Common Cycling Injuries and How to Prevent Them

In order to maximize efficiency and minimize injury risk, cyclists have to optimize both machines at play, the two machines being the bike, and the cyclist.

Battling between the bike fitting and poor biomechanics of a cyclist is a recipe for pain and poor efficiency. The following is a list of common cycling injuries as well as the biomechanical flaws that may be causing them. Fixing the flaws with corrective exercises is only half the battle, as a poor fitted bike will contribute to these injuries as well.

1. Low Back Pain

Number one, and probably the most common is low back pain. Just because you are sitting while riding, doesn’t mean you can relax and sit in a slumped posture. A slumped posture places excessive tensile force on the muscles in the low back, and asking those muscles to work extra hard for several miles usually results in some amount of discomfort. The main motion to look out for is a pelvis that is posteriorly tilted like this athlete in the picture below.

Posterior pelvic tilt results in excessive flexion at the low back.

The posterior pelvic tilt is typically caused by decreased hip flexion, a motion often limited by tight hamstrings. Further, decreased abdominal strength can result in this slouched forward position. Have your therapist assess your hamstring length and your abdominal strength to determine if these may be the cause of the low back pain you are experiencing.

2. Hip Impingement

When the head of the femur pinches with the acetabulum of the pelvis a pain in the anterior aspect of the groin may occur. This pinching tends to occur when an individual places their hip into more flexion, adduction, and internal rotation than their hips actually have motion for. It can also occur due to weak, or inactive gluteal and abdominal muscles as their role is to rotate the pelvis posteriorly. Riding with your knee more medial than your hip can result in impingement at the hip, pain in the anterior aspect of your thigh, and definitely decreased efficiency while riding.

The excessive adduction and internal rotation can result in impingement at the femoral-acetabular joint.

3. Patello-femoral (Knee) Pain

The movement causes of anterior knee pain is very similar to the movement caused of hip impingement. The adduction and internal rotation of the femur causes impingement at the hip, as well as compression of the patella and femur at the anterior knee. The picture below shows how a simple step down test can identify this movement pattern, which suggests poor gluteal recruitment and / or strength.

The excessive genu values during a step down may result in excessive compression at the patella-femoral joint.

4. Achilles Tendonitis

Posterior ankle pain while riding is often due to excessive plantar flexion of the ankle at the bottom of the power stroke. If you are pedaling with your toe pointed down at the bottom of the stroke, you are likely overusing your posterior ankle muscles which attach to the achilles. This overuse can lead to tendonitis. Reasons why this occurs can be a poor bike fitting where the seat may be too high, but it can also occur as a result of poor activation of more proximal musculature such as the gluteals and quadriceps.

Ankle Plantar Flexion at bottom of power stroke.

5. Neck Pain

The amount of mid back curvature while cycling certainly can lead to higher stress at the cervical spine or neck as you keep your head up to see what is ahead of you. Excessive curvature (known as excessive thoracic kyphosis) will lead to an even greater stress at the cervical spine. As the picture below shows, the excessive kyphosis is often a result of limited hip flexion. This means that solving your neck pain while riding often means improving your hip ROM through stretching and improving abdominal control.

Excessive kyphosis at the thoracic spine can result in excessive compression at the cervical spine while cycling.

The first step to eliminating pain and improving efficiency on the bike is to diagnose the problem. Often times a bike fit and a movement assessment will identify the cause of the dysfunction. Our next blog post will focus on movement assessments and exercises you can start doing to treat the dysfunction and keep you riding.

In the meantime, check out www.optimalmovementpt.com for more cycling, movement, and corrective exercise ideas, or click here to schedule your movement assessment at Optimal Movement.

How Can Physical Therapy Help with Shoulder Pain?

Shoulder impingement, rotator cuff tear, biceps tendonitis, shoulder bursitis? A variety of diagnoses associated with the shoulder share several characteristics, the most significant being a sharp pain preventing dressing, reaching, driving, and / or sleeping. How can a good physical therapist help treat a rotator cuff that is partially torn?

