Low Back Pain: Treat With One Exercise

Photo: Chakra-Jnana Yoga/Facebook

Backbends. Stand up, put your hands on your hips or low back, and bend backwards (obviously not beyond a comfortable stretch), likely around 30 degrees. Hold 1 second, then return to upright. Repeat 5-10 times. This is the single best exercise for the majority of patients with low back pain, and the following explains why.

1. Convenience. You can do this exercise anywhere to treat or prevent low back pain. It does not require equipment or even lying down. While there are various forms of back extension (lying on your tummy and pressing up onto forearms or hands, lying on your back and lifting your hips into a bridging position, various yoga poses, etc), this exercise is the easiest one to perform no matter where you are.

2. Back Extension Exercise helps 70% of patients with Low Back Pain. Moving your lower spine into a backward-bent position (arched) is one of the most effective ways to undo the force of continual forward bending and slumping that we all perform excessively every day.

3. Back Extension treats Low Back Injury which occurred in a flexed (forward bent) position. If you have Low Back Pain which began with a specific injury or traumatic event, think about the position of your back at that time. Were you lifting something? Bending forward to pick up an object? If forward movement caused your injury, back extension may be the direction of exercise to treat it. Even if you were injured in another way, this still is the direction of force that the majority of patients with low back pain need in order to minimize symptoms.


Caution: This exercise is not safe or appropriate for all individuals, so consult your physician first, especially if you have low back problems, painful medical conditions, balance problems, or anything else that may inhibit your safety. If performed in a gentle way, it is likely safe for most individuals without low back pain. No one should perform this forcefully or into an excessively far backwards position.

If you have low back issues and have not seen a Physical Therapist, ask your doctor for a referral/prescription, and find a spine PT near you!


Reference: McKenzie, Robin. Mechanical Diagnosis & Therapy: Lumbar Spine. 2009: The McKenzie Institute International, Part A.

Further reading: McKenzie, Robin. Treat Your Own Back, 9th ed. 2011: OPTP.

Does My Child Need Physical, Speech, and/or Occupational Therapy?

Pain prevention is just as important for your children as it is for you! So the more you know about what to expect, the more likely you can prevent painful or difficult medical/developmental issues during your child's early years of life. Your child may benefit from Physical, Speech, and/or Occupational Therapy in order to maximize his/her strength, motor skills, communication, eating, swallowing and overall functioning in daily life.

Here are a few brief checklists (from hceip.org) for parents of young children, to know if your child is developing at age-appropriate levels. Obviously, there is a range of norms for developmental milestones, which your pediatrician is monitoring regularly (at well visits). However, the pediatrician does not see your child on a daily basis, so you are the best person to assess his/her development! As the parent, take the initiative to know what your child should be doing at various ages, especially during the first few years of life. If you feel your child needs any therapy, request a referral or prescription from your pediatrician.

One major benefit of early intervention (of PT, OT, or Speech) is that it may be covered by various medical programs, to decrease your out-of-pocket cost. Also, it will help to decrease your child's need for therapies in the future. Do not be afraid or ashamed to put your child into one of these types of therapy because it truly will help! It does a disservice to your son/daughter if you choose not to use PT, OT or ST once you know it is needed. Having a child be able to do age-appropriate activities will improve the quality of life for your whole family. Plus, it is fun for children! Pediatric PT's, ST's and OT's love to play games in order to make learning as fun and engaging as possible!


Article 1: When Should a Parent Refer a Child to Physical Therapy?

http://www.hceip.org/physical/when-to-consider-physical-therapy/

Article 2: When Should a Parent Refer a Child to Speech Therapy?

http://www.hceip.org/speech/when-to-consider-speech-therapy/

Article 3: When Should a Parent Refer a Child to Occupational Therapy?

http://www.hceip.org/occupational/when-to-consider-occupational-therapy/

Diastasis Recti: Treatment and Exercises

Photo: miraclephysicaltherapy.com

Diastasis Recti is a condition that many pregnant women experience, including me, being pregnant three times in the past four years. So here are some exercises to treat Diastasis Recti. You may begin these exercises after pregnancy, once your OB advises. They go in order from easiest to hardest. Only perform #1 and #2 if your separation is >2 cm. Once it decreases below 2 cm, you can progress to #3 and beyond, progressively. Technique is everything, so follow all instructions carefully.

