Low back pain is the 2nd most common reason for visits to primary care physicians and the most common reason for visits to orthopedic surgeons and neurosurgeons.  It is estimated that 80% of the population will suffer from an episode of disabling acute low back pain at some point during their lifetime.  Although there are many different treatment options for those who suffer from low back pain, self care is the most important action that a person can take to maintain a healthy back, to prevent low back pain and to facilitate the healing process if low back pain occurs.

Bad habits such as the way you stand (posture) or the way you position yourself (body mechanics) can contribute to the onset of low back pain.  Poor posture and body mechanics change the optimal alignment of the spine over time leading to a process of degeneration.  Often, the process can and will result in weakened discs, inflamed joints, irritated nerves, and painfully tight overworked muscles.  Maintaining proper posture during lying, sitting and standing positions has a significant affect on reducing the stress and strain on the spine which are associated with pain and injury.  Learning how to move properly during common daily activities such as bending, lifting, turning, and reaching is also critical in preventing low back pain.  Many of you may have experienced the ill effects of poor body mechanics during activities such as moving furniture, lifting children, or snow shoveling.

A healthy back needs to be strong and flexible.  Daily exercises aimed at stretching and strengthening muscles and maintaining the flexibility of your spine will help to accomplish this.  One highly recommended exercise for your back is regular walking.

There are many other useful self care tips and techniques that can be learned to keep your back healthy.  Here are a few: maintain an optimal body weight, wear the right shoes, shift positions often at home and work, choose the right bed, use lumbar support for sitting, self-massage, or better yet get someone else to give you a massage.

A physical therapist can help develop an exercise program that is right for you while teaching you the skills you need to move safely and keep your back healthy.  If you are interested in taking care of your back to prevent the onset of low back pain or to address a current back pain problem you should consider seeing a trained physical therapist.

At some point throughout our childhood we have heard the phrases “sit up straight” and “don’t slouch.” During adulthood the idea of good posture is of increasingly great importance in maintaining well-being and optimal health. Especially during a time when our society has shown trends of increased time spent watching television, sitting in front of computers, working sedentary desk jobs and commuting long hours.

The long term effects of poor sitting posture have been associated with numerous painful conditions relating to the function of muscles, joints, ligaments, nerves, connective tissue, circulation, respiration, and digestion. Common associated diagnosed conditions include temporomandibular joint dysfunction, headaches, neck pain, shoulder pain, repetitive strain injuries, mid and low back pain, thoracic outlet syndrome, and myofascial pain syndrome. More importantly, poor sitting posture may adversely affect activities of daily living and overall energy level at work and home.

The concept that there is a single ideal posture is misleading. This idea does not take into account that people are proportioned differently or for example the multiple positions a worker needs to sustain to accomplish a task in varying situations. Factors that influence our postures include the environment surrounding us, our personal habits and attitudes at a certain point in time. There is no “perfect posture.” Posture is dynamic. Functionally, our bodies are reacting to and working against gravity and other stresses to maintain balance. Good sitting posture maintains the three normal curvatures of the spine. The lumbar (lower back), thoracic (mid-back), and cervical (neck) transform the spine into a flexible unit allowing the body and head to be erect with minimal muscular effort.

Prolonged static sitting position will eventually lead to feelings of stiffness, soreness, achiness and pain as body tissues become overloaded. The most commonly seen improper sitting posture is “slouching”; characterized by a rounded lower back, humped upper back, rounded shoulders, and a forward head position. The resultant alignment leads to biomechanical dysfunctions of the spine and the extremities, which include muscle imbalances, connective tissue restrictions, altered mechanics of the shoulder and spinal joints, increased vertebral disc compression and narrowing of the space in which arteries and nerves pass. In essence, poor posture allows one to become vulnerable to injury and is one of the factors which hinders healing and adequate resolution of associated painful conditions.

