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!
Contrary to popular belief, when you injure yourself and are experiencing pain, things don’t just go away on their own. Can you sense the sarcasm in that statement? Our bodies don’t work like that. My wife has been having some hip and buttock pain for the past few months. Initially she strained her hamstring trying to race my son…not a good idea! I treated her a few times at home and gave her some things to do on her own. Since then she has developed some hip pain which again I looked at and gave her a few things that would benefit her. Just last night she was telling me how these things were still bothering her. I proceeded to ask her how the things I told her to do were going. She said she was not doing them. WHAT???? I told her that she is no different than a lot of the patients I see. Thinking these things are just going to go away on their own without any type of treatment is a common problem that I run into.
Rest at times can help an injury. For instance, when you sprain your ankle, you need to rest it. If you continue to walk on it, the inflammation will never go away and the healing process will take twice as long. But as that inflammation starts to subside you need to load the tissue and test it to keep it’s strength and flexibility. If you were to just stay off of it and not walk on it, it will take twice as long and could turn into a chronic issue. The same goes for all injuries. Things just don’t go away.
Don’t say physical therapy and treatment didn’t work for you if you never put in the work. I get this statement a lot from patients who have had PT in the past. I went to PT for a week and it wasn’t helping so I stopped going. Or better yet, they had me do a few exercises and they didn’t work so I stopped doing them. I know we all just want things to go away as quickly as they came, but that’s just not going to happen. Healing, strength training and diet all take a certain amount of time to start working.
This isn’t a new concept. They all take work, effort and a certain amount of self discipline to see any type of results. I said this to my wife and I will say it to all of my patients. I don’t want to hear your complaints when you never took what I said seriously and did what I asked you to do. Only after you have worked hard and failed can you start to complain to me about what didn’t work. Then we will refocus and try something new, because you can’t just give up when one thing doesn’t work.
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.
For the longest time, to come to physical therapy you had to get a prescription. First you had to make an appointment with your PCP and take time out of your day. They would take a look at you and say I think you should go see a physical therapist. They would write you a prescription and send you on your way. Nowadays, there is something called direct access for physical therapy. Patients can come right off the street without seeing a physician and get physical therapy treatment. So does this mean that you no longer have to see a physician to be able to come to physical therapy? Well it kind of depends.
The short answer to if you need a prescription is no. Direct access is meant for just that, to not have to worry about seeing a physician to get permission to come to physical therapy. Now, what will decide that is your insurance. Some insurance companies still require you to get a prescription, Medicare being one of them. My best advice to people that are wondering if their insurance accepts direct access is to call the number on the back of their card and ask. If patients do call in we can check for them, but it is much easier for them to call on their own.
How does direct access help the patient? For one, it takes an extra visit to the PCP away. This means they can just come straight to the PT and not worry about seeing an extra health care provider. Another way direct access helps is that it cuts costs for the insurance companies. Unnecessary visits are avoided and this in turn makes them happy. Direct access also saves patients time. Again taking away another visit can be the difference in an entire afternoon or evening for some patients. Busy schedules require efficiency and direct access does just that. And finally, it eliminates barriers to entry. If a patient wants PT, there should not be anything that stands in their way of getting it. This, in turn, opens of and enables people to seek this service without having restriction.
So the next time you get injured call your physical therapist so that they can properly evaluate you and get you on the right path to better health!
There are a number of different braces given out after surgery for your knee. Most of the time it’s for support of the joint due to weakness. Braces can be cumbersome and bulky and very hard to deal with. The first question I usually get from patients with a brace is when can I get rid of this thing? I understand, your already in pain due to surgery and now you have to lug this thing around with you everywhere you go.
Each surgery to your knee is different and depending what was done will determine when you get out of the brace. A few different surgeries that I see commonly are ACL repair and patellar fracture. Other injuries that require a brace are quadriceps tendon rupture and femoral fractures. All of these surgeries end up with a common problem…atrophy. Atrophy is the wasting away of a muscle and in turn it becomes weaker and does not work as efficient as it once did. Your quadriceps muscles are what help support your knee from collapsing when walking, and when they are not working properly is when the brace is needed. The brace is usually locked at first to take up the slack of any weakness.