1. Mini Abdominal Crunches: Lie on your back with your knees bent. Cross your hands over your abdomen so your hands can push your rectus abdominus inwards toward the belly button. Exhale and slowly lift only your head, but not so far to see a bulge (diastasis recti). As you perform the head lift, gently push the hands inwards. Then slowly release the head down and rest. Repeat 5-10 times. Then progress to 15-20 repetitions over the next few days. Finally, progress to 25-40 repetitions. Do this for several days, and check the amount of separation of your Diastasis Recti. If the separation is improving, the exercise is getting easier, and you can perform 30-40 repetitions at once, you may be ready to progress to #2. The photo shows a towel being used to pull inward, which is an alternative to using your hands to pull.

Photo: getactive.com

2. Mini Crunch/Pelvic Tilt: Lie on your back with your knees bent. Cross your hands over the abdomen as in #1. The mini abdominal crunch with arms pulling inward is the same as in #1. But this time add a pelvic tilt concurrently. To do so, tilt your pelvis backward so your abdomen is drawn in and your back is flattened out (likely you recognize this from early pregnancy exercises). Exhale as you do the pelvic tilt. Then lower your head slowly, and finally release the pelvic tilt. Repeat 5-10 times. Progress to 20, then 30+ repetitions. Only progress to #3 if your separation is <2 cm and has been improving as you have done #1 and #2.

Photo: http://www2.nau.edu

3. Pelvic Tilt/Heel Slide: Lie on your back with knees bent. Perform a pelvic tilt (flatten out your back) and maintain it. Slowly slide one foot forward (making the knee straighter) as far as you can while keeping the pelvis tilted backward, then slowly return the leg to the starting position (still keeping the pelvic tilt), and repeat with the alternate leg. Every time you extend one of your legs, exhale. Repeat 3-5 reps on each leg. Progress to 5-10 reps on each side. Increasingly do 5-10 additional reps until you can do a total of 30-40 reps on each leg with full range of motion (knee becoming fully straight) and, of course, a proper pelvic tilt throughout.

Photo: befitmom.com

4. Pelvic Tilt/Double Heel Slide. This is the same as #3 but performed with both legs sliding forward together. It is significantly harder than #3, so only progress to this exercise if it can be done with a maintained pelvic tilt throughout. Hold the pelvic tilt and slide both feet forwards, but not so far as to lose the tilt. As you get stronger, your range of heel slide will progressively increase. Practice slowly and exhale as you extend the legs. Then slowly return both legs to the starting position. Repeat 5-10 reps. Progress to 10-20 reps, then 20-30 reps.


Reference: Kisner C, Colby LA. Therapeutic Exercise; Foundations and Techniques, 4th ed. Philadelphia: F.A. Davis Company. 2002. Page 695.

Back Health Survey Discussion: Risk Factors for Low Back Pain

The discussion points here respond to the questions from yesterday's post, entitled "Back Health Survey."

1. How frequently do you perform moderate-high intensity exercise? In general, back health is improved as you do regular exercise, especially cardio exercise and strength training. However, it is important not to injure your back during exercise with excessive, early high intensities or uncontrolled bending/twisting.
   
2. How many hours/day do you sit on most days of the week? Likely, you have minimal control over how much you sit at work, but the rest of your day is yours to stand and walk more! Too much sitting puts your spine in a rounded or flexed position for long periods of time (unless you practice perfect sitting posture with additional lumbar support). Also, sitting does not promote cell growth and circulation as well as standing/walking, so it can lead to spine issues later in life.

