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Low Back Pain

Low Back Pain (LBP) is the leading cause of disability in the United States. Low back pain can prevent a person from working, sleeping well, or staying mobile to maintain a healthy lifestyle. It has become clear in recent research that imaging does not always correlate with pain. This means that people who may show abnormalities on an x-ray or MRI, may actually be asymptomatic and in contrast, people with no abnormalities seen on imaging may actually have low back pain. The cause of this pain is neurophysiological and physical therapists can help to reduce the pain by helping improve the body’s response to physical activity.

To help reduce a person’s LBP, PTs often focus on enhancing muscular balance by improving the strength of the core/abdominal muscles and stretch the tight surrounding musculature that could be inhibiting proper movement. When working to improve muscular imbalances, we reduce the load and forces that the lumbar spine may be experiencing, ultimately reducing low back pain and beginning a pain free life.

Here are some tips and guidelines to prevent/improve LBP

Carry an object close to you and use your legs: When moving an object of any weight from the floor, it is important to remember proper form. This means pushing the hips backwards, bending at your hips and knees, maintaining an upright spine, and holding the object as close to your body as possible. When standing, maintain closeness to the object as you are moving. This significantly reduces strain on the low back and allows your leg muscles to do most of the work.

Sit with proper posture: As mentioned in previous blogs and videos, maintaining good posture will help reduce stress on the low back. It is great to use tactile and visual cues to remind yourself throughout the day to maintain good posture.

Watch the following videos to learn how to improve range of motion:

Watch the following videos to learn how to perform stabilization exercises:

Written by: Dr. Sara Polito, PT, DPT

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Love Exercise? Don’t Forget About Your Feet!

You’re on your feet all day, and they do even more for you when you engage in physical activity — especially high-impact activities like running, tennis, or sports that involve jumping. While working out your arms, legs, and abs is excellent, your feet deserve just as much attention. The tiny muscles around each foot and ankle promote balance, so exercising them can help improve your stability and reduce your risk of injuries like ankle sprains and plantar fasciitis (an inflammation of the fibrous tissue in the sole of the foot). 

The following exercises can assist you in developing improved strength and flexibility for your toes, ankles, calfs, achilles tendon, sole and top of the foot.

Ankle Range of Motion 

Works the small muscles around the ankle. 

  1. Sit at the edge of your bed with your feet slightly off the edge. 
  2. Rotate each ankle several times clockwise and counterclockwise. 
  3. You can also trace the letters of the alphabet with your toes to increase your range of motion. 

Ankle Inversion 

These exercises strengthen the small muscles that move your foot inward. 

  1. While sitting in a chair, rest your right foot on your left knee, letting your right knee fall outward. 
  2. Press on the inside of your right foot while pressing your foot against your hand. 
  3. Repeat ten times and then switch legs.

Toe Curls

Strengthen the plantar flexor muscles in the soles of your feet, which you use to press your foot downward away from the body

  1. While sitting with both feet flat on the floor, place a towel or cloth under one foot. 
  2. Curl your toes and grab the center of the towel, curling it toward you. 
  3. Relax and repeat with the other foot. 

Toe Pointing 

Also known as plantar flexion, this exercise stretches the tops of your feet while strengthening your ankle muscles. 

  1. Sit with your legs straight in front of you. 
  2. Point each foot and then relax. 
  3. You can add extra resistance by using the rubber exercise band. Loop the band around the ball of your foot and hold the other end in your hand. Point your foot, extending the band. Repeat on the other side. 

Calf Raises 

These exercises strengthen your calves as well as your feet. 

  1. Stand while holding a chair or table lightly for balance. 
  2. Rise up on your tiptoes. 
  3. Lower your heels to the floor. 
  4. Repeat ten times. 
  5. You can do this exercise with both feet at the same time, or for extra strengthening you can lift one foot off the floor while doing calf raises on the other side. Then switch legs. 

