Why Low Back Pain almost always Reoccurs

I had waited all year for the City of Trees half marathon.  My goal (as always) was to post a PR (personal record) for the event.  Since it was a fairly flat course, I figured it would be a good opportunity to run fast (at least, fast for me).  As part of my training protocol, I was squatting two days per week and working on general leg strength and cross training (practicing yoga) one day per week.

Group of people running.

My back had been sore off and on for almost five years.  Medical professionals didn’t offer me any specific reasons as to why.  Neither chiropractic nor physical therapy seemed to help much, so I just ignored it.  But not this day!

I had just completed my second work set of squatting at the gym.  At the time, I wasn’t experiencing any notable back pain.  I was on my second repetition and on my third set when my low back gave way.  The weight came down and hit the rack safety rails!  My back hurt, but worse, it felt unstable.  I decided to leave the gym in shame.  I picked up the weights I was using, but the pain began to worsen.

By the time I drove home, I could barely get out of my truck.  I decided I was tough, so I took some ibuprofen and still went to work.  By the time I made it to the office (about 10 minutes), I was in real trouble.  I walked around for a while, and I took some Tylenol before I decided to go home.  I got in my truck, but by then the pain was so bad that I couldn’t push in the clutch or hardly use the brakes.  I really don’t know how I make it home that morning, but I needed help from my wife to get out of my truck.

LowBackPainIt only got worse from there.  I went to lie on my bed.  Again, another bad plan!  An hour later when I needed to urinate, I realized I couldn’t even get out of bed!  The pain was worse than anything I had ever experienced.  After much struggle and help from my dad (who was called in to help), I was able to get upright, only to break out in a cold sweat, start shaking, and nearly pass out from the pain.  Still having to urinate, I experienced one of the more humbling things I have ever done.  I had to ask for help from my wife to urinate into a plastic bottle because I couldn’t get out of bed.

Long story short, I went to a doctor who diagnosed me with low back pain (LBP) from a lumbar strain and prescribed pain medication and a steroid pack.  After many more days of pain, I was finally upright again.

A month later, I was ready to start back into my training, but frankly, I was nervous!  My back felt weak, and I had no idea how much was too much.  The worst part of it all:  I’m a physical therapist!  Shouldn’t I known what to do?  It sure didn’t feel like it at the time.

The medication did mostly relieve the pain, but I had a chronically sore back that felt weak and unstable.  I was performing physical therapy exercises and stretches.  I was even using heat and electrical muscle stimulation (EMS).

My treatment wasn’t helping me that much.  At least, not to the point that I felt I could get resume my training for my upcoming half marathon.  All I wanted to do was to get back to training, but I was too scared to!

This experience started me down a path of study that changed my life.  I realized how incompetent I had been as a physical therapist who treated others experiencing severe low back pain.  I had new appreciation for those patients who wanted to get back to their sport and activity.  I also realized that my prior physical therapy interventions were not preparing people to get back to sport nor most high level activities.

What do you do when you’re past the worst of the pain and want to resume training, but you don’t feel physically, mentally or emotionally ready?  Your insurance money may be used up.  The pain may have dissipated, but you’re still not sure how to progress through the next steps.  What if it happens again?  Can I train as hard as before?  Am I really better?  I have lost so many days of training, should I even compete in my event?

Often after a severe case of low back pain, you may be too scared to train like you did prior to the injury, and it turns out you should be!  At least until you understand why low back pain almost always reoccurs and what you can do to prevent it. 

The most common treatment strategies for low back pain are too general for most active individuals, weekend warriors, sport enthusiasts, CrossFitters, weightlifters, and runners.  I have spent the past 11 years researching, studying, and refining best practices for treating LBP.  I have combined research with known anatomical and physiological principles in order to develop very specific strategies for LBP prevention among active individuals.  I have designed a complete guide and system to help you to prevent, treat, and manage LBP so that you don’t have to waste any training days because of ineffective treatment measures.

Treating Low Back Pain during Exercise and Athletics

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In this complete self-treatment package, Treating Low Back Pain (LBP) during Exercise and Athletics, I share very specific strategies for LBP prevention among athletes such as sport enthusiasts, CrossFitters, weightlifters, and runners.  These principles are helpful for anyone participating in athletics as well as those implementing a healthy lifestyle.  You’ll learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies.

LBP_Video

In this package, you get an in-depth look at treating LBP with a 7-part series of instructional videos in which I address low back pain prevention during exercise; specific warm ups for exercise and activities; what really is the “core” and why it matters; treatment techniques (including how to apply Kinesiological tape); and long term management strategies.  This includes nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports (such as running), and athletics.

product-cover-ot

In this BONUS eBook, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

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LBP_Cover_298px

Treating Low Back Pain during Exercise and Athletics (2016)

product-cover-lbp

In this complete self-treatment package, I share very specific strategies for LBP prevention among athletes such as sport enthusiasts, CrossFitters, weightlifters, and runners.  These principles are helpful for anyone participating in athletics as well as those implementing a healthy lifestyle.  You’ll learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies.

