Posted on Wednesday, August 29, 2018

Does Kinesiological Tape Really Work?

I was first introduced to Kinesiological (Kinesio) style taping during a continuing education class in 2005. Since then, this style of taping has exploded in the mainstream with athletes and celebrities alike wearing it. Research on this modality was initially scant. Today there are over 540 published studies with even more antidotal testimony! Although the research is ongoing and published regularly, I get asked all the time about what can you use Kinesiological tape for and how exactly it works. I will review three theories on how Kinesiological tape actually works and the different reasons for using it.

Kinesiological Taping For Achilles Tendinitis

How does Kinesiological Tape Work?

Sensory Theory (also known as the Gate Control Theory) – The basic premise of this theory is that the Kinesiological tape, when applied to the skin, activates sensory receptors present on the skin. These receptors relay information to/from the brain. Since the sensory receptors are faster than other types of receptors (such as pain) the brain reacts to the sensory information first. This can lead to altered movement patterns and awareness to the area. It can also allow for decreased sensations of pain. This theory is similar as to why we think topical analgesics (such as Biofreeze) work as well as why transcutaneous electrical nerve stimulation (TENS units) can reduce pain.
Circulatory Theory – The basic premise of this theory is that the when the Kinesiological tape is applied with little tension it forms convolutions in the skin. These convolutions create channels and reduce pressure within the tissues, lymph system, and circulatory system which aids in blood and lymphatic flow.
Muscle Activation Theory – The premise of this theory is that when the Kinesiological tape is applied at different levels of tension on the skin over the muscles and tissues, the Kinesiological tape can either mechanically or neurological increase or decrease muscle activation via a nervous system response.

Presently the truth behind Kinesiological taping is that we really don’t know exactly how or why it works. Based on my clinical experience, I believe that the Kinesiological tape interacts with the body’s tissues in different ways depending on how and where the Kinesiological tape is applied. Depending on how the Kinesiological tape is utilized, any one or combination of the three theories is likely correct.

Research states that Kinesiological style taping is at least as effective as other minimal interventions for musculoskeletal pain which may include topical analgesics like Arnica montana (Arnica Rub) or Biofreeze.

Research has also shown that taping can reduce pain acutely within first week of injury and possibly even in cases of pain which has been present for as long as three to four weeks (or longer).

Research concludes that there are some improvements in muscle and joint range of motion (ROM) and a reduction of pain. However, because the improvement isn’t significant or long standing it shouldn’t be used as a standalone intervention. Kinesiological taping is best used in combination with other interventions (such as manual therapy based techniques and exercise) which have been proven to affect outcomes over the long-term.

When Kinesiological tape is used in conjunction with other treatments, it may help speed up the recovery as the Kinesiological tape can allow for other techniques to be utilized more effectively due to the loss of pain, swelling or easing of movements.

Although there have been hundreds of research studies performed, the effectiveness of Kinesiological tape is still questioned primarily due to issues with research design. Many of the taping applications are based on theory and not science. Since there isn’t a consistent application pattern, the research studies aren’t comparing the same techniques over large enough patient populations to show a true effect. In addition, researchers still need to quantify how much tension is actually being used and the actual Kinesiological taping technique being used versus other types of techniques or interventions.

Unfortunately, without better quality research it’s unclear if the results shown in many of the studies are due to an actual effect or through placebo. For now, none of the studies show significant benefits regarding long-term pain alleviation or improved strength or range of motion (ROM). So for now, the main conclusion is that Kinesiological taping should be used only as a short-term treatment in combination with other treatments. I personally use Kinesiological tape, and I often find that my clients experience success with specific tape applications for different conditions.

What do you use Kinesiological Tape for?

Reduce pain
Reduce swelling and edema
Support muscles and joints
Reduce muscle tension
Increase strength
Improve performance
Enhance or correct movement patterns through stimulation of sensory receptors
Provide compression
Enhance healing by slightly lifting skin away from sore or injured tissues to improve blood flow and lymphatic drainage
Support injured joints and muscles without impeding range of motion (ROM)

There are dozens of companies’ now manufacturing Kinesiological style tape. There are many high quality tapes being manufactured with all kinds of colors, designs, and variations in adhesive quality and elasticity. Personally, my favorite brands are based on price point and actual use. This includes ease of application and how long the Kinesiological tape actual stays on. The brands I use most include: Kinesio Tape, RockTape, Thera-Band Kinesiology tape, Spider tape, and KT TAPE. Although there are many more brands available, I have not personally used them.

There are many different applications Kinesiological taping can be used for. Like any treatment modality, it can work wonders for one person and do nothing for another, but should we really be surprised? Many of our most popular pharmaceuticals are no different. Kinesiological taping has the benefit of rarely having significant side effects. There are rarely side effects to utilizing this style of tape as the products utilized tend to be very hypoallergenic. Occasional skin irritation has been the only noted side effect I have known of in my clinical experience. In order to avoid skin related issues (including application and removal tips), please refer to Skin Care with Taping.

I have found success with utilizing Kinesiological taping as an adjunct treatment strategy and as part of a complete treatment approach. If you are interested in specific applications for different conditions, please see the following in which I demonstrate different taping techniques.