Ankle Dorsiflexion

This exercise works the muscles at the top of the foot around the ankle. It is excellent for preventing shin splints. 

  1. Sit with your legs straight in front of you. Support your back against a wall if necessary. 
  2. Flex your right foot, bring your toes toward you ten times. 
  3. Repeat with your left foot. 
  4. You can also perform this exercise with extra resistance by using a looped rubber exercise band. Loop the band around the base of a chair or table leg and wrap the other end around the top of your foot. With the band extended, pull your foot toward you. Repeat on the other side.

Achilles Tendon Stretch

Stretches the tendon that connects the base of your calf muscles to your heel. This exercise reduces the risk of Achilles tendonitis and plantar fasciitis

  1. Stand with your hands against a wall and your feet flat. 
  2. Stretch one leg straight behind you, keeping both feet flat on the floor. Bend the knee of your front leg slightly. 
  3. Lean toward the wall, pressing your back heel down. You’ll feel a stretch in your back calf and behind your ankle. Hold for 30 seconds. 
  4. If you bend your back leg slightly and lean back into it, you’ll feel even more stretch in the Achilles tendon. 
  5. Switch legs and repeat on the other side. 

Ball Roll 

Stretches the plantar fascia on the sole of the feet, relieving and preventing plantar fasciitis

  1. Sit in a chair with both feet on the floor. 
  2. Place a golf ball or tennis ball under the foot. 
  3. Roll your foot back and forth over the ball for about two minutes, allowing it to massage the arch of your foot. 
  4. Repeat with the other foot. 
  5. You can also roll your foot over a frozen water bottle. The cold feels especially good if you have plantar fasciitis. 

Top of Foot Stretch

This exercise extends the muscles along the top of your foot, which are often neglected and can become tight. 

  1. While kneeling, sit back on your heels with your feet tucked under you and your toes pointing behind you. 
  2. Support yourself with your hands pressing into the floor if your knees are uncomfortable.
  3. You should feel the stretch along the tops of your feet. 

Should you exercise if your feet hurt?

It depends on what’s causing your discomfort. If your feet are tired, exercise is safe to do, but you can take it easy. If you have arthritis in your feet or ankles, you may feel some pain at first, but exercise will warm up the joints and make you feel better. If you’re feeling pain due to an injury like a twisted ankle or inflammation such as plantar fasciitis or Achilles tendonitis, you should take a break and see a physical therapist to learn what you should do and when you can exercise again. 

Finally, don’t discount the power of the right footwear. Choosing shoes that cushion and support will go a long way to making sure you keep your feet comfortable and healthy.

Written by: Dr. Matthew James, PT, DPT

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Concussion

Did you know that someone does not have to have a physical blow to the head in order to sustain a concussion?

As physical therapists, we treat clients who sustain a concussion secondary to a variety of different causes: car accidents, falls, sports incidents, and even non-contact injuries that may result in concussion such as whiplash. When looking at the different trajectories responsible for symptoms following a concussion, physical therapists primarily focus on the oculomotor dysfunction, vestibular dysfunction, and cervical spine pain that may be present as a result of concussion. Sometimes, these trajectories overlap, so a thorough evaluation of these trajectories is the first step to the rehabilitation process.

When treating concussions, the end goal for rehabilitation is to have the client return to their prior activities before the concussion with as little symptom provocation as possible. In order to achieve this end goal, part of the rehabilitation process includes habituation, which is a term used to describe gradual exposure to symptom provocation activity with moments of full symptom recovery. By completing these habituation exercises, the brain and body become aware that these activities are okay and normal to do, therefore overcoming the symptoms the client may experience.

Some symptoms that can be experienced following a concussion are headaches, dizziness, motion sensitivity, sensitivity to noise and light, decreased exercise tolerance, and difficulty with focusing and sustaining attention. With skilled physical therapy, we work to help reduce these symptoms for a client and tailor exercises that meet the specific needs of the patient, eventually giving the client the ability to return to activities they once were doing.