3. How often do you perform back strengthening exercise or core strengthening? I recommend you do this at least 2-3x weekly, even if only for 5 or 10 minutes each time. Good back strengthening includes back extensions (backwards bending or arching of the back). Abdominal strengthening is also good (crunches are better for your back than full sit-ups). Core strength exercises of all varieties are great for your spine health, as they strengthen the deep abdominal and spine muscles, which will give natural spine support when you do strenuous daily tasks.
   
4. What is your usual sitting posture? First, check the chair you sit in to ensure it is ergonomic. Then add a lumbar roll (rolled up towel or round pillow) behind your low back. Sit at the back of the chair, then add your additional lumbar support.
   
5. What is your present weight status? Extra weight puts more strain on all your joints, including your spine.

6. How many episodes of major low back pain have you had in your lifetime (enough to limit your usual functional activities)? Low back pain comes in repeating episodes, so if you have had several, you likely will have more in the future. But it is not too late to get treatment, of which Physical Therapy can help significantly! Not only will you learn exercises but also things to avoid and how to self-manage your symptoms.

7. How far down did your low back pain symptoms radiate? Symptoms that radiate further down the leg are worse than those in the back only. That is because nerve(s) are being pinched in the spine, causing the symptoms to shoot downward. The key to treatment is to find what eliminates the leg symptoms and moves them more centrally, to the spine (AKA centralization).
   
8. How did your low back pain resolve? Your risk of future back pain is increased if your prior back pain has never resolved or has become chronic. In this case, you and your medical team have not yet found the ideal treatment plan, so all options should be considered, perhaps multiple times.

9. How often do you practice proper body mechanics during daily activities (such as squatting instead of bending, avoiding twisting, and good lifting techniques)? This may be the single most important factor to decrease your risk of future low back injury! Simply begin to implement body mechanics changes in your daily life. Soon they will become habitual.

10. How much heavy lifting do you regularly perform? Heavy lifting can increase your risk for back pain unless it is always performed correctly (spine straight and using the legs only to do the work of lifting).

11. How often do you participate in high risk sports/activities (such as skiing, skydiving, skateboarding, 4-wheeling, etc)? Trauma obviously can cause major back injuries or worse (becoming paralyzed or even death), so proceed only with extreme caution, and practice utmost safety measures.
   
12. How often do you perform standing forward bending exercises (such as touching the toes)? This is one of the single worst exercises you could perform. Your spine does not need to be stretched into a forward bent (flexed) position. What is your reason for doing this exercise? If it is for hamstrings stretching, use an alternate technique. If you do this out of habit or from something you learned in your past, change it because this can majorly damage your spine.

Back Health Survey: Am I At Risk For Low Back Pain?

1. How frequently do you perform moderate-high intensity exercise?
     a. 5-7x/week
     b. 2-4x/week
     c. 1x/1-2 weeks
     d. rarely

2. How many hours/day do you sit on most days of the week?
    a. <4 hours/day
    b. 4-6 hours/day
    c. 7-10 hours/day
    d. >10 hours/day

3. How often do you perform back strengthening exercise or core strengthening?
    a. >3x/week
    b. 1-2x/week
    c. occasionally
    d. what do you mean by back or core strengthening exercise?

4. What is your usual sitting posture?
    a. upright, with extra lumbar support (lumbar roll, rolled towel, etc)
    b. upright, without lumbar support (decent chair but no additional lumbar roll or cushion)
    c. mildly slumped
    d. severely slumped or rounded

5. What is your present weight status?
    a. ideal body weight
    b. mildly overweight
    c. moderately overweight
    d. severely overweight

6. How many episodes of major low back pain have you had in your lifetime (enough to limit your usual functional activities)?
    a. no major episodes
    b. 1 major episode or injury
    c. 2-3 episodes
    d. >3 episodes

7. How far down did your low back pain symptoms radiate?
    a. no major low back pain in my past
    b. low back only
    c. low back and buttock(s)
    d. down to thigh (not below knee)
    e. down below the knee