Have you tried using Kinesiological taping before? If so, what was your experience like, and did it help you? 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!

Posted on Wednesday, December 14, 2016

Q & A: How did I get a Stress Fracture in my Foot?

Q. I have been diagnosed with a stress fracture in my foot. What causes a stress fracture? Now what should I do? The doctor wants me to avoid any weight bearing for the next four weeks. How do I heal? –Denise

A. Thanks for your question, Denise. I’m sorry to hear that this has happened to you. Stress fractures are a unique type of bone fractures as they rarely occur due to a specific trauma. Stress fractures typically occur due to a silique of events that leads to the bone not being able to handle the stress of your activity which results in a crack in the bone. Stress fractures are common in the foot, but they can occur almost anywhere.

Initially, you might barely even notice the pain associated with a stress fracture, but the pain tends to worsen with time. The tenderness usually originates from a specific spot and decreases during rest. As the injury worsens, the pain tends to spread out and become more diffused with a focal area of tenderness. You might have swelling around the painful area. In some cases, the entire foot may begin to swell.

Stress fractures typically occur as the bone is subjected to a new unaccustomed force without enough time for recovery. Bone adapts gradually to increased loads through remodeling, a normal process that speeds up when the load on the bone increases. During remodeling, bone tissue is destroyed, and then rebuilt. This is a similar process in muscle tissue. When the load and/or volume of activity are too much for the bone, a fracture will occur.

Risk Factors for a Stress Fracture:

Certain sports. Stress fractures are more common in people who participate in sports such as track and field, basketball, tennis, dance or gymnastics. High repetitive impact sports tend to have the most stress fractures.
Increased activity. Stress fractures often result from increasing the amount or intensity of an activity too quickly. For example, people who suddenly shift from a sedentary lifestyle to being more active (increasing training volume significantly) or those who rapidly increase the intensity, duration or frequency of training sessions.
Gender. Women are more likely to develop a stress fracture, especially those who have abnormal or absent menstrual periods (known as amenorrhea).
Foot problems. People who have flat feet or high, rigid arches are more likely to develop stress fractures. Worn or poorly fitting footwear or high heels can also contribute to this issue. For runners, transitioning too quickly from a more built up running shoe into a minimalistic style can be a factor.
Osteoporosis. Osteoporosis or osteopenia causes weakening in the bones that makes it easier for stress fractures to occur.
Prior stress fractures. If you have experienced one or more stress fractures, you’re at a higher risk.
Poor nutrition. Lack of Vitamin D, calcium, Vitamin K, and magnesium can make bones more likely to develop stress fractures. Generally poor eating habits are also a factor.
Hard surfaces. Spending long periods of time or training on hard surfaces, such as concrete, can increase your risk.
Smoking. Smoking leads to poor blood flow and affects the body’s ability to heal and recover.
Obesity. The heavier you are, the more forces that ultimately go through your foot. Depending on how you are exercising, your particular footwear and the surface which you walk on can contribute to increasing your risk factors.
Gait abnormalities. Alterations to your normal mobility (from either another injury or a change in your body) that affect how you typically move. The change in mobility, along with your activity level, can be enough to overload the bone. Particularly, when other risk factors are present.

In most cases, it’s not one specific risk factor that leads to the stress fracture, but a combination of risks and events that lead to the injury. Diagnosis is usually through X-ray. However, an acute injury may not initially show, so a second X-ray may be needed after a week or so to confirm the diagnosis. A bone scan can also be useful to determine if there is an injury to the bone.

In the case of a poorly healing bone, the use of a bone stimulating electrical device may be recommended by your physician.

Initial Treatment

Non-weight bearing or limited weight bearing for four to six weeks is a very common course of treatment. It provides enough time to initiate the healing response while reducing the stress on the injury site. If you continue to stress the site of injury, the fracture can worsen and require more invasive treatments (possibly even surgery). Crutches, a walker or a Roll-A-Bout knee walker can be used while you have weight bearing restrictions. A walking protective boot is also typically used to protect the injury site.

As with many injuries, the initial treatment for a stress fracture in the foot is PRICE (Protection, Rest, Ice, Compression, and Elevation).

Protection. Wear a walking boot, and limit weight bearing on the foot.
Rest. Limit any activities that cause pain. Depending on the severity and your personal health status, this can last from two to eight weeks. Those with diabetes usually take a significantly longer period of time to heal.
Ice. Use ice as needed for pain and edema control. 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. If swelling is present, utilize a simple ACE wrap around the foot and ankle to help with the swelling and pain. Start at the toes, and work up the leg. Take care to not apply the ACE wrap too tightly as over squeezing the foot can be irritating.
Elevation. Use pillows to position the foot above the level of your heart to help reduce swelling. This would be an excellent time to apply ice, too.

In general, the application of heat, cold, or over the counter (OTC) topical agents, such as Arnica Montana (an herbal rub) or Biofreeze, may help you to manage pain and stiffness.

Addressing Your Risk Factors

After you have initiated PRICE and the pain and swelling has decreased, address any risk factors (if and when possible).

