What should I do if the treatment doesn't make me feel better?

What should I do if the treatment doesn't make me feel better?

This is a tough question because every situation is different. If you are suffering from acute pain and it is very new you probably need to give treatment a little more time, especially if you have just started Physical Therapy. This holds true for chronic pain and recent initiation of treatment. It takes about 4-6 weeks for muscles to make lasting changes in strength, length and endurance. So if you have just started a lumbar stabilization exercise program you need to give it 4-6 weeks before you start to measure results.

Also, sometimes pain is not a good measure for progress. If you are able to tolerate more, perform more advanced exercises and resume more day to day activities but your pain is about the same you are actually demonstrating progress. You are doing more without increase in symptoms. That is sign of progress!

In addition your symptoms may change indicating progress. For example, if you have had nerve symptoms into your legs, known as radiculopathy, and that pain moves into your low back, this is also a sign of progress. Even if you pain has intensified in your low back, the centralization of pain, or concentration into your low back indicates decrease in neurological symptoms and is a sign that you are improving.

If you have been participating in Physical Therapy for more than 3 months and you continue to have significant pain without any relief, you may need to take a closer look at the situation. Have you truly committed to the lumbar stabilization process? Have you been faithful with your home exercises? Have you given your best to improve strength in your low back? If the answer is truly yes to all of these questions, you may need to have further diagnostic testing such as MRI and consult an orthopedic surgeon or neuro surgeon for further treatment. Otherwise, you may need to re-establish your commitment level to the process and really give lumbar stabilization and Physical Therapy the effort to improve.

What treatment do I need?

What treatment do I need?

Treatment for acute low back pain

Acute low back is symptoms that has lasted less than 3 months. If your low back pain has just recently started these tips can help:

Immediately after you back pain starts for the first day or two, try to rest in a comfortable position. Lying on your side with a pillow between your knees, on your back with 2-3 pillows under your knees maybe the most comfortable you can get. Try no to stay in one position for too long. Get up every 2 or 3 hours and move in a pain free way, either a short walk or gentle stretches while standing. Try to stay up and moving around for 15-30 minutes. Then resume a comfortable resting position.

Certain over the counter medications can help control your pain and reduce some symptoms associated with an inflammatory response. Take ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve) to address pain, swelling and irritation or take acetaminophen (Tylenol) to control pain. Follow the directions on the bottle for dosage amount.

Heat and Ice can help to control symptoms as well. Try using a heating pad on a low or medium setting, a warm shower, hot bath or sitting in a hot tub for 15 to 20 minutes every 2 to 3 hours. Or try using an ice pack for 10 to 15 minutes every 2 to 3 hours. You may also want to try switching between heat and cold.

Resume normal activities as soon as you can. Staying sedentary for longer than 1-2 days can actually cause more back pain and problems. Movement helps your muscles stay strong.

If you have low back pain for more than 3-5 days, call your doctor and get into Physical Therapy to address remaining symptoms and strengthen your low back. Once you have back pain you are more likely to have a reoccurrence of low back pain. Getting the proper strengthening and stretching exercises quickly can help reduce that risk.

Treatment for chronic low back pain

Chronic low back pain is symptoms that has lasted longer than 3 months. As low back pain continues beyond 3 months, it becomes very important that you get the help you need to resolve your injury. Going to see you doctor and getting the diagnostics done that may help to explain continued low back pain Furthermore it is important to undergo Physical Therapy treatment to address symptoms, strength deficits, spine joint restrictions and general movement pattern disruptions. With the proper lumbar stabilization regiment you can improve your low back pain and restore function without more invasive measures.


Other therapies to consider in addition to tradition Physical Therapy:

Acupuncture: When you have pressure on the nerves, acupuncture can help relive that pressure and help to reduce pain. When the acupuncture needles are put in certain places in the body, you will relieve the pressure on a nerve. By relieving that pressure on a nerve, the muscles begin to relax, the blood begins to flow into an area, and pain is reduced. Also accupuncture releases endorphins which also adds in pain reduction.