If you’ve been keeping up on previous posts from Optimal Movement Physical Therapy you’ll know that Physical Therapy is not focusing on repairing damaged tissue, rather the focus is on identifying the reason the tissue became damaged in the first place. Once the faulty movement is identified, it can be corrected, and once it is corrected the pain can be alleviated. After all, many studies have shown that individuals can have a tear with no pain at all. Even further, the amount of pain that one has is not proportional to the size of the tear.

Well if the tear is not causing the pain, then what is causing the pain?

Take a look at the following video to better understand faulty mechanics.

Ideally, we want the humerus and the shoulder blade to move together in order to optimize the sub-acromial space. In this video, you can see the scapula does not move as the humerus moves which results in pinching of the structures within the subacromial space.

This poor movement results in impingement of the bursa, biceps, and part of the rotator cuff. Therefore this movement pattern can be the underlying cause of impingement, rotator cuff tear, bursitis, biceps tendonitis, just to name a few.

The sub-acromial space is a small tunnel where several structures pass through. With optimal biomechanics none of these structures become impinged. When the space is smaller because of poor posture, muscle imbalances, and / or faulty movement, the structures can become irritated and painful. Evidence of poor posture and muscle imbalance can be identified by a physical therapist examining your posture and movements. The area of focus for the therapist is the scapula, as the resting position and movement of the scapula is what determines the size of the space. When we are looking at your scapula we are determining whether the resting position is downwardly rotated, anteriorly tilted, and / or depressed as all of these positions will cause impingement.

An anterior tilt of the scapula is one where the inferior border is more prominent than the superior border.

Downward Rotation of the Scapula is one where the inferior angle is more medial than the superior angle of the scapula.

In the examples above, the scapula is starting in a poor position. This poor starting position results in a higher likelihood of impingement because the scapula will have difficulty getting full upward rotation. The scapula is in fact starting behind the starting line.

All hope is not lost. The scapula and it’s resting position, as well as how it moves can be retrained. Typically the muscles which are not “pulling their weight” include the mid and lower trapezius as well as the serrates anterior. At Optimal Movement Physical Therapy, we are looking for faulty scapula movements, testing for weakness at these muscles, and prescribing corrective exercises to eliminate the faulty mechanics.

The Other Side of ACL Rehabilitation

During my first affiliation, my clinical instructor and myself had the opportunity to assess an individual 5 days after he had undergone an Anterior Cruciate Ligament (ACL) reconstruction surgery.

5 days? Shouldn’t he still be recovering?  What exercises could he do? What should he not do? Should I put my hands on his knee? Why was he coming in to see us so soon?

Luckily, as a student physical therapist, I was not on my own, and I had a great clinical instructor. He picked up on my fear and understood the importance of not allowing that fear to be portrayed to the patient. It was a huge learning point for me, not only because I learned the proper ACL rehabilitation protocol, but I learned the importance of portraying confidence and giving reassurance to the patient.

Since that initial encounter with a patient who had undergone an ACL reconstruction surgery, I have rehabilitated hundreds of patients who had undergone a similar surgery. The reassurance and rehabilitation process has become second nature. There are stages of rehab, and goals that go along with each stage. The progression starts with ensuring quadricep activation and progresses to ensuring optimal neuromuscular control to minimize the risk of re-injury. From a physical therapists point of view, the rehabilitation process is pretty simple and straightforward. I don’t want to belittle the process, but unfortunately rehabbing an individual who has suffered an ACL rupture has become fairly common, and it can therefore be pretty easy as a practitioner to forget about the client. While this may be commonplace in a Physical Therapy clinic, the individuals going through this process are likely going through a challenge completely unlike anything they have ever done before.

Life has a funny way of reminding you why you are doing what you’re doing, and who you are doing it for. 

