Tag Archives: Muscle Weakness

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Simple Guidelines for Treating Low Back Pain

Did you know that low back pain (LBP) affects nearly 80% of the US population at one time or another? It is one of the most prevalent medical conditions in the United States and one of the most common reasons why people miss work. However, in MOST cases, LBP is not a sign of a serious life-threatening condition. Only approximately 3% of serious pathology cases report low back pain as a symptom.

While most LBP is not serious, it can be very painful and have a significant impact on your mobility and quality of life. The good news is that you can follow simple guidelines to navigate an episode of LBP.

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.)

Simple Guidelines for Treating Low Back Pain:

Opt for conservative care

Most episodes of LBP improve quickly with conservative care. Research has effectively shown that early intervention with physical therapy is more cost effective, improves long-term outcomes, and decreases downstream health care dollars spent in unnecessary imaging and treatments. Unfortunately, the longer persistent LBP is ignored, the more fearful a person can become. This fear leads to decreased mobility which only makes the episode worse.

Surprising to many, but imaging does not correlate well to the causes of LBP. Worse, it often induces fear. The use of imaging is to rule things out. Negative imaging is good news! If your symptoms don’t match what is found on imaging, then more than likely that is not the cause of the pain you are feeling.

Keep moving

Exercise and movement in all directions is safe and healthy for the spine, even when it hurts! If you have LBP, move. If it is painful, modify and try moving again.

When your back hurts, aim for neutral posture to minimize any strain. Spine posture during sitting, standing, and lifting does not predict LBP or its persistence very well.  However, improper posture in sitting, standing, and lifting can increase shearing, torsion, and loading on structures. Avoid putting an excessive load on irritated tissues which can certainly exacerbate an already sore back.

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.

With mechanically driven low back pain, 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.

Strengthen your core muscles

Your core is likely not what you think it is. Weak abs do not cause LBP. However, poorly coordinated pelvic musculature can precipitate and perpetuate LBP.  Stop performing sit ups and start learning how to truly activate and strengthen the muscles of the inner core. Watch now as I describe what really the “core” is and why it matters. CLICK HERE

Constant low back pain can result from chemical inflammation to sensitized or damaged tissues. Intermittent pain is more often mechanical. Understand that medications are useful for helping reduce chemical inflammation, but addressing mechanical factors as well will lead to a quicker (and long term) recovery in most cases.

Unfortunately, low back pain will re-occur almost 90% of the time. To ensure a complete recovery from an episode and to help prevent re-occurring episodes, address other contributing areas such as the upper back (thorax) and your hip mobility. Typically, there is weakness in the deep stabilizing muscles known as the multifidus muscles. In the presence of LBP, these muscles will 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. Not all “core” work is created equally, so the strength of these muscles should be addressed.

Be as active as you can

Don’t stop moving, but avoid exercises that make your back hurt more. Typically, this includes flexion biased movements like sit ups. It’s important that you remain as active as you can. You may need to taper down 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, continue to work on cardiovascular conditioning and core muscle activation (particularly, the lumbar extension exercises). Lift weights if you are able. Refer to the rule of thumb for movement (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.

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

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package. USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat re-occurring low back pain episodes.

If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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Fitness Exercise Won’t Help Your Low Back Pain

It’s estimated that approximately 82.1 million adults in the United States spend an estimated $28.6 billion on gym memberships each year! Now combine that staggering number with the estimated $50 billion dollars plus spent annually on back pain related issues. Even with the general fitness craze we have seen over the past years, low back pain (LBP) remains 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.

With so many active individuals and crazy fitness trends you would think that all of this exercise would actually help reduce low back pain, right? Wrong…It turns out that not all exercise (and especially, not all “core” exercise) is created equally.

It’s time to address how to safely self-treat your low back pain through movement and exercise as well as some helpful methods for a speedy recovery. (Not to mention, possibly saving you time and money by avoiding a physician visits for pain you can manage safely and independently with a little instruction.)

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.

With mechanically driven low back pain, 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.

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. Not all “core” work is created equally, so the strength of these muscles needs to be addressed.

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. These 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. Stand with good posture as well.

Stretch the Muscles of the Legs and Pelvis

Hip flexor and hamstring stretches can 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.

Be as Active as You Can

Don’t stop moving, but avoid exercises that make your back hurt more. Typically, this includes flexion biased movements like sit ups. It’s important that you remain as active as you can. You may need to taper down 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). Basically stay as active as you can, even lifting weights if you are able.  Just 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.

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. 