LBP_Video

In this package, you get an in-depth look at treating LBP with a 7-part series of instructional videos in which I address low back pain prevention during exercise; specific warm ups for exercise and activities; what really is the “core” and why it matters; treatment techniques (including how to apply Kinesiological tape); and long term management strategies.  This includes nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports (such as running), and athletics.

product-cover-ot

In this BONUS eBook, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

5 Tips to Prevent Low Back Pain during DIY Projects

Many of us will be planning our yearly DIY (Do It Yourself) projects now that it’s nearly summer time (in the U.S.).  I have a few minor landscaping projects that will be addressed this summer, too.  Whether it is an outside landscaping project, an indoor painting project, moving furniture around, and spring cleaning (don’t forget the garage!), you are likely to be exercising different muscles and performing activities that you aren’t used to.  It’s easy to imagine the new paint color or a beautiful landscape design.  Now imagine crawling around on the floor because you can’t stand up as your best laid plans are derailed by a bad episode of low back pain (LBP).  Not exactly the picture you were hoping for!

Exhausting work in garden

Whether you are an avid exercise enthusiast, runner, CrossFitter, weekend warrior or couch potato, you are likely to experience an episode of LBP despite being young or old.  LBP is estimated to affect nearly 80% of the U.S. population at one time or another, and it’s one of the top reasons for physician visits.  Fortunately, most LBP is mechanical–meaning it’s from a physical or structural cause not related to conditions such as cancer or infections.  The problem with this type of LBP is that it usually comes back.  People who have had an episode of mechanical LBP are 90% more likely to experience it again.

If you are going to be tackling those DIY projects and desire to still be standing upright at the end of the day, it’s best to minimize your risk factors for experiencing LBP by being proactive!

5 Tips to Prevent Low Back Pain during DIY Projects:

1. Warm up.

Just like any other exercise and/or event, you should warm up first.  A good place to start is to perform standing back extensions and press-ups.

StandingBackExtensions_PressUps

2. Loosen up.

So many of us sit too much!  This causes tightness in the hip flexors and hamstrings.  Try stretching your hip flexors and hamstrings.

HipFlexors_Hamstrings

3. Limit the amount of time spent in one position (including sitting).

Don’t sit or bend over for a prolonged period of time without at least standing up straight (and preferably, performing additional standing back extensions and press-ups as well as stretching your hip flexors and hamstrings).

If you are sitting, maintain proper posture.  Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve.  A great tool to help you with this is a lumbar roll.

4. Use common sense.

If you don’t think you can comfortably lift something, be sure to ask someone for help.  Stay within your limits, and don’t over estimate those limits!  Just because you could lift 100 lbs. in high school, it doesn’t mean that you still can.  Use common sense and proper technique when lifting a heavy object or when performing repetitive lifting.

After taking a prolonged rest, be sure to spend a few minutes warming up and loosening up again.  Don’t make the mistake of sitting down and resting during your lunch break, only to launch back into the project without making sure that your back is ready.  Take the extra time to be certain that your back is ready to start working again.

5. Preventing LBP is always best.

Once you have experienced an episode of LBP, you have a 90% chance of it reoccurring.  Be proactive!  Reoccurrence rates can be impacted and reduced!

Developing adequate strength in the lumbar extensor muscles and core musculature is the primary way to prevent initial episodes and to prevent reoccurring episodes of LBP.  Research clearly indicates that the right targeted exercises are the most effective way to manage LBP.

Stay tuned in during this upcoming month as I introduce you to my new complete self-treatment package, Treating Low Back Pain during Exercise and Athletics.  I have designed a complete guide and system to help runners, CrossFitters, exercise enthusiasts, and weekend warriors just like you (and me) prevent, treat, and manage LBP so that you don’t have to waste any training days because of ineffective treatment measures.  In the meantime, be sure to check out my FREE resource, 10 Minutes per Day Low Back Pain Prevention Guide.  Download the .pdf file, which is full of photos and exercise instructions, to get started!

For additional information on LBP, please refer to the following:

Which DIY (Do It Yourself) project do you hope to accomplish this upcoming summer?  Please share below.

Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!  If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thephysicaltherapyadvisor.com.

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

A Barbell Knee Stability Exercise for Runners

Patellar Femoral Pain Syndrome (PFPS) is the physical therapy term for runner’s knee, a common condition experienced by runners.  It accounts for roughly 25% of all reported cases of knee pain.  PFPS is a term used to describe pain in many areas of the knee including:  pain near the insertion point of the patellar tendon, just below the patella or knee cap; pain just above the knee cap where the quadriceps muscle is blending in and forming the quadriceps/patellar tendon; and/or pain underneath the patella.

Although there are many types of knee pain, many of the potential causative factors for PFPS are similar to other conditions such as IT Band Syndrome (ITBS) and Patellar Tendinitis.  Treatments for knee pain can vary wildly from person to person.  It can be quite painful and significantly affect a person’s ability to run or move properly.  In the case of PFPS, the cause of the pain is often associated with a patellar or knee cap that is tracking in the femoral groove improperly.