I was watching my beautiful 1 year old daughter, and my wife was behind me apparently doing a bunny hop. 2 milliseconds and a loud pop later and my wife was lying on the ground clutching her knee…

“I’m fine” she said minutes later as she attempted to stand and take a step, only to realize that her knee would not support her. My mind was racing,

Mechanism of injury – Check.

A loud pop – Check.

Instability and buckling – Check.

She needed an MRI. Any doctoral student, physical therapist, athletic trainer, and high school soccer player probably could tell you that those are the magic words for an MRI. Unfortunately, none of these people work for our country’s big insurance companies who requested documentation, an orthopedic surgeons prescription, and a precautionary x-ray (as if an x-ray would actually save them money?). On top of these requirements, the time it would take to get an appointment with a physician who could then refer us to an orthopedic surgeon in order to order an MRI was months away. This was simply not an option.

A favor from a local surgeon and money out of our pocket got the needed MRI, which of course revealed our suspicions. After asking around a bit, we found a great surgeon and we set the date.

And the babysitter.

And babysitters for the next month.

I was sitting in the waiting room the day of surgery thinking about what my wife was going through. Thinking about what she would be going through immediately after surgery. What happened to this being straight forward and simple?

It’s not just quadricep activation and knee flexion ROM when it’s you and your wife. It’s not just stages and goals when your daughter is confused by Mom’s inability to chase her. It’s not so easy and commonplace when it’s your wife who needs help with the brace and the timing of pain medication.

It’s over the last 2 weeks since my wife had her surgery that I get the reminder that we all need from time to time. Therapy is more than numbers and exercises. It has been a huge stepping stone for my wife going through one of the toughest challenges of her life. It has turned her from complete frustration to optimism in one hour’s time. The challenge is hers and ours to overcome, but we don’t have to do it alone. Therapy is about people and helping them with new challenges. Therapy is about chasing 1 year old daughters again.

The last 2 weeks of surgery and rehabilitation have definitely been challenging, but also a good refresher on the importance of the patient-therapist relationship. That patient is treading new territory, and the struggles associated with our insurance based healthcare system likely have not squashed any concerns the patients have. Each day brings a new step forward and my wife has started down her road to recovery. A great surgeon and rehabilitation team have definitely pushed her in the right direction, and provided some insight into what individuals go through during the rehab process.

More to come as rehab continues…

A Hip Solution to Low Back Pain

Welcome to the new Physical Therapy world. Gone are (or should be) the days of the ultrasound, hot pack, and nice massage. No longer do we treat only the location of pain. Each patient who fell through the cracks after their e-stim machine turned off begged for something more, and the time has certainly come.

Say hello to your new Physical Therapist. Your new therapist doesn’t bother dusting the ultrasound machine as he or she is too busy examining movement. One hour of pain free walking after short term treatments is not enough. Your new Physical Therapist is asking why the pain always comes back after one has sat for too long. A manipulation is only magical if the pain doesn’t return after repeated bending. Physical Therapists don’t simply stop at the area of pain, they move on to determine why that area of pain is under so much stress during seemingly simple movements.

Shooting numbness down your leg while sitting? Piercing pain at your low back with only minutes of walking? Could it be that the answer to your problem is not a laser to damaged areas of your spine? Could it be that the reason the pain occurs while you are sitting is due to tight hip musculature? What if stretching the hip flexors could relieve the pain associated with the osteoarthritis found on the x-ray? Some colleagues of mine have recently explores the relationship between hip stiffness and low back pain here.

In a nutshell, every movement is comprised from multiple parts of the body. Even sitting, the most common position for todays common man is quite complex. Sitting in a low seat requires up to 110 degrees of hip flexion. Ideally, the pelvis will not tilt posteriorly, and the low back will not round into flexion. Unfortunately, most people don’t have 110 degrees of hip flexion. Sitting without hip mobility can result in excessive tensile stress to the low back, and therefore cause that aching low back pain after prolonged sitting.

You can have soft tissue done, a manipulation, or even surgery if you can find the right (or wrong!) surgeon. But, when you go back to sitting without the hip flexibility the pain will return.

