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 NovaCare 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 3/5/20 Haley Taffera
Whether it’s on the athletic field, a job-site or in one of our outpatient centers, our athletic trainers are counted on to be the frontline support for injury prevention, treatment and ongoing management of care for athletes, workers and patients and customers. In honor of National Athletic Training Month, we asked our National Director of Sports Medicine John Gilmour, M.A., ATC, to share how our incredible team of athletic trainers makes an impact in the lives of thousands of people across the country on a daily basis. View the video here...
Be sure to visit our Facebook, Twitter and Instagram pages throughout the month of March as we recognize and celebrate our colleagues.
Posted on 5/10/2017 by Jamie McGaha, OTD, OTR, COMT, CEASI
Join NovaCare Rehabilitation and NovaCare as we celebrate National Arthritis Awareness Month! Recognized each May by the Arthritis Foundation, arthritis impacts more than 50 million people in the United States and is the number one cause of disability in the country. Did you know there are more than 100 types of arthritis? Currently, one in five adults is affected by at least one type of arthritis1. By 2030 an estimated 67 million adults will have doctor-diagnosed arthritis, with two-thirds being women2.
The hands are one of the most common sites for arthritis. The most functionally limiting type of hand arthritis affects the base of the thumb, also known as basal thumb arthritis or first carpometacarpal osteoarthritis (OA).
In the past, we thought the only way to alleviate pain from thumb OA was to rest the joint in a splint and not exercise. Now we see too much time in an orthosis can make the thumb weaker and it may even be harder for you to do things when you take the brace off.
New evidence in the field of hand therapy has taught us that there is so much more we can do other than rest and that it is important for the joints’ health to move! We have found that by understanding our own thumb anatomy and learning how to find the correct muscles in the thumb, we can strengthen weakened or disused muscle, helping to stabilize the arthritic joint. We can also decrease overuse and tightness in muscles that are working too hard because others are not helping. Better muscle function and greater stability can contribute to less pain and decrease time you need to rest or use an orthosis.
Not all thumb OA is alike. A visit to your hand therapist would allow you to find out which muscles are tight and which are weak. Together, you and your hand therapist would then design an individualized plan of care for your symptoms related to the activities you desire to do.
The right exercises can be so effective that the joint can become better aligned; this has been shown with healthy thumbs on X-ray3. Your hand therapist can also help you to determine when to wear your orthosis and when not to, so your thumb has the appropriate support at the correct time.
There are many new techniques being used in therapy. It’s even hard for the physicians to keep up to date on all the new techniques! Checking in regularly with a hand therapist may provide solutions to many of your aches, pains and limitations from hand and thumb arthritis.
Barbour KE, et al. Vital Signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitations- United States 2013-2015. MMWR 2017; 66(9); 246-253.
Hootman JM, Helmick CG. Projections of U.S. prevalence of arthritis and associated activity limitations. Arthritis Rheum 2006;58(1):26–35.
McGee C, Adams J, Van Nortwick SS, O’Brien VH, Van Heest AE. Activation of the first dorsal ineterossesous muscle results in radiographic reduction of the thumb CMC joint: Implications for arthritis prevent [abstract] Paper presented at The British Society for Surgery of the Hand; January 2015.
Jamie McGahaBy: Jamie McGaha, OTD, OTR, COMT, CEASI. Jamie is a licensed occupational therapist focusing on hand therapy and upper extremity rehabilitation with NovaCare in Austin, TX. She completes ergonomic assessments and has experience with ergonomic interventions. Jamie is also an assistant faculty member for anatomy at the University of St. Augustine’s occupational therapy program. She is a certified orthopaedic manual therapist for the upper extremity, has current and ongoing research on the subject of thumb arthritis and is a member of the American Society for Hand Therapists and the Central Texas Hand Society.
Posted on 3/1/2019 by NovaCare Rehabilitation and NovaCare
National Athletic Training Month is held every March in order to spread awareness and celebrate all that athletic trainers do: provide vital health care services for life and sport. The National Athletic Trainers’ Association’s theme for 2019 is “ATs Are Health Care.”
This year’s theme is a great way to educate folks that athletic trainers spend their days helping people in diverse settings with injury prevention, treatment and ongoing care management. They play a vital role in enhancing an athlete's performance and work closely with team physicians, athletic directors, coaches and employers to ensure that athletes are healthy and performing at their peak potential.
Take a moment to think about the term/word “athlete.” You may think of the traditional athlete, from high school to professional – on the playing field, ice, court, you name it. But, there’s also dancers, gymnasts, first responders and military personnel, all of which require specific training and care due to their dynamic and unique movements.
And, let’s not forget athletes working in an industrial setting, such as airline personnel, warehouse and retail workers, hotel/resort and theme park staff. We are proud to treat such individuals as part of our WorkStrategies® Program.
“Within Select Medical’s Outpatient Division, we employ more than 900 athletic trainers who work in diverse settings across the country. We are proud to employ hardworking, dedicated and talented athletic trainers who spend their days treating and helping to assess and provide care to athletes. Truly, athletic trainers are a vital part of the health care process.” - Michael E. Collins, P.T., ATC, MBA, vice president of sports medicine
In celebration of National Athletic Training Month, NovaCare Rehabilitation and NovaCare are spotlighting our all-star team of athletic trainers throughout the month on our Facebook, Twitter and Instagram pages. Don’t forget to “Like” us and “Follow” us, too! And, check out this great video on our YouTube page.
Visit the National Athletic Trainers’ Association website at www.nata.org or contact a NovaCare Rehabilitation or NovaCare center near you today to learn more!