Stop Smoking

If you smoke, please stop. It not only affects your bone density, but it has negative effects on every other body system. It also increases your risk of cancer and heart disease.

Nutritional Management

Address any nutritional deficits. This includes having adequate levels of Vitamin D3, Vitamin K1 and K2, magnesium, and healthy fats.

Vitamin D3 is critical to the absorption of calcium, through the intestinal wall, which is important for bone health. Although calcium is a critical component of bone health, I cannot recommend extra supplementation because of the potential cardiac risks to over supplementation. A healthy varied diet will typically supply adequate calcium levels (assuming that adequate Vitamin D3 levels are present for absorption and that you are avoiding drinking soda). Vitamin D3 is also a critical nutrient in maintaining a healthy immune system.

Research indicates that Vitamin K can help to reduce bone loss by helping the body regulate osteoclast function with in the bone. An osteoclast is a type of bone cell that breaks down bone tissue. These very important cells are integral in maintaining proper bone density and insuring an appropriate amount of calcium in the blood stream. Without adequate calcium, many critical cell functions can be affected (including heart function). Both Vitamin K1 and K2 have been proven to reduce the risk of fractures, including hip and vertebral.

Vitamin K, found in green leafy vegetables, has anti-coagulation benefits. If you take blood thinning medications, your physician will need to know how much you consume on a regular basis.

Magnesium is a critical component of bone health and health in general. Magnesium helps the body to regulate calcium levels. This has a positive effect on bone health and also has been proven to reduce the risk of kidney stones.

I also use magnesium as a sleep and recovery aid. I consume it at night to help me sleep. Magnesium can also reduce muscle soreness, cramps, and/or spasms. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.

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 in 100 mg intervals 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 quite as absorbable, Thorne Research Magnesium Citrate is also a fantastic product.

If you’re female (and especially if you suffer from amenorrhea, abnormal or absent menstrual periods), then consuming adequate levels of fats is pertinent. Adequate levels of Omega-3 fatty acids and other healthy fats (primarily from plant sources such as avocados and coconut or olive oil) are critical in order to insure that your body has what it needs for proper hormonal support. Amenorrhea can be a sign that your diet is lacking in adequate high quality fats as well as a sign of overtraining.

Avoid Soda and Distilled Water

Excessive soda intake (particularly diet soda) has been linked to poor bone density. The exact cause isn’t entirely clear. Many theorize that the acidic nature of the soda along with the chemicals and additives cause increased osteoclast activity in the bones. This releases more calcium into the blood stream in order to help fight the negative effects of soda consumption. It’s clear that too much soda is bad for your health and bones. Similarly, distilled water is water that has been leached of all other nutrients and minerals. Drinking too much distilled water can leach needed nutrients out of the bones.

Weight Management

It’s important to manage your weight effectively. Excessive body weight can cause additional stress on the body. Whenever possible, work toward optimizing your health. This includes maintaining a healthy body weight. The heavier you are the more stress forces present throughout the lower extremity.

Rehabilitation

Once you’re cleared by your physician to initiate exercise and activity, it’s time to progress your rehabilitation. For detailed descriptions and photos of potential helpful exercises, please refer to Foot Stress Fracture Rehabilitation Exercises. (If you’re already working with a rehabilitation professional, such as a physical therapist, consult with him or her prior to starting my recommended rehabilitation exercises.)

Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the tissues on the bottom of the foot including the plantar fascia. I recommend initiating a complete ankle/foot strengthening protocol. Please refer to Ankle Resistance Exercises Using the Elastic Exercise Band.
Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as weakness in the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which ultimately can lead to a stress fracture or even metatarsalgia. Improving your balance can help to reduce the risk of metatarsalgia and is an important part of the rehabilitation process. For more ideas on how to improve your balance, please refer to Improving Balance by Using a Water Noodle. As your pain level improves, I recommend that you perform these balance exercises without shoes on.
Add an orthotic. Often times, the stress fracture occurred due to alterations in foot mechanics or an old or poorly fitting shoe or orthotic. If you are recovering from a stress fracture, consult with a podiatrist or a physical therapist that specializes in orthotics to determine the proper orthotic or shoe for you.
Did you progress too quickly into a minimalistic shoe? The standard built up shoe offers more foot support and padding than most minimalistic style shoes. If you attempted a quick progression, this may have contributed to the injury. Unless you are a child or teenager, expect a safe transition to take at least three months. A slow transition will allow your body to adequately adapt to the new stresses.
Weight training. Once you’re cleared by your physician, initiating or returning to a weight training program is critical to the development and maintenance of strong bones. Weight training (particularly barbell training) loads the skeleton progressively over time, which can decrease bone loss and increase bone mineral density. It also positively affects the hormones, such as human growth hormone (HGH) and testosterone, needed to improve bone density and muscle strength. Barbell training is the most effective method due to the progressive load on the skeletal system, and the muscle pull being exerted on the bone, which also stimulates bone formation. The key to maintaining and improving bone density is always progressive axial skeletal loading and the associated pull of muscles against the bone during activity (particularly, strenuous activity). Examples of such exercises include squats, lunges, and dead lifts.