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package. USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

Want to peek inside the video content? Watch now as I describe what really the “core” is and why it matters.

WATCH NOW

If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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Why We Can Be Our Own Worst Enemy

I must warn you that this is not the typical post from me. All of the information is true and sadly, not exaggerated in any way. My hope in documenting this true account of events is that it will help others know how to better avoid injury. If you do develop an injury, then maybe some of my self-treatment strategies could be helpful.

What most people don’t know about me is that I have struggled with low back pain (LBP) for over 20 years. Early on, I had years of constant and chronic LBP. This pain helped drive me to seek out different self-treatment methods. I began to understand LBP along with the best practices on how to self-manage and most importantly, avoid future flare-ups. This has personally helped me manage my own pain while helping thousands of others either directly with physical therapy or by sharing my book, Treating Low Back Pain during Exercise and Athletics.

Even with all my diligent efforts (most of the time), the occasional LBP flare-up occurs. Unfortunately, the last incident was due to poor judgement on my part. In early November of last year, I had been sitting a lot while working on a few projects, and my back started to ache. It was mild at first. However, by mid-month, I could hardly get out of a chair and walk.

As a physical therapist (PT) that specializes in treating LBP, I should have known better, but I chose to do what most people do. I ignored it, and pressed on. I reminded myself that I’ve had this pain before, and it typically goes away. Right then, I didn’t have time to address it.

Monday morning rolled around, and I was scheduled for my 5 mile tempo run. As any runner or exercise enthusiast knows, if it’s scheduled, then it must be done (no matter what, right?). I was sure my back would loosen up as I ran. Often times, a warm up prior to running makes it feel better. (If I was being honest, the pain was pretty bad that particular morning. It was preventing me from sitting, getting out of my car, and even walking straight. Was that a good enough reason to cancel a run?)

I managed a short walking warm up since that was all I could muster and proceeded into a slow jog. About 2 miles into my jog, my right calf started to hurt. Why stop? I was sure it would all shake loose soon…

As mile 3 approached, I was falling apart. My back hurt to the point I couldn’t stand up straight. My right calf was completely locked up. It was giving me a sharp pain with every step. The bottom of my left foot started aching. I finally shut it down and limped home.

Later that day, my calf wasn’t any better (neither was my back), and now I had full on plantar fasciitis. Pretty good start to the week, but I got that run in. By the end of the day Monday (post run), I was miserable, but I didn’t dare tell anyone.

As a PT, I should have known better. I started to analyze exactly what was going on. For some reason, my disc bulges (a pre-existing problem at L4/L5 and L5/S1) had flared up for no apparent reason and were hurting terribly. My back pain had caused a left lateral shift in my spine, which meant I couldn’t stand normally. The nerve tightness down my left leg affected my walk, so I could not fully stride out.

In hindsight, my sad attempt at a run early that morning was actually a terrible idea! I had obviously been running with a poor gait pattern. This altered gait pattern with poor running mechanics resulted in a right calf strain and the development of plantar fasciitis in my left foot. (And this all started in 3 miles!)

My initial treatment was to determine my directional preference for my lumbar spine pain:  

A directional preference is a way to identify 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 moving in the opposite direction. If you were moving into flexion, try extension. If you had trialed extension biased movements, try flexion. Find the movement pattern that helps the pain improve and that has a positive effect on any other symptoms you may be having.

I determined my directional preference. As I performed my series of movements, my symptoms were peripheralizing (returning back to the middle of my back to the point I could stand straight and walk normal).

After a series of 10 side glides followed by 10 press-ups (as demonstrated below), I could eliminate 75% of my LBP and symptoms as long as I didn’t sit. Sitting would immediately bring the pain back on. For the next several weeks, I avoided sitting at all costs including during dinner.

I also started back extensions over an exercise ball (3 sets of 15 repetitions as demonstrated below) every morning as part of a lumbar strengthening program. I chose back extensions to insure that I was working my lumbar extensor muscles. I kept my movement patterns within my directional preference. This was preceded by and followed by side glides and press-ups as well as continuing to avoiding sitting. I stopped running since I couldn’t fully walk or jog without an altered gait pattern.

For my calf, I started foam rolling and stretching regularly. I used a mobility band (as demonstrated below) as a way to provide compression while I performed heel raises (typically a set of 20-30 repetitions). Thankfully, I had the opportunity to trial a product that not only utilized the compression from the mobility band, but added a way to self-mobilize the calf. The CTM Band worked exceedingly well for this. (“CTM” stands for compression, tension, and movement.) Use code MTA15 for a 15% discount. (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.)

