July: Low Back Pain

I often hear from patients that they just don’t know what to do when an acute onset of low back pain strikes. Most will stay in bed initially or run to the ER for fear that movement will injure something permanently. Remember, pain is an indication of tissue damage and we want to reduce stress on these tissues to allow healing. So I want to give you some easy guidelines to use which should shorten the early period of intense pain:

  1. Find a position of comfort. Sounds obvious, but sometimes we over think the obvious!
  2. Apply ice 10-20 min at a time and give it an hour between applications.
  3. Take an anti-inflammatory medication (approved by your physician).
  4. Follow the Progressive Upright Posture Principle (see below).
  5. Avoid aggravating activities.

What is the Progressive Upright Principle?

Start Non weight bearing to help damaged tissues to heal without stress (basically, lie down in a position that stops the pain).

Common postures that decrease strain to back are side lying with 2 pillows between thighs, or lying on your back with legs over an ottoman or pillows. Then apply a controlled increase of appropriate stress to tissues which will actually speed up healing. For example, after lying down comfortably on ice for an hour, stand up and slowly walk around until pain returns than resume a lying down or sitting posture of comfort./p>

This principle takes listening to your body and reacting, not continuing an activity or chore until the pain is unbearable. Usually with 24-48 hours of repeated rest and upright movement, the symptoms dissipate and become stable.

After the acute stage of symptoms, if experiencing a daily pain when first waking or after heavy labor and it seems to be more of a stiffness than an inflammatory process, then it is alright to begin using heat.

Now, it’s time to come and see a PT for evaluation to find out what is causing the pain. Usually, low back pain (as in all joints of the body) is generated from a movement dysfunction. However, if symptoms include leg pain and/or leg weakness, it is best to seek the opinion of a spine specialist MD first.

Amy’s Back!!!

Amy Voorhis has been with us for several years working as a PT aide, but recently went back to school to become a Physical Therapist Assistant at Northern Virginia Community College. She has been in and out of the office for periods of time the last two years taking classes and doing internships, but she graduated in May and is back full time! She is now seeing patients as a PTA.

You’re probably thinking to yourself, “What is a PTA?” A PTA is a licensed healthcare professional who assists the PT in providing patient care after the evaluation. See the American Physical Therapy Association’s explanation here: ww.apta.org/PTACareers/RoleofaPTA. So, what does this mean? Essentially, in an outpatient setting like ours, a PTA can do almost anything a PT can do, except the evaluation. They have their own schedule of patients whom they see under the direction of the PT.

Amy also has a bachelors degree from James Madison University in Athletic Training. She is certified in Sportsmetrics, which is an injury prevention program for athletes, and has special training in group exercise for older adults. Amy has a special interest in nutrition for a healthy lifestyle and is an avid indoor cyclist.

NFL columbine uses it, NHL uses it, most college teams use it, and its spreading….anyone can benefit from it!!!

What is FMS?

The Functional Movement Screen (FMS) is the product of an exercise philosophy known as Functional Movement Systems. This exercise philosophy and corresponding set of resources is based on sound science, years of innovation, and current research.

How it Works – Simplifying Movement

We all want the most efficient exercise plan that targets are greatest weaknesses and flexibility issues and having a Functional Movement Screen performed can give you these answers. This is a great test for athletes from middle school to senior years! The test is sensitive to pick up motor control issues needed to safely excel in sports and lack of flexibility patterns that will make you more likely to suffer an injury.

Put simply, the FMS is a ranking and grading system that documents movement patterns that are key to normal function. By screening these patterns, the FMS readily identifies functional limitations and asymmetries. These are issues that can reduce the effects of functional training and physical conditioning and distort body awareness.

The FMS generates the Functional Movement Screen Score, which is used to target problems and track progress. This scoring system is directly linked to the most beneficial corrective exercises to restore mechanically sound movement patterns.

Exercise professionals monitor the FMS score to track progress and to identify those exercises that will be most effective to restore proper movement and build strength in each individual. Below are the 7 tests and they have to be done as instructed and a trained professional can pick up the sometimes subtle and sometimes obvious issues of muscle tightness, weakness, or coordination.

Injuries that were once seen mostly in active adults are now occurring more frequently with children. In a time when young athletes are more likely to specialize in one sport and participate year-round, youth sport participants are more prone to injury than ever. As many as 28% of football players in organized sports will sustain an injury between the ages of 5 and 14.
One key in injury treatment and prevention for youth is early recognition. The Functional Movement Screen (FMS), is frequently used as a baseline to assess injury risk by identifying key risk factors.

