to do it this way? This way is harder for me to do it. It’s easier if I do it this way. These are just some of the things my patients say during their time with me. Now I’m all for doing something a certain way if it is easier and more efficient. But when it comes to exercise there is some form that we all must follow. So why is it so important that we follow proper form while doing exercise? And what can happen if we don’t?

Injury prevention: this is the number one reason why form during exercise is important. If you continue to do an exercise incorrectly, you run the risk of injury. In my world of physical therapy most people that come to see me are already injured or have some form of pain. The last thing we want to do is cause another problem.

Efficiency: with proper form comes efficiency. We all want to be efficient with things because this makes things work more smoothly, it saves time and helps to not overwork yourself. Being efficient with exercise allows our body to adjust quicker and avoid fatigue. This, in turn, will prevent injury as we talked about above.

Accessory muscle use: if proper form is not used this can cause you to use accessory muscles. These muscles are the ones that start to kick in if the other is either too weak or your form is not correct. The best example I can give is when someone is doing a bicep curl with a barbell. If the weight is too heavy or their biceps are just weaker they start to rock their back and extend back and forth. This causes them to start using muscles in their back and increases risk of injury. My advice is always quality reps increased weight. It’s better to do 20 quality reps with a lighter weight than 10 reps of heavy weight with poor form.

Increased joint mobility: form plays a role in mobility of our joints. Deep squats for instance, are a great example. Deep squats are an excellent exercise to get more mobility in your hips, knees and ankles. If the goal is to increase the mobility in those joints then this exercise is for you. But if we decide to just do squats to 90 degrees of knee flexion this could cause a decrease in the mobility of the hips because they are not going through that entire range of motion. Now mini squats and squats to 90 are great for strengthening but if you want increased mobility this will cause those structures to tighten and not allow for full mobility. In turn, causing you limitation and sometimes pain.

As I tell all of my patients. I am not interested in how much weight that you can do or how many reps. I just want you to have proper form while doing your program.

Can wearing a back brace do more harm than good?

31 million Americans experience low back pain at any given time. It is the number one cause of disability worldwide. Also, low back pain is one of the most common reasons for someone to miss work and the second most common reason for someone to go to the doctors. Really? That many people have back pain? It is that common for them to go to their primary care doctor for it? Why are they not coming to physical therapy first? That’s a topic for another day, but seriously low back pain is a huge issue that a lot of us deal with on a daily basis. I see it first hand every day as I treat patients frequently with this problem. Some are strains, disc herniations, fusions, fractures and just general arthritis symptoms. It’s inevitable that I will get the question: “Do you think a back brace will help me?” “My friend’s brother has worn a brace for years and says he thinks I need one.” So I decided to share my opinions and some general facts about back braces to hopefully help you make that decision.

What is the back brace being used for? This should be the first question anyone should ask. The type of injury or problem that you are having will be a key factor whether you will benefit from a brace or not. When do you plan on wearing it? Is this something that you are planning on wearing all day? Do you want to use it while you are doing house work or working out at the gym? Are you planning on wearing it while you sit? These are some key questions that you need to focus on in order to see if this is right for you.

In my opinion, I never recommend for a patient to wear a back brace. This is usually what I tell them. I don’t recommend that you get a back brace. I feel you would not benefit from it and here is why. Your back is already vulnerable in the fact that you are injured and you are in pain. Your muscles are not working to their full potential and are weak. If you were to put a brace on, chances are that you would get some relief initially, but you would only be hurting yourself. Think about it this way, once you put that brace on your muscles are going to say to themselves, I don’t have to work as hard as I was before because I have this trusty brace doing most of the work. So as your muscles decide to take a nap they are also shrinking which is called atrophy. Now they are not as strong as they were before. After using this brace for the past several weeks you start to feel a bit better. You think, “Hey I feel pretty good let’s try going without the brace today.” Within 30 minutes you feel worse than you did before. And now you put the brace back on because that’s the only way it feels better. See, the brace is doing most if not all of the work for your core and those muscle decided that they wanted to be lazy and not work. Sure it helped take away your pain temporarily, but in turn it was hurting you in the long run.

Now, here is when I feel you can and should wear a brace.

When you are weight lifting or power lifting: weight lifters have been using belts and back braces for years. These are only used for a very short period of time and are taken off so your back is only being assisted for a short amount of time.