It works both ways. Some individuals have tight hip flexors and therefore lack full hip extension while walking. This results in excessive extension at the spine, and/or a compensatory rotation at the pelvis resulting in unneeded torque at the spine.

Once again, any treatment at the spine is missing the cause of the dysfunction.

The Physical Therapy world is changing. You can now see your physical therapist without a Physician prescription in most states. More and more therapists are screening movements and looking for this type of hip dysfunction well before the low back pain even starts. Find yourself a great local therapist and determine the cause of the pain today. Check http://www.optimalmovementpt.com for more information.

What are your favorite hip mobility exercises? Stay tuned for the next blog to learn the best mobility exercises for the hip.

5 Common CrossFit Injuries

“WOD, Box, Kipping, muscle-up”.

When you first enter the crossFit world it seems like they’re speaking a different language. Then, you bravely take a step into a “box”, learn some new terms, and you realize, it is a different world. Take your next step into this world and now you’re doing “wall-ball’s, box-jumps, and dominating your WOD (workout of the day). But, like any high level physical activity, there are some common injuries to look out for, prevent, and treat if you are, or are going to be a crossFit athlete.

Let’s get one thing straight before we start talking common crossFit injuries. CrossFit is awesome. The sense of camaraderie and competition has helped tens of thousands of people move and exercise. CrossFit and the common injuries associated with it are far superior to the common injuries and diseases associated with a sedentary lifestyle. Look at other forms of recreational and competitive exercises including running, cycling, playing football and basketball; all are great forms of exercise, but they all have common injuries as well. Move better, listen to your body, and exercise smartly. Get in touch with a good physical therapist to help you initiate and maintain a healthy lifestyle.

With that disclaimer out of the way and without further adieu, here are the 5 most common injuries associated with crossFit, as well as tips you can do to treat and prevent them.

1) Low Back Pain

If you are going to participate in crossFit, get ready to squat. The squat is simply the best exercise to work the whole posterior chain (glutes, hamstrings), a vital area of the body that is typically ignored. For this reason, the inclusion of the squat in any exercise program is a great idea, as long as you have the flexibility and strength to pull it off. When one lacks hip flexion, or has poor abdominal and glut activation, or weakness of the glutes, the compensation is excessive trunk flexion and overuse of the lumbar spine paraspinals. This muscle group is simply not made to support the trunk during a squat, let alone several repetitions of the squat, and especially not with weight over the shoulders.

Treatment / Prevention

– Have your physical therapist check your hip flexion ROM as well as the strength and activation of your glutes during a squat.

– Ensure proper squat form without weight before adding weight. You may require corrective exercise for flexibility and muscle coordination before performing a multitude of squats with weight or for time.

2) Anterior Shoulder Pain

Shoulder pain amongst this group is due primarily to one of two factors (or a combination of the two). One factor is that many crossFit exercises including the overhead squat, the snatch, and the thruster all require the shoulder to move to its end range of motion into flexion and external rotation. If you don’t have this range of motion, then aggressively throwing your shoulder towards the end range of motion can result in shoulder impingement. The second factor is that many crossFit exercises place the weight anterior to the body which may result in excessive recruitment of the biceps and pecs. This imbalance between anterior musculature and slap stabilizers can, once again result in impingement at the shoulder.

Treatment / Prevention

– Have your passive ROM assessed by your therapist. If you don’t have 180 degrees of passive flexion while lying on the table, don’t expect to lift to 180 degrees during a snatch.

– Assess the activation and strength of your middle trapezius, lower trapezius, and serrates anterior. These guys should be working to counteract the pull of the biceps and pecs.

3) Wrist Pain

Once again, crossFit is bound to incorporate squats, and lots of them. One version of the squat is the front squat where you place the barbell in front of you in the rack position. This position places your wrist into maximal wrist extension while holding a load. This is very similar to any plank work you may do, again a favorite amongst crossFit trainers.

