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.

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

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.

Running Assessment

This is why I wanted to be a Physical Therapist…

I just completed my first running evaluation at Optimal Movement Physical Therapy. My client, marathon runner, John Hackney, has been having some knee pain of late during his runs. I think even more frustrating is the recurrence of a hamstring strain during his marathon competitions. Seeking a biomechanical evaluation with his insurance and scouring the internet for some information yielded little results. I was very happy to be able to provide some answers.

Running is hard to analyze. The movements occur so fast that it becomes very hard to see the movement faults. One second you think you see something important, but the next second it has disappeared. The best way to break down a runner is with video analysis, but the problem with this technique is that it requires more time than most therapists have with their patients. I have come to realize through several of Chris Powers’ lectures and discussions, that the only way to provide a meaningful assessment to high level athletes is by giving them the time they need to be thoroughly assessed. In fact, pain and movement can be so confusing, that the majority of clients need more time than most therapists can give in order to clear up the confusion (but more on that subject in a later blog…).

Seeing the majority of clients (especially high level athletes) leave a clinic without a thorough understanding of their problem is part of the reason I started Optimal Movement Physical Therapy. Within John’s first session, we were able to analyze not only his running, but several other functional tasks including squats, step downs, and single leg stance. Further, the video analysis provided by Simi provided specific metrics on all functional movements. The measurements taken of body angles during running and step downs will allow a post treatment comparison after John has completed some corrective exercises. After analyzing all of the functional movements, I still had time to measure John’s strength and flexibility (decreased hamstring length, decreased gluteal activation, and quad dominant movements – no surprise there). Lastly, John and I had time to discuss the problem, strategize how he can reach his goals, and determine the most appropriate corrective exercises for him (again, more on specific corrective exercises of individuals in a later post).

Motion analysis of marathon runner in saggital view.

In my opinion, this is the way physical therapy evaluations should be. Full of information on the individual’s specific movement with measurements and goals to attain. Oftentimes, a client is left to simply trust a therapist’s or healthcare professional’s word. When given specific measurements, a client can better understand the problem and is more motivated to correct the problem. At first glance, John does not have a lot of faulty movements or impairments, but after 26.2 miles every impairment is magnified. In order to identify and measure these impairments, skilled physical therapists need only spend a little more time with their patients.