When your job requires you to lift a lot throughout the day: I see Home Depot workers wearing braces all the time. And as soon as they are done with the lift they take of the brace. This is fine because you are not allowing the brace to carry the load all day long.

Scoliosis: This type of brace is used to stop the progression of Idiopathic Scoliosis. This brace must be used in order to prevent the curvature from getting any worse.

It can be very confusing a to when you should or should not wear a back brace. I suggest that you take into account what you are trying to use it for and ask your Physical Therapist or other licensed health care provider. Braces can be a life saver, but they can also leave you worse than when you started.

A hunter’s guide to prevent Low Back Pain

Being from Southwestern Pennsylvania hunting is a big deal! I have always loved the outdoors, but I got into hunting later in life. About 10 years ago my father-in-law told me to buy my hunting license. He had everything else I needed firearm included. If I didn’t like it I was only out $20 for the license. That morning it rained, and rained, and rained some more. We saw 1 deer, and even though I never got a chance to shoot at anything I instantly fell in love with it! The next year I decided to buy a compound bow and get into archery. In my opinion archery season is the best time to hunt. Temps are warmer, you see more deer and there are a lot less hunters in the woods. There is something about being in the woods by yourself with nature! You can’t describe it until you are actually in it. I can go out and not see a thing, but I still feel it was a good day because that is also my time to sit and think. It’s my time to sit and unwind. It’s my time to sit and forget about stress and relax. Sitting is the common denominator here! As hunters we do a lot of sitting while we are in the woods. Sometimes we sit for 4, 5, 6 sometimes 12 hours while in the woods. Now you may be thinking “I sit that long at work, what’s the big deal?” Well, seats are a little different in the woods. Most archery hunters sit in a tree. Tree stands are not all that comfortable in my opinion, and if you have back problems it can be a nightmare. We put our bodies through hell trying to sit still and not move all while trying to stay warm. We find the best spot to try and conceal ourselves even if it means we have to sit crouched down in the most uncomfortable position for hours. All this to try and shoot a deer! Sitting for any length of time is not a good option for you. It can lead to poor health and most importantly Low Back Pain. 

Poor posture can and will lead to back pain. Over time if you sit in a slouched position for too long it puts stretch on the structures that stabilize your spine. You have multiple structures that support and brace your spine, ligaments and muscles being the main supporters. As we sit slouched those muscles tend to want to relax and not work to support our spine. The ligaments that run the entire length of our back are put on a stretch for the entire time we slouch, and most of the time that is hours. Think of it this way, you have a rubber band that you keep in a stretched position for an extended amount of time. Eventually that band is going to lose it’s elasticity and not work properly. This is how the ligaments in your back work as well. So if they are constantly on stretch, when you need the support it will not be there. Hunters need to understand that even though they sit a lot while waiting for their trophy, they need to prepare like this were any other sport. Getting into a good exercise routine will help and prevent injuries. Anyone that thinks nothing goes into hunting needs to try and drag a 200 lb deer out of the woods! It ‘s not fun trust me!

Here are some ways to try and save yourself from back problems this hunting season…

Dress in layers to stay warm:

When you have back pain chances are good that cold weather is going to bother it. Dressing warm can help decrease the amount of stiffness you experience. Also, if you are dressed warm enough you will not have to get into awkward positions to try and stay warm.

Try to use a 2 man ladder stand:

I am a big proponent of ladder stands. They are so much easier to get in and out of because they are permanent. And they are much more comfortable than a hang on. What a 2 man provides is more room. When you have more room to move around that gives you a chance to change positions and not have to sit and stiffen up. It also makes it easier to stand up and stretch a bit.

Stand up every 45 minutes:

Standing up puts your back into more extension which helps to keep your back in a less vulnerable position. While standing up you can do some calf raises to get the blood flowing through your legs and to try and keep yourself warm.

Try to pick a tree that is straight for the most part:

It’s hard to pick a tree to put your stand on, especially if you are looking for one that is straight. My suggestion is as straight as you can get. Once you put up your stand you need something to rest your back on. If you pick a tree leaning forwards that is just going to put you into a more flexed position. Try to keep your mid back up against the tree at all times. This will force you to put your chest out and extend your low back keeping it in a better position. You can also try an Ameristep Lumbar Support for added postural correction while sitting.

