Posted on 9/13/2017 by Andrew Piraino, P.T., DPT, OCS, CSCS
Low back pain is common. It’s so common that about 80 percent of adults will at one point experience this condition. It ranks among one of the top reasons to see a physician and costs the United States more than $100 billion dollars every year.
When faced with an episode of low back pain, it’s easy to go into crisis mode. You may be routed through various specialists and receive various imaging tests, such as X-rays and MRI. These tests can reveal scary findings, such as “herniated discs,” but don’t panic.
First, many of these findings are normal. Researchers have found that in adults without low back pain, two of out three have an abnormality at one disc or more. This makes imaging of limited use, unless something like a fracture is present that needs surgical management. Physicians agree; the American Academy of Family Physicians recommends against any imaging for low back pain for the first six weeks unless serious signs are present, such as trauma.
Often, you may be referred for physical therapy. You may have some familiarity with various exercises and hands-on treatment provided by therapists. But why is physical therapy unique, and what exactly does it do?
Physical therapists today are doctoral-level trained specialists in human movement, completing four years of undergraduate education, three years of doctoral training and often further residency or fellowship training in addition to board certification. Poor movements and postures can cause low back pain and, therefore, physical therapists are optimally equipped to address the cause of the problem rather than treating the symptoms. Just like the song lyrics to ‘Dem Bones,’ each area of the body affects another, which is what physical therapists are trained to observe and address.
For example, take a truck driver who has worsening low back pain with sitting in his truck and bending (pictured below). While a massage at his back area makes him better temporarily, his pain always returns several days later. A physical therapist may look at this driver and find he has tight hamstrings (the muscles on the back of the thigh). Every time he straightens his right leg to reach his pedal, his tight hamstrings pull his back into a bent position (Figure B). And so, all day long, as he drives, his back is bent over and over while he operates the gas and brake pedals. Try sitting up straight and then straightening your knee. You may find it’s hard to do!
Low Back Pain
A - Driver at rest.
B - Driver's hamstring pulls on his pelvis and bends his back whenever he tries to use the pedal.
C - Driver after physical therapy treatment to improve his hamstring flexibility... no more dysfunction!
While physical therapy may provide hands-on treatment to alleviate pain, it would also include exercise to decrease stiffness of his hamstrings, which would allow him to move without causing his back to compensate every time (Figure C). Therefore, our truck driver is able to sit and drive all day without pain. Rather than seeking symptom relief, he now knows what caused the pain, and the exercises and positioning to prevent it from returning.
This is a simple example, but it appreciates the entire body’s contribution to movement and pain, rather than focusing on the area of pain alone. Hopefully this demystifies what physical therapists do, and how they work to optimize each person’s movement and prevent their painful condition from returning!
If you are experiencing low back pain, please call one of our conveniently located centers in your area to experience the power of physical therapy today! For more information and to watch a brief informational video, please click here.
Andrew PirainoBy: Andrew Piraino, P.T., DPT, OCS, CSCS, treats at Select Physical Therapy in Pasadena, TX and is involved with our orthopaedic physical therapy residencies at the market and national level. He completed doctorate and residency training at the University of Southern California in 2012 and 2013, respectively, and is board certified in orthopaedics. Andrew specializes in orthopaedic movement dysfunction across the lifespan, from young, recreational athletes to adults with complex multi-system involvement.
Posted on 8/23/2017 by Colleen Boucher, P.T., DPT
Wearing proper clothing, getting the right amount of sleep and practicing proper stretching techniques are vital to an athlete’s success. But, just as is important is eating the right foods. A proper diet will allow athletes to remain active, maximize function and minimize risk for injury. Eating the right foods will also address factors that may limit performance such as fatigue, which can cause deterioration in skill or concentration during an event.
Using guidelines from the American College of Sports Medicine, we believe practicing these tips will help athletes remain active in their favorite sport. What and when you eat prior to physical activity makes a big difference in the way you perform and recover.
Eat three to four hours before your workout and make sure you’re eating food that not only contains adequate amounts of proteins and carbohydrates, but also provides sustainable energy, speeds recovery time and boosts performance. Early fatigue caused by malnutrition can result in improper mechanics, creating predisposition to injury.
Athletes should eat a diet that gets the bulk of its calories from carbohydrates, an athlete’s main fuel. Eating foods such as breads, cereals, pasta, fruit and vegetables will help to achieve maximum carbohydrate storage.
Re-fueling after exercise is just as important. Eating protein, carbohydrates and a small amount of fat after activity prevents the breakdown of muscles and can lead to better next-day performance. While protein doesn’t provide energy, it is needed to maintain muscles. Focus on incorporating foods with high-quality protein, such as fish, poultry, nuts, beans, eggs and milk.
Practicing proper hydration is equally important in reaching your optimal level of success. Athletes, especially those participating in high-intensity sports, should drink fluids early and often. An easy way to ensure you’re properly hydrated is focusing on the color of your urine. A pale yellow means you’re getting enough fluids, while a bright yellow or dark color means you need to drink more. We encourage athletes to:
Drink 17 to 20 ounces of water two to three hours prior practice.
Drink 7 to 10 ounces every 10 to 20 minutes during activity.
Drink 7 to 10 ounces of water after practice for every two pounds of body weight lost.
Drinking the right liquids is also a key factor in an athlete’s diet. Milk is preferred by many athletes as it provides a good balance of protein and carbohydrates. Sports drinks are great for replenishing electrolytes, which are lost when you sweat. If you’re losing a lot of fluid as you sweat, it’s a good idea to dilute sports drinks with equal amounts of water to ensure you’re getting the right balance of fluid and electrolytes. If possible, drink chilled fluids, which are more easily absorbed than room-temperature liquids and can help to cool your body.