In most cases, it is not too late to experience the positive outcomes of improving one’s posture.  Physical therapy evaluations incorporate a postural assessment to define the severity of the postural problem, to identify contributing factors, and to recognize the possible relationship to someone’s given pain and dysfunction. Treatment of postural dysfunctions may involve regaining the normal length of shortened muscles, mobilizing stiff extremity and spinal joints, strength and endurance training of postural muscles, addressing environmental/ergonomic factors, and education of postural awareness and correction. Awareness is the key to the success of postural reeducation. Just like your body has adapted to poor posture over a number of years, you can allow your body to adapt once again to its natural structural state.

Well much of the country has experienced record snowfall this season and of course with that comes digging out of the snow.  Snow shoveling can contribute to a host of injuries to the spine, shoulders and muscles of the body.  Most of the problems are as a result of excessive bending and twisting while carrying a heavy load.  Here are some tips to avoid pain and injury from shoveling snow.

The Basics:

Think of snow shoveling as a form of exercise, so as with any exercise prepare your body for what you are about to do.

• Don’t begin shoveling snow after eating, smoking or consuming caffeinated beverages.
• Warm-up your body with some gentle movements and stretches as you would before any exercise.
• Dress appropriately.  Ensure that you have good footwear to avoid unnecessary slips and falls, dress in layers, wear gloves that will keep the hands warm and dry, and wear a hat the will keep your head dry.
• Stay hydrated.  Drink plenty of water before, during and after.
• Stop if you are hurting or you feel pain of any kind.  Don’t make a problem worse by trying to work through the pain.  The exception is the feeling of muscle fatigue, which is to be expected.
• Take plenty of breaks.  Don’t try to finish the job all at once.  It’s better to divide the work in several segments, especially if you are dealing with large amounts of snow.
• Know Heart Attack Warning Signs: chest discomfort, discomfort in other areas of the upper body, shortness of breath with or without chest discomfort, breaking out in a cold sweat, nausea or lightheadedness.  Please call for help immediately if you are experiencing these symptoms.

The Form:

Proper body mechanics is critical to avoiding pain and injury from snow shoveling.

• Use the right shovel.  Ergonomic shovels that have a curved shaft allow for better leverage and are easier on the body.  Plastic shovels are typically lighter than metal ones.
• Proper grip is important.  Don’t keep your hands too close together.  Placing your hands further apart improves the leverage, which will allow you to work more efficiently.
• Maintain proper spine alignment.  It is critical that you keep your back straight and head in line with your spine.  Your ear, shoulder and hip should always stay in line.  To attain proper spinal alignment while bending, you should bend your knees, stick your hips back, keep your back straight and tuck your chin slightly in.
• To shovel snow: keep feet apart, bend the knees, lift the shovel by straightening your knees and not by straightening your back.  If you need to move the snow, walk your feet to where you would like to dump the snow.  Never bend at the waist and twist to move the snow to the side.  Never thrown snow over your shoulder.
• Push whenever you can.  Pushing the shovel with one leg in front of the other, knees slightly bent and back straight is always better than lifting the snow.
• Lighten the load.  Don’t try to move heavy amounts of snow.  It’s better to minimize the load.

Remember to take frequent breaks and stop if you feel pain.

If by chance you do end up injuring yourself, consult a physical therapist for a consultation so that your pain and functional limitations are kept to a minimum.

APTA ENDORSES BackTpack®

ALEXANDRIA, VA, February 9, 2007 — The American Physical Therapy Association (APTA) has endorsed the BackTpack®, an innovative carrying system that uses the vertical force of gravity to ensure proper alignment of the skeleton, developed by physical therapist and APTA member Marilyn Miller von Foerster, PT.

School student wearing the BackTpack.

“Physical therapists are acutely aware of the postural problems children face when trying to adapt to a heavy load, such as arching the back, bending forward, or leaning to one side,” said R Scott Ward, PT, PhD, president of APTA. “The backpack was designed so that children and adults may be better able to maintain correct posture while carrying a load,” Ward said. “We are pleased to be able to endorse a product that can contribute to the effort to prevent back pain and improve balance.”