It’s critical that you to slowly progress back into high impact activities. It’s equally important that you address any of these risk factors in order to help reduce the risk of re-occurrence. If you have experienced one or more stress fractures, you’re already at a higher risk. As you taper up activity, monitor for signs of swelling and pain. If symptoms occur, taper down the intensity. Continue to work in a pain free range in order to strengthen around the injury site.

If you don’t experience a significant relief as you progress into your rehabilitation, please consult your medical professional. I recommend a physical therapist that specializes in feet or who works with athletes for the treatment of stress fractures. The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. You may also consider consulting with a podiatrist.

Thanks, Denise, for the question. I hope you find this information to be helpful as you manage your condition.

Have you experienced a stress fracture in your foot before? Which treatments worked the best for you? Which treatments didn’t seem to help as much? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please e-mail 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.

Posted on Wednesday, October 19, 2016

Q & A: A Holistic Approach to Managing Autoimmune Disorders (Myasthenia Gravis)

Q. I have been diagnosed with Myasthenia Gravis. It’s affecting my speech, swallowing, and general head, neck, and arm strength. Are there certain activities that I should modify or avoid? Which type of exercise can I perform in order to improve my function? –Owen

A. Thanks for your question, Owen, as it presents an opportunity to discuss a very devastating autoimmune disease, Myasthenia Gravis (MG). Your willingness and desire to maintain your strength and physical function despite the disease is an encouragement to others who may be suffering as well.

Approximately 50 million Americans (20 percent of the population or one in five people) suffer from autoimmune diseases. Women are more likely than men to be affected. Some estimates state that 75 percent of those affected are women.

Myasthenia Gravis (MG) is one of many different types of autoimmune diseases such as Rheumatoid Arthritis (RA), Multiple Sclerosis (MS), and Amyotrophic Lateral Sclerosis (ALS, which is also known as Lou Gehrig’s Disease).

An autoimmune disorder occurs when the body’s immune system attacks and destroys different parts of the body because it has confused itself with a foreign body or invader. The body’s own immunogenic response against itself is a challenging and difficult problem to fix. Although there are many different and evolving treatment methods, most (if not, all) autoimmune disorders are not curable.

In the case of MG, it’s considered a neurologic autoimmune disease because the immune system attacks the nerves that control certain muscles of the body. Symptoms of MG vary wildly and sometimes can be quite severe. Symptoms may include:

Muscle weakness
Drooping of one or both eyelids
Double vision
Altered speech
Difficulty swallowing
Problems chewing
Limited facial expressions
Weakness in your neck, arms, and legs. (If the neck is weak, it may be hard to hold up your head.)

Proper medical management is critical in all cases of autoimmune diseases. Those diagnosed with MG (or any other autoimmune disease) should always be medically managed by a specialist in the disease. In most cases, management of MG will be overseen by a neurologist (preferably, with experience in treating MG and other neurologic autoimmune diseases).

In order to best address any autoimmune disorder, a multifactorial approach to managing the disease should be implemented. Although the condition may affect one specific aspect of your body, a healthy and balanced body will always function better and be more resilient to fight and thrive in spite of the condition. In addition, it’s important that you and your loved ones learn as much about the disease as possible.

A Holistic Approach to Managing Autoimmune Disorders (Myasthenia Gravis):