Finally, avoid extreme diets as they increase the risk of micro-nutrient deficiencies. Vitamin and mineral supplements aren’t necessary if your diet includes a variety of nutrient-dense foods. Often, these supplements require supervision and monitoring for safety and effectiveness.
By: Colleen Boucher, P.T., DPT, center manager from NovaCare Rehabilitation’s Sicklerville, NJ center. Colleen has been a part of the NovaCare team since 2001 and enjoys treating all types of patients. She has a strong interest in vestibular rehabilitation and concussion management.
Posted on 7/20/2017 by NovaCare Rehabilitation and Select Physical Therapy
The dog days of summer are upon us, but you don’t have to stop exercising outside just because of the warmer temperatures. NovaCare Rehabilitation’s Paul Hansen, ATC, from our Minnesota community, and Select Physical Therapy’s Andy Prishack, P.T., ATC/L, center manager, from the Fair Oaks, VA center, explain how to keep safe while enjoying some of your favorite summer activities.
• Avoid exercising between the hours of 11 a.m. to 3 p.m. as that is considered the hottest part of the day. Limit high intensity workouts to either early morning or early evening hours when the sun’s radiation is minimal.
• Stay hydrated by drinking a glass or two of water before you head outside. If possible, carry a bottle of water or even a hydration pack and take a drink every 15 minutes even if you’re not thirsty. The easiest thing to do is pay attention to the color of your urine. Pale and clear means you’re well hydrated; if it’s dark you need to drink more fluids.
• Wear clothing that’s light in color, lightweight and has vents or mesh. Microfiber polyesters and cotton blends are good examples. The lighter colors will help reflect heat and the cotton material will help with the evaporation of sweat.
• Feeling nauseous, dizzy or exhausted, along with moist and flushed skin are symptoms of heat exhaustion. Stop what you’re doing and get out of the heat. Remove or loosen any tight clothing and apply cool, wet cloths. Slowly drink a half-glass of cool water to rehydrate yourself and continue doing so every 15 minutes until you feel better.
With the temperature rising, many are also headed to the nearest body of water with kayaks, surf and paddle boards. Water sports are an excellent way to get in exercise and challenge our upper body strength and balance. Heather Wnorowski, P.T., from NovaCare Rehabilitation’s Sewell, NJ center, has a few tips to keep in mind for the water sports novice and seasoned pro.
• Always get in an adequate warm-up. While the temperatures may be warm, it doesn’t mean our muscles are. Dynamic stretching is a great way to get your blood circulating and muscles warm before hitting the water.
• Since water sports are heavily dependent on our shoulders, it’s important to strengthen your postural and rotator cuff muscles in order to avoid repetitive stresses and impingements of the shoulder.
• Don’t forget the rotational mobility of your mid-back! Kayaking and other paddle sports involve a lot of thoracic spine rotation in order to propel you forward. Make sure you’re able to twist from side to side without pain before heading out for a day on the water.
• Last but not least is balance! Balance is an important part of maintaining an upright position while on the water. Practice standing on one leg at home. Once you’ve mastered that, try standing on a foam cushion and closing your eyes. Make sure you have someone or something nearby to hold onto in case you lose your balance.
Have a great summer and be sure to stay safe out in the heat!
Posted on 6/12/2017 by Heather N. Wnorowski, P.T., DPT, OCS
Across the country, baseball and softball season is in full swing. Whether it’s at a backyard barbecue or an official game, athletes of all skill levels are taking part in America’s favorite pastime.
Over the past few years, a large emphasis has been on the youth athlete and overuse injuries in pitchers. We have learned to monitor pitch counts, plan structured rest and encourage multi-sport participation with athletes.
But what about outfielders, catchers and the weekend warriors who enjoy playing in their neighborhood league?
Common injuries aside from the shoulder and elbow exist in youth and adult baseball/softball athletes, such as back pain, knee pain and Achilles injury. Many overhead athletes have concurrent complaints of back pain or contralateral knee pain (knee pain opposite of their throwing arm). Why?
When you think about baseball and softball, a player is doing rotational movements that require the entire body. Unless they switch hit, these rotational patterns are always to the same side. What then happens is they may overdevelop certain muscular groups on one side in comparison to the other. In doing so, this can cause overuse injuries of these groups or we may injure or strain ourselves doing normal daily activities due to this imbalance.
The easiest way to avoid injury at practice or during a game is to develop a proper warm-up routine. An adequate warm-up usually involves a little bit of sweat, which can be hard to get in the dugout. Try performing some of these full body movements to warm-up quickly and efficiently:
Overhead walking lunge
Heather Overhead Lunge
Split squat with one foot on the dugout bench
Heather Split Squat
Lunge with trunk and arm rotation
Heather Lunge Rotation
Shoulder rotation with banded pull aparts
Heather Band Rotation
PNF diagonal pattern with banded pull aparts
Heather PNF Bands
Incorporating a low back and abdominal strengthening routine into your normal strengthening routine is also recommended. To be most efficient, you need a good transfer of force between the upper half and lower half during throwing or batting. Without a solid core, athletes with lose force and become less effective. Abdominal exercises that require rotation in both directions, isometric holds (planks, side planks), and lumbar extension strengthening should all be incorporated into your programming.
Heather Stretch 1 Heather Stretch 2
Having a good balance of strength (right and left sides comparable) and a solid warm up routine will help to prevent injury and enhance performance. Hopefully these tips prepare you for your season and keep you healthy on the field. Best of luck in your upcoming season!
By: Heather N. Wnorowski, P.T., DPT, OCS. Heather is a staff physical therapist at our NovaCare Rehabilitation center in Sewell, NJ. She earned a doctorate of physical therapy from Widener University and is dedicated to developing efficient avenues of treatment to influence superior patient outcomes.