Moving When It Hurts

Over the past 13 years and 25,000 Physical Therapy sessions, I have treated many patients who are afraid to move through pain. Let's consider the patient with chronic pain who has had pain for more than five years related to a work injury or a car accident. There is no question that they are experiencing pain, and in some cases they have severe pain. But some individuals get into the habit of fearing pain and therefore fearing any movement that causes pain. These people sometimes stop moving altogether. 

Have you met people who are sedentary all day? They can't work because they are disabled or retired or any other reason, and they literally can't, won't or don't do anything. They sit down or lie down all day. They only leave the house for doctor visits. They don't go out for leisure or social time or hobbies or anything at all. 

I encouraged a patient today to just start walking, even if it is for a few minutes at a time. Of course, she voiced concern that it makes her back hurt. So I explained that a walking program is not going to make her back worse overall. She will not gain more damage to her spine by walking, but she will cause more damage by the overall lack of movement of her spine. 

To clarify, this is not referring to patients with a brand new back injury or current flare-up. Most of you know someone who has "thrown his/her back out." In that situation, there may be a few days or weeks in which he/she can barely walk and cannot stand up straight. I would not tell that patient to start a walking program today. 

However, if someone you know has chronic pain but has stopped moving for many months or years, he/she likely needs physical activity. If you are not sure where to start or what movements are safe, come see your local Physical Therapist!

Postures and Low Back Muscle Strain

Photo by Larkery

One cause of low back muscle strain is having an unhealthy spine through habitual poor posture. If you sit all day in a slumped position, your low back is loaded into a forward or flexed position, and the muscles of your back are continually stretched. As a result, you may be more likely to strain a back muscle from light tasks such as loading/unloading the dishwasher. 

Not only does slouching affect your back muscles, but it causes your disks to bulge backwards. The more pressure from bad posture, the more likely your disks cannot realign properly. This leads to pinched nerves, which shoot pain or other symptoms down your leg(s), such as sciatica. 

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 such as moving furniture. 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.

Why You Should Get Physical Therapy For Your Back Pain

I recently treated a patient with leg pain that radiates from his back. It goes into his thighs and even down below his knees. This pain began 3-4 months ago, and he is unsure how it started. Before his session, I knew his walking had been problematic because when he stood up in the lobby, he significantly stooped over and could barely get his balance. He was using furniture and walls to hold onto. So my initial goal was to find an exercise that would immediately improve his ability to stand up and walk. 

I treated him for 10 minutes with one or two exercises lying on the mat. Then he stood up tall and walked easily back to his chair. He could not believe he was walking that well because since his symptoms began, he has the most pain and difficulty with initially getting out of a chair to walk.

So if you have back pain, you could possibly be only a few minutes away from pain relief. Schedule your Physical Therapy today!

Changing Crib Sheets Without Pain

There are a few baby-related tasks that can be near-impossible without straining your back, so here is what I do for changing crib sheets.

Photo: National Media Museum

1. Buy at least 3-4 crib sheets and 3-4 waterproof pads. I promise that the price of these is far less than a back injury.

2. Take the mattress out of the crib to change the sheets.

3. Layer your waterproof pads and crib sheets over each other so that when the top layer gets wet, you simply remove it and your clean, dry one is already there.

4. As soon as possible, remove the bumper pads. For safety reasons, they are not even recommended anymore. Changing the crib sheet is much easier when there are no bumper pads in the way.

5. Consider using a sheet saver. It is a sheet that actually attaches to the bars of the crib, so it is fairly easy to snap on or off (each sheet has at least 12-15 snaps). There are some safety concerns with this because it does not fit as tightly as a fitted sheet. To get it on or off, it still takes several minutes, and you have to be able to reach all four sides of the crib.

6. For crib sheet selection, buy the T-shirt material ones that stretch a little.

7. Change the sheets for a toddler bed the same way--by taking the mattress out first.

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.

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.

What Your Toothbrush Tells You About Back Pain

Where do you store your toothbrush? Most of us store it right on the bathroom sink. Why do you store it there? Why don't you store it up on the top shelf or down in the bottom drawer? Your answer gives a simple example of BODY MECHANICS! You store your toothbrush within close reach to make life easier and more convenient. Why bend if you don't have to?

BODY MECHANICS is using your body to its advantage so that you don't have to work harder than necessary for whatever task you are doing. Here is another example. Ladies: why don't you carry your heavy purse by holding it with 1 or 2 fingers? You have naturally learned that the easiest way to carry a large handbag is strapped over your shoulder. 

We all practice good body mechanics with things like where we place our cups/plates/silverware in the kitchen, where we put our socks in our drawers and where we position our debit cards in our wallets. We want easy access to the objects that we use the most every day. So good body mechanics comes naturally...until we deal with our backs. We use our backs for things that our legs and arms should do, such as lifting and bending. Our leg muscles are massive and powerful and can do much heavier lifting than our back muscles. And our shoulder and arm muscles are very strong and able to lift, carry or hold significant amounts of weight.

So to prevent back pain, keep your back straight and use your legs more. Try squatting down using only your legs (maintaining a straight spine position) the next time you need to reach down toward the floor. Here is one easy way to demonstrate bad body mechanics: hold one arm straight out in front of you (with elbow straight) and place a dictionary or phone book in your hand. Time yourself to see how long you can keep it there.

Right Way To Unload Dryer, Short Video

Wrong Way To Unload Dryer, Short Video

What is a good stretch for my low back?

A lot of my low back patients tell me that they have tried to stretch their backs out by bending forward to touch their toes. Unfortunately, this is not a good stretch for most of them. So how should you stretch out your back if it feels tight or stiff?