Massage Therapy: Massage improves blood circulation, which aids in recovery of muscle soreness from physical activity. Massage relaxes muscles for an improved range of motion. Massage leads to increased endorphin levels. Endorphins are the chemicals the body produces that make you feel good, which is very effective in managing chronic pain.

Aquatic Therapy: Water exercise also known as aquatic therapy takes advantage of the unique properties of water to mobilize joints, increase range of motion and to develop balance and stability. If a back injury has short circuited your regular workout routine, a water exercise program might be a good alternative during the healing period. In addition, water offers an excellent core strengthener to help prevent back pain.

Do I need to have any tests?

Do I need to have any tests?

The most common test for low back pain is a Physical Exam.  Physical Exams are typically performed by Primary Care Physicians or Physical Therapists to identify the cause of low back pain.

If the Physical Exam results in any findings outside the norm, typically you will be referred for diagnostic imaging.  You may also be referred to an orthopedic surgeon or Neuro surgeon, who are the specialists in spine health.

Common imaging tests include X-Rays, MRI, CT Scan and Bone Scan.  These tests can further determine the cause of back pain.

X-Rays:  Spinal X-Rays are pictures of the spine used to find injuries or diseases that affect the bones or joints in the spine. X-Ray help to diagnose spinal fractures, dislocations, bone spurs, disc disease, osteoarthritis or scoliosis. 

MRI: Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to allow physicians to assess a patient’s spinal anatomy and investigate an anatomical cause of the patient’s back pain.  MRI gives specific detail to determine spinal alignment, disc height and hydration, vertebral body configuration, intervertebral disc space, nerve integrity or abnormalities in the spine that may cause spine pain.  MRI can help diagnose degenerative disc disease, spinal dysfunction, nerve root compression, and degenerative changes in the spinal column.  

CT Scan:  Also known as CAT scan, it combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. Using CT, the bony structure of the spinal vertebrae is clearly and accurately shown by CT scanning, as are the intervertebral disks and, to some degree, the spinal cord which can help to diagnose cause of back pain.

Bone Scan: A bone scan is a nuclear scanning test that identifies new areas of bone growth or breakdown.  A bone scan can often find a problem days to months earlier than a regular X-Ray test.

What is causing my low back Pain?

What is causing my low back Pain?

There are various causes of low back pain, however most low back pain is triggered by some combination of overuse, muscle strain, and injury to the muscles, ligaments, and discs that support the spine. Many experts believe that over time muscle strain can lead to an overall imbalance in the spinal structure. This leads to a constant tension on the muscles, ligaments, bones, and discs, making the back more prone to injury or re-injury.

The most common causes of low back pain are: Injury or overuse of muscles, ligaments, facet joints, and the sacroiliac joints.

Pressure on nerve roots in the spinal canal. Nerve root compression can be caused by a herniated disc, often brought on by repeated vibration or motion (as during machine use or sport activity, or when lifting improperly), or by a sudden heavy strain or increased pressure to the lower back.

Osteoarthritis (joint degeneration), which typically develops with age. When osteoarthritis affects the small facet joints in the spine, it can lead to back pain. Osteoarthritis in other joints, such as the hips, can cause you to limp or to change the way you walk. This can also lead to back pain.

Spondylolysis and spondylolisthesis, vertebra defects that can allow a vertebra to slide over another when aggravated by certain activities.

Spinal Stenosis, or narrowing of the spinal canal, which typically develops with age.

Fractures of the vertebrae caused by significant force, such as from an auto or bicycle accident, a direct blow to the spine, or compressing the spine by falling onto the buttocks or head. 

Spinal deformities, including curvature problems such as severe scoliosis or kyphosis. 