For my plantar fasciitis, I also performed calf stretches as well as used a small ball (as demonstrated below on the left) to mobilize the bottom of my foot. Pain in the morning seemed to be the biggest issue, so I would sit up and stretch before getting out of bed (as demonstrated below on the right). By the end of the day, my foot would really start to hurt. Since I was unable to sit due to my back, I used a padded stool to kneel on whenever possible.

I continued this treatment plan for over 3 weeks. For the first 2 weeks, I was unable to run, so I concentrated on rehabilitation exercises only. During this time, I utilized a self-prescribed course of over-the-counter Ibuprofen (anti-inflammatory). I didn’t have any medical issues with taking this medication. Please consult your physician before taking any medications or supplements.

I also initiated a supplementation protocol consisting of adding collagen hydrolysate to my daily smoothie as well as taking CapraFlex by Mt. Capra. (It combines an organic glucosamine and chondroitin supplement with other natural herbs and enzymes which are designed to reduce inflammation, promote bone and joint healing, and wellness.)

This continued for approximately 4 weeks. The rationale behind the supplementation was to insure that my body had the necessary building blocks to heal and to provide additional anti-inflammatory support to my body during my recovery.

After 3 weeks, I returned to running for only shorter distances (under 5 miles). I was tapering back into other exercise routines with appropriate modifications which included increasing my warm up and cool down times and avoiding bending forward since I wasn’t 100% better.

The reason I chose to share my most recent LBP episode with you is because I have heard versions of this story over and over again from other runners, weekend warriors, and patients.  We really can be our own worst enemy!

As a PT, I should have known better than to run that day. As a runner and weekend warrior, the feeling that it may be a “mortal” sin to miss a scheduled run or work out can be a powerful temptation to do it even though your body may be telling you to reconsider.

As any frequent exerciser knows, a few aches and pains is par for the course. In fact, it’s pretty normal! Oddly, I will have just as many if not more, aches and pains when I stop running and exercising as when I’m regularly training.

The moral of my story is a reminder to be very self-discerning and self-aware to understand what is a typical ache and pain versus something more serious. In my case, not being able to walk normally due to pain should have been a clue not to run abnormally either. My abnormal running pattern that day is what led to the overuse injuries in both my calf and foot. What was surprising even to me was how fast the pain developed and turned into a true overuse injury in only the course of 3 miles!

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package.

Treating low back pain does not need to be difficult or expensive. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

SAVE 15% NOW!

If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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Why Does My Lower Back Hurt?

Have you ever wondered what exactly makes your back pain worse? Why does your back continue to hurt on and off again? Why does it seem to “act up” right at the wrong time? Is it something you are doing? Is there something seriously wrong? Is it just bad luck?

These are all fantastic questions. It’s time to answer the age old question as to why your back keeps hurting. Here are the top reasons why your back may be hurting and what to do about it.

The Top Reasons Why Your Back may be Hurting:

You smoke or vape.

Smoking is a major risk factor for low back pain (LBP). The chemicals in cigarette smoke affect both the lunges’ ability to exchange oxygen and the body’s normal healing response. These chemicals alter the blood supply to the discs and other spinal structures which affects nutrient exchange and increases the risk of pain. Healing time for all medical conditions worsen with smoking.

You’re biologically male.

Males have a higher risk of LBP. Females tend to experience more cervical or neck pain. (Obviously, you have very little control over this factor other than the knowledge that you’re at an increased risk if you are a male.)

It may be your parents’ fault.

A family history of low back pain increases your risk. In some cases, this may be due to actual structural deformities which may be genetically linked. More commonly, it’s a learned behavior, such as chronic sitting and slouching (poor posture), that can lead to a higher risk of LBP.

You’re pregnant.

Pregnancy increases your risk for LBP due to structural changes as the baby develops and hormones change. The expectant mother releases relaxin, a hormone which loosens the whole body, to prepare for the baby’s delivery. Again, a risk worth taking! Most women can manage the pain by modifying posture and movements while learning techniques for self-management.

You don’t exercise.

A sedentary lifestyle will increase your risk for LBP. The spine is designed to work and move. In order for the spine to remain healthy, it requires exercise and movement.

I WANT TO GET RID OF MY BACK PAIN NOW!

You sit for more than 2 hours a day.

Sitting for a long period of time not only affects your general health status in a negative way, but it also increases your risk for LBP. It’s even worse if you’re a heavy equipment operator who sits on a vibrating surface.

You have poor posture.