Common Causes and Risk Factors for Knee Pain and specifically, Patellar Femoral Pain Syndrome (PFPS) include:

  • Poor quadriceps strength (particularly the inner/medial quadriceps).
  • Poor hip abductor and/or hip external rotator strength.
  • Improper foot biomechanics during the single leg stance phase of the gait cycle or the mid foot strike during running.

One of the primary treatments for nearly all types of knee pain (including PFPS, Patellar Tendinitis, ITBS, and meniscus injury) is to improve your quadriceps and hip strength.  Quadriceps strength is an important component to your long term management and recovery.  As part of the quadriceps strengthening protocol, I have found it useful to skew toward the inner quad, known as the vastus medialis oblique (VMO).  Although you cannot specifically isolate the VMO, I still recommend implementing exercises that are likely to activate the muscle more when performed correctly.

The other critical factor is weak hip abduction and hip external (lateral) rotation muscles, which significantly contribute to PFPS.  The purpose of the lateral and external rotators of the hip is to prevent internal rotation (rolling in) of the hip and knee.  They also provide the stability for the pelvis and lower leg when in single leg stance.  The hip muscles are critical in controlling knee stability and ultimately, patellar (knee cap) tracking.  Adequate strength of the rotators and abductors of the hip is critical.

In this video, I demonstrate how to perform an advanced exercise known as the clock or star drill.  It’s an excellent exercise to work on knee stability and balance while specifically focusing on quadriceps and hip strength.  Although I demonstrate the exercise with a barbell in the video, I recommend that you initially be perform it without weight (as demonstrated below).  As you progress, then you could add weight.

ClockExercise

Have you performed the clock or star drill before?  If so, what was your experience like?  Please leave your comments below.

For more information on how to self-treat differing types of knee pain, please refer to the following:

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Q & A: Spinous Process Fracture

Q.  My son was recently injured in a weight room accident that resulted in a C7 spinous process fracture. The neurosurgeon says not to worry about it and that he can return to sport in six weeks.  He is a very talented athlete, and he’s trying to get a college football scholarship.  I’m concerned for his safety and scholarship prospects.  Do you have any advice? -Jennifer

A.  I am so sorry to hear about your son’s injury, Jennifer. Weight lifting is such a critical component to any training program as well as for those who are trying to maintain muscle mass and general health. Sadly, accidents happen and can be very serious. However, weight training will be an ongoing critical training component if your son is to compete in football at a collegiate level.

Thank you for letting me share his imaging pictures. Viewing the imaging allows for a better discussion, but please note that I have not evaluated your son.  The following advice is only for the purpose of general discussion.

Spine_Collage

(Left: X-ray of C7 fracture. Right: CT Scan of C7 fracture.)

As you can notice on the imaging provided, only the spinous process was injured. Although close to the lamina of the vertebra (which has a primary role of protecting the spinal cord), it was not injured.  This was confirmed by the physician’s physical exam, X-rays, and CT Scan. I’m glad that the injury was taken seriously with appropriate medical follow up.  One should never take unwarranted risks when evaluating spinal injuries.

This particular fracture is also known as a Clay Shoveler’s Fracture. This occurs when the end of the spinous process is either broken off by a physical impact (as in the case of Jennifer’s son when the barbell hit his neck) OR as a result of the muscle pulling so hard that it breaks the bone and literally tears off part of the spinous process.  The role of the spinous process, particularly in the cervical region, is to help limit cervical hyper extension.  More importantly, the spinous processes are there as an attachment point for muscles and ligaments.

C7 is the largest cervical vertebrae in the neck. The C7 vertebra is right in the middle of transition from the cervical spine to the thoracic spine and is home to many fascial attachments and muscular attachments from the neck and shoulder girdle.  Many of the deeper neck extensors and rotators such as the splenius capitus and splenius cervicis as well as the trapezius, rhomboids and serratus posterior muscles have C7 attachment points.

Typical Symptoms

In most cases, there is pain immediately after the injury which is often described as a burning or “knife-like” stabbing pain.  Other symptoms include muscle tightness and sharp pain that increases with repeated activity and movement of the neck or shoulder girdle. The pain is often described as feeling similar to a severe muscle strain in the upper back.  The area of fracture as well as the nearby spinous processes is typically very tender as are the nearby muscles.

If only the spinous process is injured, you should not see any neurologic symptoms. You will likely see loss of cervical motion and possibly shoulder motion as those motions will cause muscles to pull directly on the site of injury which limits one’s desire to move.  Symptoms are typically worse with the head down or when the arms are active in front of the body (such as driving or working at the computer).

Treatment Considerations

Bone healing is a complex process and will differ significantly among individuals. Factors affecting bone healing include:  the type of fracture and the patient’s age; underlying medical conditions; and nutritional status.  For a person with good health status, the bone will take on average six to eight weeks to heal to a significant degree.  In general, children’s bones heal faster than those of adults.

