Archive for the ‘Back Care’ Category

I recently received a lengthy email from someone filling me in on their back problems going back eight years.

He had a disc problem in his lower back that called for surgery. He was looking for a therapist who would take someone on with chronic back issues. 

Past therapies he endured included passive modalities such as TENS and ultrasound. He said he has an exercise routine but isn’t consistent with it. When he exercises, his back flares up.

WHERE TO START?

During a typical physiotherapy assessment, I start by looking at the alignment of the body. Is the pelvis resting properly, and what is the mid- to upper-back doing? The muscles of our bodies are both short (cross only one joint) and long (cross more than one joint). In our backs we have muscles that cross several spinal segments.

What is happening at the hips and mid-back? Even our shoulder can effect what’s going on in our lower back.

The lower back is not meant to twist. Twisting comes from the hips and mid-back. If these are tight, twisting happens in the lower back. The result then is a breakdown of the joint stabilizing system and discs. 

BALANCING THE MUSCLES

The best treatment technique I have come across for releasing tight muscles is Intramuscular Stimulation (IMS www.istop.org). If there are tissue adhesions and fascial tightness in conjunction with tight, ropy, reactive, shortened bands of muscles, then the addition of massage therapy techniques, with stretching is hugely beneficial.

MOBLIZING THE JOINTS

If there’s a joint that’s stiff or stuck (not moving or hypomobile), mobilization and/or manipulative techniques are useful to get it unstuck. 

RETRAINING THE SYSTEM

Once the system/body is properly aligned with more normal muscle tension (not over-reacting to all your movements and activities) then I look at re-training the system (re-programming) it to work at its best.

DID YOU KNOW?

We tend to run on autopilot most of the time? We only use about five per cent of our conscious brain throughout the day. Most of what we do runs off of our subconscious programming. 

Re-training your muscles takes concentration and repetition (in other words time and dedication). 

It’s like when you first get behind the wheel of a car. You need to focus on what you’re doing at all times and thinking about every move. 

It’s like learning to walk again after a brain injury or stroke. It can be done but you have to do the work. 

It’s not just about going back to the gym, starting back into running or taking up boot camp. You will just run those old, automatic brain patterns when you do these activities. 

NANCY MCNEIL is a local personal trainer (www.forever-fit.ca) who runs a back fit class that was developed in conjunction with me. The focus is on re-training the core from the inside out. You start by finding your inner core muscles, then progressively work on more challenging core exercises. The goal is to be able to engage the inner core muscles while doing certain movements without the compensatory muscles kicking in. 

I also refer my clients to Pilates instructors or a Somatics group (www.appliedsomatics.com)  in town to help with supervised muscle re-training exercises.

SELF CARE

When it comes to care of the body, it does not matter whether it’s the back, shoulder, knee, hip, elbow or neck, it requires work on your part. The therapist is there to assist while you release certain muscles or joints that need releasing. A client (you) can take a pro-active approach and do self release or massage techniques and stretching. The therapist can show you exercises that will be most beneficial for re-training and strengthening, but we can’t do them for you. 

We can advise you what activities you should avoid and when, but we can’t keep tabs on you at all times.

It’s your body and the only one you get in this lifetime. Help it last a lifetime by giving it the maintenance it needs. 

Give it a rest when it needs it and fuel so it can function optimally and heal well.

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

As a kid I was always very active. Growing up in Ontario afforded me many opportunities for skating and outdoor rinks were everywhere, and lucky for me my neighbour Jack had one. I was skating by age two. When the ice melted, we switched gears to road hockey.

Organized sports started for me around age eight. There was softball in the spring, soccer in the summer, and hockey in the fall/winter months. 

With this bundle of activities, not forgetting the wipe-outs off my bike, there were bound to be a few injuries here and there.  As kids though, we tend to be able to just let our injuries heal and get on with life. 

What I didn’t realize then, was I was developing tight ropy bands in my muscles that would eventually make it harder and harder to stretch.

FORGET ABOUT IT

I do remember having a conversation with my mother and telling her about pain I was having during an activity. The response I believe was, “if it hurts, don’t do it.” 