Check out our Facebook page (@specialedptNJ) for videos with examples of different techniques we use for oculomotor training, vestibular rehabilitation, and for cervical pain.

Written by: Dr. Rachel Balluch, PT, DPT

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The Thoracic Spine

Where is it? The Thoracic Spine is at the mid to upper region of our back where most of our ribs attach. This portion of the spine can often become stiff and sometimes lose mobility if we are not moving a little bit every day, or if we are sustaining a poor posture while sitting for too long. Stiffness and limited mobility may result in increased discomfort or pain, ultimately leading to even less body movement. Sometimes thoracic spine stiffness can even lead to other pain in the body, including the shoulders, low back, and neck. While being at home, we may not be moving as much as we typically would especially if we are busy at the computer working or even binging the newest Netflix show. This can create stiffness and pains we did not have before and ultimately may reduce our general health.

So, what can we do to help reduce the risk of thoracic pain and stiffness while remaining at home? Listed below are 3 simple exercises to remain mobile and limit any onset of pain.

Daily Exercises:

  • Thoracic extension: Sit in a chair with a supportive back. Using an object of cylindrical shape, place in the mid region of spine, below the shoulder blades. Interlace your fingers and place them behind your head. Lean backward while thinking about rounding the spine around the cylinder object. Complete 10 repetitions for 2 sets. Hold eat repetition for 5 seconds.
  • Open book stretch: Laying on your side, use one pillow under your head and one pillow between your knees. Then, extend both arms outward in front of you, palms facing each other. While keeping the core engaged and limiting low back rotation, rotate the upper arm up and into an arch motion, as if a book was opening. Hold for 5 seconds. To improve rotation, follow your thumb with your eyes and head. Repeat exercise for 10 repetitions, performing on both sides.
  • Seated side bends: While sitting in a firm chair, place both at your side, elbows bent. With one arm, reach up and over your head to the opposite side. Gently reach with hand, as if you are trying to grab something. Hold for 5 seconds. Repeat 10 times, then complete on the opposite side.

In addition to these simple exercises, ask your physical therapist about skilled manual techniques that can be used in the clinic to help improve your thoracic mobility, therefore improving posture and reducing possible stiffness and pain. Remember, in addition to these exercises, look at our previous blog on posture to help limit increases in thoracic stiffness.

Written by: Rachel Balluch, PT, DPT

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Perfecting Your Posture

Good posture impacts your appearance as well as your overall health by relieving strain and fatigue from your muscles and ligaments. Poor posture, on the other hand, increases your risk of injury and pain.

We start with straight posture when we are young and it declines as we age. Our muscles become less flexible and we heal slower. Our spinal discs shrink in height, giving us a shorter, more hunched appearance. Gravity constantly pushes down on us, forcing us forward over time. We also find ourselves in seated positions more often than we should. Whether we are commuting in the car or now sitting at our desks/computers due to the COVID-19 pandemic, we frequently lean forward, especially when looking down at our phones or tablets.

What can we do?

Exercise

Exercises that target the upper body, lower body, and core muscles are recommended. Aim to “strengthen and lengthen”. Strengthen the muscles that are overstretched (i.e., upper back, abdominal, and buttock muscles) and lengthen the muscles that are shortened and tight (i.e., chest and hip flexors). Specific muscles differ for everyone, so speak with your health professional to learn which exercises work best for your individual condition.

Sleep Alignment

Good posture is attainable even while you sleep. When sleeping on your side, place a firm pillow under your head and another between your knees to keep alignment and relieve pressure from the back and hips. When sleeping on your back, flex your knees slightly and place a pillow underneath your knees.

Daily Changes

■ While sitting for long periods at your desk or in a plane, set an alarm to stand every hour for a chance to readjust the pressure on your spine.

■ When sitting, use a footstool to keep your feet firmly planted and place a small, rolled towel at your mid-back to help you sit upright.