The BackTpack® is available in sizes for children and adults from 4′0″ to 6′3″ tall. Its vertical design allows for proper posture, and the side pockets and cell phone and pen pockets offer better balance, easy accessibility, and overall convenience when standing, sitting, or walking.

“It is crucial for lifelong spinal health to practice good posture habits, especially during the years of rapid and permanent skeletal development,” Miller von Foerster noted. “I am pleased to be able to use my education and training as a physical therapist in this way and to offer the BackTpack® as a new tool to help people of all ages achieve improved posture and reduce the incidence of back pain.”

Miller von Foerster, who has helped patients with back conditions for 35 years, is a native Oregonian and received degrees from the University of Oregon, Duke University School of Physical Therapy, and San Francisco State University. For more information on the BackTpack®, visit www.backtpack.com.

Physical therapists (PTs) are health care professionals who diagnose and treat individuals of all ages, from newborns to the elderly, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability.

The American Physical Therapy Association (www.apta.org) is a national organization representing nearly 70,000 physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access “Find a PT” to find a physical therapist in their area, as well as physical therapy news and information, at www.apta.org/consumer. For more information about the meaning of APTA’s product endorsement, visit www.apta.org/productendorsement.

Available at ISSA PHYSICAL THERAPY in a number of different styles, sizes and colors.

The BackTpack is perferct for traveling.

Great for parents on the go.

ML830 Cold Laser

Are you looking for an effective and alternative treatment option that can relive pain and help your body heal itself from chronic injuries?  Then you might consider low level laser therapy (LLLT) or cold laser therapy.

The application of cold laser sends light (photons) into injured tissues.  The photons emitted can penetrate two inches beneath the skin surface without being absorbed by the skin, fat or blood, thus targeting deeper tissues.  Once the photons penetrate injured tissues, they stimulate and energize the cells to repair and strengthen itself.  In short, the body converts laser light into a form of energy that it can harness for self repair and healing.

Cold laser has been used for over 40 years in other countries, and has been FDA approved in 2002 for safe use in the United States.  Cold laser has endless applications because of its approach to healing.  Its low intensity does not burn like other high powered surgical lasers.

The benefits of laser treatment are pain reduction, reducing inflammation and increasing tissue healing time.  It is effective in treating many conditions that limit people from leading healthy and active lifestyles such as Arthritis, Neck and Back Pain, Headaches, Shoulder Rotator Cuff Pain, Carpal Tunnel Syndrome, TMJ Pain, Tendonitis and Bursitis, Plantar Fasciitis, Fractures and many other conditions.

Most treatment sessions last between 15 – 30 minute intervals, and most conditions may take up to 5 – 8 treatments before significant improvement is noticed. Countless people are reaping the benefits of cold laser and eliminating their dependence on pain medication, delaying and avoiding surgery, decreasing and eliminating pain, and returning to a healthier and active lifestyle.

Physical Therapy an Alternative to the High Risks of Methadone

Tallahassee, Florida, August 18, 2008 – A recent investigative report1 published in the New York Times highlights the alarming increase in methadone prescriptions for the treatment of chronic spinal pain.  The result has been a shocking increase in methadone related deaths.  Physical therapists can play a role in providing patients and physicians with an alternative to dangerous pain medications like oxycodone and methadone.

Methadone was once limited to use in addiction treatment centers to replace heroin, but today it is frequently given out by physicians to manage spine and joint pain.  The Drug Enforcement Administration noted that from 1998 to 2006, the number of methadone prescriptions increased by 700 percent.  “Many legitimate patients, following the direction of their doctor, have run into trouble with methadone, including death,” noted pain specialist Dr. Howard A. Heit from Georgetown University.  Florida alone, which keeps detailed data, listed methadone as a cause in 785 deaths in 2007, up from 367 in 2003.