This is all well and good, but it doesn’t always solve the underlying issue. There are four progressive stages of an overuse injury such as tendonitis. 

1. PAIN DURING USE

This is your body’s first signal something isn’t right. Perhaps there’s a muscle imbalance, or you’ve overworked a muscle and it’s tight and tired. The pain calls it quits if you stop the activity, but comes on again when you start the activity back up.  

WORDS OF ADVICE: This is the time to contact a therapist for help.

2. PAIN DURING USE AND FOR A FEW HOURS AFTER ACTIVITY

This is a signal it’s getting worse. There’s more tissue damage happening and likely some inflammation. 

 3. PAIN THAT LINGERS FOR THE REST OF THE DAY BUT IS GONE BY THE MORNING

Not good.

 4. PAIN THAT’S STILL THERE THE NEXT DAY

Even worse! This is never a good sign. What happens when you get to this stage is you may have to stop doing the activity for a prolonged period of time and will likely require more intensive and prolonged treatment (I know… but please don’t shoot the messenger).

What does this mean for you? Well, it’s a more costly recovery, not only for the cost of treatment sessions, but often the pain starts to interfere in other areas of your life, such as work. 

WHY DO AN ACTIVITY THAT HURTS?

Therapists understand you don’t want to stop doing activities you love to do, or that you don’t want to (or financially can’t) stop, like working. It may be easy to give up vacuuming, doing the dishes, or laundry and if you’re fortunate enough, someone else in the house will take these jobs on for you. It’s much harder, though to give up your green thumb, store away the tennis racquet or hockey gear, or say goodbye to running or bootcamps.

These are activities that invigorate you and are a huge part of your social sphere… I know. 

Would it not be better, though to give these activities up for 3 to 6 weeks while you receive treatment for the injured area and perhaps other areas contributing to the out-of-balance muscles, rather then giving them up for 3 to 6 months? 

Sometimes in the case of shin splints that have progressed to stress fractures, you will be off for a year, and perhaps not able to return to that activity ever again. 

When it hurts, don’t do it works to take the pain away, but you might be missing an opportunity to find out why it hurts when you’re participating in that activity and get to the root of the issue. 

AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE

My mother wasn’t wrong. Doing the painful activity can make it worse.

The part she left out, however, was to go see someone who can help discover why you’re getting the pain when you do the activity, so you can one day do it pain free.

Also keep in mind: don’t wait until you’re getting the pain at rest as well, be proactive with your health, and it will save you in the long run.

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

Is this good posture?

You decide after watching this video. 

This was a 10 minute presentation to a local business networking group. In this talk I reveiw our spinal curves and why we loose height as we age. 

Do you want to know how to sit properly? 

What about spinal degeneration and aging?  What about treatment? 

I also explain a little bit about the physiology of Intra Muscuar Stimulation (IMS). 

So get comfortable and enjoy the talk (find it in the video section of this blog).

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the links there. We’re now on Twitter too! To book an appointment at Start Line, call the clinic at 250-746-7463.

What would you think if you were informed that you had “degenerative disc disease?” It would be shocking to think of having a disease of the disc.

What is the disc?  

What kind of disease is it? 

Is it curable? 

Well, this condition is really not a disease. It is really one part of the spinal anatomy that is wearing out faster than the other parts that are wearing out from the normal aging process. 

In order to fully understand what is happening, we need to understand how the spine works and what is normal aging.

UNDERSTANDING THE ANATOMY OF YOUR SPINE

Picture taking 24 of those kids blocks (the ones with the alphabet letters on them) and stacking them one on top of the

 other. These represent our vertebral bodies. But they are not stacked perfectly, they are slightly curved one way for

the first five (your lower back or lumbar spine is a lordosis).  Then they curve the opposite way for the next 12 (your

 thoracic spine is kyphotic).  They curve again the other way (like the lumbar spine) for your neck (or cervical curve).

Now take a 10 lb bowling ball and balance it on top.  This represents your head.  Of course these curved stacked

 blocks are not resting on the ground but sitting on the pelvic (sacrum which is a small upside down triangle bone of

five fused together blocks) that sits between your two pelvic bones. This all rests on two pedestals (your legs). 