Do abdominal bracing and pelvic floor exercises:

The proper way to activate and brace your abdominal muscles is to pretend like someone is going to punch you in the gut and brace. At the same time activate your pelvic floor. This is called a Kegel exercise. Women are familiar with this. Act like you need to go to the bathroom real bad and you need to hold it until you pull over to a rest stop. These 2 combined exercises are the basis behind any functional movement that we do. If we learn to do these things before we actively do something, this will save our backs.

Field dressing your kill:

If at all possible try to face uphill while field dressing. This will put your back in a position so that you don’t have to lean over as much keeping you in a minor extended position.

Dragging a deer out of the woods:

Most people know that going downhill is a lot easier than uphill. If this isn’t possible, find a few friends that you can take turns with. If you have an ATV get it! Don’t waste time trying to be macho! Guys with low back pain from being stubborn are not macho…they are stupid! Make things easy on yourself and get help when possible!

Start an exercise program meant for stability and endurance:

If you have no idea how to do this, find a Physical Therapist! Stabilizing the spine is something that I deal with on a weekly basis. Having a strong core and back will help be more effective not only while hunting, but with general functions throughout the day. 

Low back pain can be avoided, and prevented if you take the right steps. Next time you are out in the woods try a few of these tips. Hunting can be a lot of fun, but if you don’t take the right steps to prevent back pain you will be laid up all season.

Even Physical Therapists need treated…

Last year after a long baseball tournament season for my son I started to notice I had pain in my right foot. I wore spikes most of the summer and into the fall and I just attributed it to that. My pain had started to go away, but after playing in the “Turkey Bowl” during Thanksgiving I continued to have pain. I again had the same spikes on…you think I would have learned. Well, I finally started to treat myself at work. Since I am the only PT in my clinic I had to do things myself. I did a lot of the same exercises and self stretching techniques I give to my patients. I also decided to try some arch taping and that really seemed to help me. After about 6 weeks my pain had subsided and I felt back to normal. At least I thought it did!
I have been running for part of my exercise routine for about 8-10 years. At the end of last year right around the time my foot started to feel better I decided to up my running throughout the week. I would go to the gym and start out my workout with a 2 mile run then strength train. This was 4 days a week. On my off days I would do 2-3 mile runs. The only day I didn’t do anything was Sunday. My foot felt great! I had no problems or pain. Spring came and baseball began. I decided to buy new spikes! The season lasted until just a few weeks ago.. My foot had minor problems throughout the summer, but never got to the point it was the year before. Until 4 weeks ago… 

My foot was killing me all of a sudden! I really did not have a reason for the pain. I had new spikes all summer and they never bothered me. This pain was different. To not get too clinical my foot hurt across the top from where my arch is at it’s highest, to the other side. The top middle portion hurt the worst. I don’t know about other Physical Therapists, but when it comes to my own body I, for some reason forget how to diagnose! For some reason when I have something wrong with me I decide I have no clinical knowledge and I can’t think logical! It is very frustrating! So I decide to start treating it again, but this time it was not helping. I did a lot of the same things to it that I did before, but I had very little success. I even tried taping it again and it only helped for a short while. So now I feel like I have a serious problem! Everything was going through my mind. Do I have a stress fracture? Did I tear a ligament? Do I have Arthritis? I felt like an old man when I got out of bed in the morning, and if there would have been a fire I would have had a hell of a time getting out of the house. So many things crossed my mind. It was also affecting me with regular activities. Catching football with my son, running after my daughter, walking around the yard to weed eat was sometimes a challenge. I decided it was time…time to get a consult from a specialist. Now, I will say that I exhausted all options before I called to make an appointment. I felt that I had it under control, and for the most part I did. I just needed that extra person to confirm what was wrong with me.  

I made the appointment for this past Friday. I will say that their costumer service at the front desk leaves a lot to be desired. At my clinic, we are very receptive to all patients, especially new patients when they come through the door. So now I’m even more skeptical thinking I made the wrong decision to get another opinion. Now of course that day was a great foot day for me and I had very little pain or irritation, but I still thought it would be good to get it checked out. I got X-rays done and went and waited for the doctor. She came in and thankfully I did not have a fracture! Well that’s great! Why can’t I figure out what is wrong with me? We talked about my profession and what I had thought was going on. We came to a happy medium and she thought the best thing for me was custom orthotics. I didn’t have a fracture, or a torn ligament or arthritis. From everything that I had been doing in the past year and a half had taken a toll on my foot. If I would have just listened to my body and reviewed my activity over the past year I probably would have came up with the same conclusion. I really do lose my mind when something is wrong with me.  