■ As you stand waiting to cross the street, distribute your weight equally between both feet. Activate your muscles and slightly bend your knees, as locked knees put extra stress on your bones.

■ When walking around, carry a light and even load, by holding packages in two hands or in a backpack strapped on both shoulders. Make sure to have canes or other assistive devices properly sized to meet your proper posture.

■ When driving, set your mirror while sitting with proper posture. Once you can no longer see, you know you must sit back up.

Written by: Matthew James, PT, DPT

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Low Back Pain 

The spine is composed of 33 vertebrae divided into five sections (cervical, thoracic, lumbar, sacral, coccygeal). Each section of vertebrae has a slight curve and a different shape. The cervical (neck)  and lumbar (low back) vertebrae curve inwards, like a “C,” known as a lordotic curve. The thoracic (chest) vertebrae curve outwards, known as a kyphotic curve. Scoliosis, another spinal curve, occurs when the vertebrae move sideways, or laterally.

Each vertebrae has a hole in the center, called the vertebral foramen, through which the spinal cord passes. Between each vertebrae are intervertebral discs, which allow you to move and bend.  Low back pain can be the result of disc displacement, narrowing of the openings where the nerves exit the spine, weakness or spasm of the muscles surrounding the spinal column, or compression on any of the pain sensitive structures around the spine.

There are some common diagnoses that we, as physical therapists, see    frequently in the clinic. Spinal stenosis refers to the narrowing of the spinal canal which pushes on a nerve, resulting in pain. Spondylosis is a form of arthritis in the spine and can affect the joints between the vertebrae, and sometimes put pressure on the nerves. Spondylolisthesis occurs when one vertebrae moves anteriorly, or forwards. Vertebral stress fractures may occur with these two conditions. Spinal instability is closely related to spondylosis, and refers to the loss of control of the lumbar spine. Herniated discs occur when there is too much pressure on one part of the disc, usually the front part, which forces the disc material outwards. The discs in your spine have a firm outside with a jelly-like material inside; there are varying degrees of how much of this material is outside of the disc, or herniated.

When you come to physical therapy for your low back pain initial evaluation, your therapist will ask you a variety of questions in order to determine exactly which structures are involved and which therapeutic exercises will be of most benefit. You may be asked to provide information about the onset and duration of symptoms, if any positions aggravate or improve your pain, and if you have any particular goals for therapy, amongst other questions. While physical therapy will not fix any structural impairments, treatment is focused on general strengthening of muscles surrounding the affected area to reduce pain, improve posture, and improve overall quality of life. These muscle groups include, but are not limited to, the quadriceps and hamstrings in the leg, abdominal muscles (transverse abdominis, obliques), back (trapezius, latissimus dorsi), and the glutes. Your therapist may also implement a stretching routine, or nerve glides, which aim to reduce tension on a specific nerve by moving the body through a specific range of motion.  Manual therapy interventions, such as soft tissue massage and joint mobilizations may be included depending upon the case, to improve the motion between joints, reduce muscle guarding, and improve overall motion. As always, it is important to be open and honest with your physical therapist so that you will receive the best and most accurate care for your condition.

Aly May, PT, DPT and Rachel Einhorn, Rehabilitation Aide

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Fitness vs. Fatness: Does the scale outweigh the sweat?

Cheer to ringing in the new year! We at Specialized Physical Therapy would like to kick off 2018 with another popular topic: New Year’s Resolutions. Yes, weight loss resolutions may be cliche but every great step starts with a commitment.What I’d like to tackle on today is what keeps you moving and committed past the initial difficult weeks; the debate over fitness versus fatness. Does what reads on the scale matter if you are choosing healthy behavior change, lowering your risk for diseases and potentially increasing years to your life expectancy?

To start, this has been highlighted  by some big players:

So where are we with the controversy: We’ll some good news is here! Recent large scale studies continue to show that it’s not just about the results on the scale. Being fat and fit is better than being unfit, period! Yes, proper fitness across all weight groups have significant reductions for all cause mortality, even when compared to a normal weight, unfit person!