But of course these blocks are not just sitting one on top of the other. They have small water-filled balloon type

 structures between them.  These are the discs.  This does not sound like a very stable structure at all does it?

HOW DO WE STABILIZE OUR SPINES?            

In order to add stability to this stack of blocks, we add a strip of duct tape to the front and the back. This represents

 your ligaments. We will talk about the structure of muscles, ligaments, and tendons another time. You can also add

 some smaller strips of these ligaments between the blocks (running between two adjacent blocks or spanning a few

 blocks).  

HOW DO WE GET THE SPINE TO MOVE?

Now we know that the spine has to move, so the tape can’t be too tight and rigid.  To add to the stability, but allow

 some movement we add in some small elastic bands (muscles) close to the blocks. These attach to the bony parts

sticking out from the vertebra (spinous processes and transverse processes). Some of these bands run between only a

few blocks, while others span more than a few. 

In the back there are three layers of these muscles.

The deepest layer adds the stability to the vertebrae (www.dianelee.ca) for more information on the inner

 core).  The middle layer helps move the back, pelvis and neck in different directions. While the outer layer helps

move the arms and legs.  All add some stability (inner versus outer) to the spinal column. 

These elastics are controlled by electrical signals coming through wires (nerves).  

WHAT HAPPENS AS WE AGE?

DECONDITIONING

First of all, many people in middle age get caught up in the rat race of life and stop being physically active.  So now the

 muscles don’t work as well as they should. 

CHANGES IN THE DISC

At the disc level, there is a movement toward the disc moving into the bone. To picture this, take your hands and hold

 them slightly apart but level with each other (young disc). Now cup your hands but without moving them together.

Notice how your fingers come together. The part where your knuckles bend is the part moving into the vertebrae. As

 the fingers come closer together what happens to the duct tape that is spread between the fingers on the right and

 those on the left?  Yes the tape crinkles. It does not shorten because it, unlike the muscles, is not very elastic. 

WEAR AND TEAR

Now you have a muscled deconditioned back with loose ligaments. Now part of your stack of blocks

is moving too  much. This puts stress on the joints (where two bones come together) and the discs.

 The joints may start to wear under stress and soon you will be told that you have arthritis. Or the

disc starts to be placed under too much stress and you develop a bulged or herniated disc. There is also a lot of stress

 on the disc if you are doing a lot of bending and twisting, or sitting in a slouched position.

SPEEDING UP THE AGING PROCESS

Fractured end plates

Now you can speed up this aging process by doing a number of things.  You could have had a hard fall

 onto your back or buttocks. Just think of all those impact sports we played as children, the falls off our

 bikes and monkey bars or those tumbles because we really should not have been doing gymnastics,

but the teacher did not listen to us. These falls can create a fracture to the thin plate (end plate) on the

bottom of your vertebrae. The disc then gets exposed to foreign material causing an inflammation process and it

starts to degredate (thin). This is your “disease” process. 

SMOKING

You can make the disc more fragile by smoking (reduced blood flow and nutrients get to the disc).There is a study out

 supporting that individuals who smoke and perform heavy lifting activities are at increased risk of lower back

injuries.  Smoking is essentially like putting your nice supple tissues into a dehydrator.  They start to become like

 dried out leather and tear more readily. (Also if you fracture a bone, it has been shown to not heal as well, and

sometimes not at all in smokers).

MUSCLE IMBALANCES (TIGHT OR WEAK)

You can have nice tight muscles in the back that will compress the disc and which can limit nutrition to the disc and

 compress the spinal joints (contributing to arthritis). Another thing that has been shown to occur after trauma to the

 back (fall or other accident, repetitive trauma from bending and twisting) is the deepest muscle (multifidus) can shut

down. Yes it just stops working. Now you can imaging what would happen if one person at work just up and quit. All

the other people would have to step in and try and do the work to keep the pole from falling over or moving too

 much.  So now the middle layer of muscles get overworked and tight. Some people even try to keep the pole stabilized

 by squeezing their buttock muscles. This just leads to a whole new set of problems. 