To learn more about Functional Movement Screens check out this link: www.functionalmovement.com/fms

Its almost summer, great time to work on problem areas with school out. Give us a call to set up an appointment.

Pilates YouTube

Here is our very own Caitlin demonstrating Pilates finding neutral, bracing and marching on our new YouTube channel

Caitlin offers Pilates classes M/W/F 10:00 to 11:00

Or Private Pilates lessons. Sign up now 669-6100

In May our blog will be about how to treat your back pain yourself when your lowback pain first starts.

Sweat and Smiles: March!

Neck and Shoulder Pain: A Discussion About Posture

by: Jen Lausten PT, DPT & Amy Smith ATC

Lets face it our sedentary work postures are not healthy and our seated posture is something we have watch and to be mindful of, or we will end up sore.

Anything we do in life habitually or compulsively will usually end up becoming irritated.

A common habit is how we sit in front our computer, how we position our arms using mouse or keyboard. Body alignment and mechanics matter for decreasing load on our muscles and joints. It is just simple physics.

So why do my neck and shoulders become sore and tense? How is the shoulder and neck interrelated?What are trigger points?

 

Let’s start with our alignment. If we dropped a plumb line from our ear down, would our body be upright or leaning forward? Our head is typically too far forward. This makes our neck bend forward, which can ultimately put a strain down into the low back.

 

How do I fix my seated posture at work?

Start by simply sitting tall up on butt bones. Think of rolling your pelvis and belly button forward. Roll your shoulders back, but don’t let your rib cage raise up. This is good upright posture!

Close your eyes and let your arms naturally hang at your side. Now bend ONLY your elbows to a 90 degree angle. Now open your eyes. Where are your hands? They should reach the keyboard.

Look at your screen. Is it comfortable to see without turning head to the side or looking up or down? If not, you need to fix your work station. If you’re using a laptop more than one hour per day, it would be best to have a detachable keyboard in order to have correct posture.workstation posturetrigger point

 

 

Why is it bad to have head forward posture?

forward head skeletonbad posture

The man above doesn’t realize that over time, if his shoulders are in front of his body, it’s causing unnatural strain on small important shoulder muscles called the rotator cuff. The rotator cuff controls and helps stabilize the shoulder. If you are in a slouched posture, over time the pectoralis minor shortens, thus keeping the shoulder rounded all the time, even when you’re not at the desk. When this happens, the small tunnel that the superior rotator cuff tendons pass through becomes smaller, which causes rubbing along bone from increased tension. This can lead to bony spurs, which can exacerbate the problem.

shoulder impingements

These issues weaken the rotator cuff. Now, when you than go do something more physical, such as lifting or straining to reach for something, you have set the shoulder up for injury.

It is also common for us to keep too much tension in our upper trapezius muscle (shrugging shoulders up). Over time, this too becomes adaptively shortened and that causes the middle and lower trapezius to be over stretched. When muscles are overstretched, trigger points can occur because the muscles are working overtime to try to correct the faulty posture.

trigger

Trigger points can also develop in the levator scapulae muscle when the scapula constantly remains in a protracted position (rounded shoulders). When you add a forward head to this, the head is pulling the other attachment of the levator scapulae, which can lead to nagging pain in the upper back.

 

In summary, many of our neck and shoulder problems can be prevented with proper alignment!

 

Tune in next month for PILATES! We are going to talk about how you can fit a few easy, effective exercises into our day and improve our posture.

 

 

 

 

 

 

 

Sweat and Smiles: February!

Running and Foot Pain

by: Jen Lausten PT and Amy Smith ATC

 

Why do my feet hurt?!

You may assume it’s the structure of your feet and it’s partly true. Both flat feet and high arches can cause problems in the soft tissue of feet.

One more wonderful part of middle age is the wearing away of the fat pad that provides cushion on the heel (calcaneus). The body also becomes less forgiving to the wear and tear because your high arches are too inflexible or your flat feet are overly stretched.

Often, in the clinic when we have patients complain of foot pain, it’s from a recent change in lifestyle, such as starting to RUN. It doesn’t seem fair that we want to make a healthy decision to improve our fitness and than get hurt and discouraged. It is usually due to increasing the running distance or the intensity too quickly. Another aggravator can be the surface on which you are running, such as downhill or on uneven ground.

Here was an interesting blog by a scientist who happens to be a runner. He began very unfit, only able to run 50 yards, and now can do 50 km! He wrote out a safe progression from walking to running. His program uses good common sense, and references several running experts.

http://moregrumbinescience.blogspot.com/2010/02/running-progression.html

In a nutshell, get good at walking before you run!! Walk 30 min a day and make sure you feel pretty good the next day too.