Compression fractures: Compression fractures are more common among postmenopausal women with osteoporosis, or in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

Common Lower Back Pain questions

As a Physical Therapist, I get so many questions about what do about Lower back Pain. I have listed several of them below and will answer them as well. However, the list is long enough that I am not going to answer them all today. Over the next few Blogs, I will hit them all. I am sure that if you are experiencing back pain, you have asked one or more of these questions.

As always, when you have questions about your health, it is important to ask you Doctor.

Here are some common questions that I have been asked about Lower Back Pain:

• What is causing my back pain?
• Do I need to have any tests?
• What treatment do I need?
• What should I do if the treatment doesn't make me feel better?
• Do I need to stay in bed or rest?
• Can I still go to work?
• How long will it take for me to get better?
• What else can I do to make my back feel better?
• Are there any exercises that can make my back stronger?
• Are there any alternative or complementary therapies that might help?
• What can I do to avoid getting a backache again?
• Is it all right for me to drive?
• What is the difference between a herniated disc and a bulging disc?
• Are there any medications I can take for pain?
  
• I just injured my back, but it doesn't hurt enough to go into the doctor. What can I do?
  

Do any of these sound familiar? I am sure they do. Stay tuned for the answers in the next several posts.

Doctorate of Physical Therapy

Today I would like to discuss the degree of Doctorate of Physical Therapy. We received a phone call at the end of last week from an irate gentleman who seemed to think that there was no such thing as a Doctorate of Physical Therapy. This individual would not listen to anything let alone reason, so I decided this would be a good topic. There is indeed a Doctorate of Physical Therapy. It is an intense graduate program offered by several universities and I have one on the wall so I am certain that it exists.

The field of Physical Therapy is transitioning its accredited university programs so that all will offer the doctorate. Originally the profession required only a Bachelor's degree, next it moved towards a masters degree, but the profession is now moving towards the Doctorate. In addition to the degree, Physical Therapists must also have a license to practice. The Doctorate of Physical Therapy in an entry level degree. Similarly Medical Doctor and Juris Doctor are entry level doctoral degrees. In all of these cases, the profession warrants the knowledge required to practice within theses fields.

In addition, in the state of California, a law was passed in the past few years to allow Physical Therapists with a Doctorate degree to go by the title "Doctor". This was a tremendous step in the profession of Physical Therapists! I hope that other states will follow suit.

-Dr. Juliette Norman DPT

Posture

Somehow the posture post didn't get published on Wednesday...so here it is today!

Posture! It is the position in which you hold your body upright against gravity while standing, sitting or lying down. Good posture involves training your body to stand, walk, sit and lie in positions where the least strain is placed on supporting muscles and ligaments during movement or weight-bearing activities.

Good posture can help reduce the incidence of back pain! It is worth it!

Here are two great websites that will give you all the skinny on good posture, and steps to keep it good:

1) American Physical Therapy Association

http://www.apta.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=20457

2) Wikipedia - How to improve your posture

http://www.wikihow.com/Improve-Your-Posture

Be an expert on posture! Your back will thank you.

Back Healing Center

The Back Healing Center! It is a place to come get your back healthier! It works...I know because I helped design it. I am the one treating patients and I believe in improving lumbar strength, eating better and resuming a healthier lifestyle. That combination works to help decrease back pain. Making back pain better is something I am very passionate about. If you have been following this blog, I can imagine you have already picked up on that.

So what makes the Back Healing Center different? Truth be told it is the commitment and passion brought to the program by the individuals who have designed it. The reason it works is that the program incorporates a total approach to back pain including lumbar stabilization exercises, traditional Physical Therapy techniques, an emphasis on nutrition and wellness and Spine Six Biomotion Therapy. Quite frankly, the SpineSix Biomotion therapy is the piece that makes us a cut above. This is an amazing piece of technology that mobilizes the spine at each individual segment to promote proper spinal alignment, decreases soft tissue stiffness, and promotes healing of joint surfaces and soft tissue. So basically it helps to reduce pain and restore spinal mobility so that you may resume an active lifestyle.