This chart is comparing the relationship between physical activity level, body mass index and cardiovascular disease mortality rates of almost 14,500 individuals tracked over 17 years.

Lower left bar (in red) is the normal weight, unfit group while the upper right bar (in blue) is the obese, fit group.

Bottom line: don’t be discouraged if the scale doesn’t tip favorably, keep pursuing this healthy behavior change and you will be rewarded!

Current guidelines for physical activity:

Adults: 1.) 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity per week

2.) And at least 2 days of muscle strengthening activities across all muscle groups

“You lose weight in the kitchen, you gain health in the gym”

-Tim Difrancesco, PT, DPT, ATC, CSCS

Former Head Strength and Conditioning Coach: LA Lakers

Further information:

https://www.cdc.gov/physicalactivity/basics/adults/index.htm

https://www.ncbi.nlm.nih.gov/pubmed/14580628

https://www.ncbi.nlm.nih.gov/pubmed/24438729

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I Blame It On the Weather

Although you might not see it, your joints may certainly let you know winter is coming. There is little research that supports the effects of weather on joint pain. However, there is evidence that indicates there is a strong indication in people with Osteoarthritis,between joint pain and average humidity especially in cold weather conditions. The effect of humidity on pain was stronger in relatively cold weather conditions. The correlation is strong with a three day average, however there was no significant association between day-to-day weather changes 1.

Osteoarthritis (OA), is a degenerative joint disease characterized by damage and loss of articular cartilage and changes in bone. It is the most common cause of chronic pain in older persons and the leading cause of disability 2. A study was done with six different European countries with different climates, which identified characteristics of older persons with OA. Low temperature, high atmospheric pressure and high humidity shows a high correlation with pain in RA, low temperature and high humidity in OA, and low temperature and high atmospheric pressure in FM 3. Science behind all of this stipulates changes in temperature and humidity may influence the expansion and contraction of different tissues, such as muscles, fascia and connective tissue in the affected joints. As a result, this could elicit a pain response, which may discourage you from taking that mile walk in the morning. In addition, low temperatures in the environment may increase the viscosity of the synovial fluid, thereby making joints stiffer 2. This can further lead to more sensitivity to the pain of mechanical stresses your joints feel when you go to stand up. If you are reading this and are above the age of 65 years, female and have anxiety, you might find this information useful. You are a candidate whom might feel the effects of low temperature and humidity changes more than others. Research indicates, women and or who are more anxious, are more likely to report weather sensitivity (Figure 1). It is also suggested that weather affects mood, resulting in an alteration of pain perception2.

But why?… A possible explanation could be that poor mood might increase subjective complaints of pain or more anxious people with OA might tend to blame their symptoms on something they can comprehend but cannot control more than less anxious people with OA2.

What can you do to prevent the cold getting to your joints?… Early treatment such as exercise or even physical therapy for weather-sensitive individuals with OA, especially women can help. Doing different strengthening and balance exercises on top of cognitive and psychological interventions may reduce suffering and may help maintain a functional lifestyle 2.

Since there is some evidence out there supporting the relationship between joint pain in OA and weather, this may help individuals with OA, physicians, and therapists to help better understand and manage fluctuations in pain1. Next time you find yourself blaming the weather for your knee pain, you might want to smile before getting out of that blanket to change your mood.

Citations

Timmermans EJ, Schaap LA, Herbolsheimer F, et al. The Influence of Weather Conditions on Joint Pain in Older People with Osteoarthritis: Results from theEuropean Project on OSteoArthritis. J Rheumatol. 2015;42(10):1885-92.

Timmermans EJ, Van der pas S, Schaap LA, et al. Self-perceived weather sensitivity and joint pain in older people with osteoarthritis in six European countries: results from the European Project on OSteoArthritis (EPOSA). BMC Musculoskelet Disord. 2014;15:66.