However, with a spinous process fracture that is separated to this degree, the bone will most likely never heal. The bone will not re-attach itself back to vertebrae.  When this occurs, it’s known as a non-union.  Scar tissue and fascia will surround the injury site and in most cases, form a solid fibrous pseudo-union between the two pieces of bone.  In most cases, there will be no deleterious effects from the injury and healing process.  Like bone healing, this process typically takes six to eight weeks for most individuals.

Acutely there is likely to be pain, but long-term pain typically subsides. However, as with all injuries, there is the risk of chronic pain or long-term irritation to the area associated with the muscle and tendon that insert/attach onto the spinous process involved in the injury.

Pain Management

Initially, I don’t recommend treating with NSAIDS (non-steroidal anti-inflammatory medication) as there is research that indicates that the healing response could be delayed. Instead and whenever possible, I would recommend other alternatives for pain management like applying heat or ice. Typically no more than 20 minutes per hour would be recommended, and don’t apply heat or ice directly to the skin (use a towel as a barrier).

Pain medication, such as acetaminophen, is always an option if recommended by your physician. You may also want to consider utilizing topical agents, which can help to decrease pain and muscle spasms. The method of action varies greatly according to the product used.  You may find that one product works better than another.  Some of my favorite products in my medicine cabinet include:  Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.

Another option is oral magnesium. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates. Taking additional magnesium (particularly at night) can help to reduce muscle cramps and spasming.  It is also very helpful in reducing overall muscle soreness and aiding in a better night’s rest.  Most people are deficient in the amount of magnesium they consume on a regular basis.  I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.  Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

Soft tissue massage of the adjacent muscles as well as electrical stimulation can both be used to reduce pain.  If pain persists, please discuss the options with your physician.

Activity Modification and Exercise Considerations

Activity involving the head, neck, and shoulders should be limited initially. In some cases, the physician may ask that a cervical collar be worn for several weeks.  Opinions on this vary greatly and will be dependent on the exact location of the fracture.

The basic idea is to avoid heavy use of the muscles that would specifically pull on the injury site. This would include muscles that flex, extend, rotate or side bend the head as well any arm movements that move the shoulder.  This would obviously include any type of heavy lifting or placing anything on top of the injury site like a barbell.

Although this seems very limiting, you can still move the neck and shoulders. Gently perform range of motion (ROM) of the neck and shoulders to maintain full mobility. This will also help to limit pain and muscle spasms of the surrounding tissues.  The idea is to limit extreme movement, limit the movement under load, and limit the speed of movement.

I would specifically limit most activity for at least six to eight weeks to insure an adequate amount of scarring has occurred. In addition to the above noted limitations, I also wouldn’t perform any activities that would be jarring to the body (such as jogging).  If you want to maintain your cardiovascular endurance, you could peddle on a stationary bike while keeping your upper body mostly relaxed.

At around the four to six week mark, I would slowly start working on the cervical extensor and shoulder girdle muscle exercises (as demonstrated below).  You will want to engage the muscles symmetrically as to not cause asymmetrical pulling over the injury site.  These exercises will help to engage the muscles (the cervical extensors and scapular muscles, including the rhomboids and trapezius muscle) specifically used to stabilize the injury site.

ITYExerciseCollage

Begin by performing these I’s, T’s, and Y’s exercises on a Thera-Band Exercise Ball. Start slowly without resistance.  Keep your chin tucked and head aligned with the body.  Move your arms slowly up and down in each position of I, T, and Y.  Start with 10 repetitions for 3 second holds, and then progress the number of repetitions as long as there is no pain.

Once you can easily and pain free perform 20 repetitions with 3 second holds, add a 1-2 pound weight in each hand and start the progression initially at 10 repetitions.  Be sure to always let pain guide the progression.  The exercise should remain pain free.

After the six to eight week mark, initiate a slow, but steady return to exercise. Start with lower extremity exercises such as the leg press, body weight lunges, squats or step ups.  During this time, progress with targeted exercises designed to strengthen the muscles of the mid trapezius, rhomboids, and neck extensors.

Let pain guide your progression. If you perform an activity that causes pain near the injury site, then that activity should continue to be avoided in the short-term.  Continue to perform exercises bilaterally to be sure that the force/pull over the injury site is symmetrical.  For example, when you start on rowing, then it should be a two-handed row and not a one-handed version.

Progression of exercise of the associated muscles should be slow and again, pain should be carefully monitored. Any pain provoking movements early in the rehabilitation phase should be avoided.  When returning back to weight training, start with a weight approximately 50% of your prior max.  Work within that weight for a week or two, and then slowly progress back to the prior weight used (depending on your symptoms).

You may also return to light jogging. If there is no increase in your pain level, then slowly progress back into full running and sprinting.

Exercises to avoid for at least twelve weeks include: barbell squats; overhead press; power cleans; squat cleans; and snatches.  Avoid anything that would put direct pressure over the injury site or exercises that include a speed and power component under load (such as the power clean).