So if you have low back pain, check out the Back Healing Centers.

www.backhealingcenters.com

Neck Pain

Most of this blog to date has focused on low back pain. In truth, more people suffer from low back pain than neck pain. Or at least that his been my experience and there is certainly statistical data that claims close to 80% of people suffer from back pain, or have suffered from back pain. That is certainly significant. However, neck pain is also very prevalent in today's society.

There is a reason that the cervical spine as well as the lumbar spine tend to break down. These are the two sections of the spine that are responsible for mobility. The low back allows you move the trunk froward, backwards and turning to either side. It allows your upper extremities more reaching mobility since the base can move around.

The neck is responsible for the mobility of the head. The ability to move your head from side to side and swivel around allows the versatility for the visual field. The mobility of the neck allows a significantly greater visual span.

As any other joint in the body increased mobility at a joint correlates with increased risk of joint wear and tear and potential for break down. In addition, we spend exponentially more time sitting. In general we spend a tremendous amount of time sitting in our cars, sitting in front of the computer, sitting in front of the television. All of these activities promote a posture of the shoulders rolling forward and the head jutting out, what we call forward head posture. This poor postural position puts extra strain on the nerve roots that exit the spinal column in the cervical spine leading to pain in the neck and can worsen to pain down the arms.

Ergonomics can make a big difference to neck pain in the work place. Most importantly to address neck pain is to make sure that you have good posture. So take a good look at your posture and see if you can work towards improving it today!

More to come on Posture on the next post.

Weight and Back pain

Recently I have started hiking in the morning before work 3 days a week. It is a great cardiovascular activity and it gives me time to just ponder different things. Today, I was thinking of the impact of weight on joints and the body. Carrying extra weight and the increased force with each step pounding through your body. The impact extra weight has on all your joints from ankle, moving up to knee, through the hip and into the low back.

If I were to hike my trail with a 30Lb pack on my back, I would certainly notice the difference through all my joints. That is comparable impact as when we move around when if overweight. For every extra pound of body weight we lug around it is an increase of 7Lbs of force through our joints. I always recall that statistic when thinking on this topic and it is staggering to me. If you are 10lbs overweight (and honestly how many of us wouldn't benefit from losing 10lbs...I know I could), you are putting an extra 70lbs of force on your joints. That would certainly increase the wear and tear on your joints and make you more susceptible to osteoarthritis. That wear and tear will also translate into increased wear and tear in your lumbar spine, and predispose you for low back injury.

Far too often low back pain is associated with obesity. And there is a direct correlation between increased adipose tissue in your abdominal region and decreased strength and therefore stability in your low back. For this reason, nutrition is paramount to help decrease low back pain. If you are overweight and suffer from low back pain, not only do you need to address the back pain, but you also need to address the potential cause of your back pain being directly linked to your obesity. As you address the low back pain and get active to strengthen the muscles that will increase stability in your low back, make nutrition a priority as well. Increased activity and proper nutrition can help to decrease your weight and decrease low back pain. So, follow my example and go for a hike!

Ergonomics - Proper Workstation Set-up

Ergonomics is the science of designing the optimal work environment. There are several elements to ergonomics but my focus is in designing the optimal work station to minimize repetitive injury associated with word duties.

The key elements to work station ergonomics are how you are seated in relation to your work space and specifically with your computer, as most people spend a majority of their work time at the computer. Here are some basic principals to make sure that your work station is ergonomically correct.

Sitting position: You should be seated in a chair with your hip angle at 90 degrees and your knees angle at 90 degrees. Your chair should have good lumbar support so that you are sitting up straight.

Keyboard Position: The keyboard should be above your legs so you have ample room for your legs. However, low enough so that your shoulders are relaxed and arms are comfortably by your side with elbows bent at 90 degrees. Also, your keyboard should be angled so that your wrist position is straight or slightly cocked up while typing.