Medical/Physician Management. Depending on the condition and triggering events, this may include pharmacological management or surgical intervention. In the case of MG, the trigger may be a tumor in the thymus gland. Your physician may order a CT Scan of your chest to screen for a tumor.
Speech Therapy. Often with MG or other autoimmune disorders, you may develop difficulties with swallowing. I highly recommend that you work with a Speech Therapist (ST). Speech therapists are highly trained medical professionals that specialize in treating disorders that affect swallowing, speech, and cognition. They can use very specific treatment modalities from exercise to diet modification. Neuromuscular electrical stimulation (NMES) can be utilized to help the muscles responsible for swallowing improve in strength and coordination.
Nutritional Management. Consume foods that promote a low inflammatory diet, including a diet high in Omega-3 fatty acids and other natural herbs (like garlic and turmeric) which can naturally lower inflammation. Consuming food that helps to support the immune system is important because the nervous system is affected by MG and other autoimmune diseases. This includes a diet high in Omega-3 fatty acids and having adequate Vitamin D3 levels. Include foods that support the nerves and are typically high in good fats such as avocados, coconut oil, and healthier fish (such as sardines and wild caught salmon). If you’re experiencing difficulty with swallowing, be sure that your food is prepared in such a way that you can safely eat and that it’s in accordance to advice from your speech therapist.
Weight Management. It’s important to manage your weight effectively. Excessive body weight can cause additional stress on the body. Whenever possible, work toward optimizing your health. This includes maintaining a healthy body weight. Depending on the autoimmune disease and your body in particular, this may also mean maintaining enough body weight.
Activity Modification. As the disease progresses, it’s important to understand how your body is functioning, and then learn how to adapt to manage the disease. Unfortunately, certain activities and how you perform them will need to be modified or avoided. Learn to pace yourself and take more frequent rest breaks. Adequate night time sleep is also critical. If any of your joints are affected, learning to limit the use and strain on them will be important. Utilize adaptive devices (such as a cane) in order to limit the strain placed on your body during activities. An assistive device will allow you to be mobile and will reduce your risk of falling.
Modalities. This is a broad category, but there are many ancillary treatments that can be utilized to help you feel more comfortable. The good news is that they rarely have associated side effects. In general, the application of heat, cold, or over the counter (OTC) topical agents, such as Arnica Montana (an herbal rub) or Biofreeze, may help you to manage pain and stiffness. Gentle massage and TENS (Transcutaneous Electrical Nerve Stimulation, a form of electrical stimulation performed by a physical therapist) may also be beneficial for pain relief. TENS is different than the neuromuscular electrical stimulation (NMES) used by speech therapy. TENS is used for pain control only.
Limit Stress. Often in cases of autoimmune disorders and in particular, MG, poor stress management will lead to worsening symptoms. The ability to effectively manage stress will be critical in managing your symptoms. There are many different methods to help you manage stress more effectively. Common methods include: meditation; journaling; deep breathing; Tai Chi; and yoga. You may also need to reconsider certain friendships and relationships in your life. The key to effectively managing stress is to find an enjoyable activity, and then stick with it. This is a process–a journey (not a destination).
Exercise. Implementing exercise in order to promote general health will not only help you to feel better, but it will optimize your well-being during this very difficult time.
- Strength Training. Strength training is encouraged, and the exercise program should be established by a professional who is familiar with managing MG. All exercises should be performed in a slow and controlled environment within the available range of motion (ROM). Maintaining muscle mass through strength training is critical and should be performed only one to two times per week to minimize any risk of over fatigue.
- Endurance Training. Endurance training is critical for general health and should be included as part of a comprehensive exercise program for individuals with MG. Focus on less impact activities such as bicycling, rowing, and water aerobics. Avoid excessive fatigue.
- Flexibility Training. Flexibility training is important for everyone as part of a healthy lifestyle. Take every joint through a full ROM at least once a day. I highly encourage a regular two to three times a week flexibility program in addition to a daily ROM program. Tai Chi and yoga both also address aspects of strength and balance and are wonderful for managing stress. Other options include: Pilates; water aerobics; and a stretching routine.
- Aquatic Therapy. Water can also be very useful in pain control and help with relaxation. Many find that performing a regular exercise program in an aquatic environment can satisfy most exercise needs, including flexibility and strength.

Managing an autoimmune disorder, such as MG, is difficult and everyone’s journey will be different. Your specific treatment protocol should be individualized based on your specific condition, how the symptoms are affecting you (which will vary over time), and your current health status.

Thanks, Owen, for the question. I hope you find this information to be helpful as you manage your condition.

What has your experience with managing autoimmune disorders been like? Are there any treatments that have or have not worked well for you? Additional discussion can help others to manage these difficult diseases as well. Please leave your comments below.

Posted on Monday, October 20, 2014

How to Safely Self-Treat Low Back Pain

Did you know that an estimated $50 billion dollars is spent annually on back pain related issues? Low back pain (LBP) is one of the most prevalent medical conditions treated in the United States and throughout the western world. It affects nearly 80% of the U.S. population at one time or another. It’s one of the top reasons for physician visits and one of the most common reasons for missed work days. The previous post, 12 Sure Fire Ways to Injure Your Back, addressed potential risk factors for low back pain. This follow-up post includes how to safely self-treat your low back pain and helpful methods for a speedy recovery. (Not to mention, possibly saving you time and money by avoiding a physician visit for minor pain!)

To safely self-treat your low back pain, first take a moment to assess your symptoms and pain level. What led to your pain and/or injury? Did the pain come on suddenly or slowly? Evaluate the severity of the injury. If you’re experiencing any of the following, please seek immediate medical attention:

Loss of bowel/bladder function.
Uncontrollable pain. The pain is so severe you cannot function or move.
You are losing muscle function or control. The muscles in the legs will no longer work. (This is different than pain preventing the muscle from working.) This sensation of paralysis occurs when the muscles will not actually function.
Significant loss of sensation in the leg or groin area. This is not a tingling sensation, but an actual loss of sensation. For example, you cannot feel the toilet paper when you wipe after using the toilet.
Onset of pain without any known mechanism for the injury. (Thoroughly consider your activity. Many times, a slow onset of pain begins several hours after performing an activity.)

Fortunately, most LBP is mechanical–meaning it is from a physical or structural cause and isn’t related to conditions such as cancer or infections. Most LBP will have a directional preference for extension. A majority of injuries occur when performing a forward biased (flexed movement) like chronic slouching or a spinal flexion biased movement. For discussion purposes, I will be addressing an extension biased program.

You should be able to alter and change your LBP within a short period of time. First, establish a directional preference by identifying a pattern to the pain. Does the pain get worse when you bend over or does it improve? What happens when you repeat this movement? Determine how your pain responds. If it spreads away from the spine and down into the leg, beware that you are moving in the wrong direction. Stop that particular movement, and instead try flexion biased movements. In my experience, most episodes of LBP tend to respond better to extension biased movements. If flexion or extension doesn’t help or change the pain in any way, then you may need assistance from a medical provider.