Treatment / Prevention

This one is pretty simple. You need full wrist extension range of motion to get into this position. Without it, you will have discomfort every time you place your wrist in maximal extension.

4) Knee Pain

Squats, squats, and more squats. And some times lunges. Once again, squats are great for the posterior chain and they are a very functional exercise. That myth that squats are bad for your knees is completely false. Let’s change the phrase to “bad squats are bad for your knees”. Squatting with excessive knee flexion compared to hip flexion, and/or excessive femoral adduction, and/or poor gluteal activation can result in a high amount of stress on the knee joint. Read this previous blog for more specifics on Physical Therapy and knee pain here.

Treatment / Prevention

– Have your physical therapist assess your squat

– Have your glute strength assessed and perform corrective exercises to activate your glutes in order to avoid the excessive knee flexion and/or femoral adduction compensations.

5) Elbow Pain

One of the most common causes for elbow pain is excessive gripping, something crossFit athletes do a lot of when they begin adding weight to their exercise program. All of the muscles responsible for gripping originate at the elbow. Repetitive gripping therefore results in overuse injuries at the elbow.

Treatment / Prevention

A new focus for treatment of lateral epicondylitis, or elbow pain with gripping, is strengthening of the scapula stabilizers. Improving the stability at the proximal shoulder has resulted in a decreased amount of stress at the elbow and may therefore eliminate elbow discomfort with gripping tasks. For more on scapula stability for the lateral elbow, check out this article.

The 5 best local races for 2015

If you are the runner or cyclist in your family, chances are you will be unwrapping some new gear this holiday season and getting ready to shed some of the calories you’ve either intentionally or unintentionally put on during the holidays. Whether you are a competitive  veteran chomping at the bit to toe the line, or you are planing a training regimen for your first big race, one of the most exciting parts of doing a race is picking which one you’ll enjoy this year. The following is a list of some great local running races for you to gear up for, or to utilize as part of a training program for a bigger race.

1. Run through Redlands – March 8th 2015. 5K, 10K, 1/2M. This is a great run through some historic settings of Redlands. Prepare for some hill work as this run ascends from downtown through prospect park up to sunset before traversing back to the Redlands Bowl.

2. Highland Y Run – January 25 2015. 5K, 10K, and 1/2M. One of the best times to run in the Inland Empire is the winter while there are snow capped mountains and blooming citrus trees. All proceeds from this race go towards scholarships at the YMCA.

3. Citrus Heritage Run – January 10 2015. 5K and 1/2M. Ok, so maybe you should have already finished your training for this one. But if you are a seasoned runner, why not start the new year with an early run. This run is put on by a great local running group with proceeds benefiting local student athletes.

4. Redlands Chamber Night Light Run – December 27th 2014. 5K. The good news about this run, is not many people actually run it, rather they enjoy the show and move along a gradual pace. This run is in its 2nd year and the focus is have a good time while enjoying the lights around downtown Redlands. Look out for the Optimal Movement Physical Therapy Team this year!!!

5. Los Angeles Marathon – March 15, 2015. Marathon. If this race isn’t on your bucket list, it should be. It’s what most of the members of local run groups are training for and it is the best local marathon. The race course was changed several years ago to now incorporate a Dodger Stadium beginning and a Santa Monica finish (the one good thing Frank McCourt did for LA).

What local races are you looking forward to this year? Add your favorites in the comment section and let me know if I missed one. Remember to train safe and listen to your bodies rather than focus on a mileage goal. Also remember, you don’t run to be fit, you have to be fit to run. Let us know if you need our help with returning from an injury or optimizing your training plan to avoid an injury. Visit our website and get in touch with any running related questions you may have.

www.optimalmovementpt.com

How can Physical Therapy help with my Low Back Pain?

This post continues the discussion on how we as physical therapists can best treat our patients’ ailments. Check out the previous post regarding treatment and communication of a patient with knee pain here.