Monitor Position: The monitor should be directly in front of you at a distance of 18-24". You should not have to turn your head to look at monitor. Also, the monitor should at the height of your line of vision. Ideally the line of vision is at the top edge of monitor so you look down slightly to see screen. You should not have to tilt head up or down to see monitor.

Sometimes it is difficult to make these adjustments due to furniture that is not adjustable, or you are not the right size for your station. You can use books to raise your computer height, you can adjust your chair higher and use a stool under your feet to optimize your position to your desk. Do what you can to optimize the computer position to you. If you accommodate your body position to your computer station you will have wear and tear on your tendons and muscles that can lead to back pain, neck pain, shoulder and wrist pain. Good ergonomic positioning can limit the risk of that damage. And ask for help if your work station is terrible, it will keep you healthier and make you more efficient at your job.

Back Pain - First Response

What should you do when you back goes out? Common concern for those of us who have suffered from low back pain. The initial phase is incredibly painful and it hurts with all movement.

The common tendency is to lie in bad and avoid all movement. And sometimes, when the pain is bad and the spasm so severe, this is literally all you can do until some of the acute symptoms subside a bit. However, it is not he ideal treatment for the low back. In general, you want to try to keep the back loose as much as you can. Using ice and heat to control pain and inflammation and reduce spasms is an excellent approach at home, and typically is something you might have on hand. Over the counter anti-inflammatory medications (for example ibuprofen or naproxen) can help to reduce inflammation and decrease the pain. Gentle stretches can help keep the back loose as well. Pulling a knee to check and holding it for a minute, rotating bent knees back and forth in a pain free range can also be helpful. Basically any gentle movement that does not provoke back pain is an excellent way to keep the back moving.

Once you can move around more comfortably, I strongly recommend Physical Therapy. It will help to manage pain and inflammation, strengthen the low back to help prevent the re-occurrence of low back injury. After your low back goes out it is more likely to do so again without addressing the problem. Improving mobility, strength and function is the goal of every Physical Therapy program. It can make the difference for your back health!

Common Question: Heat vs Cold

Should I use heat or ice for my low back pain? I get this question all the time from my patients. Bottom line for low back pain use whatever helps to relieve the pain. But lets go into the principles of both ice and heat as modalities.

The rule of thumb for heat and ice is after an injury the first 24-48 hours is the acute phase and ice is the best to manage inflammation (swelling) and help to control pain. After the first 48 hours the injury moves into sub-acute and then chronic phases and heat is the best modality.

Cryotherapy or treatment of ice helps to decrease inflammation. It is a very easy to apply anti-inflammatory and can help control swelling, pain associated with swelling and decrease pain by numbing the area of pain. Ice is very effective for superficial joints like ankles, knees and shoulders. It can also have benefit to the back, however because the back is a much larger area it is hard for the ice to reach the depths of the tissue needed. Ice should be applied for 10 - 15 minutes with enough layers to protect from frostbite or frost nip. Ice can feel cold, burning and painful before it turns numb. Just make sure to have protective layers between the ice and the skin such as a pillowcase or towel depending on your sensitivity levels.

Heat is a great option to treat muscle tissue. It increases circulation to an area which can help to warm up the area. This is particularly beneficial for muscle tightness, spasm and soreness. Typically people with low back pain feel much better after lying on a hot pad or pack for 10 minutes. Associated with low back pain is muscle spasms and feelings of tightness in the low back, so heat can help to loosen this region up. Heat can be applied for 10-15 minutes at a time or longer depending on how hot the heat source is. Be careful not to burn yourself with the hot pack and use towels or protective layers to minimize risk of burns.

In general, both heat and ice can be beneficial for low back pain. Heat for the muscle tissue and ice to decrease inflammation. Both help to reduce symptoms and decrease pain. So both are helpful. Ultimately it is up to you, use the one that feels good!