8. How did your low back pain resolve?
    a. no major low back pain in my past
    b. completely resolved
    c. partially resolved
    d. never resolved

9. How often do you practice proper body mechanics during daily activities (such as squatting instead of bending, avoiding twisting, and good lifting techniques)?
    a. All the time; with both difficult and easy tasks
    b. Most of the time, especially difficult tasks
    c. Sometimes
    d. Rarely

10. How much heavy lifting do you regularly perform?
     a. occasionally-rarely. Always with good technique
     b. frequently. Always with good technique
     c. occasionally-rarely. Without considering technique
     d. frequently. Without considering technique

11. How often do you participate in high risk sports/activities (such as skiing, skydiving, skateboarding, 4-wheeling, etc)?
      a. rarely and not likely to in the future
      b. once every few years
      c. multiple times per year
      d. very frequently

12. How often do you perform standing forward bending exercises (such as touching the toes)?
      a. never. not since elementary school calisthenics
      b. occasionally, when I need to stretch my back
      c. frequently, during my usual workouts
      d. daily or multiple times daily


Score: Count your score by assigning points to each letter answer.
Legend
a: 0 points
b: 1 point
c: 2 points
d: 3 points
e: 4 points


Results:
>30 points: Get to know your Physical Therapist and spine surgeon. You will be seeing us a lot.
20-30 points: Moderate risk unless you make major changes immediately.
13-20 points: Mild-moderate risk. Consider ways to improve!
6-12 points: Mild risk. But beware and don't become complacent in these areas.
0-6 points: You have a healthy back and are at low risk as long as you continue good habits!

Tune in next time for more discussion about these questions/answers!

Post your answer in the comments section. There will be three prizes awarded!
 

Do High Heels Affect Knee Pain?

Photo: State Library of New South Wales

Yesterday I took advantage of the perfect, Spring weather to play in the backyard with my daughter, and we ended up pulling weeds. So much for playtime, but for a 2-year-old it counted as fun. I was careful, of course, about my body mechanics for back safety. But in the process, my knee started hurting (I do not have any knee problems). As a PT, my first thought was: "what exercise can decrease my pain?" I sat on the floor with my leg extended in front of me, and I gently pushed down on my knee (into a straight position; AKA knee extension) and repeated ten times. Unfortunately, it did not help.

Afterward, I decided to wear 3-inch wedge heel flip flops because they felt better on my knee than my flat ones. Without time to explore further exercises, I continued my busy day, of which the next activity was to take my kids to Monkey Joe's for a birthday fiesta. Monkey Joe's is the ideal playhouse for kids over age 3-4, but most of the bounce houses and slides are too big for my daughter, so I had to accompany her on all of them. By the way, if you ever do so, be sure to wear socks (I regret being barefoot on the slides)!

Amazingly, at the end of the day, my knee no longer hurt! There are two possible explanations: my heels or my activity level at Monkey Joe's. Please understand that I would not usually recommend someone to do that much climbing when experiencing knee pain because it usually aggravates the knees. But one of those factors or the combined effect was surprising for my condition. Remember that my heels were not excessively high nor thin but a wedge. Also, my knee pain was mild and new. Chronic or recurrent knee pain likely would not respond the same way.

What is your experience with wearing heels and knee pain? Please share in the comments section for everyone's benefit!

Low Back Muscle Strain

Causes of Low Back Strain: 

One very common form of low back pain is due to a low back muscle strain. This usually occurs because of improper lifting, sports activities, twisting of the back, car accidents, or improper strengthening. General workout activities can contribute, such as a challenging exercise class, machine weights or free weights.  In these cases, one or several muscles of the low back are strained through over-stretching, over-contracting, moving too quickly, twisting or pulling. The muscles have a strain placed on them when they are in an awkward position or there is a traumatic force on them if they are in a neutral position.

