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!

Does The Weather Really Increase Joint Pain?

Photo: Dale McDonald, State Archives of Florida

Almost all my older patients report they feel more pain when the weather is cold and/or rainy. But is it really true? Here is an example of someone who told me: "I woke up with a lot of leg and back pain, and I think it is just because of the weather." So my goal was to show that her pain could be improved, regardless of the present weather conditions.

On a scale of 0-10, pain was 7/10 at the start of our session. Her first exercise was the same one she had been doing for homework: lie face down on the mat and press up onto her hands. Doing this for a few sets decreased her pain from 7/10 to 5/10 and made her leg feel better. With a few more exercises in the same direction of movement (backwards or back extension), her pain further decreased to 1/10 and was located in the center of her low back and not her leg. Objectively, her baseline movements improved and became less stiff and less painful.

So, how much of her pain was weather-related? Some of it may have been caused or aggravated by the climate change, but most of it was movement-related. So within one hour of treatment with the proper movements, her pain decreased from 7/10 to 1/10, and the weather was still cold and wet when she left.

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!

What Are The Treatment Options For Low Back Pain?

1. Oral pain medicine, which may include non-steroidal anti-inflammatories (NSAIDS like Ibuprofen), steroids, narcotics, muscle relaxers, etc.

2. Physical Therapy, which may include exercise, joint mobilizations/manipulations, modalities (such as electric stimulation, lumbar traction), postural corrections, body mechanics, education about cause of pain and forms of self-treatment/prevention, hands-on techniques, taping, functional activity training, aquatic/water therapy.

3. Injections to the lumbar spine (such as Cortisone).

4. Surgery (more common with major spine trauma or with chronic low back pain that has failed to improve with conservative treatments).

5. Chiropractic care, including manipulations and decompression (a form of lumbar traction).

6. Alternative therapies, including massage, accupuncture, etc.

7. Advertised home treatments, such as an Inversion Table, Back2Life, etc.

8. TENS (transcutaneous electrical nerve stimulation) unit, which is a device that you connect to electrodes placed on the skin of the low back. This is similar to the electric stimulation at Physical Therapy and Chiropractor offices.

9. Over-the-counter creams, medications, heat/ice, patches, supplements.

10. Bracing (more common after certain low back surgeries).


My biggest advice for you is 3-fold:
Prevent low back pain; it can be prevented!
If you have occasional low back pain, read the book "Treat Your Own Back," by Robin McKenzie.
Try Physical Therapy before other treatment options.

The difference between Chiropractors and Physical Therapists

Let's imagine you have back pain, and you need some help. Who do you call? The good news is that you have options: primary care doctor, spine specialist, physical therapist, chiropractor or even alternative medicine (such as accupuncture).

So what is the difference between the treatment you get from a chiropractor and a physical therapist?

Chiropractors specialize in manipulating (popping) various joints and segments of the spine and pelvis. They usually take x-rays to determine the areas that are not properly aligned. Then they develop a treatment plan, which includes manipulations to many different joints of your back. Depending on the chiropractor, you may also get electric stimulation, heat, ice, and decompression (a form of traction). More rarely, you may get some exercises. Most health insurances cover chiropractic care, but you will likely have co-pays. And anything your insurance does not cover (certain procedures), you pay out of pocket. Many chiropractors recommend that you continue treatment for weeks-months and then come back periodically for spine adjustments.

Physical Therapists specialize in decreasing pain and restoring normal physical function through exercise, education, hands-on techniques (which may include tissue or joint mobilization and joint manipulations), posture/body mechanics training, functional activities, modalities (such as electric stimulation, heat, ice, decompression/traction, ultrasound), gait training (improving walking patterns), balance training, stretching and/or strengthening. All health insurance covers Physical Therapy, but you will likely have co-pays. To see a PT, you simply need a doctor's prescription (if you want your health insurance to pay for it). PT's aim to find out the cause of your pain/symptoms, to treat them and to teach you how to prevent them again in the future. The goal is to make you independent in managing your own symptoms so that you no longer need PT. Depending on your injury/surgery, you may need PT for 1-2 visits or up to several months.



References:
American Physical Therapy Association (www.apta.org)
American Chiropractic Association (www.acatoday.org)

The danger of your first episode of Low Back Pain

Did you know that one of the biggest risk factors for low back pain is prior low back pain? It sounds obvious, but this has huge implications for you. It means that preventing a first episode of low back pain decreases your chance of having future episodes. Therefore, you are less likely to have chronic low back problems in your future.

Each of you is in one of these categories:
Group 1. No prior low back pain
Group 2. Prior low back pain

Here is my advice for both groups.

Group 1. Prevent an initial back injury and a first episode of low back pain through good posture, body mechanics/ergonomics, lifting correctly, avoiding bending/twisting and regular exercise. This is urgent for you because if you hurt your back once, you will very likely hurt it again. So prevent it now, before it is too late.

Group 2. See a Physical Therapist if you have frequent episodes of low back pain. Prevent future episodes through good posture, body mechanics/ergonomics, lifting correctly, avoiding bending/twisting and regular exercise. It is harder for you to prevent future back pain than group 1 because you have already injured your spine in the past. But Physical Therapy treatment can be very effective to teach you how to manage and prevent symptoms.



Ref: McKenzie Institute International. Part A. Mechanical Diagnosis and Therapy of the Lumbar Spine.

The time I needed PT

I knew I wanted to be a PT since high school. But in college I actually needed Physical Therapy for knee pain. Every time I ran, the back of my knees would hurt during the run and afterward. I actually had to stop running because the knee pain made it hard for me to climb stairs. I lived on campus at King College (a small school in Bristol, TN), where I had to walk and climb stairs a lot.

So I saw a PT here in Columbia on one of my breaks from school. He showed me several exercises, and as I did them for the next weeks-months, my pain progressively decreased. However, I was afraid of the pain returning, so I stopped running completely. At the gym I did the elliptical machine instead, which did not bother my knees.

I went through the rest of college and grad school without returning to running. I did other forms of cardio but stayed off the treadmill. Several years later, I finally decided to try jogging again. Everything I learned in PT school kept me from having knee pain. I learned how to warm up, do the right stretches and avoid hurting my knees again. So now I can jog regularly without pain! I actually do the treadmill now much more than the elliptical.

All this is to say that PT works! If you have an injury or frequently painful area, find a good PT near you! But ideally, you can learn how to think like a PT now to prevent future pain.

ABC's of PAIN PREVENTION

This was my 2-year-old's idea, when I asked him what to blog about today.

Always Be Cautious (especially when lifting).
Do Everything with a safety Focus.
Get out of the House and Into shape!
Jump into preventive medicine/wellness!
Keep your body moving.
Look for More Nutrition.
Over-exaggerate Proper body mechanics (even when your spouse teases you).
Quit making excuses.
Eat Right most of the time.
Splurge on occasion without feeling guilty.
Think like a PT!!!
U can have a more Vibrant body: With more eXercise!
Yoga, pilates and Zumba are great tools to improve your health!