So what causes atrophy to happen? When you have surgery on your knee it becomes inflamed. That inflammation works it’s way into the quad and causes it to shut down. When the muscle stops working it starts to atrophy. Have you ever heard the saying “ if you don’t use it you lose it”? Well this statement holds true, especially after surgery. Another reason atrophy occurs is after surgery the last thing you want to do is move your knee or even put weight into it. When you are not working the muscle like it is used to, you start to atrophy. It’s the same move it or lose it atmosphere.
What do we do in the clinic to determine when you can stop wearing the brace? We want to make sure that you have proper strength in your quad muscle to support your knee when you walk. One way we determine this is to have you perform a quad set. You are instructed to keep your leg straight and push the back of your knee down into the table or the bed. We look at if your quad muscle is firing properly and moving your knee cap as it’s activated. We then ask you to perform a SLR. This is done by laying on your back and doing a quad set. Then while keeping your leg straight, lift it up off of the table. If you can keep the leg straight without the knee bending in the air you are ready to be out of the brace.
So the next time you are wondering when that pesky brace can be thrown out ask your physical therapist. The more you do your home exercises the faster you will be able to get rid of it.
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.
When most people have an injury, especially if it involves the neck or low back, they feel they need an MRI right away. Also, if a person is ordered to come to physical therapy after their injury without getting an MRI or some sort of advanced diagnostic testing they question why. These patients are usually fearful and hesitant to start physical therapy for fear that something is being missed about their condition and they might get worse or injure themselves more.
Many studies have have been done to show if there is any value of ordering an MRI or advanced diagnostic test following an injury. Unless it is a very serious injury there is very little correlation between positive findings and the relationship to level of pain.
Physical therapy is always the best conservative approach to any type of musculoskeletal injury. Early intervention is key to the overall healing process. Starting treatment early reduces the risk of the injury turning chronic. This can also help save you and your insurance company time and money. Unnecessary testing can get very expensive and this is what we are trying to avoid.
As physical therapists we are trained in detailed evaluations. I can guarantee that my evaluation will be more detailed than just about any health care professional that you will see. Education is a big part of what we do during our evaluation. We are able to find “red flags” and if something doesn’t add up we refer you out to another health care professional. There are clinical tests that we perform to determine what tissues are effected and if those are positive then we take the next step into treating them.
Advanced diagnostic testing is not necessary to have before starting physical therapy treatment. Sometimes, waiting to get a test before starting can delay the healing process of your injury. Physical therapists evaluate and treat a wide variety of injuries and can help with pain reduction and prevention of future injuries.
If you look all over the news especially on ESPN there is no way you are missing all the hype behind Tom Brady the quarterback of the New England Patriots. Now, let me preface that I am a huge Pittsburgh Steelers fan and it pains me to even talk about him. But it is really amazing what he has done for the length of time that he has done it. How has he been this good for so long? How is he getting ready for his 17th season in the NFL and 16th as a starter? Brady is 40 today August 3rd and in football years that is an eternity! The average NFL career is between 3-6 years depending on position and ability of play. Brady has broken records, won 5 Super Bowls, is a two-time NFL MVP and has the most wins as an NFL quarterback EVER! So how does he do it? How has he been able to keep up with all of these other younger more versatile quarterbacks? And how does it seem that he just has a knack to win the big game?
To be an NFL player you have to be special! You don’t just luckily get drafted and you don’t just get a starting job because you made the team. You have to work and work hard if you want to be successful in the league. There are many players that have gone past their years as a football player trying to get that one last season before leaving the game that they have loved to play for so long. Payton Manning comes to my mind right away. Even though he won a Super Bowl to end his career he was a shell of himself that year. His defense carried him most of the way and he did what he needed to do to win, even if it wasn’t pretty. Tom Brady has evolved as the exact opposite only getting better and more focused with age.
Let’s start with his diet and how he decides to fuel his body. It is no secret that he eats vegan most of the year. Now I’m not saying this is the option for ultimate health because there is no way that I could go without meat. But this is his secret to success. Diet plays a huge rule in your health and weight control. I have posted in older blog about the 80/20 rule that most should follow. 80% diet and 20% exercise. There is no need to kill yourself at the gym 6 days a week if you are not eating the right things to fuel your body. Next, his workout regimen is very strict requiring him to wake up very early each day because of his busy schedule as an NFL player. His workouts along with him being very conscious of his health play a huge rule in how he is able to keep going. He is a very focused individual and it shows through all that he does.