So there you have it! We can’t figure out everything, and it was a lesson I had to learn on my own. I was just being stubborn like most of my patients! I do feel that going through these steps helped me understand what a patient goes through. Even Physical Therapists need treated now and again! 

Raking leaves have your back screaming? Here are some ways to avoid Low Back Pain this fall.

The fall season is by far my favorite season of the year! Don’t get me wrong, I love the summer months. But there is something about the fall that I have always loved even as a little kid. I mean when October is your birthday month, how can you not love fall? Fall brings on cooler temperatures, beautiful colors, sweatshirts, backyard fires and of course Oktoberfest beer! Fall also brings lots and lots of leaves! If you are fortunate enough to live in a region where the leaves change colors it’s a great sight! It is also a big pain in the Ass to clean them up! Most people’s tool of choose is a rake. Now raking leaves can be enjoyed by some and it’s a good way to get your kids involved by helping out. But most of the time they are just jumping into the piles of leaves. However, if you are not careful, you can end up sidelined because of low back pain, all caused by raking leaves improperly.

It’s Saturday morning and you decide to finally go outside to clean up the mess that mother nature leaves every fall. You start at one end of the yard and just keep going. You have been at it now for about 4 hours and you can see the finish line. You know you should stop for lunch or take a break, but you decide to push through and get it done. Afterwards you feel a little sore in your low back, but you just attribute that to being inactive and raking an entire yard! You feel accomplished now! You feel that you have completed something! You decide to have a fire outside and grab a few Sam Adams Octoberfest beers! When you hit the sack for the night you feel good, especially after drinking a few cold ones. The next morning you wake up and can’t get out of bed! You think to yourself…what the hell did I do? Does this sound familiar?

Here are some tips to try and limit your low back pain or even avoid it while raking leaves:

1. Choose a good leaf rake: Make sure it is proportionate to your body size. If it is too long or too short that can be an issue and cause unwanted stress on your back.

2. Warm up: Before you venture outside do a few light stretches in your house. Stretch out your hamstrings by bending over to touch your toes. Stretch your quads/thighs out by pulling your foot back towards your butt. Lay on your back and pull your knees to your chest 5” x 10. Lay on your back and bend your knees. Let your legs fall side to side and hold 5” x 10.

3. Practice Abdominal Bracing/Pelvic Floor activation: The proper way to activate and brace your abdominal muscles is to pretend like someone is going to punch you in the gut and brace. At the same time activate your pelvic floor. This is called a Kegel exercise. Women are familiar with this. Act like you need to go to the bathroom real bad and you need to hold it until you pull over to a rest stop. These 2 things combined are the basis behind so many activities and you should do them during all of them. While you are raking practice doing these as you move the rake and bend over to pick up leaves. This creates a counter pressure on your back and helps stabilize it so that you try and prevent injury.

4. Keep good posture: Like with any exercise that you do you have to have good form to prevent injury. Raking leaves is the same thing. While raking leaves try to keep your knees slightly bend and to reach with your arms and not your back. After about 15-20 min stand straight up and extend your back looking up towards the sky.

5. Rake with the wind if it is present: Using the wind to your advantage is always a good thing. It makes you not have to work as hard and it actually helps take pressure off.

6. Bend with your knees engaging your abs in tip 3: When bending over to pick up leaves remember to engage your abs and pelvic floor before hand as in tip #3. Bend at your knees keeping your back straight and not bending over.

7. Stay hydrated: Make sure to drink plenty of water. Your body functions optimally when it is properly hydrated. Muscles get fatigued if they do not have the proper water content.

8. Take frequent breaks: If you take breaks and take your time you are less likely to injure yourself. Don’t be in such a hurry, especially if your kids are helping you. Enjoy the fall weather, before you know it it will be snowing!

So, while your sitting waiting for the leaves to change and eventually fall think about these tips. Focus on trying to do things at a steady pace, and take your time. It’s better to be safe than sorry! Have a great fall and happy leaf raking!