Rehabilitation Recap

Due to the amount of information presented, I want to re-iterate the important parts of the rehabilitation process. Be sure that you have your physician’s clearance prior to resuming activity.

0-4 weeks: This is the time for pain management and activity modification. You want the area to scar down.  Exercise and activity should be limited although you should maintain full range of motion (ROM) of the neck and shoulder girdle if possible.

4-6 weeks: Initiate a cervical stabilization program and scapulothoracic exercises starting without any resistance.  Perform the I’s, T’s, and Y’s exercises on an exercise ball (as demonstrated above).  Progress with these exercises and continue with cardiovascular exercise such as riding a stationary bike.  You may also start bench pressing, but begin light and monitor your pain level.

6-8 weeks: Progress with shoulder and upper back exercises. Be sure to use two-handed movements.  Depending on your pain level and strength, lower body exercises can be initiated.  Begin with body weight exercises, and then progress to resistive exercises.  Continue to limit direct pressure over the injury site or asymmetric forces.  Lower body exercises, such as the leg press and dead lift, may be started.  Exercise should be mostly pain free.  If you experience pain during an exercise or movement, discontinue for now and then retry it in a week or two.

8-12 weeks: During this phase, slowly start tapering up on all activity.  During this time, you can progress your jogging to eventually sprinting as well as road bicycling.  You can progress back into lower extremity exercises as tolerated as long as there isn’t any significant associated pain at the injury site.  Focus on neck and upper extremities exercises with two-hands/arms bilateral exercises.  Focus on exercises that develop strength in the muscles surrounding the injury site without causing increased pain or asymmetrical force.  The preference is for two-arm movements for now.  This is also the time to start working on thoracic mobility to insure the entire vertebral chain can move freely.  Be sure to have full shoulder and cervical mobility.  Continue to avoid any specific pressure on the injury site.  If you haven’t already, you could start the following:  dead lifting; front squat; and lunges with load.

12+ weeks: Return to full activity. However, let pain and common sense continue to be your primary guide.  At this stage, you can return to light squatting.  I recommend a low-bar position as this typically lines up just below the spine of the scapula and should be below the C7 injury site.  Start single arm movements, such as a one-armed row, as well as power movements, such as the clean and snatch.  You can also initiate overhead lifting.  The key is to progress slowly and see how your body responds.  Begin with 50% of the load used prior to your injury.

If you don’t already own a copy, I would highly recommend that you purchase Starting Strength: Basic Barbell Training by Mark Rippetoe. This text should be regarded as the authority on strength training and should be used as a guide for beginners to advanced weight training enthusiasts.

Once a full return to weight training activities has been accomplished, a full return to sport should also be possible. Any sports that involve high impact, such as football or mixed martial arts, should have your physician’s approval in order to insure that the fracture is stable.  In most cases, the level of pain present will be a great indication of how stable the injury site is.

If you are unsure about how to properly progress in your training and rehabilitation, I recommend that you work with a highly qualified trainer or sports medicine professional to insure that you are performing your particular exercise and sport in a manner that will keep you safe and the fracture stable. The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it’s a good idea to hear your physician’s opinion as well).

Good luck to your son and you, Jennifer! I hope you find this information helpful.  Thankfully, this type of injury usually results in a full return to function without many long-term deleterious effects.  The key is to allow adequate healing time, and then slowly and strategically progress back into full activity.

Have you ever suffered from a spinal fracture or avulsion fracture? Have you experienced an accident while weight training?  Please share your story below.

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com. For additional health and lifestyle information, join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

How to Self-Treat Patellar Tendon Pain with a Mobility Band

Patellar tendon pain (often called patellar tendinitis or patellar tendinosis) occurs when the tendon connecting your knee cap (patella) to your shinbone becomes inflamed and irritated. Patellar tendinitis is often called “jumper’s knee” because it occurs so frequently in sports like basketball and volleyball.  It also affects runners due to poor lower extremity biomechanics during running.

Patellar Tendinitis symptoms include:

  • Pain directly over the patellar tendon.
  • The tendon is usually tender and swollen.
  • Knee motion can cause “crepitus” (when you hear and feel a crunching or grinding sensation). This may or may not be painful. It’s usually felt under the tendon or the lowest part of the knee cap.
  • Pain with jumping.
  • Pain with kneeling.
  • Pain when walking downstairs.

PatellarTendonPain

The initial course of treatment should include RICE, which stands for Rest, Ice, Compression, and Elevation.

  • Rest. In this case, rest would indicate tapering down from your regular exercise activity and discontinuing running (for the short term).
  • Ice. Apply ice to the painful area. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response, so limit it as much as possible.
  • Elevation. Depending on your pain level and the amount of swelling present, this step may be more or less beneficial.