The rule of thumb for movement: If the pain worsens by spreading peripherally down the buttock and into the leg and/or foot, then the condition is worsening. We must stop that activity. If the pain centralizes and returns back toward the spine (even if the pain worsens slightly), then keep moving as the condition is actually improving. For a thorough discussion and an excellent treatment resource, please refer to Treat Your Own Back by Robin A. McKenzie.

Although most LBP isn’t considered serious, the pain tends to re-occur. One major reason for this is that the deep stabilizing muscles known as the multifidus muscles reflexively shrink, weaken, and lose function. Without proper rehabilitation, the muscles will not fully recover. This increases the risk of future episodes because the spine no longer has the ability to stabilize itself normally.

How to Safely Self-Treat Low Back Pain:

Perform Press-ups – Once you have injured your back, immediately start press-ups. Perform this exercise with high repetitions and frequently throughout the day as long as the pain does not periperalize down the buttock and into the leg and/or foot. Lie on your stomach and perform 10-20 press-ups. Move slow and easy, but work your way up to full motion multiple times a day.

Perform Standing Back Extensions – After sitting, stand up and perform standing back extensions. Ideally, perform this exercise at least 10 repetitions each time you stand.

Activate the Multifidus – Start exercises to activate the multifidus muscles as soon as possible. Think spine extensor muscle activation. Again, perform this exercise frequently during the day after the initial injury. The Lumbar Extensor Exercises are designed to progressively activate the multifidus muscles (with the final exercise being the most challenging). Once the pain subsides and muscle function improves, more advanced lumbar extension strengthening and stabilizing exercises should be performed to decrease your risk of re-current low back pain.
Don’t Sit – Walking is critical to your recovery! It’s the number one way your spine receives nutrients and disposes of metabolic waste products. Walk frequently, and try to avoid any prolonged sitting.
If you Sit, Use Good Posture – Use a McKenzie Lumbar Roll to help insure a good lumbar curve. If you can’t sit comfortably, listen to your body and don’t sit! Be sure to stand up and walk every 20-30 minutes. Make sure you stand with good posture as well.
Stretch the Muscles of the Legs and Pelvis – Hamstring, Hip Flexor, and Piriformis Stretches for LBP help to reduce muscle spasms and tightness throughout pelvis area when performed daily. Stretch for at least 30 seconds at a time, 2-3 times each session.
Reduce Inflammation and Support the Healing Response – I recommend starting a thirty day course of CapraFlex by Mt. Capra. CapraFlex is an organic glucosamine and chondroitin supplement which also includes an herbal and spice formulation designed to naturally decrease inflammation and support healing. I recommend it to anyone recovering from an injury or attempting to prevent injury when performing at a very high level. I personally use it, and in my practice, it has helped clients recover faster and prevent injury. It can interfere with some blood thinning medication, so if you are on this type of medication, please check with your physician.
Ice as Needed for Pain – 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. Individuals with poor circulation or impaired sensation should take particular care when icing.
Use Topical Analgesics for Pain – There are many topical agents which can be used for pain. My two favorites to help manage pain and stiffness are Arnica Montana (an herbal rub) and Biofreeze.
Be as Active as You Can – Don’t stop moving! It’s important that you remain as active as you can. You should taper certain activities that you know will increase your pain. This typically would be activities involving heavy loading of the spine such as squats with weight, deadlifts, and other activities that may cause forward flexion (particularly under a load). As you are able to, continue to work on cardiovascular conditioning and core muscle activation, particularly the lumbar extension exercises. Remember the concept of peripheralization and centralization. If your pain progresses from the area of the injury into your leg, then you need to stop that activity. If the pain remains constant or is progressing out of the leg, then continue with the activity as you are helping the body to heal.
Ask for Help – Yes, even physical therapists have to ask for help sometimes! Many useful manual techniques can help to manage LBP. You just can’t perform them on yourself. If your pain is not improving, I highly suggest seeking a qualified and competent physical therapist who works with clients suffering from LBP. The American Physical Therapy Association 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 seek your physician’s opinion as well).

Low back pain is a serious and debilitating condition. It will either most certainly affect you or someone close to you. Be pro-active in maintaining a healthy back by incorporating these helpful methods for a speedy recovery. Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!

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Posted on Wednesday, September 10, 2014

Q & A: Exercises Beneficial in Managing Rheumatoid Arthritis

Q. I have rheumatoid arthritis in my hands, wrists, and elbows. What type of exercise can I do to keep my upper body strength? –Gloria

A. Thanks for your question, Gloria, as it presents an opportunity to discuss a very devastating disease, Rheumatoid Arthritis (RA). Your willingness and desire to maintain your upper body strength despite the disease is an encouragement to others who may be suffering as well.

