Should I have an MRI first?

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.

Can your discs actually slip?


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.

Disc Anatomy:

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.

Is physical therapy going to be painful?

Before I leave the room after all of my evaluations I always ask my patients if they have any questions. I also ask, if what I just explained to them makes sense? At least 50% of the time, if not more, I get “ is this going to hurt? It is a very good question considering the majority of people have no idea what to expect from physical therapy. When people are already in pain to start the last thing they want is to have more pain. Also, at this point, people can be fearful of movement. Therefore, it can become challenging trying to explain what to expect. Let’s talk about this question of pain and if it’s really something to expect when you go to PT.

I absolutely hate when people say that I love putting them in pain! I also get very upset when patients and PT’s alike will state PT stands for pain and torture. Or a PT is a physical terrorist. Really? Is that what most people think we are and do to people? Let’s get one thing straight. My job is to promote movement, function and mobility using your own body to heal itself. I am not here to try and put you in the most pain possible. I have no desire to try and increase your pain nor do I get excited when I do. This is a misconception that a lot of people have and it needs to stop.

Yes, there are times that you may have some discomfort from certain movements, activities and treatments. Take the shoulder for example. A patient that has RTC surgery is going to have pain during PT because you have to move the joint in order for you to gain motion. The shoulder is healing from surgery and that is another reason that it is going to be painful. Any time you have limited motion you are going to experience some sort of pain/discomfort because the joint is not moving properly. It’s not a sign for me to see how much pain I can put you in. It’s just a guarantee that you will be in some sort of discomfort because of the limited motion the joint has.

Will you experience some sort of pain during PT? Depending on what you are coming for the answer is yes. Other times PT can and should be very relaxing and calming. General soreness from activity and exercise is not what I consider pain. It’s just your bodies way of telling you to move your ass more often and you wont feel this way. If you are seeing someone that calls themselves a pain and torture expert or refers to themselves as s physical terrorist I suggest you find a different place to go.

When things get tough will you quit?


As most of you know that read my posts my son plays travel baseball and I’m a coach on the team. Lately it has taken over my life, and I’m okay with that because I enjoy it so much! But I keep finding different reasons to talk about it because these kids show me something different each week. As with all 9 year olds there is an up and down attitude about them each day, week and month. One day they look like super stars out there and nothing can stop them. The next day they look like they are back in T-ball again. This past weekend was one of those weekends where you wondered how they would respond after the events that took place.

We played in a tournament called the Battle of the Boarder in Youngstown Ohio. Leading up to the weekend we knew that competition was going to be very good. 2 teams in particular were going to be there. Beaver Valley Red and West Hills. The last time we played West hills they beat up on us pretty badly. By about 13 runs to be exact! It wasn’t pretty, but our kids had bounced back in the next tournament they played in to take 2nd place. We were in a different bracket then either team and were set to face 2 teams we had never played. The day before the tournament started one dropped out and our schedule changed. Now we were scheduled to play Beaver Valley. I was excited to see how our kids matched up against them since we had never played them before. Once the kids heard that was who they were playing that’s all they talked about. They obsessed about it actually! And it was not in a good way. The game started and we walked the first batter, not a good start! Nerves were probably going crazy for most, but we managed to get 2 outs and the score was only 1-0. Then all hell broke loose! We committed 6 errors giving up 12 runs in the first inning! After the first inning it was 12-0! How does this happen? Little things like catching the ball before trying to throw it. Balls going through their legs, and coming in on fly balls instead of stepping back first. All things our kids do very well most of the time. Their nerves got the best of them. Needless to say the game ended in 4 innings after losing 18-1. We lost the second game 12-6 against another team we had never played mostly due to mistakes and kids just not being in the game. It was tough to watch and hard to talk to the boys afterwards. Sunday would tell us what type of team we have and how they respond.