Here is a simple exercise that you can do this weekend at home, either on your bed, on the couch or on the floor. Lie on your tummy (face-down), and prop up onto your forearms. Hold this position for a few minutes as you watch AFV, play Angry Birds or read the paper. This is a position that children stay in sometimes when they watch TV or play video games, but it actually is a very healthy position for adults as well! Think about the position that your low back is in throughout most of your day. How often, if ever, do you stretch your spine in the backwards direction? The forward position (flexion) of your spine occurs whenever you sit or bend forward, so it is likely the majority of your day. Therefore it does not need to be stretched in that direction.

So try your new backwards (extension) stretch for at least 3-5 minutes, at least 1-2x/day, and you likely will get better results than other back stretches.



Ref: McKenzie, Robin. Treat Your Own Back, 9th edition. Orthopedic Physical Therapy Product: 2011.

How to avoid BACK PAIN with reaching/bending

My patients with back pain typically fall into two categories: trauma vs non-trauma. Traumatic injuries can come from a major accident or an easy task done incorrectly (bending down to pick up shoes from the floor and then patient is unable to stand back up). Non-traumatic back pain frequently comes from repetitive poor postures and bad bending/reaching habits.

Based on my posts "How many times per day do you reach to the floor," the number is likely more than 30 times and may be even higher than 50 for those of you with small children. So how can you modify these RTF's (reach-to-floors) so as to decrease your risk for back pain, back spasm, back strain or worse?

First, check your back position each time you reach down to the ground or a low surface. You can squat (with your back straight) or use the golfer's grab (kick 1 leg back behind you). You can sit on a stool or chair. You can kneel. You can get on your hands and knees. You can sit on the floor. Be creative; there are many ways to reach down without straining your back. It simply takes the effort to think twice before you bend.

Next, modify where you place the objects that you use the most to be at an easy-to-reach height. For example, store your dish soap in a decorative container on the counter instead of under the sink. What objects do you have in your lower cabinets, cupboards, drawers and shelves? They should be the ones you use rarely. Anything you use multiple times/day should be easily accessible with minimal reaching required. This is especially true for those of you with back problems (which limit your ability to bend) and knee problems (which limit your ability to squat).

Finally, always give yourself the mechanical advantage. Use your big muscles to do the work they were made for (thigh, buttocks muscles). They are easily able to do the work of lifting so your back does not have to.

How does a P.T. think?

Today I was making some videos for you all about body mechanics. I will be editing and posting them soon, so stay tuned! But it brought to mind how good body mechanics is second nature for me. For my patients (or family members), it takes much more effort and thought. So let me explain how a P.T. thinks:

1. Every time I need to reach down to the floor or to a lower height, I always squat or do the golfer's grab.
2. Every time I run, I think about avoiding foot and knee pain.
3. Every time I pick up my kids, I squat.
4. Every time I lift up something, I make sure I am in a safe lifting position.
5. With every chore, I consider my technique and body mechanics.
6. Every time I sit, I check my posture.
7. Whenever I go to the gym, I think about everyone's technique, especially if it puts him/her at risk for PAIN.
8. I watch how people walk and analyze what orthopedic problems they may have.

The list could go on, but you get the idea. So until it becomes second nature to you, here are two suggestions. First, listen to your body. You will feel your back straining when you bend the wrong way. If there is a task that always causes you pain, modify it! Secondly, do what a P.T. would do! If someone were videotaping the way you do that task, would it be a good or bad ergonomics example?

Major Preventable Injuries

You hear about injuries and accidents every day. But are they truly accidents? Which ones could be prevented?

1. Burns
2. Falls
3. Diving accidents (esp. diving into shallow water)
4. Alcohol-related accidents
5. Unsafe driving
6. Rotator cuff tears
7. Back strains

Safety and injury prevention is your individual responsibility. If you truly want to live with minimal physical pain, you must practice safety at all times. This is true whether you are at home, at work, in the car or at the mall. Do not expect your employer to make your work environment or work station safe. Your manager will not be the one experiencing your pain if you get hurt at work. Do whatever it takes to keep yourself safe from these types of injuries. I do not want you to end up being my next P.T. patient, and trust me--you do not want that either.

Low Back Pain Prevention 101

Low back pain prevention is actually quite simple and comes down to 2 main rules.

1. Don't bend your back.
2. Don't twist your back.

If you can keep these 2 rules during your daily functioning, you will not injure your low back. Low back injuries typically occur in one of these two positions. For example, bending forward to unload the dishwasher or twisting to put laundry from the washer into the dryer. The more weight you are holding when you do one of these things, the higher risk for low back injury. Obviously in your daily life you need the mobility to be able to do some bending and twisting, but if bending or twisting must be done, do it the right way. If not, you may be getting P.T. soon.

So how do you bend without hurting your back? First, you have heard the old saying: "bend with your legs, not with your back." Squat instead of bending forward. Use your legs to their advantage. They were made to do the work of lifting. Your back was not made for that. Stick out your bottom in order to keep your back straighter when squatting (such as when you brush your teeth). Keep your vertebrae in the same position as when you are sitting upright or standing tall.  That is the only stable back position.

How do you twist without hurting your back? Avoid twisting by turning your whole body instead of twisting your back. Take more steps with your legs so that your back stays straight. If you must twist, do so very slowly and without holding much weight. Take your time when doing housework or yardwork tasks in order to do them without twisting. Shift weight from one leg to the other while doing things like sweeping or raking. Be cautious with vaccuuming, laundry and outdoor power tools; check your back position as you do these tasks.

Lastly, especially avoid forward bending and twisting together!!! That is a recipe for a low back disaster.

Have you hurt yourself doing housework or yardwork the wrong way? Please share your story.