If you want to get serious about your health and the way that you feel I suggest you take a look at what this man has been able to accomplish. Tom Brady is an extreme case, but he is a perfect example of what hard work and dedication to your body and health can get you. Is 40 really the new 25? If so, Patriots fans would seem to think he might have at least 10 years left in the league! We all wonder how much longer he will be in the league for. The short answer, as long as his body will let him be. Truth is there is no telling how much longer he will play. He’s like the damn energizer bunny! All that I know is as a Steelers fan his retirement can’t come soon enough!
I had to go to the dentist the other day to get my teeth cleaned. Yes it was that time of year again, my 6 month check up and cleaning. As I was leaving the office I went to the front desk and scheduled my appointment for the next 6 months not even thinking about it. I said good bye to the office staff and went on to work. As I was driving to my office I started thinking about how natural it was for me to schedule a follow up visit with my dentist. It’s drilled into our brains that maintenance on our mouth and teeth will prevent us from having problems in the future. Catching things early can prevent pain, decrease cost of care and keep our mouths healthy overall. If we have an issue in the mean time we just give the dentist a call. Can this work with physical therapy?
As the day went on I thought about it more and more. What if I started to set up a follow up check up after discharge for all of my patients? Six week, Six month and one year is what went through my mind. This is what is done at your PCP, dentist, surgeon, dermatologist and many more health care professionals. I know first hand what happens when patients are discharged from PT. 95% of patients stop there home program the day after they are done. 6 months to a year goes by and all of a sudden they have a problem again. Who do you think they call? Not me! They call their PCP or their surgeon. That is what people think of when dealing with pain, strains, weakness, functional deficits. Finally patients will come back to me after going through the chain to be treated. Look at the time and money it takes for someone to get to me.
Now, what if I discharge someone and set up a 6 week follow up to see how they are doing? Add certain things as well as make sure they are continuing to improve. Just doing this would prevent them from having to spend insurance money to go to their PCP only to tell them to come to me. This would also help patients be held accountable to what they should be doing knowing that they will have to come to see me in 6 weeks. This can train patients to think about follow up appointments. This can help patients understand the importance of their health and know who they can come to for their musculoskeletal needs. We as physical therapists have to do a much better job of keeping in contact with their patients, making trusting relationships and making sure people are getting everything that they can out of us. We are such a valuable asset that most people don’t know how to use. Take advantage of it!
You were doing yard work all day, went to lift that last bag of topsoil and felt a pop in your back and pain down your leg. You hobble into the house, sit down, pop a few Tylenol and put some ice on it. The next day you can barely get out of bed so you go to your physician. You come out of the appointment with all kinds of information. Everyone asks what happened and you say I have a slipped disc in my back. This term has been used for a long time. Is it really possible for one of your discs to slip in your back? Is that even a medical term? Is it something that we should be concerned about?
A disc can’t physically slip. The term is not accurate. Discs are attached to adjacent vertebrae with tough, ligamentous fibers, so discs can’t “slip”. These discs are very flexible in nature and allow for spinal movement and shock absorption. However, over time discs break down with wear and tear. A disc can move, bugle and completely rupture, ultimately expanding past it’s normal position of comfort.
The term slipped disc is often used interchangeably, and most of the time incorrectly, with bulging and herniated discs, but there is a difference in the terms. The anatomy of a disc helps to understand how the they are defined.
Annulus fibrosus – is the outer layer of the disc and is composed of a fibrous layer helping protect the inner portion of the disc.
Nucleus pulposus – is the inner layer of the disc and is composed of a gel like substance.
There are many layers in your back that help protect the disc. You have muscles and multiple ligaments along your spine that are the front line defenders. If any or all of those layers are weakened the annulus is all that is left before the nucleus. When a disc bulges the nucleus pushes into the annulus and causes the disc to lose shape and push into the spinal canal. This can cause a nerve to be pinched and cause symptoms down the leg. When a disc herniates the nucleus is now not contained in the annulus and leaks out into the canal causing pain and sometimes numbness or weakness.
Looking at these two terms and knowing how they are defined tells us there is no way that a disc can physically slip out of place. The term is widely used around the health care field. We just need to understand what it is being used for.