July 19, 2009
Over the years, I have worked with literally thousands of people who suffer from mechanical lower back pain. During that time, I have identified several self management tips that are worth knowing. These tips fall into the category of “management of biomechanics” during activities of daily living.
First of all, most people who suffer lower back pain experience the pain episodically. Each episode is worse, last longer and over time, starts to come on more frequently. This is typical, and is the main reason why management of lower back pain is worthwhile.
My tips are these:
- The pain is worse in the morning, and there is more risk in the morning. It is important then, to take care of the back first thing out of bed. This is true because during the night, the disc imbibes water creating increased intradiscal pressure in the disc before you get out of bed. You are indeed taller when you wake up than when you go to bed! So the first tip is to be cautious in the morning. I have advised people who have significant morning pain to actually get up in the middle of the night and walk around for several minutes as a way to mitigate the morning pain.
- Walking is great medicine. The literature points out that maintaining your activity is of no harm, and I believe necessary to overcome episodic back pain. Sub maximal exercise gets your blood circulating, relaxes your muscles and generally promotes good health. The weight bearing also compresses the disc and squeezes some of the water out, meaning less pressure on the nerves. So a good walk every day is helpful.
- Biomechanics is key. Be thoughtful about what you do. Face the things you do, keep lifting to a minimum, but when you do lift, keep the object as close to your center of gravity (around your belly button) as possible.
- Avoid prolonged sitting. And when you do sit, a firm chair with back support and arm rests is ideal. Try to use lumbar support when you sit. For instance, when getting on an airplane, put one of those little pillows behind your back.
- Use prolonged ice daily. I mean ice plus water in a plastic bag right on the skin for at least 30 minutes. The cold penetrates at about one cm every 10 minutes. It takes a half hour to numb the muscles and dull the pain. Be careful not to use gel ice packs because they tend to be too cold (if your freezer is below freezing) and not stay cold for long enough.
- Finally, get fit. Fit people have a much lower incidence of lower back pain than the population at large. This is more of a long term strategy, but if you are stronger, your muscles do a lot to support you. Along with this of course goes flexibility and core stability. Develop your core and don’t forget your back side when you do so. Core exercises include hamstring exercises, and back muscle exercises as well.
Back pain tends to be episodic, the episodes tend to be more frequent over time, they tend to last longer each time and also to be more severe each time. Reversing these trends is the goal of managing your back pain. Follow my advice and you will be able to do so!
Filed under: abdominal exercise
,acute back pain
,facet joint pain
,low back pain
,lower back pain
,lower cross syndrome
,nerve root compression
,pain in the butt
,physical therapy for back pain
,return to function
,SI joint belt
,SI joint Sacro-iliac joint
,SI joint stabilization
| by Neil Chasan, PT, MMT @ 11:23 am | |
July 14, 2009
As an orthopedic physical therapist who builds custom orthotics and provides custom orthotic therapy, one might be surprised that I am also an advocate of barefoot running.
I believe that running around barefoot forces the foot into an ideal posture for running unlike the sophisticated running shoes on the market today that allow and even encourage running.
The runner who is a “heavy striker” is a great candidate for barefoot running. While there have not been many studies examining the benefits of barefoot running compared to shod running, the fact is that there is a lower incidence of chronic injuries associated with barefoot running. In fact, an article in Sports Science notes that “running barefoot is associated with a substantially lower prevalence of acute injuries of the ankle and chronic injuries of the lower leg in developing countries”.
The heel strike is a normal part of the normal gait cycle in walking, but in running, it is preferable to be a mid-foot striker rather than a rear foot striker. Heel strikers are “puling themselves along” while mid foot and fore foot strikers are “pushing themselves along”. I encourage heavy plodders to try to run on their toes in order to move the strike toward the forefoot. In contrast, look at this image and see both the body posture of the runner and how by leaning forward his strike is naturally more underneath him, and as such, is naturally more of a forefoot or even mid foot strike.
I have found that one of the best ways to do this is to run barefoot. By running barefoot, there is a tendency to stay off the heel because excessive heel strike is actually painful, which should tell us something about the way the foot is designed. Remember, there is good evidence from at least a couple of world class runners, that barefoot running does not interfere with performance and, it may be argued, that barefoot running might even enhance performance.
I also want to promote a great new shoe to assist one in their barefoot running efforts. The Vibram Five Finger Classic Water Shoe, shown below is a really useful way to get into barefoot running so that as one does so the risk of injury to the sole of the foot is minimized.
Vibram Five Finger Classic Water Shoe
The shoe is available at REI for example, and costs about $75.00. Pretty good value. The people I know who are wearing the shoe are very impressed with the feeling they have about the shoe and how it gets them onto their toes during their runs.
So the take away is this: If you are having trouble as a runner with chronic injuries, or if you are a really heavy striker and you can hear your self running, or if you describe yourself as a really “heavy” runner, then you might be a really good candidate for barefoot running to help you re-educate yourself to be more of a forefoot or even a mid-foot striker. If you go in this direction, then the Vibram Five Finger Classic Water Shoe might be a good solution for you.
Filed under: achilles rupture
,custom orthotic therapy
,femoral stress fracture
,high ankle sprain
,peroneal tendon subluxation
,return to running
,return to sport
,severe ankle sprain
,shin splints posterior tibial tendinitis
| by Neil Chasan, PT, MMT @ 2:15 pm | |
July 8, 2009
I have seen a number of people recently who suffer postural headaches. In the society we live in where so many people work at a desk in front of a computer monitor, this is not much of a surprise. Computer work leads to a forward head posture that causes mechanical complaints to emanate from the sub-occipital region.
Ideal posture is defined this way:
- The head should rest over the shoulder girdle rather than forward
- The shoulder girdle should be depressed and retracted rather than elevated and protracted
- The sub-occipital region should be flexed and relaxed rather than compressed and stressed
- The Sternocleidomastoid muscle should be oriented backward rather than vertical
- The Upper Trapezius should be more vertical rather than horozontal
The causes of postural headaches could be many. For example:
- Trigger points in one or more cervical spine muslces refer pain to the head
- The TMJ might be upset which in turn can cause musculoskeletal headaches as well
- The sub-occipital joints can refer pain to the head
- Entrapment of a sensory nerve in the sub-occipital can refer pain to the head
- Bruxism or grinding of the teeth can refer pain the the head, especially if the Temporalis muscle is irritated by the process.
The key to reducing your headaches, if they are postural by nature, is to improve your posture. catch yourself with your head out in front of you, and try to retract your head by elevating your chest and bringing your head over your shoulder girdle.
In that position, do very gentle chin tucks repetitively to gently unload the sub-occipital region.
Also, get some aerobic exercise to help the neck muscles relax