In this video, I demonstrate how to utilize a mobility/compression band as a self-treatment method for patellar tendinitis. Mobility/compression bands, such as the Rogue Fitness VooDoo X Bands or EDGE Mobility Bands, are a novel way to self-mobilize tissue either of the quadriceps or the patellar tendon. The use of a mobility band not only helps to mobilize the tissue, but it affects blood flow to the area and speeds up healing.  A mobility band also helps to reset some of the receptor cells in the muscle tissue which cause excessive muscle tightness.

As demonstrated in the video, start by applying the mobility band just below the tibial tuberosity, and then over the patellar tendon to the base of the patella. Next, perform the seated knee extension and then the squats.  Typically, the mobility band will only be in place for one to two minutes.  If you experience numbness or tingling, please discontinue the treatment.  (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.)

In addition to utilizing the mobility band, I often find that it’s critical to improve general tissue mobility. I recommend stretching and mobilizing the tissues of the lower legs.  Myofascial release of the quadriceps muscle is an important component in order to relieve the pain while reducing the pressure and tension through the patellar femoral tendon and joint.  This is typically a very effective and important step as most will find pain relief from improving quadriceps mobility.  I tend to utilize the foam roller for the larger part of the quadriceps.

LacrosseBallForQuad

I also use a tennis or lacrosse ball to aggressively work the tissue above the patella. You can use your hand to press the ball in and work it around the tissue.  To use the weight of your leg for a more aggressive mobilization, place the ball on the ground and mobilize the tissue with your leg on top of the ball.

For additional helpful tips and tricks on treating knee pain, please refer to my guest post for the Marathon Training Academy, How to Self-Treat Runner’s Knee.  Much of the advice and training recommendations are also relevant to treating patellar tendinitis.

Have you tried using a mobility band before to treat patellar tendinitis? If so, what was your experience like?  Please leave your comments below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Masters Runners: Body Changes and Injury Prevention Strategies

MTA_MastersRunners

http://marathontrainingacademy.com/masters-runners

Marathon Training Academy

April 18, 2016

In this guest post for Marathon Training Academy, you will learn how running and a healthy lifestyle can help to slow down age related declines. As a masters runner, discover how implementing these injury prevention strategies can help you to enjoy running for a lifetime.

SeniorRunnerThe question most often asked in regard to the older runner: Is it safe? The answer is yes!  Running can actually help to decrease some of the physiological declines that occur with age.  Who is considered to be an older or masters runner?  Typically, masters runners are over the age of 40.  Shocked?  Me, too!

While it’s true that getting older is not for the faint of heart, it’s also true that if you do nothing, the following age related declines in physical functioning will occur regardless. Implementing exercise while adjusting your diet can help to slow down age related declines so that you can age gracefully.  And, yes, running can be part of that process!  Continue Reading

3 Simple Exercises to Help You Age Well

We are all capable of navigating a successful aging process if we are intentional with our behaviors.  Although successful aging has a different meaning for each of us and outcomes will vary, commonalities exist in most scenarios.  In order to age successfully, you will need to fully embrace what it will take to accomplish the goal of living safely, independently, and comfortably within your community.

Elderly couple walking through the park hand in hand

Mobility is vital to independence.  Independent mobility is different for everyone.  It may be through ambulation or use of an assistive device such as a cane, walker or wheelchair.  You need to maintain the ability to be independently mobile regardless of utilizing a mobility or assistive device.  Aspects of maintaining mobility include adequate balance, strength, and endurance.

The following 3 simple, yet vital exercises will help you to maintain your functional mobility and independence:

Walking

Walking is a wonderful method of exercise.  Out of all the possible movements humans can perform for mobility, we are best at walking!  Since most of us started at a very early age, we are familiar with walking.  It has different purposes and offers many benefits.  We walk to get somewhere, to have fun, to relax, and to exercise.  Compared to other activities, walking is easy on your body and can fit into your busy schedule.  Walking daily can reduce stress, improve circulation and hormone regulation, maintain strength and bone density, reduce pain as well as benefit your overall well-being.  It just makes you feel good!  Walk daily!

Squatting

Squatting in some form or capacity is a normal part of daily life.  The muscles needed to perform a squatting motion or a sit to stand motion are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something.  This motion helps to maintain lower extremity strength and range of motion as well as maintaining bone density and proper hormone regulation.  It can also help improve balance and even aid in digestion.  A simple method to practice this exercise is to move from sitting to standing.  As you improve, find a lower surface to practice from.  Eventually, the goal would be to move into a full squat (as long you don’t have any medical barriers that would prevent that particular motion).

Standing on One Foot

Balance is an important part of mobility.  It is usually overlooked and taken for granted until mobility is significantly affected.  Like all exercise, balance exercise should be fun and convenient.  Balance, just like muscle strength, is a use it or lose it proposition.  A simple, yet effective method to maintain and/or improve balance is stand near your kitchen counter and practice standing on one leg.  You should be able to stand for at least 30 seconds.  To increase the difficulty, practice balancing with your eyes closed.