The next morning the kids warmed up and you could tell they were more lively and upbeat. They started out strong and lead most of the game until the bottom of the 5th giving up 2 runs to be down 5-4. The kids battled that last inning but couldn’t find a way to get another run. We lost that game, but showed great resilience and determination to come back after getting the crap beat out of us the day before. It was great to see how our boys responded.

I wanted to share this with you all because there are always going to be times in life and in physical therapy that you are going to want to quit. Things are just going to get too hard for you and giving up seems to be the easiest thing to do. I know because I have felt like quitting before. My first 2 weeks of PT school I almost quit! I felt that it was going to be too hard and too much for me to handle. I was sick of school at that point and now I was going to have to go for an additional 3 years! I went home that weekend and thought about it a lot. I kept telling myself I could go and get a job for a little while and figure it out. Then I realized that I committed to doing this and this was what I felt passionate about. I’m so glad that I decided to continue my journey. Just know that it’s normal to want to just give up when things are tough and not going your way. It’s the way you respond and show resilience that makes all the difference.

My experience with custom orthotics, and will they work for you?


A while back I wrote a blog about how even physical therapists need treatment sometimes. I went over my experiences with a foot problem that I developed over a few summers ago. I wanted to do a follow up post on my current situation and how it has taught me something that I teach my patients on a daily basis.

To summarize my experience I started to get some foot discomfort in the fall of 2015 after a long season of tournament baseball. I used to wear spikes when I coached because it made it easier to do things with the players. That Thanksgiving I played in a Turkey bowl and wore those same spikes and the next day I could barely walk. It took about 2-3 months of self treatment and taping methods to finally get some significant relief. It would still bother me from time to time, but I could deal with it. Well, summer came in 2016 and I decided to get a new pair of spikes thinking that it was just the brand the they were a few years old. At first it felt fine, but as the season wore on I could feel my foot slowly hurting again. I finally just started wearing regular running shoes and that seemed to help, but never completely. I finally bit the bullet and went to see a foot specialist. I was diagnosed with nothing more than over pronation of my forefoot and in turn my arch was collapsing causing significant pain. This is honestly nothing that I already didn’t know. I just wanted to make sure I didn’t have a stress fracture. To my relief I was recommended to get custom orthotics done so I obliged. I didn’t receive a call for a few months and by that time my pain was gone so I never called back.

Fast forward to April 2017 and baseball season had been in full swing since Thanksgiving indoors of course here in Western PA. We were just getting outside and I started wearing my spikes again…bad move. They hurt so bad that I decided to get some turf shoes most coaches wear. I also decided to call the foot specialist again to pick up my orthotics. I made an appointment and within 10 minutes of being there I was walking out with orthotics in my shoes. The initial feeling was a little different. I wasn’t sure what to think really. I just knew that I needed to give them a shot. I always tell my patients with any type of change in footwear whether it’s new shoes or orthotics do it in steps. So I wore them for an hour for the first week. Just one hour a day, then bumped it up to 3 hours and so on. I now wear them all day when I’m at work because I am on my feet most of the day. I have to say that since wearing them I have not experienced foot pain at all!! It’s amazing what a difference they do make and I’m very happy I made the decision to get them.

My advice to my patients with foot problems is always try orthotics, especially if they have a flat foot. I usually tell them to try an over the counter version to see. Some insurances don’t cover them and it can be expensive. So before they go full out I tell them to go the cheaper route first. Now that I have had such a positive experience with orthotics it will drive me to be more aware of patients that will benefit from this.

If you have any questions about your foot problem or any musculoskeletal issue that you may be experiencing please don’t hesitate to contact me! 

nicksivrichpt@gmail.com

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.

I treat PAIN all day every day

Throughout the week 10-20% of my patients cancel. It’s a given. Anywhere you go, regardless if it is a medical facility or not, cancels happen. I have cancelled things on occasion as well. Something comes up and you don’t have a ride, you have to work late or you just plain forgot. Things happen in life and that’s why we prepare for these types of things to happen. Sometimes, the reason for cancelling is actually the reason you should be coming in.