Rheumatoid Arthritis (RA) is one of 171 different types of arthritis. RA is most commonly diagnosed in women, with nearly three out of four cases involving women. Over 46 million people in the United States alone suffer from one form of arthritis or another, and this number is climbing rapidly. The most commonly recognized forms of arthritis are osteoarthritis and RA. Osteoarthritis is most commonly associated with “wear and tear” syndromes (degeneration of the joint from excessive use or injury). RA (known as an inflammatory arthritis) is an autoimmune disease in which the immune system works against normal body cells by attacking the joint surfaces and eventually, even the body organs. As the condition progresses, joint surfaces become severely damaged–leading to deformities and dysfunction.

A person with RA should always be medically managed by a specialist in the disease. Symptoms are typically quite severe and not only cause pain and deformities, but also excessive fatigue and loss of appetite. RA can be found in only one joint or area, but it’s usually associated with many areas in combination, typically in a symmetrical pattern. Eventually, it can affect the entire body including the internal organs.

In addition, it is important that you and your loved ones learn as much about the disease as possible. There must be a multifactorial approach to managing the disease. Consider the following:

Medical/Physician Management – This may include pharmacological management or surgical intervention, including total joint replacement.
Nutritional Management – Eat foods which promote a low inflammatory diet, including a diet high in Omega-3 fatty acids and other natural herbs (like garlic and turmeric) which can naturally lower inflammation.
Weight Management – It is important to manage your weight effectively. Excessive body weight can cause additional “wear and tear” (particularly on the lower extremities joints) and can worsen any damage caused by RA. Also, excessive weight can worsen RA symptoms or even cause osteoarthritis. If possible, you don’t want more than one form of arthritis if it can be avoided.
Activity Modification – As the disease progresses, it is important to understand how your body is functioning and then learn how to adapt to manage the disease. Unfortunately, certain activities and how you perform them will need to be modified or avoided. Learn to pace yourself and take more frequent rest breaks. Adequate night time sleep is also critical. Depending on the joints affected, learning to limit the use and strain on the joint is important. For example, if your knee is affected, then repeatedly going up and down stairs could cause a strain. You may choose to eliminate or minimize the frequency of that particular activity. Repetitive joint motion and in particular, repetitive joint loading and hyper loading, should be avoided and/or minimized. Learning to use adaptive devices to limit the strain placed on the body during activities will also be helpful.
Modalities – This is a broad category, but in general the application of heat, cold, or over-the-counter topical agents, such as Arnica Montana (an herbal rub) or Biofreeze, may help manage pain and stiffness. Gentle massage and TENS (Transcutaneous Electrical Nerve Stimulation, a form of electrical stimulation) may also be beneficial.
Splints – Many times, custom or over-the-counter splints (particularly for the upper extremities) can be utilized to provide support and comfort to joints which are in pain and/or suffering from deformity.

Now that you have a clear understanding of RA and options available to manage the disease, I will specifically address Gloria’s question regarding exercise for the upper extremity and exercise in general. Although the research for exercise for individuals with RA is far from complete, it indicates that a regular exercise and range-of-motion (ROM) program is a critical component to proper management of the disease. (Make sure you are adequately rested before performing any exercise program.) General guidelines for exercise include:

Strength Training – Strength training is encouraged, and the exercise program should be established by a professional who is familiar with managing RA. Excessive shearing forces and rotational forces and/or exercises should be avoided. Joints with severe involvement should be exercised with caution and an emphasis should be placed on ROM versus actual loading of the joint. All exercises should be performed in a slow and controlled environment within the available ROM. Maintaining muscle mass through strength training is critical and should be performed only one to two times per week to minimize any risk of over stressing the joint.
Endurance Training – Endurance training is critical for general health and should be included as part of a comprehensive exercise program for individuals with RA. Avoid cardiovascular exercise (running, jogging, skipping, jump roping, etc.) which produces high impact forces. Instead, focus on less impact activities such as bicycling, rowing, or water aerobics.
Flexibility Training – Flexibility training is important for everyone as part of a healthy lifestyle, but it’s critical for those with RA. A person should take every joint through a full ROM at least once a day. I highly encourage a regular two to three times a week flexibility program in addition to a daily ROM program. Appropriate options include: yoga, Pilates, Tai Chi, water aerobics, or a self-stretching routine. The program should be performed in a slow and very controlled manner by taking care to never overstretch a joint or to move too quickly.
Aquatic Therapy – Many find that performing a regular exercise program in an aquatic environment can satisfy most exercise needs, including flexibility and strength. Water can also be very useful in pain control and help with relaxation. Exercising in a reduced gravity environment like the pool limits the compression forces on the bones. Additional weight training or body weight exercise should still be performed to insure adequate bone density as one ages.

To specifically answer Gloria’s question on the upper extremities, I would encourage her to daily perform an upper extremity stretching routine which takes all of the upper extremity joints through at least one full ROM. Be sure to take several rest breaks during the day to perform stretching and ROM exercises. Strengthening exercises for the shoulders, elbows, wrists, and fingers would also be beneficial. Be sure to work the finger extensors (opening the hand) and not just the flexors (squeezing). Finger Putty is a great product which enables you to perform a variety of hand and finger exercises. I would also encourage an emphasis on posture and upper back stretching as demonstrated in My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain. Gloria, I hope you find this information to be helpful as you manage your RA. Please let me know if you have additional questions.