In western culture, we spend most of our day sitting slouched or standing hunched over. This is an excellent way to increase your risk for LBP. It’s one of the major risk factors for disc herniation and development of spinal stenosis.

You don’t warm up before exercise.

This is a common mistake which can lead to injury. Jump out of your bed in the morning without warming up, and then start your exercise routine. (Please don’t!) Instead, prepare your body for challenging activities in order to avoid injury. A warm up should consist of a cardiovascular component and a dynamic stretching routine of the actual exercises you will be performing to insure you’re ready for the movement. This is also pertinent for weightlifting and running.

You keep moving even when you’re exhausted.

This is a common problem among CrossFitters (including myself). Just keep pushing yourself even when you can’t see straight. Typically, this results in poor technique which further increases your risk. Combine poor technique with muscles which can no longer perform the proper movement pattern, and you’re likely to become injured. High Intensity Training (HIT) is a wonderful form of exercise and has many health benefits as long as you’re able to properly perform the exercise.

You’re using poor technique.

Poor technique, along with feeling exhausted, often occurs when performing exercises that are too advanced. Performing unfamiliar lifting techniques or lifting too much weight will likely result in poor technique. Please see your coach, athletic trainer or physical therapist for the proper technique for your activity of choice.

Your training volume is too high.

Who needs a rest day? ALL of us can benefit from taking a break. Training every day without regard to rest is an excellent way to cause over training syndrome and injury to your back.

You’ve experienced prior episodes of LBP.

Once you have experienced LBP, you are more likely to have re-current episodes. This may be the major reason why your low back pain re-occurs. This is partially due to weakness in the deep multifidus muscles that help support the spine and prevent shearing forces. This weakness can be addressed with proper physical therapy intervention. The loss of structural strength is the primary reason why your back pain continues to re-occur, and this can be changed.

Core strength does matter, but it is likely not what you think. Most people don’t quite understand the relationship between the “core” and lumbar stabilization. It’s way more than just doing sit-ups. In fact, sit-ups may actually make your back pain worse.

Low back pain is a serious and debilitating condition. It will either most certainly affect you or someone close to you. Be mindful of your risk factors and be pro-active in maintaining a healthy back! The good news is that nearly all low back pain is mechanical (meaning there is a physical reason for the pain). There are physical treatment options that not only can help you recover from the pain, but also to avoid re-occurring back pain!

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package.

Treating low back pain does not need to be difficult or expensive. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

SAVE 15% NOW!

If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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How to Prevent Back Pain while Working from Home

The COVID-19 pandemic has transformed work and how it is done. Many people transitioned from working in an office setting into working remotely from home. Many employers have extended work-from-home (WFH) options as coronavirus cases continue to surge. With the shift of working environments, there has been a rise in back pain and other posture and structural driven pain from the neck, shoulders, arms, and low back. Much of this increase in pain is due to poor home working conditions and more sedentary behavior as we spend more time at home during the COVID-19 pandemic.

Low back pain (LBP) continues 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. Yet most of us do not currently seek care or in some cases, we cannot even get appointments into our medical providers because of the pandemic.

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. It’s best to minimize your risk factors for experiencing LBP by being pro-active. This means that you can effectively self-treat YOUR low back pain without expensive medical visits, surgery, pills or injections.

How to Prevent Back Pain while Working from Home:

Fidget more. Limit the amount of sitting that you spend at one time. Since you’re at home, you can sit in different positions and in different locations. Get out of a sitting position every hour, and ideally, walk. If you aren’t able to walk, then try to shift your position at least once every twenty minutes.

Frequent position changes can help to avoid LBP. Don’t get stuck sitting for hours in the same position (particularly, if it’s uncomfortable or if you’re sitting with poor posture or with poor ergonomics). If you’re standing, then stand in different positions. Put your foot up on a stool, and then switch feet. Stand on different surfaces when possible (hardwood, carpet or softer padding like a standing mat). Variety is the key to avoiding low back pain.

Sit with good posture. If you’re going to sit for any period of time (regardless of the position), maintain your posture. Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve. Even if you don’t have an office chair at home, lean back in the chair (don’t slouch in your lower back). A great tool to help you with this is a lumbar roll. Ergonomics are important, so find ways to support your back while keeping your shoulders and neck in a relaxed position.

Stop looking down. Try to keep your devices at eye level, or slightly down. Don’t position them so that you have to look up at them. Limit the amount of time spent looking down whether that is from texting or reading a paper or even writing. If you tend to spend 30-40 minutes at a time looking down at your device, work toward reducing that time in half.

I WANT TO GET RID OF MY BACK PAIN NOW!