Postures and Low Back Pain:

Another cause for low back muscle strain is having an unhealthy spine through habitual poor posture. If you sit all day in a slumped position, your lumbar spine (low back) is loaded into a forward or flexed position, and the muscles of your back are continually stretched (elongated). As a result, you may be more likely to strain a back muscle from light tasks such as loading/unloading the dishwasher. On the other hand, those with a healthy spine (through repetitively good posture and exercise) may tolerate light tasks but strain their backs when doing more strenuous work (ex: heavy yardwork). It is important that both individuals practice good posture and body mechanics in order to avoid straining the low back during routine daily tasks, and especially during difficult physical activities.

Treatment of Low Back Strain

Low Back Muscle Strain should first be treated with ice for at least 2-3 days. If you see a doctor, you will likely be prescribed a muscle relaxer, anti-inflammatory, and/or pain reliever. Other treatments are rest, ice/heat, massage, and Physical Therapy. Depending on the severity of the muscle strain, you may have pain for a few days to several months. This type of LBP can be prevented by maintaining proper posture/body mechanics, proper lifting, regular exercise, caution with sports activities, and maintaining a strong core.

15-Minute Home Workout For Busy Parents

As much as you may love (or hate) to exercise, it is often difficult getting to the gym when you have children. Between school, ball games, meals, work and housecleaning, you may not have the extra 30-60 minutes to do a usual cardio and strength exercise routine. So here are a few exercises you can do at home with no equipment and only 10-20 minutes of time.

1. Push-ups. This is a great one to start with, as it pumps up your heart rate! Repeat until fatigue. This is also ideal between leg strengthening exercises.

photo: gethealthywithheather.wordpress.com

2. Triceps Presses. The further you straighten your legs, the more challenging! Extend your elbows to lift your body weight, then lower back down to position shown in picture. Repeat until fatigue.

photo: self.com

3. Jumping Jacks. This is also a good warm-up or can be done between strength exercises. Perform for 1-2 minutes.

photo: sixpackfactory.com

4. Plank Jumping Jacks. Be sure to keep your back straight and your arms/shoulders stable. Hands can be on the floor, as in the starting push-up position. Repeat quickly until fatigue (30-60 seconds at a time).

photo: italktofood.com

5. Plank Mountain Climbers. Alternate legs quickly, while maintaining a strong plank position, for 30-60 seconds at a time.

photo: amy-allender.blogspot.com

6. Forward Kicks with Alternate Forward Punches. Do you remember Tae Bo? This is a classic kickboxing exercise that incorporates arm and leg strengthening. Repeat 10-15 reps with right leg/left arm. Then do the same with left leg/right arm.

photo: exercise.about.com

photo: shape.com

     


7. Calf Raises (on one leg) with Lateral Leg Raises (other leg). Do the two at the same time. You may need arm support for balance. Repeat 10-20 reps, then do the same on the other sides.

photo: drwannabe.tumblr.com

photo: iposture.com

     

Laptop Ergonomics Video

This video gives you some ideas for how to improve your posture and positioning when working on the computer. It is very brief (2 minutes).

Back Pain Prevention: Avoid Twisting

Never twist your body when holding something. It is common for me to ask a patient with low back pain how he hurt his back and he responds that he was holding a heavy box and twisted his back. This is one common way to cause a disc in the low back (lumbar spine) to bulge or herniate, which is a very common diagnosis in PT clinics. The complication associated with disc problems is that if a lumbar disc bulges out of its normal position, it can compress the nerves in the spine, causing pain and other symptoms into the leg or legs. It is much easier to prevent a disc herniation than to treat one after it occurs!

            One common way for this to happen is while doing the laundry. Many people twist their bodies when putting clothes from the washer into the dryer. This is worsened because they are holding wet clothes while twisting their backs, causing more injury than if nothing were held. Instead, step over to the dryer, then squat to throw the clothes in. It takes a conscious effort every time, but just remember "step, squat, and toss." It only takes one wrong twist to cause low back pain which could last for months or years, so avoid twisting—every time!
         Here is a video showing what not to do. I posted it a year ago, but it's funny and worth another viewing.