“These are senseless deaths,” said Dr. Timothy Flynn of Regis University in Denver, CO, and President of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT).  “Patients should be aware that these medications are not the best option to reduce the symptoms of spinal pain. Research has shown that early movement and treatments like exercise and spinal manipulation offer strong benefits to spine pain and disability.”  “The medical management of spinal pain in this country is a failure,” continued Flynn, “we too often initiate prescription drug therapy before choosing safe and effective alternatives.”  Flynn suggests that patients seek out physical therapists as a first-line treatment for these conditions.

A February 2008 report published in the Journal of the American Medical Association reports that from 1997 to 2005, pharmaceutical expenditures for the management of low back pain increased by 171% while the rate of good outcomes fell.  “All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients,” said Richard A. Deyo, a physician at Oregon Health & Science University in Portland and a coauthor of the report.  “But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.”

For more on the benefits physical therapists can provide in the management of spinal pain, contact your nearest physical therapist or visit the American Academy of Orthopaedic Manual Physical Therapists website at www.aaompt.org.  AAOMPT represents physical therapists by promoting excellence in orthopaedic manual physical therapy practice, education and research.

Dr. Richard Deyo, MD, MPH will be the key note speaker at AAOMPT’s Annual Conference in Seattle this November.  The conference theme will focus on pain management and physical therapists’ role in this important area of care.

Dry needling is an effective and efficient therapy method for the treatment of myofascial trigger points.  Trigger point dry needling is performed by medical doctors, physical therapists, nurses, chiropractors, and dentists that are specifically trained in the technique. The approach is based on Western anatomical and physiological principles. The technique utilizes fine solid acupuncture needles to release trigger points in muscle, but in all other aspects it is different than traditional acupuncture. Other terminology used to describe similar techniques to dry needling includes intramuscular stimulation (IMS) and twitch-obtaining intramuscular stimulation.

Dr. Janet Travell first described trigger point injections in the early 1940’s. Injections are performed by injecting trigger points primarily with saline or analgesics. Through the years it has been shown that it is not the substance that is being injected that is providing the therapeutic benefit, but rather the mechanical stimulus of the needle hitting the trigger point. When a needle tip hits a trigger point, a characteristic ‘local twitch’ is noted by the clinician and the client. This local twitch is involuntary. It has been shown that the elicitation of local twitch responses is the most important aspect in obtaining a successful therapeutic outcome for trigger point deactivation. There are a number of hypotheses as to the reasons why dry needling works. Dry needling and the subsequent local twitch responses may mechanically disrupt the contracted nature of the trigger point. Dry needling stimulates certain sensors in the body which modulate pain signals. Dry needling and the subsequent local twitch responses can cause local biochemical changes and result in an increase of blood flow in the trigger point area.

The benefits of trigger point release through dry needling include a decrease in the tightness and the pain associated with a particular muscle. Often times an immediate improvement is noted. Dry needling is tolerable for most, but not all people. A limited amount of muscle soreness is to be expected for 1-2 days, after which the soreness resolves. Dry needling is never used as an isolated treatment; it is followed by myofascial release and soft tissue work to minimize soreness and to maximize connective tissue flexibility. Other important aspects of musculoskeletal improvement of pain and function requires addressing possible contributing factors which includes the presence of joint or spinal dysfunction, postural imbalances, poor coordination of movement and poor posture and body mechanics with activities of daily living.

Not all medical professionals are trained in the assessment or treatment of myofascial trigger points. Trigger point dry needling requires highly specialized training. One must be adept at finding trigger points before one can attempt to treat them. If you have suffered of pain or tightness of muscular origin, I would urge to consider the possibility of trigger point dry needling as a treatment option. It has made a world of difference in many people’s lives.

Most everyone has heard the saying “no pain, no gain” when it comes to exercise. This may be true in terms of a healthy individual and when it refers to the muscle burn sensation that accompanies exercise. It may also be true in terms of the two days of soreness that follows the start or progression of a strengthening exercise program, or that follows the performance of an activity that has not been performed in a while. This soreness is better known as “delayed-onset muscle soreness” and is a normal part of the adaptation process of muscle breakdown.