Stand more. A standing desk can be a wonderful luxury. At home, you can get creative and use a higher counter top for a make shift standing desk. Use boxes or books to improve the ergonomic positioning. The set up should allow you to look straight ahead when you work on your computer while in a position that your arms can hang down naturally with the forearms supported. No one can see your set up. Even if it’s not esthetically pleasing, it’s best to keep your body feeling good.

Take a break to exercise. Take advantage of being home and take a 15 minute stretching or yoga break. How about 10 minutes to roll out and utilize the foam roller or maybe a few core exercises like planks? Have some fun with it. My favorite 10 minute work-from-home exercise break includes: 25 air squats, 25 push-ups, 5 minutes stretching on the foam roller, and then a few press-ups.

I highly recommend press-ups. Lie on your stomach and perform 10 to 20 press-ups. Go slow and easy, but work your way up to full motion. Perform these multiple times a day as time allows. This is much easier to do when working from home versus an office environment.

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.

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package.

For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

Want to peek inside the video content? Watch now as I describe what really the “core” is and why it matters.

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If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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5 Tips to Prevent Low Back Pain When Shoveling Snow

In many parts of the world, snow season is upon us. Whether you are shoveling snow or using a mechanical snow blower, your risk of experiencing back pain is likely higher than any other time of the year. If you’re one of the lucky ones who live in a warmer climate, these tips can be just as helpful as you manage those DIY (Do It Yourself) projects.

Whether you’re shoveling snow, working on an outside landscaping project, moving furniture around or just deep cleaning, you’re likely to be exercising different muscles and performing activities that you aren’t used to. Your best laid plans can be derailed by a bad episode of low back pain (LBP). Don’t worry, you can prevent this! If it’s a little too late and you’re already experiencing LBP, I can guide you forward without expensive medical bills, pills, injections or surgeries.

Fortunately, most LBP is mechanical–meaning it’s from a physical or structural cause that is 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’re going to be shoveling that snow or 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 When Shoveling Snow:

  1. Warm up.

Just like any other exercise and/or event, you should warm up first. Pre-activity:  A good place to start is to perform standing back extensions and press-ups. This exercise can also very helpful if you are already experiencing low back pain.

  1. 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.

  1. Limit the amount of time spent in one position.

This means to limit the amount of time slouched over the shovel or snow blower. 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). TAKE A STANDING REST BREAK TO STRAIGHTEN BACK UP.

I WANT TO GET RID OF MY BACK PAIN NOW!
  1. Use common sense.

If you don’t think you can comfortably lift something, be sure to ask someone for help. If your back is starting to get sore from all that hard work, TAKE A BREAK, but don’t immediately go sit down in a slouched posture. Sitting (especially with poor posture) after working your back really hard is a major risk factor for developing low back pain.

Be sure to work within your limits, and don’t overestimate those limits! Just because you could lift 100 lbs. in high school doesn’t mean that you still can. Always use common sense and proper technique when lifting a heavy object or when performing repetitive lifting and shoveling.

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.

  1. 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.

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, I have the solution for you. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes. 

The Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package includes:

Treating Low Back Pain during Exercise and Athletics eBook

In this eBook, you’ll learn why it is critically important to prevent the first episode of low back pain. LBP has reoccurrence rates as high as 90%. If you have already experienced an episode of LBP, you’ll learn why exercise is an important component to long term management. Most importantly, you will understand how to avoid pain and injury in order to take your training to the next level. Topics include:

  • Specific strategies for LBP prevention.
  • How to address specific causes of LBP.
  • Best practices on how to prevent and self-treat when you experience an episode of LBP.
  • A step-by-step LBP rehabilitation guide complete with photos and detailed exercise descriptions.
  • How to implement prevention and rehabilitation strategies.

 7-part Series of Instructional Videos

Nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports, and athletics. An in-depth look at treating LBP with a 7-part series of instructional videos in which I address the following:

  • Potential Risk Factors for Lower Back Pain
  • What are the Core Muscles?
  • Prevention during Exercise (Part 1 and 2)
  • Initial Treatment
  • Further Treatment and Taping
  • Long Term Management Strategies and Final Recap

LEARN MORE HERE

If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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A Core Stability Exercise that Anyone Can Do

Proper core and lumbar extensor strength is the key to preventing an episode of low back pain (LBP) as well as an important component to treating LBP. Low back pain is estimated to affect nearly 80% of the U.S. population at one time or another. In general, most of us don’t spend enough time properly strengthening our core muscles. In this video post, you will learn how to engage your abdominal muscles with a simple ball exercise that I recommend to all of my patients initially in my LBP rehabilitation program.