“The starting point doesn’t matter. Being consistent matters. Getting out for your next workout matters.” –Grumbine Science

 

Here is why your feet hurt from running from a Physical Therapist viewpoint:

The plantar fascia is a celery-like structure that connects the heel to the ball of the foot. It is like a band that connects a tripod that consists of the heel and the bones of the ball of the foot. The goal of the plantar fascia is to stabilize and support the arch, assist with pressure distribution across the foot, and to transfer the strength of the Achilles tendon to the forefoot by helping propulse the foot from heel to toe motion.

 

Another reason for your foot pain could be foot wear. Your running shoes may be worn out or not fitting properly. So, if you are about to start an exercise program, make sure you get the correct shoe for your foot shape (high arch=supinator or flat feet=pronator). It is also important to get the correct type of shoe for the activity you are planning to do (i.e. running vs. cross training).

 

 

Symptoms

How do you know if you have plantar fasciitis?

The most common complaint is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn.

The pain is usually worse:

  • In the morning when you take your first steps
  • After standing or sitting for a while
  • When climbing stairs
  • After intense activity

The pain may develop slowly over time, or suddenly after intense activity.

What can you do about it

  • Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation
  • Heel and foot stretching exercises

 

  • Resting as much as possible for at least a week
  • Wearing shoes with good support and cushions

Other steps to relieve pain include:

  • Apply ice to the painful area. Do this at least twice a day for 10 – 15 minutes. A good way to do this is to freeze a water bottle, and roll it under the arch of your foot.
  • Try wearing a gel heel cup. These can usually be found at your local sports store or pharmacy.
  • Use night splints to stretch the injured fascia and allow it to heal. You can use a traditional splint, or a Strassburg sock (pictured below) may be more comfortable to sleep in.

If these don’t work should see PT to treat with modalities to decrease inflammation, as well as to possibly provide deep soft tissue mobilization in the areas of the calf that may be providing too much strain to affected area. Sometimes, immobilization is what it really needs, and a walking boot is issued for 6-8 wks to calm down the inflammation.

Next month we will discuss how to assess your computer posture and to improve shoulder and neck pain caused from forward head and slouching!

Sweat and Smiles: January!

by Jen Lausten PT and Amy Smith ATC

We mentioned in last month’s introduction that we would be discussing how our hips can be the “quiet” cause of our low back pain, or even knee or foot pain.
First of all, long and strong hip muscles, such as the Rectus Femoris, Iliotibial Band, and Psoas Major can easily become tight and cause biomechanical pain elsewhere in the body.

A typical problem for a sedentary person, such as someone with a desk job who does little exercise, is when the psoas hip flexor muscle becomes shortened and tight. This can lead to low back pain when standing up because the muscle originates from the lumbar spine, crosses the front of the hip and attaches on the thigh. This can be seen in the picture below. This tightness causes the low back to arch too much (hyperlordosis), which causes compression pain in the lumbar segments of the spine.

So what can you do about it? Here is a simple stretch for the hip flexors (psoas).


If the muscle is very tight, you may need deep soft tissue work from a physical therapist.
Another common problem is having Iliotibial band (ITB) tightness.

As you can see this muscle attaches to the top of the pelvis, runs down the side of the leg and attaches to the tibia below the knee. This is an unusual muscle because it consists mostly of fibrous tendon and doesn’t have much of a muscle belly. When tight, this can cause hip bursitis or lateral knee pain. This occurs commonly with avid cyclists and sedentary people. Here are a few easy stretches below:

 

The one above with the roller is painful at first but is very effective!

Now you are probably wondering how in the world the hip can cause foot pain. If you think of the body in a biomechanical sense, you will see that if the body cannot achieve movement in one place, it will find it somewhere else. The body will always take the path of least resistance. So for example, if the hip isn’t moving well, one way the body may accommodate is by rolling the ankle inward.
Tune in next month for more on this type of foot pain, as well as Plantar Fasciitis, a common source of foot pain, and the biomechanical solutions next month!

Welcome

Hi all,

I want to welcome you to our first post for Sweat and Smiles blog. I hope to bring you interesting and informative exercise and injury related topics. I am Jen Lausten, a Physical Therapist that specializes in orthopedic injuries.

You can find more about myself and the rest of our staff on our websites: www.tompkinspt.com or www.medicalgymleesburg.com.

You can also visit us on our facebook:

www.Facebook.com/TompkinsPhysicalTherapy

 

Our first topic will be in January:

Common injuries that originate at the hip, however are felt elsewhere in the body such as low back and knees.