I have heard a lot of different reasons for cancelling over the years. Some are pretty standard as you would expect. Some are off the wall and I just shake my head. But whatever the reason is I’m okay with because you had the courtesy to call me and let me know. There is one reason though I have a hard time dealing with. “ I’m calling to cancel my appointment today.” “ Is everything okay?” “Yes, I am in a lot of pain today and need to cancel.” “I called my doctor and they gave me some pain meds.” Wait a minute what? They cancelled because they are in pain? Isn’t that the reason they came here in the first place? They were lifting something heavy and injured their back. Now they are dealing with back pain and need my help. Why would someone cancel because they are in pain?

As a physical therapist I am a musculoskeletal specialist. I help people get back to things they want to do by developing a program that puts them in the best position to win. I treat pain all day every day without the side effects of a pill! I don’t give you long term use effects by damaging your liver nor do I cause an addiction. I help people get back to the life they once lived without having to rely on me all of the time. I lead them to independence. I make decisions for them to guide them in the right direction. PAIN is usually a very common symptom of most of my patients.

So why would someone cancel if they are in pain? Early on in my career I had no idea and just attributed it to a patient being lazy. Sometimes that is the case, but most of the time it is just that the patient is misinformed. I didn’t do a good enough job explaining to them exactly what my plan was and what it was going to take in order for them to get better. Now, some patients just don’t pay attention and that’s on them. But I can always do a better job at communicating. So, if you are currently going to PT or are planning on going know that at times things might get flared up. You might get worse before you get better. You might experience more discomfort than you did before, but pain should not be a reason to cancel. I always want to see my patients if they are in pain. It ‘s what I am here for!

Ask questions and educate yourself before you get cut


Educating yourself as well as being educated about your body and some of the injuries that we have is very important. Google is a very powerful tool that we use for different things throughout the day. You hear people all the time saying, “Just google it!” It’s so easy isn’t it? It’s also very easy to ask questions about what is going on. When patients are seen by a physical therapist, a PCP, a surgeon or dentist questions should be asked by both the patient and practitioner. Communication is key to the success of the treatment set forth. As a practitioner you need to know details about what the patient is going through. You need to know what type of symptoms they are experiencing so your course of action will follow that. As a patient you need to know what is going on and what is going to be done about it. Do you think this is important?

I was just evaluating a patient after he had had shoulder surgery the other day. The script said eval and treat, status post right shoulder surgery. I had started talking to him about when his surgery was and asked him a few questions about what was done. I knew he did not have a rotator cuff repair, but I was unsure as to what was actually done because the script was so vague. I said what exactly did you have done to your shoulder? The patient looked at me with a straight face and said “ I have no idea what the doctor did he just told me I needed surgery.” WHAT????? Are you kidding me? I didn’t say that to the patient, but I was for sure thinking it. What kind of person would just take the doctors word for it and let them cut into their body part without even knowing what they were doing? It makes absolutely no sense to me. Now, I want to give the benefit of the doubt to the surgeon because I’m sure he explained something to him. Or did they?

This isn’t the first patient I’ve had like this and it wont be the last. Are they putting too much trust in their surgeon? I would say yes they are. I would never recommend to do a treatment on a patient without first explaining to them exactly what was going on and what we are trying to do to help it. Educating yourself about your condition through self searches and questions is highly recommended and a big key to help yourself get well. I’m not suggesting to self diagnose yourself. I am simply suggesting that you research your problem so you can have some sort of knowledge about your condition, then ask questions. Knowing exactly what is going on helps understand why things are being done. Don’t just let a medical professional treat you without knowing exactly what they are treating you for. We all have to be proactive in our care and take action to be more informed about what is being treated and why. This, in my opinion, will help clinician and patient relationships as well as trust. Educate yourself and stay informed, only good can come of it.

How much does weight really impact my joint health?