“No pain, no gain” is not true when one has been injured. When one is recovering from an injury it is not wise to exercise with pain. When one is performing their rehabilitation program, one should only exercise in a pain-free range. If there is always a bit of pain present, as it is true after an injury or surgery, then you should never do exercise that creates more pain or increases your pain response. The increase of pain perception is the body’s way of letting you know you are overdoing things and that some tissues are not able to handle the stress that is put on them. The soft tissues (tendons, ligaments, muscles, and fascia) involved become weak and over-stressed.

Pain is a subjective feeling that we all have experienced at one time or another. We expect that we are going to experience pain after an injury or trauma. However, if there is no presence of pain during exercise we may think that there is nothing to worry about. This may not always be the case. Pain during exercise is the body’s way of telling us whether we are exercising too hard or overstressing our bodies. But just because pain is not present, does not mean that we may not be doing harm. For instance, a sedentary or deconditioned individual may not experience a pain response during exercise. However, then one day they find they have back pain or neck pain due to a lack of muscle endurance or some other musculoskeletal problem. For this reason, many people move into pain patterns without any apparent reason or trauma.

In summary, exercise should be performed without any increase in pain. Therapeutic exercise is utilized to promote healing, increase metabolism, and introduce gentle controlled loads so that the soft tissues can adapt to normal forces. Periodic maintenance through exercise can prevent non-traumatic pain patterns from occurring. It is important to give plenty of feedback to your physical therapist or other health professional so he or she can monitor and make any adjustments to your exercise program.

At least one member of nearly half (44%) of America’s households suffers from chronic pain. Within Maryland, 49% suffer from pain on a monthly basis and 40% experience pain almost daily.

The impact of chronic pain is devastating for the individual as well as for society. Persons with chronic pain suffer physical, psychological, and social detriments. Many say that their pain disturbs their ability to sleep and their productivity at work. It interferes with the ability to participate in daily home, leisure, and recreational activities. It can negatively interfere with sexual relations as well as relations with family and friends. Chronic pain sufferers describe feeling anxious, irritable, or depressed as a consequence of their pain. In severe cases, pain sufferers describe feeling helpless and alone. Chronic pain may be the single most costly medical problem in the U.S.

Annual costs for medical expenses, lost income, and lost productivity are estimated to exceed $50 billion. The International Association for the Study of Pain defines pain as: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described by the patient in terms of such damage.” Acute pain is indicative of inflammation and tissue damage resulting from injury, illness or recent surgery. It is short lived and usually subsides after the underlying cause and subsequent inflammation has resolved.

On the other hand, chronic pain can last for months or years. Chronic pain may start as a progression of acute pain after an injury or illness, even perhaps after the original problem has resolved. It can also be as a consequence of ongoing sources of pain related to medical conditions such as low back pain, cancer, arthritis, headaches, neuralgias, neuropathies and other pain disorders. In chronic pain, constant firing of pain signals occurs in the nervous system.

Over time, this persistent bombardment of pain signals can actually change the structure and function of the central nervous system thereby lowering the threshold of pain. For example, an individual’s perception of a normal painful stimulus can actually be perceived as extremely painful or an individual’s perception of a non-painful stimulus can actually be perceived as painful. These are only some of the examples of the complexities of chronic pain.

A skilled physical therapist will initially evaluate and treat involved painful nerves, muscles, and joints to decrease pain and improve function. This may lead to a decrease number of pain signals firing in the central nervous system and hopefully contribute to breaking of the pain cycle. Physical therapy can also be helpful in managing chronic pain by restoring normal movement patterns, developing a realistic exercise program, and providing education regarding goal setting, pacing of activity and other self management techniques.

Although the general medical approach to chronic pain is to manage the problem, there are occasions in which the underlying cause was not addressed but once treated may result in a significant improvement in one’s pain. An example of a chronic pain condition often overlooked is Myofascial Pain Syndrome, which describes pain due to sensitive knots in muscles called ‘Trigger Points’.

Despite the fact that chronic pain is a medically complex problem and can influence all facets of an individual’s life, a multidisciplinary treatment approach can alleviate one’s suffering in the management of the condition.