I would love to hear from more of you! What are your experiences dealing with rheumatoid arthritis? Have you or a loved one been dealing with this condition? What has worked or not worked for you? Additional discussion can help others to manage a very difficult disease. Please leave your comments below.

Posted on Monday, August 25, 2014

Muscle Cramping & Spasms – Treatment Options

The list of potential reasons for developing a muscle cramp or spasm is quite long and somewhat arduous. Once the cramp or spasms begin, it’s often quite painful! Therefore, we’re highly motivated to act quickly to eliminate the spasm. What can you do to prevent muscle cramps and spasms? More importantly, how can you recover from experiencing one? I will provide simple treatment options to quickly help aid in your recovery.

For discussion purposes, I will address a spasm which isn’t caused by a serious medical condition such as a fracture, muscle tear and/or injury, or other medical conditions which would require the immediate attention of a healthcare practitioner. If you believe that the spasm is from a serious medical condition, please do not attempt to self-treat the condition–immediately seek competent medical advice.

Over training or overexertion is a common issue experienced by many of the clients who I work with. It remains a very sensitive topic as no one wants to admit that he/she was physically unprepared for an event or activity in which he/she participated in. Don’t worry! The point of participating in competition and other difficult activities is to test your body and to have fun! During a race or sporting event, you will likely overreach from your training plan. The hope is that your body is physically prepared to handle this overreaching without injury. If you experience muscle cramps or spasms before or during an event, modify your training routine for the next event.

Top Tips for Treating Muscle Cramping & Spasms:

Massage – Contact a masseuse, physical therapist, athletic trainer, or friend who is skillful in body work and massage to relieve the area in spasm. The specific massage technique to use will vary according to your preference. Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.
Foam Roller – The foam roller allows you to perform self-massage and tissue mobilization. The foam roller is a wonderful tool to prevent muscle cramping and spasms. Please refer to the following posts for more information: Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion. I highly recommend a High Density Foam Roller to help aid in your recovery.
Other Self-Mobilization Tools – Many times, a friend or masseuse isn’t available to assist when you need the help the most. A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary. You can get creative and use a tennis ball or golf ball, but I like a specific tool called a Thera Cane Massager. This tool allows you to apply direct pressure to a spasming muscle. When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief! I am also a big fan of the Thera-Band Standard Roller Massager. I particularly like that its firmness allows for a deep amount of pressure. If you prefer something similar (but more flexible, for the boney regions of the thigh or lower leg), I recommend The Stick Self Roller Massager.
Topical Agents – Many topical agents can help decrease and eliminate 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.
Magnesium Bath – The combination of warm water with magnesium is very soothing and relaxing. Options include: Epsoak Epson Salt or Ancient Minerals Magnesium Bath Flakes. I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
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. 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.
Increase your Electrolyte Intake – You may need to increase your potassium, sodium, or calcium intake to your diet or consider supplementation. Sherpa Pink Gourmet Himalayan Salt contains the electrolytes you would expect as well as a host of other trace minerals. I have found this to be highly effective for cramps and muscle soreness. It also helps me to sleep more soundly. I highly recommend it to anyone who is suffering from chronic cramping or after participating in an athletic event. Drink a small glass of warm water, mixing in a teaspoon full of pink Himalayan sea salt, before bedtime.
Fix Your Posture – Poor posture is one of the most common causes of muscle cramping and spasming as well as pain. This is particularly true if you spend a good portion of your day sitting. Sign up to receive my weekly blog posts via e-mail, and I will share with you My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain. These simple exercises, with complete instructions and photos, will help you to improve poor posture and can be performed at home.
Move More – Not only has research proven that sitting for more than two hours at a time decreases your expected life span, but extended sitting also leads to increased muscle tension, cramping, and pain. If you sit most of the day, get up and walk. If you stand most of the day, frequently change your standing posture. To optimize health and joint function, you should take each joint in your body through a least one full range-of-motion (ROM) every day.
Stretch – Stretching is a wonderful way to help eliminate a muscle spasm. We instinctively stretch when we feel a spasm begin. Try gently stretching (lengthening) the muscle which is in spasm. I recommend beginning with a short 30-60 seconds stretch, then repeating as needed. If the spasm or cramp is severe, you will likely need to continue stretching several times in a row, multiple times throughout the day. Stretching should always be part of a general fitness and lifestyle program. As we age, muscle and tendons tend to lose elasticity so stretching becomes even more important. I highly recommend a daily stretching routine or participation in a group class, such as yoga, which incorporates full body stretching.
Acupuncture – I am personally a big fan of acupuncture. It is very useful in treating all kinds of medical conditions. It can be particularly effective in treating muscle cramps and spasms as it addresses the issues on multiple layers. Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
Speak with your Physical Therapist (PT) or Physician (MD) – If the above techniques are not helping or if the muscle cramps and spasms continue to come back regularly, speak to your medical provider to determine if other causes are contributing to the problem. 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).

What are your top tips for dealing with muscle cramping and spasms? Please post your comments below as we could all use a few more tricks to eliminate pain!

The Physical Therapy Advisor

Empowering You to Reach Your Optimal Health!

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