If you have the occasional twinge of pain in your knees, hips or even your back, it is your body’s way of warning you of a potential problem. Pain is your body’s way to tell you that something is wrong and you need to do something about it. Similar to an engine light coming on in your car, pain is indicating a possible problem. Now, what is the cause? There are multiple reasons why your body sends off pain signals. First, if you injure tissue your brain tells you that you are in pain. If you have bad posture, eventually you will feel pain. Our joints are designed to take a lot of pressure during different activities. But when that pressure is increased just the slightest it can cause an enormous chain reaction and your function can be lost. So how does increased body weight really impact our joints health?

Studies have shown that for every pound of excess weight exerts 4 pounds of pressure on your joints, your knees in particular. Let’s just think about that for a minute…if you are 10 pounds overweight you have 40 pounds of extra pressure on your knees. If you are 100 pounds overweight now you have 400 pounds of pressure on your knees!!! That’s a crazy statistic! Now, walking on a level surface puts a force equivalent to 1 ½ times your body weight normally with everyone. So if you weigh 200 pounds you are putting 300 pounds of pressure on your knees. If you add an incline, the pressure goes up. Going up and down a step increases this pressure 2 to 3 times. And squatting, a very functional activity that we all do on a day to day basis, can add up to 5 times your body weight of pressure. This is why it is so important to know what we are doing to our bodies and the affect a few extra pounds can have.  

What does this mean? Well, with increased pressure on joints this can lead to joint break down, in turn causing osteoarthritis. Obesity and being overweight is one of the leading risk factors of osteoarthritis. Osteoarthritis is caused from wear and tear of joints. Once the cartilage is worn away this causes a bone on bone atmosphere which causes inflammation in the joint. Increased weight causes this breakdown to occur quicker than normal. And, pain levels can be even worse with those that already have osteoarthritis. Now you have an inflamed joint that is bearing 3-5 times the amount of pressure that it should.  

What can be done to avoid this? The simple answer is to lose some weight. Most people can afford to lose a few extra pounds. It’s easier said than done, I know. It all comes down to 2 questions. Is it important to you? And what are my goals? You really have to decide what is important to you. If not having pain is important to you, then this should be a priority. If being able to do any activity you want without pain, then this should be a priority. What are your goals? I would suggest setting small goals at first so that they can be easily reached. Seek out another partner to hold you accountable during your journey. In the long run it’s a life style change and it needs to be done in steps. Nobody ever said that getting to a healthy lifestyle is easy, but once you get there it is very easy to maintain that environment.  
So to sum it up, weight has a huge impact on your joint health. Your joints already have a great deal of pressure put on them when doing a specific activity. Adding any additional weight, just increases that pressure even more. This, in turn, can cause other issues such as osteoarthritis. Having a healthier lifestyle can and will prevent such things from happening and should be a priority.  

My low back pain experience with weekend DIY!

I’m pretty handy and I love DIY projects at home! My wife and I basically remodeled our entire first house that we owned. Some would say we only work well together for a short amount of time because we both want to be in charge. We all know that she is always in charge…shhhhhhh don’t tell her I said that! After fixing our house just the way we wanted it we outgrew it and decided to move. Isn’t that how it always works? A little over 4 years ago we decided to build a house to our exact liking so that we would not have to do any remodeling. Well, 2 storage areas, a laundry room, a shed, and 2 bathrooms later we are still looking at projects that we want to do. Oh, I painted the entire house as well. As I look at the projects that I have completed it makes me feel good knowing that I am able to do these things. I have always said if I was not a Physical Therapist I would have probably followed in my grandfathers footsteps as a carpenter! But it seems that every time I do a project I suffer for a few days or weeks afterwards. Whether it is from carpal tunnel in my hand after running an impact drill for 2 days straight, or shoulder pain from painting all weekend. There always seems to be something that triggers a pain in my body. Even though I know how to properly do things, I can still slip up and get lazy.