These three exercises are critical for maintaining mobility and function as we age.  Walking and squatting are some of the first abilities we develop as children, and they need to be the last ones we lose as we age.  Your ability to perform these exercises is fundamental to how you are able to function throughout your life.

Which of these three simple, yet vital exercises can you implement in order to maintain your functional mobility and independence?  Please leave your comments below.

Looking for relevant senior related resources in your community?  The Seniors Blue Book is full of relevant resources for seniors as well as helpful articles on successful aging and elder care.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

(This article first appeared in the Seniors Blue Book, April through September 2016, pages 116 and 117.)

Why Exercise can Reduce Your Risk of Falling

There are many aspects that should be addressed as part of a thorough fall prevention program. None of them should be to limit mobility except in only the most extreme scenarios.  A thorough exercise program is a critical first step in reducing falls.  The American College of Sports Medicine (ACSM)’s Exercise and the Older Adult and The Office of Disease Prevention and Health Promotion’s Physical Activity Guidelines both state the need for all adults (and especially, older adults) to remain active in order to reduce the risk of falling.

Senior couple in the gym

A thorough exercise program should address the following four basic areas of fitness and mobility: balance; strength; cardiovascular (aerobic conditioning); and flexibility. Before starting a new exercise program, it’s best to consult with your physician to resolve any potential medication issues and be certain that you are healthy enough for exercise.

Balance

Visual System

This is the relationship of the head and eyes to your surroundings. Most people are very dependent on their eyesight for balance. Eyesight is easily impaired in dark or dimly lit environments. It tends to decrease with age due to medical conditions, such as glaucoma or macular degeneration.

Vestibular System

Our vestibular system is part of our inner ear. It provides us with information on head acceleration and gravity. It also works closely with our brains to process information on the head’s position in its environment. It helps us produce reflexes which affect our sense of equilibrium and our eyes’ ability to hold a gaze on a desired target.

Somatosensory / Proprioceptive System

The integration of the neurological system (including the brain and nerves throughout the body) with the musculoskeletal system is the somatosensory system. This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. This also includes our ability to distinguish between hot and cold.

Proprioception, which is part of the somatosensory system, is a fancy word describing our brain’s ability to know where we are located in space. For example, if we close our eyes and lift our arms overhead, we know where our arms are located.

A common problem affecting the somatosensory system is neuropathy. One very common form of neuropathy is from diabetes. Neuropathy is when the nerve cells (typically in the extremities like hands and feet) will die. This may be due to poor blood supply, trauma, infection, disease, or even side effects from medication. The death of the nerve is the “neuropathy” which presents initially when a person may feel cramping, shooting or burning pain. Ultimately, it affects the person’s ability to feel sensations which causes numbness. Having numb feet makes it very difficult to balance!

For more information on balance, please refer to Q & A: How Do I Improve Balance? (Part I).

Strength

Strength training is ideally performed two or more days a week and includes a rest day in between sessions. The focus should be on a slow regular progression of weight bearing exercises which are designed to improve posterior chain strength. This includes the back extensors, buttocks, and hamstring muscles. The focus should also be on the calves and quadriceps muscles. Each plan must be designed for you as the individual.

The overload principle states that a greater than normal stress or load on the body is required for training adaptation to take place. The one exercise that should be addressed in some form or another is the squat. This basic movement insures that you can move from a sitting to standing position.

In short, the squat works just about every muscle in the trunk down toward the legs. These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something. The squat is a critical exercise to maintain mobility and function as we age.

Cardiovascular (Aerobic Conditioning)

Aerobic conditioning is ideally performed for a total of 150 minutes per week. It should be performed in at least ten minute intervals at a moderate intensity.

High Intensity Training (HIT) or High Intensity Interval Training (HIIT) may also be implemented into a cardiovascular training program. The research on the effectiveness of HIT continues to grow. Even more impressive are the findings that HIT can be safely performed at any age and with almost every medical condition.  It’s now even being implemented in many progressive Cardiopulmonary Rehabilitation Programs, where people are recovering from all kinds of cardiac and pulmonary disorders such as COPD, heart attacks, and heart valve replacements.

Perform your cardio activity in short bursts (ranging from 30-60 seconds at a time) followed by a one to two minute recovery. The 30-60 seconds should be at a high intensity, meaning your rate of perceived exertion (RPE) is high. You should be breathing heavy.  Accommodations can be made for almost any type of medical condition.  For example, HIT may be performed while using a stationary bicycle, an upper body only bicycle, a rowing machine or in the pool.  You can also walk uphill at a quick pace, then stop and rest.  The point is to get your heart rate up, and then bring it back down for a full recovery prior to repeating.

Walking should also be implemented into a daily cardiovascular program. Ideally, your walking program will be separate from your specific 150 minutes of cardiovascular exercise per week.

Flexibility

Stretching is ideally performed 10-15 minutes for five days per week. An excellent time to work on a flexibility program is after a workout.  Static stretching is an excellent method to maintain flexibility, and it’s ideal to perform during a cool down.