The core muscles are part of the body’s natural method of stabilizing the spine. The core muscles, along with intra-abdominal pressure, help to form the round cylinder that is utilized to support the spine. Ligaments and boney articulations are also important in spinal stabilization. Most people don’t realize that the core actually consists of two separate groups of muscles, the inner and outer core muscles, and neither group involve the rectus femoris muscles (the six pack).

The Multifidus Muscles

  • The inner core consists of the muscles of the pelvic floor, the transversus abdominis (TVA), diaphragm, and the multifidus muscles (which span the vertebrae along the back side of the spine as shown above). The TVA wraps all the way around the stomach and attaches to the spine. This is what helps to form the cylinder. When contracted (in conjunction with the pelvic floor and diaphragm), it helps to increase the intra-abdominal pressure to support the spine.
  • The other muscles that help to support the spine are known as the outer core muscles. These muscles are responsible for movement of the trunk and spine as well as aiding in stability. The inner core muscles do not actually produce any trunk or spine movement. The outer core muscles consists of the following muscles:  lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors). Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Those working on core strength may not be performing the correct exercises. Performing proper core exercises (and particularly, lumbar stabilization exercises) are the primary treatment modality for LBP.

In this video, I demonstrate an easy and effective way to actively engage the inner core abdominal muscles. This exercise is typically safe even early on during the rehabilitation process for low back pain. 

For more information on how to effectively exercise and work the core muscles in order to prevent or treat LBP, be sure to check out my book, Treating Low Back Pain during Exercise and Athletics. You will 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 to eliminate pain and get back to training and exercise sooner.

AVAILABLE NOW ON AMAZON!

In addition, check out this sample video, Segment 2: What are the Core Muscles?, taken from my Treating Low Back Pain (LBP) during Exercise and Athletics Video Package which you can purchase HERE.

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. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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An Easy Exercise to Prevent and Treat Shoulder Pain and Instability

Proper rotator cuff and scapular muscle strength is critical to preventing and treating shoulder pain.  In this video, I demonstrate one of my favorite rotator cuff and scapular stabilizing exercises using an exercise band.  It works the lower trapezius, deltoid and rotator cuff muscles.

The rotator cuff is a critical component to shoulder mobility.  It’s made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates, slides, and glides properly in the socket, which is made up of the scapula.  The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly perform their movements.

The scapulothoracic muscles are the lower trapezius, middle trapezius and rhomboids primarily and proper strength and function in these muscles is critical to insuring proper shoulder blade movement and general shoulder mechanics.  Weakness in these muscles is often associated with shoulder impingement syndrome.

Weakness in the rotator cuff or scapulothoracic muscles can lead to rubbing of the rotator cuff tendon on the bone or impingement of the bursa within the shoulder leading to impingement syndrome (which can eventually lead to fraying and tearing).  With proper muscle strength and balance, you can help reduce the risk of this occurring.

Shoulder impingement or a partial rotator cuff tear can be very painful and may take many weeks to recover.  Many different causative factors can lead to these conditions.  In most cases, shoulder impingement (or even small partial tears) can be completely rehabilitated and should (when treated properly) leave no residual effects once a person has recovered.

For more information on how to address shoulder impingement, please refer to How Should I Treat Shoulder Pain and Impingement?

For an example of another shoulder exercise that can be helpful in improving rotator cuff and scapulothoracic strength, check out my video on How to Treat Shoulder Pain with an Exercise Band.

In addition to proper rotator cuff strength, it’s important to address adequate shoulder and thoracic (upper back) mobility.  Be sure to check out My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  Subscribe and you will automatically gain access to this FREE resource.  Download the .pdf file, which is full of photos and exercise instructions, to get started!

Shoulder pain can be debilitating by limiting your ability to exercise and perform daily tasks.  Be proactive in your care and management.  If you continue to experience pain, seek additional help.  Don’t let the pain linger.  The longer a condition is left untreated, the more potential for harm and damage which potentially could lead to a longer recovery.  The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Which treatments have you found to be the most effective in dealing with shoulder pain?  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!

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Do I Have a Pulled Muscle or Something Else?