“Well, the reason for your low back pain is that you have degenerative disc disease.”

or,

“You have a slipped disc at L4/L5 which is compressing a nerve.”

or,

“the arthritis in your back is equivalent to a 90 year old.”

Pretty scary huh? How can physical therapy help with diagnoses like these? Can physical therapy remove the arthritis found on imaging?

No it cannot. But perhaps there are more important questions to ask. I would assume that the more meaningful question(s) may be; Can physical therapy eliminate the low back pain I experience when I am walking my kids to school. Can physical therapy allow me to lift items from the floor, and therefore allow me to perform my household duties? Can physical therapy eliminate the discomfort I experience while sitting for prolonged periods at work, and therefore allow me to be more productive? Can physical therapy eliminate the discomfort I have while I play recreational sports so that I can get back to playing basketball?

The answer to these questions is yes. But, look at the disconnect that many patients experience. Originally, they seek out a healthcare professional with a complaint during some type of meaningful activity. Rather than receiving an answer or a long term intervention, the original complaint gets warped into a diagnosis of “degenerative disc disease”, “arthritis”, or “stenosis”. Could it be that what’s causing the discomfort is not the diagnosis, but rather faulty movement?

Why do we rely on imaging to dictate the cause of our discomforts? Look at this research article performed on individuals without low back pain. This study utilized MRI images on individuals without low back pain. Only 36 percent of individuals without low back pain had “normal” findings. 52 percent had a disc bulge, and 27 percent had a disc protrusion. This, once again, begs the question, could it be that what’s causing the discomfort is not the diagnosis, but rather faulty movement?

This is actually great news for individuals suffering from low back pain. Nobody can treat  a diagnosis of stenosis or arthritis. But a movement expert can assess and implement a program to help individuals who have pain with specific activities. Treatment begins with identifying faulty movement, understanding the reasons for the poor movement, and specific corrective exercises to eliminate the poor mechanics.

For example, take a look at this diagram;

No diagnosis is causing this discomfort. Poor movement places a high amount of stress on the joint, the disc, the muscles, everything. Change the movement, change the pain. 

That being said, sometimes the desired activity requires more strength and flexibility than an individual has.

This individual likely does not have the core strength to lift appropriately given this quick movement screen. In order to lift appropriately, she may require a strengthening regimen. Every body is different and requires an individualized assessment and program prescription.  In order to get here, push your diagnosis to the side and begin identification of movements which may cause the discomfort.

Optimal Movement Physical Therapy is dedicated to helping individuals identify and treat their movement faults. Visit our website or e-mail us at alan@optimalmovementpt.com so that we may help answer any questions.

The Benefits of Gettting Your Exercise in Before the Big Meal

Looking for reasons to stay moving this holiday season? Look no further than the Energy Lab in Redlands!!! This is my favorite place to work on optimizing movement and staying healthy.

Jill Ruth Rooks

The holiday season is in full swing!  That usually means we fall out of our routines and into some habits we thought we had left behind.  With food everywhere, parties, late nights, and lists of things to do – the opportunity for weight gain and a general sense of fatigue and the “blahs” is prevalent.  There is a way to counteract those effects and still celebrate the holidays and enjoy all the cheer.  It is within your reach and it is as simple as EXERCISE!

A little bit of exercise goes a long way!  Talk about making you more productive during a season where we generally feel like we never have enough time to get everything done.  A little hit of exercise will boost your energy level and allow you to fly through your lists!  You will have a glow and not only look better, but feel better too!  Make…

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My Knee Pain is due to Arthritis, how can Physical Therapy Help?

“I have arthritis in my knee, can Physical Therapy get rid of the arthritis”?

No, it wont. Anybody that tells you differently is wrong.

In fact, you can replace the diagnosis with nearly any degenerative diagnosis for the knee.

Can Physical Therapy heal the torn meniscus?

No.

Can Physical Therapy heal the remove the cyst found under the patella.

No.