Tai Chi is an excellent form of exercise that positively affects your flexibility, strength, and stability while stimulating the somatosensory system. Yoga, like Tai Chi, also addresses many of these same areas.

Foam rolling is also an excellent method to improve flexibility. Individuals taking blood thinning medications or with blood clotting disorders should consult his/her physician prior to using a foam roller for mobilization.

For more information on flexibility, please refer to How to Maintain Healthy Joint Motion.

Each exercise program should be tailored to the individual. A physical therapist can help you design and implement an exercise program.  Physical therapists can also help you address the risk factors listed in What You can do to Prevent Falls.

The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Which area of fitness and mobility (balance, strength, cardiovascular, and flexibility) could you specifically improve on in order to reduce your risk of falling? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

What You can do to Prevent Falls

“Falls don’t just happen, and people don’t fall because they get older. Often there is one underlying cause or risk factor involved with the fall.” –National Institutes of Health (NIH)

Many older adults are concerned about the possibility of falling. In many cases, such apprehension leads to a reduction in activity which only increases the risk of falling and debility over the long term. I recently had the opportunity to speak to a large group of adults regarding the topic of falling. The intent is not to scare people, but to encourage everyone that most falls are preventable!  The goal for healthy aging is the opportunity to live well, be active, and feel empowered to live your life the way you want to.

Son with Elderly Father

The Truth about Falling

  • One-third of adults over 65 fall each year and more than half of adults over 80 fall annually.
  • In older adults, falls are the leading cause of fatal and non-fatal injuries.
  • Adults over 75 are five times more likely to be admitted to a nursing center for over a year from an injury related fall.
  • 20-30% of older adults that fall suffer a moderate to severe injury including lacerations and fractures.
  • Recent information from the Centers for Disease Control and Prevention (CDC) show that each year at least 250,000 older people (those 65 and older) are hospitalized for hip fractures.
      • More than 95% of hip fractures are caused by falling.
      • Women fall more often than men, and experience three-quarters of all hip fractures.
      • Women are more often diagnosed with osteoporosis and osteopenia, a disease that weakens bones and makes them more likely to break.
      • The older you are, the greater the chances of breaking your hip when you fall.
      • Over 20% of people who suffer a hip fracture will die within one year and over 50% that survive will never return to their prior baseline.
      • For excellent patient resources, please refer to Older Adult Fall Prevention.

Fall Risk Factors

Intrinsic (Self Risk Factors):

  • Balance and gait impairments.
  • Visual and motor reaction time problems.
  • Medication side effects and reactions. (Polypharmacy refers to taking more than four medications.)
  • Visual impairments.
  • Cognitive impairments.
  • Cardiovascular issues.
  • Incontinence (loss of bladder or bowel control).
  • Medical complications such as urinary tract infections or dehydration.
  • Vestibular dysfunction.

Extrinsic (External Risk Factors):

  • Poor lighting.
  • Stairs with poor railings.
  • Throw rugs or slick floors.
  • Improperly fitting clothing or footwear.
  • Lack of or improper use of assistive devices such as canes or walkers.
  • Cluttered living areas.
  • Rushed movements such as hurrying to answer the phone or a door.

What You can do to Prevent Falls

Fall Proof your Home:

  • Make sure that you have adequate lighting. This eliminates potential trip issues and helps if you have a visual impairment.
  • Remove loose throw rugs or tack them down.
  • Avoid slick floors.
  • Remove clutter from the floor.
  • Add grab bars and hand rails as needed in the bathroom or near steps and stairs.
  • Re-organize commonly used items to make them easier to reach.
  • Make sure you have clear pathways with extra room to accommodate any assistive devices such as a walker.
  • For an excellent resource for practical strategies to fall proof your home, please refer to http://nihseniorhealth.gov/falls/homesafety/01.html

Fall Proof Yourself:

  • Have your eyes regularly checked and always wear appropriate eyewear. For example, if you wear reading glasses, don’t wear them when you’re walking.
  • Be sure your footwear and clothing fit appropriately. Pants can fall down off your waist and cause you to trip. Pant legs that are too long or improperly fitting shoes are also common trip hazards.
  • Use your assistive devices, such as canes and walkers, appropriately and be sure they fit properly.
  • Be sure you have adequate lower leg and core strength.
  • Be sure you have adequate balance and stability.

Many research studies indicate that exercise can reduce the risk of falling. A thorough exercise program should address aerobic conditioning, strength, balance, and flexibility.  For more information, please refer to Why Exercise can Reduce Your Risk of FallingBefore starting a new exercise program, it’s best to consult with your physician to resolve any potential medication issues and be certain that you are healthy enough for exercise.

Most falls are preventable if you are proactive. A fall can significantly and permanently alter your ability to care for yourself and function independently.  Maintaining your physical function and mobility is a critical component to aging well and gracefully.  For more information, please refer to 8 Easy Strategies to Limit the Risk of Falling.

Have you or a loved one been injured from a fall? Which strategy can you implement to reduce your risk of falling?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.