Unless you’re gifted with extraordinary medical abilities, you probably can’t immediately tell the difference between a pulled muscles or something else. Hey, let’s face it, most people aren’t doctors. Not everyone can instinctively tell where their pains are coming from. And, if you’re reading this post, my guess is that you might be one the ones who struggle a little. The good news is, though, it’s absolutely normal not to know the cause of your pain; both people who suffer from sudden, fleeting pain, as well as those who experience ongoing, chronic pain, are often dumbfounded as to its cause. More often than not, though, people jump to the conclusion that they’ve pulled muscles. The effects of this type of ill-informed opinion can be life-changing, and that is why we’re about to expose the hidden answers behind what it means to have a pulled muscles, and whether or not something completely different might be going on.

What are pulled muscles, actually?

This is a good question, and it is the best place to start on your journey to discovering the true source of your pain. Remember, if you have an informed understanding of your ailment, you’ll be able to heal the source and permanently eradicated the pain. With that in mind, here is some information about what pulled muscles actually are and whether or not you have one of them, or, something completely different:

  • Pulled muscles are muscles which are forcibly stretched and pulled beyond their capabilities. In other words, a pulled muscle is the result of a forceful movement exerted on that muscle. Take an elastic band as an example: as the band is stretched beyond its elastic means, it will eventually knot up or snap. This is exactly what happens to a muscle under the same conditions; a pulled muscle is the painful result of forced overextension.
  • Alright, so how do you damage your muscles in this way? The most common activities leading up to pulled muscles include overuse, improper form during workouts, a failure to warm up and down before and after exercise, and skipping over stretching routines. Muscles need to be primed for exercise, and if this crucial step is neglected, they tend to be less flexible and more prone to damage and pain.
  • That’s all good and well, but how can you then tell if you pulled a muscle or if you’ve done something else? Well, the biggest distinction between a pulled muscle and a different source of pain is the fact that your flexibility is limited after you hurt yourself. Essentially, this means you struggle to bend, stretch, or generally move the muscle. The muscle is tight and sore. In addition, you may experience swelling in the pulled area. You’ll most likely also experience stiffness and weakness in the muscle following the damage and, eventually, (if you don’t receive treatment for the correct diagnosis) you’ll become ‘knotted up’ in the area around the muscle as a greater amount of muscular tissue succumbs to stiffness and overuse.

Here’s the problem, though: you may be experiencing all this and yet you’re still unsure whether you have a pulled muscle, or something else like, for example, a structural issue or pinched nerve.

Luckily, there is a way to tell. Pinched nerves, in particular, effect different areas of the body and produce different sensations. Take a look:

What is a pinched nerve?

  • Unlike a pulled muscle, a pinched nerve occurs when the body tissue around a nerve applies too much pressure to it. In other words, a pinched nerve has nothing to do with stretching or pulling: it is, in fact, the restriction of the nerve by its surrounding tissues and muscles. Let’s use another metaphor: a garden hose. Running through the garden hose is water vital for the plants in the garden. In the same way, your nerves carry vital information about the condition of your body to your brain. Let’s take it a step further: when the garden hose bends or is pinched, the water runs out and the plants suffer. Similarly, when the tissues around a nerve impede its ability to function correctly, the body is effected and you feel pain.
  • Now, you may be thinking, ‘sure, but how is this pain different from a pulled muscle?’ First of all, the origin of the pain is different: discomfort from a pulled nerve is traced back to the nerves themselves, all of which are found inside the cartilage, tendons, bones, and muscles of the body. It is not the muscle which is sore, it is the actual nerve. Furthermore, the symptoms of a pulled nerve are different from pulled muscles, in that one may experience tingling, numbness, sudden bouts of weakness, burning sensations, and an increase of discomfort when trying to sleep.

Both pulled muscles and pinched nerves are painful; they both decrease mobility and increase suffering, yet it is absolutely vital to understand that these two problems are treated very differently. The biggest mistake most people make is that they muddle the two, thereby exacerbating the pain and prolonging the healing process.

The thing is, if your discomfort goes untreated – or is treated incorrectly – you risk prolonged bed rest, extended periods off of work, a decrease in activity and mobility, weight gain, muscle weakness, and daily, extreme discomfort. None of these sound particularly appealing and, if you’re reading this, it’s most likely that you’ve already experienced one or more of these results. It’s time to take action.

So, if you’re unsure why you are experiencing pain or you feel as though you’re not getting any better, it’s time to get help. Physical therapy offers you the chance to find and heal the true cause of your pain, thereby allowing you to access the pain-free life you deserve.

Physical therapists can help you improve, restore or maintain your ability to move and function in your daily life. To learn more about physical therapists, visit the American Physical Therapy Association (APTA).