GAME PLAN

Don’t fret, it’s not too late. With a proper assessment to determine all your muscle imbalances (what is tight and what

is not helping out) and working on releasing the tight muscles and getting the lazy ones back to work, you can in most

cases improve the stability of your spine, reduce the compression and irritation to the spinal joints and take some of

the stress off of the disc. However, you need to be willing to do some work. You will likely be required to start a

 stretching program, and work on re-engaging your inner core (reconnecting the wires from your brain to the

muscles) and then working on overall conditioning. 

IF YOU’RE MOTIVATED: 

1. www.dianelee.ca

 We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook site by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

  

How do you know that traction will work for you (and you won’t hurt yourself)?

Physiotherapists have used traction as a treatment modality for decades (used medically for over 50 years). There are certain tests that we do to help determine who will benefit or not from traction.

Nowadays you don’t need to see a physiotherapist to have traction with the invention and sale of the inversion table.

WHY WOULD SOMEONE HANG THEMSELVES UPSIDE DOWN?

The rational behind traction:

• Arthritis
  • light separation of the vertebrae (bones) in the spine
• Disc bulges or herniations
  • takes stress off of the discs

 

We, as upright walking humans, are subjected to the law of gravity. I have read over the course of the day we can loose up to 2 cm in height (so always measure your height in the morning). First thing in the morning we also have more fluid and height in the discs in our backs, which is why people with back pain from disc problems (herniations or bulges) often feel more pain in the morning. 

There is a list of contraindications for inversion table use. You should not use an inversion table if you have the following medical conditions:   

Glaucoma
Pregnancy
Hiatal hernia
Ventral hernia
Detached retina
Extreme obesity
Middle ear infection
Arterial hypertension
Severe vascular disease
Anti-Coagulants (use of)
Conjunctivitis (pink eye)
Bone weakness, recent fractures
History of congestive heart failure
History of space-occupying brain lesion
Vulnerable areas of stress from recent surgery

WHY SEE A PHYSIOTHERAPIST FIRST?

1. Traction can aggravate the problem.

2. There may be other treatment techniques that would also be helpful.

• IMS
• Exercises
• Manual Therapy
• Education

3. There are several different causes of back pain (www.cbihealth.com).

4. May aggravate conditions in the knees and hips.

Bahram Jam reviewed Spinal Decompression in the APTEI report (www.aptei.com/report winter 2009). In this review, Bahram looks at an article published in Chiropr Osteopat. 2007 May 18; 15:7. This is more of a review based on marketing claims and scientific literature. 

The conclusion drawn is there are few studies that exist supporting spinal traction. 

There was a good study published in Spine 2007 Dec 15: 32 (26) again summarized by Bahram in the APTEI report on who might benefit from traction. 

People with the following symptoms are likely to benefit from traction:

1. Leg symptoms below the knee

2. Signs of nerve root compression (a pinched nerve where it exits the spinal column)

3. Peripheralization of symptoms with extension (backwards bending decreases the pain in your leg)

4. Symptoms down one leg when the other is lifted (positive crossed straight leg raise)

Conventional traction versus inversion tables

(Physiotherapy Theory and Practice (2000) 16, 151 –160 © 2000 Taylor & Francis)

• Randomized controlled – 29 clients with lower back pain and sciatic from disc herniations.
• Both groups benefited (as noted by clinical changes on CT scans) but there was no clinically significant difference between the groups.   

When making the decision to invest in the “spinal decompression” advertised in the newspapers, or on an inversion table, or physiotherapy, I would suggest doing your research and know what you’re getting for your investment. 

IF YOU’RE MOTIVATED:

1. Bahram Jam’s reports: Chiropr Osteopat. 2007 May 18; 15:7 online: (www.aptei.com/report winter 2009) and Spine 2007 Dec 15: 32 (26)

2. (Physiotherapy Theory and Practice (2000) 16, 151 –160 © 2000 Taylor & Francis)

1. http://www.energycenter.com/grav_f/contra.html

2. www.cbihealth.com

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook site by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.