Ergonomics Rap with Sustainable John - Lawrence Berkeley Lab

Click on the title to view this video about workplace ergonomics! Good reminders for those of you who sit at a desk all day.

Back Pain Prevention: Proper Lifting Techniques

Photo: New York Public Library

Never lift an object if you are in a forward bent position. The picture here shows a proper squat in order to reach down to the floor. Your spine is a perfectly stable system of bones (vertebrae) with discs in between each one. This system is designed to support your body weight and has the capacity to support much more weight (for example, carrying furniture) if the spine is maintained in its neutral position. (Note, it is not designed to support excessive body weight). The neutral position of the spine is when each vertebra is stacked on the one above it, which happens when you are demonstrating proper posture. You lose the stability and strength of the spine when you are twisted or bent, which removes the vertebrae from their properly stacked resting position. When this occurs, the muscles of your back have to be used in a way they were not made for. Why not use the stability of your spine when you lift instead of straining weak back muscles? 

Back muscles can be strengthened, but strong back muscles alone cannot prevent back injuries when your spine is in a compromised position, such as bent forward. Instead, it is best to lift when your back is straight and you use your legs to do the work. This involves squatting down but maintaining a straight back position. Our leg muscles are very strong and large and are made to do the work of lifting heavy objects, if we use our legs instead of our backs. If you are familiar with weight lifting, squatting is the exercise in which one can lift the most weight, compared to dead lifts, bench press, etc. This is because the thighs and buttocks have huge, powerful muscles, which are much less prone to injury. I rarely see patients for quadriceps (anterior thigh muscle) or gluteus maximus (buttocks muscle) strains whereas low back strains are very common in outpatient PT clinics.

The Latin American Diet

Photo: State Library and Archives of Florida

I have some firsthand experience with Latin America, but if you are Latin American and have different traditions, please share in the comments section. I do not mean to over-generalize, as I know that no one wants to be stereotyped. Here are some healthy eating habits that I have seen.

1. Lots of fresh fruit and fresh-squeezed fruit juices. You may be surprised at the fresh juices because they include much more than OJ, and they are prepared and served fresh! Some varieties I have loved are cantaloupe, watermelon, blackberry, pineapple, and mango. The juice ingredients are fruit (often including the skin) and maybe a little extra water/ice or occasionally a touch of sugar. Freshly cut fruit of any sort is frequently served with dessert.

2. Rarely serve cooked vegetables but salads instead. Once I brought a green bean casserole and a broccoli casserole to a potluck at church (a Hispanic church), and they were not touched. So my poor husband who does not like broccoli had to eat broccoli casserole the entire next week. And the salads are frequently served without salad dressing! All that is needed for flavor is freshly squeezed lime and a touch of salt/pepper.

3. A variety of beans, served as a side, in a soup or cooked into other foods. Legumes are a perfect source of protein, calcium, fiber and iron. See link below for more health benefits of beans.

4. Uncommon to find creamy/milk-based sauces. Instead, meats are grilled or cooked with fresh vegetables.

5. Freshly prepared hot sauces. All it takes is roasting the peppers, then blending them.

6. Soups made with clear broth rather than cream-based and served with fresh lime. Try adding lime to your next chicken noodle soup and you will never turn back. You may not know that most Mexican restaurants (at least here in the South) serve an amazing chicken soup (usually includes pico de gallo, avocado, rice, chicken breast and lime).

7. Avocado! Frequently it is simply sliced and served with the side dishes. Of course, guacamole with fresh cilantro is the perfect addition to any Tex-Mex dish.


Additional Info:

After-40 Nutrition: The Surprising Health Benefits of Beans, from DoctorOz.com:
http://www.doctoroz.com/videos/after-40-nutrition-surprising-health-benefits-beans