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.

World Physical Therapy Day!!!

World Physical Therapy Day is September 8, 2014!!!

World Physical Therapy Day is a day to recognize the profession and all the benefits a Physical Therapist provides to the community. Are you currently participating in therapy? Have you had therapy in the past? How has therapy helped you? How could therapy help you?

For most individuals who have participated in therapy they are aware of the importance of the Physical Therapist as well as the role a therapist can provide in improving movement and function. For those of you who are not aware, the benefit therapy can provide is different for every individual. Every person you encounter has their own concerns and fears. My profession gives me the time to really understand and empathize with concerns and fears, which opens a window into making a real change on the individual level.

Whether it’s running that extra mile, picking up a grandson, getting up the stairs at night, or simply making it through the work day, Physical Therapists help individuals meet their specific goals. A Physical Therapist is a specialist on movement and can help optimize performance, return from an injury, and prevent future injuries from occurring. Imagine the health benefits of having a Physical Therapist who knows you. Think about it, most individuals have their own personal Physician and Dentist. Why not having your own Physical Therapist who can screen and educate on proper movements to maintain optimal health.

Optimal Movement Physical Therapy provides these benefits to many resident in the Redlands area. If you need someone on your team, we would be happy to listen to your concerns. Check out our website here. If you would like to learn more about World PT day, check out the World Confederation for Physical Therapy website.

In celebration of World PT Day we’re holding a contest! If your life has been significantly impacted by a Physical Therapist, let us know in the comments for a chance to win a $25 gift certificate to one of our favorite stores that encourages movement – REI! Follow us on Facebook, Instagram and Twitter for additional entries! Please leave individual comments letting us know where you’re following us! Giveaway ends Monday, September 15th at noon PST. Winner will be chosen by random draw and will be posted Monday evening!

Disclaimer: we are not affiliated with REI in any way. We just really like them and what they stand for!

http://www.OptimalMovementPT.com

A winner has been chosen for World PT Day contest. Thomas has been selected via the website random.org. Please email me at alan@optimalmovementpt.com.

Low Back Pain Paradigm Shift

Ten years ago, if you had low back pain and saw a Physical Therapist, you would most likely be prescribed “core strengthening” exercises. In fact, even today, you will most likely be given some exercises for the muscle group which provides stability at the low back. It’s not a bad idea, it works and there is a lot of research to support this paradigm. It’s become so commonplace that the argument is no longer whether you should train the abdominals, but more on how you should strengthen this muscle group. Brace or hollow? Sit-up or plank? There is multitude of articles and blogs on which exercises are best for persons with low back pain, and professionals often prescribe them without a second thought.

But, what happens when getting stronger doesn’t work? What are we missing?

The truth is, nobody has a “strong” core. It’s something we all have to work on. That’s why we can get away with prescribing it to everyone, because it always tests weak. Sure, some people have a stronger core than others, but in relation to the stiffness of the hip or shoulder, the trunk is often less stiff. Further, some people with a strong core still have back pain. So, again, what do we do when simply getting stronger doesn’t work?

That’s when it’s time to look at the movement. Look at the person’s function. Which movements are they required to do? What are their preferred movement patterns? Are they using the strength they already have?

Case in point: This client complained of low back pain and sciatica for the past 6 months. We began looking at abdominal strength as part of our objective exam only to find that she had great strength. When pointing this out to her, she noted that she is quite active. She hikes, does yoga, runs, stand up paddle boards, does pull-ups and planks. How could she have back pain?

Standing posture with measurements showing mild swayback posture.

The examination did not show many treatable impairments. When a client has a fairly clean strength and mobility examination, we get to move on to function. This client is very active, but the activity she does the most is holding her one year old son who weighs nearly twenty pounds. So, it’s time to check out her function.

Increased swayback posture when standing with twenty pound load (aka her son).

As you can see, the standing posture changes dramatically. The shoulders are no longer lined up with the hip, but they have shifted posteriorly. This client has shifted into extension when she holds her child. This excessive extension is just enough stress through her low back to cause some discomfort.

So, if she has enough strength, then, what is the treatment?

There is no exercise that will magically cure this shift. The only exercise or treatment for her is awareness. After a few small corrections, we are able to prescribe her only “exercise”.

Improved standing posture with 20 pound weight.

No rehab exercises needed. In fact, she is already doing more than I ask most patients to do anyways. She just needs to use what she already has and contract her abdominals while holding her son. She has all the moving parts to perform this movement optimally, and her rehab sessions have been cut from several to one.

This client is a great example of a client with low back pain who will not respond to abdominal exercises. The paradigm has shifted. It’s time to look at function. It’s time to look at movement. At Optimal Movement Physical Therapy, we assess, diagnose, and treat movement.

www.optimalmovementpt.com

Rebecca is the owner of be. Her mission is to inspire and educate people to live healthier and happier lives by spreading knowledge about the importance of nourishing their bodies with the best food. Check out her site at http://www.benourishedbehealthy.com.