But, there’s a caveat. After confirming the patients correct belief that physical therapy cannot make the anatomical change which is the source of pain, the education typically goes something like this:

“Physical Therapy will not remove the arthritis found in your knee, but it’s possible that we can identify how your movement, flexibility, and/or strength issues may be placing excessive stress through your arthritic joint, therefore causing the pain. While we can’t remove the arthritis, if we relieve the stress we may remove the pain allowing you to perform your desired activity”.

Potential further education may be:

“In fact, the profession has done studies in which individuals without pain have similar radiographic findings as your x-rays. Potentially it is not the arthritis that causes the pain, but the stress placed on that arthritic joint during walking, ascending stairs, squatting, or any other movements is causing the pain”.

Let’s optimize movement to relieve the knee pain.

This is important education for Physical Therapists to give to their patients to assist in defining what the profession can do. Physical Therapists can help optimize movement to reduce the stress placed on the body. The switch from pain is due to the tissue source needs to be changed to the pain is due to the excessive stress placed on the tissue source.

How can changing movement change the amount of stress through the knee? Take a look at this research article which focuses on the amount of torque placed on the hip and knee during a common squat exercise.

Keep in mind that the squat is a very functional movement. What I mean by functional, is that this is a motion which is performed often by nearly all individuals. A simple motion of sitting in a chair, or lifting an item from the floor is a squat. Minimizing the amount of stress through the knee during a squat, therefore decreases the amount of stress through the knee during other functional tasks.

In this picture the amount of force placed through the knee is cut by 30% simply by cueing the individual to squat with his knees behind his toes. Imagine how much force could be eliminated when his strength and flexibility are even further optimized.

Check out www.OptimalMovementPT.com to learn how you can reduce the amount of stress through your painful knee, or any painful areas during your desired functional task.

Abdominal Bracing for Chronic Neck Pain

What’s causing the pain? How do I alleviate the pain for good?  These questions from our patients has led the profession down a new route. A route that no longer looks at just the source of pain, but also the cause of pain. It has led us to a new concept, dubbed “regional interdependence“.

In short, regional interdependence is looking at the whole body to better understand the cause of one’s pain location. As you can imagine, the education and treatment of a person will be quite different when focusing on the body as a whole rather than having tunnel vision solely on the area of discomfort. No longer are the days where physical therapists simply identify the source of discomfort and apply direct interventions solely to the source of pain. The profession has realized that the majority of our patients are not looking for the quick cure, but rather the long term answer. The latest from the profession has suggested intervening at the thoracic spine for pain located at the cervical spine, treating the hip for individuals suffering from low back pain, even interventions focused on the brain and understanding pain for treatments of chronic pain.

A piece of research that I was lucky enough to take part in during my Spine Rehabilitation Fellowship offers a new paradigm on the potential treatment of chronic neck pain. The research was part of a platform presentation at the 2014 APTA Combined Section Meeting in Las Vegas, and (keep your fingers crossed) will be available after it is published shortly.

The study may be the initial step to eventually show a potential relationship between trunk stability and chronic neck pain, offering a new approach for the treatment of chronic neck pain. A quick synopsis of the rationale:

Moseley showed that individuals with sub-acute neck pain also have impaired trunk muscle function.

This study showed a difference in the deep neck flexor endurance test exists between individuals with and without chronic neck pain.

This begs the question, will trunk stabilization improve the endurance time during the deep neck flexor test, therefore improving the endurance deficit that may be the cause of discomfort for individuals with chronic neck pain? The initial study shows that there is a difference in endurance time when an individual is given manual bracing at the trunk. Of course, there are several more steps needed before trunk stabilization exercises are prescribed for individuals with chronic neck pain.

A basic summary of the research: trunk stability may play a big role in the long term treatment of chronic neck pain. No longer are the days of simply looking at the location of pain for treatment (cervical spine), but rather towards the whole body for the cause of pain (trunk stability). The physical therapy profession is ever changing, and with some more research the new paradigm for treatment of individuals with chronic neck pain may include trunk stabilization.

www.OptimalMovementPT.com