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.

Do I need a prescription for physical therapy?

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!

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.

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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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.