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. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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Falling: Facts Behind the Fear

If you generally step more gently as you go down the stairs, hold the hand-railing a little bit tighter, and take careful note of where your feet land next… you’re not alone. The vast majority of us either consciously or subconsciously fear the sudden jolt and feeling of vertigo related to feeling taking a tumble – not to mention the pain that comes afterwards! Our worst fears are realized when we start to think about the horrendous consequences of a fall: hip-fractures, muscle tears, back pain, even broken legs all come to mind. Yikes! Is it any wonder that a common nightmarish theme is falling out of bed? In fact, a fear of falling is so common that most people don’t even know they’re afraid! That’s right – the fear isn’t consciously spoken about or acknowledged, rather it translates into minute, prolonged posture and gait abnormalities which, if left unnoticed, can wreak havoc on one’s mobility and self-confidence. That’s why this post looks at why most people are secretly afraid of falling, why most don’t even know they’re afraid, and – thankfully – what we can do about tackling this problem.

Being afraid of falling is more than a cautious tip-toeing around objects: it’s an overarching alteration of the way we assess, approach, and interact with the world around us. Unbeknownst to many of us, the fear of falling actually restricts our movement, thus it can, in fact, cause pain and immobility over time. And not only that, it can actually reduce self-esteem, restricting us from otherwise social interactions along the way. So few of us ever really acknowledge the overarching effects of our fear that, consequently, we forget how our daily lives are being impacted – we become accustomed to limitations and we accept our worry as part of life. And yet, it doesn’t have to be that way!

Decreased Balance

As you’ve gotten a bit older, you’ve stopped riding on your bicycle, stopped practicing yoga, and stopped rowing down the river in your canoe. The result? Your balance has deteriorated and you’ve started feeling the impact this has had on your mobility. The less balance-orientated activities you do, the less you hone your balancing skills, thereby allowing weight to be unevenly distributed throughout your body. This causes straining and overcompensation in certain areas and weakness in others. Subsequently, an unbalanced body wreaks havoc on your brain: is it that much more likely to fear falling… after all, it knows your balance is off! The answer? Well, get back on the yoga mat, dust off the bicycle, and start practicing activities that increase your balance; a daily effort to evenly distribute weight and create a greater awareness of your body’s balance is, ultimately, a giant leap on your road to overcoming the fear of falling.

Muscle Weakness

Just as you’ve given up the rowing, you’ve also neglected to do your daily walks or stretches, thus your muscles have started to weaken and lose strength. Without muscle strength, your body isn’t capable of giving you the confidence needed to overcome a fear of falling. Again, your mind understands that your body is incapable of compensating for a fall if you have weak muscles, thus it trains you to restrict movement accordingly – it lessens the probability of a fall. Why not start walking for 30 minutes a day? Muscle weakness starts alongside a sedentary lifestyle: get active and feel the confidence return to both your body and mind.

Footwear

When it comes to falling, footwear matters. Yes, of course, wearing 9-inch heals to the park is asking for a tumble, but realistically, wearing shoes that are incapable of supporting and distributing your weight evenly is setting you up for failure. Footwear needs to be comfortable and stable, thus giving you the reassurance of a good, strong, supported stride. In addition, good footwear offers you balance! So, don’t hesitate to ditch the heels and opt of support and comfort – your body and muscles with thank you for it!

Obstacle Awareness

Clutter, mounds of clothes, various sofas, and random chairs in your home place before your body a daily obstacle course – from stepping over a coffee table, to swiveling around a badly-placed chair, these movements impact your peace of mind, place stress on your already weak muscles, and increase your fear of falling. The stress associated with navigating the living-room is, at its most basic level, akin to traversing an uneven hillside: the fact that you do it every day makes your mind and body feel as though you need to be protected, and thus your movements become limited. Obstacles feed your fear. If watching Marie Kondo is motivation enough to clean out the clutter, then waste no more time! Clear a path to freedom from fear!

At the end of the day, we know and understand that your fear of falling is far-reaching: from your body to your mind, your mobility and lifestyle are both being affected. That’s also why we know that seeing a professional, hands-on, caring physical therapist is by far the best, most effective, and safest way of tackling the issue. A qualified physical therapist is able to diagnose the root cause of the problem, assess posture, gait, and muscle tension, and work with you in order to free you from your daily anxiety.

Furthermore, physical therapy offers you tailor-made exercises and stretches, thereby allowing you to maintain a strong, stable body and a life free from fear! With physical therapy, the self-confidence to step out proudly, strongly, and bravely will become second nature to you. To learn more about physical therapists or find one in your area, visit the American Physical Therapy Association (APTA).

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. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!