Strusberg I, Mendelberg RC, Serra HA, Strusberg AM. Influence of weather

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The Best Athletes in the World are just that, Athletic

-Mythbusting early sports specialization amongst youth aged kids

Well we’ve reached another school year, the leaves are starting to change and pumpkin spice everything is here. We at Specialized Physical Therapy are happy to kick off Physical Therapy Month with a discussion on an important topic. Early sports specialization is defined by the American Orthopaedic Society for Sports Medicine as follows: 1. Participation in intensive training and/or competition in organized spots greater than 8 months per year. 2. Participation in one sport to the exclusion of participation in other sport and 3. Involving prepubertal (less than age 12) children. In a survey of 3090 athletes across the major competitive levels, current high school athletes are specializing about two years earlier than current collegiate and professional athletes.2 While two years may seem insignificant, it may mean missed opportunity for key developmental periods to develop proper movement patterns in favor of becoming better at that individual sport. It is generally accepted that kids are getting more competitive than ever, we are bringing you the evidence to go against current trends and that earlier sports specialization is doing more harm than good for your athletes.

This graphic is from the American Academy of Pediatrics. While it is widely known that athletic scholarships are extremely competitive, what should immediately jump out to you is that overuse injuries as well as burnout are increasing more than ever in the current athletic environment.

Who is to blame? Quick Answer: Everyone but the athlete

The 10,000 hour rule: This may have been incorrectly used and glorified in the media as the origin was from previous studies evaluating the formula to chess players’ success.1 There are many factors that must be taken into account in order to attain elite status. From unique physiologic qualities to understanding that young athletes must learn important fundamental physical movement skills that transfer to multiple sports.1 Therefore, it may be possible to achieve elite status from an accumulation of other activities and not just sport specific training.

The loss of deliberate practice: A shift from youth-driven or free play has shifted to more structured parent and coach driven activities. It is important to recognize that playing sports without the consistent intervention of coaches (before age 13) has been identified as necessary to develop essential skills.3 Many professional athletes will often say that their best memories as a kid were playing pickup games without the pressure of a parent or coach where they really fell in love with their respective sports. Also, it is only in late adolescence that children may develop the necessary skills needed to invest in highly specialized training and understand the costs/benefits of intense focus on one sport. 3

Earlier recruitment: College recruitment has been reported as starting from as early as sixth grade.3 This has created unnecessary pressure for children and according to the US Olympic Committee are at a developmental stage where they are just starting to moving from the Discover, Learn, and Play stage to the Develop and Challenge stage.3 In multiple consensus statements provided in this blog post, there must be a tempering of expectations during competitive events and the level of skill necessary at each age level.

Still don’t agree:

There were 322 athletes invited to the 2015 NFL Scouting Combine, 7% of whom played multiple sports in high school and 13% of whom only played football1

Watch Sidney Crosby, considered the best NHL player right now, display amazing footwork on the ice and was a former soccer player in his youth: https://www.youtube.com/watch?v=0DDYIBLUZxk&t=310s

Recommendations:

*Sidenote: It is unclear whether high risk sports such as figure skating, gymnastics and diving poses a risk for long term health and well being as there are conflicting reports.1

References:

  1. Brenner, J. S. (2016). Sports Specialization and intensive training in young athletes. Pediatrics, 138(3), e20162148.
  2. Buckley, P. S., Bishop, M., Kane, P., Ciccotti, M. C., Selverian, S., Exume, D., … & Ciccotti, M. G. (2017). Early Single-Sport Specialization: A Survey of 3090 High School, Collegiate, and Professional Athletes. Orthopaedic Journal of Sports Medicine, 5(7), 2325967117703944.
  3. LaPrade, R. F., Agel, J., Baker, J., Brenner, J. S., Cordasco, F. A., Côté, J., … & Hewett, T. E. (2016). AOSSM early sport specialization consensus statement. Orthopaedic journal of sports medicine, 4(4), 2325967116644241.