My latest DIY project at home was to redo our hallway bathroom. My 6 year old daughter calls it her bathroom. We had never done anything with it and it still had the original paint…very boring. My wife and I watch a lot of HGTV and our show of choice is Fixer Upper. Of course my wife wants everything they do. The thing she wanted the most…SHIPLAP! For those that don’t know what ship lap is, it’s planks of wood hung horizontal on the wall. They come in all shapes and sizes as well as thickness. We decided to go with 1”x6” planks. She wanted it half way up the wall to be even with the countertop of the sink. We also decided on a new paint color as well as trim for the bottom and around the window. We bought most of the material 2 weeks ago and then I was off to bring out my inner Chip and Joanna!

It took me about a week to finish the project mostly because I started on a Sunday. As I started the project it was mostly painting which was not a problem. Hell, I’m like a pro now I don’t even have to use tape for trim work. Once I started to measure out different pieces of shiplap to cut I noticed as the day went on my low back started to bother me. I really didn’t think anything of it because I attributed it to what I was doing. I just wanted to get it done and didn’t even pay attention to it. These are all things I tell my patients to avoid and here I am not practicing what I always preach. It happens to the best of us. The next 2 days I was unable to work on the project because of my work schedule as well as my sons baseball practices. What I did notice was increased back pain throughout the day. The good thing is I’m a Physical Therapist and I was able to treat it at work as well as at home. By the end of the week I had a lot of relief and then I started working again. After about 30 minutes of constant bending to measure and cut wood I began to feel the pain again. This time I was smart and did what I tell my patients. I took a break, did a few different techniques and got back to work. I was more aware of what I was doing as well as bracing my core when bending and lifting things. I decided to make a small list of what you can do during those DIY projects. These techniques are great to prevent injuries so you don’t have to totally stop your project.



Brace your core:

This is probably the most important thing to do when you are bending over a lot as well as lifting things from any height. When I explain to people what to do it’s simple. Imagine you are going to get punched in the stomach and brace your abs. After this is established you want to engage your pelvic floor. With this imagine what it is like driving on the highway and you have to pee. You engage your pelvic floor by holding your pee. Do both of these at the same time when you are doing a lot of bending. And always do this when lifting something.

Lift with proper technique:

I use the acronym A SAFE LIFT

A: Always communicate

You want to always communicate especially if you are doing a lift with someone else. But even if you are lifting something small communication as to where you are putting it is key.

S: Stagger your feet

When approaching anything to lift off of the floor you want to stagger your feet to get a better stance and base of support.

A: Abdominal Squeeze

Just as above you want to brace your core before any and all lifts.

F: Flex your knees

Don’t bend with your back when getting down to the floor. Always flex your knees to get closer to the object you are trying to lift.

E: Easy movement

The movement lifting should be easy. If you are struggling to even lift it a few inches off of the ground it is too heavy.

L:Lock lumbar spine

Again this goes with bracing your core, but you also want to keep extension in your lumbar spine so that you are not predisposing yourself to injury.

I: Imagine the move

This is very important because it will make you visualize what the move will look like and prepare you for what you are going to do.

F: Face the load/hold close

Make sure you are always facing the load and you pull it close to your body when you lift it.

T: Toes follow nose

Make sure you are not twisting your body or torso. Your toes follow the way your nose goes.

Hamstring stretching: 

Stretching your hamstrings is a very important thing to do. Tight hamstrings can lead to lower back pain so in turn we should all make sure that we loosen them before, during and after activity.

To stretch your hamstring you can do it multiple ways. First you can lay on your back and put a strap or long towel around the bottom of your foot across your arch. Keep your back flat on the floor and both legs straight. Pull your leg with the strap up in the air keeping it from bending until you feel a stretch in the back of your leg. Hold it for 20 seconds and do that 5 times.

Another way to stretch your hamstrings is to stand with your feet together and reach for your toes. Keep your knees straight and make sure you feel a stretch in your hamstrings or the back of your legs. Again, hold this for 20” x 5.
Projects at home are great and they make you feel that you have accomplished something. However, if you are not careful you will wind up on the couch in pain. The above activities are suggestions to try and prevent as well as help with low back pain. The best way to treat it as well as prevent it is to see a Physical Therapist.  
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