The many faces of Low Back Pain

As a Physical Therapist I see people with so many types of back pain. There is the classic pain across the low back that is a low grade nagging pain. There is the pain that is much more severe with radiating pain down the leg either along the back side of the legs as far as into the heel, but typically along the back of the thigh into the knee. Or the radiating pain that wraps around the hips and deep into the groin along the front of the thigh and can go as far down as into the toes. Pain has been described to me in so many ways as "sharp", "dull", "aching", "nagging", "like a toothache", "deep", "radiating", "stiff", "tight" and "just pain". Some people have pain bending forward, others bending back. Some people have pain only when they are sleeping and feel better when they are moving around. Other people only have relief when they are sleeping. Some people have pain when they are sitting, others get relief from sitting. Some people can control their back pain by walking, others can barely walk to the bathroom because it is so painful to stand upright. Every person I treat has a very individual form of pain, manifesting itself in unique ways. There are common trends in back pain, but what I see in every person who complains about back pain is that the pain is interrupting normal day to day movement! The other common trend, is that every version of low back pain can be improved with strengthening of the lumbar stabilizers. I have seen it time and time again with my patients. It takes time for a strengthening program to take effect, but it does work. So my message to people who suffer from low back pain is get the help you need to interrupt your low back pain so it stops disrupting your day to day life!

Lumbar Stabilization

The key to rehabilitation of lower back pain is Lumbar Stabilization.

Lumbar stabilization is a series of exercises and stretching designed improve strength of the core muscles responsible for providing stability and support of the lumbar spine. Lumbar stabilization is a program that helps to improve patient's physical conditioning and decrease symptoms associated with low back pain. It helps with better posture, safe movements associated with lifting turning and twisting, helps with movement awareness, as well as functional strength and coordination that assists in management of low back pain.

The muscles that are critical to lumbar stabilization are the lumbar mulitfidi and the transverse abdominus muscle. The lumbar mulitfidi are the deepest layer of muscles in the back. The transversus abdominus is the deepest of the abdominal muscles. The combined action of these muscle groups as an internal corset are considered to be the most important of the lumbar stabilizers. In addition, in a weakened state they can contribute to low back pain. These weakened muscles are commonly found in those who have trouble with ongoing low back pain.

Lumbar stbailization is the exercises designed to isolate these muscles and will improve the protection and support that these muscles provide. A lumbar stabilization program will improve the strength, coordination and function of these muscles which will help to reduce symptoms associated with low back pain and help to improve daily movement.

Anatomy of the Back - Muscles

Spine Anatomy - Abdominal Muscles

The abdominal muscles are paramount of importance when discussing low back health. Weakness in these muscles correlates directly with low back pain. Without good abdominal strength, the lumbar spine does not have the stability it needs to combat forces of every day movement. The abdominal muscles are also called 'the core' muscles. Having a strong core can protect from lumbar spine injury and ultimately keep your back healthier and you happier!

Abdominal muscles provide various roles: movement and support to the trunk, assist in breathing, postural support and define the form of each individuals body shape.

The abdominal muscle group extend from various places on the ribs to various places on the pelvis. The muscle closest to the surface is Rectus Abdominis or the muscle that makes up the six pack ab look in very fit individuals.

Below or deeper to the rectus abdominus is the external obliques followed by the internal obliques. The external and internal obliques are pairs of ab muscles that are located on either side of the torso. They are very important for body posture and involved in, rotation and side bend of the spine.

The Deepest abdominal muscle is the transverse abdominal muscle. It has a tremendous effect on body posture when properly conditioned by providing stability to the lumbar spine. It is very deep in the torso and therefore you cannot touch this muscle from the outside. It wraps around the torso, creating an effect similar to a back support belt.

The abdominal muscles work as a group and act spinal flexors, or bending the trunk forward. The back muscles, or spinal extensors, counterbalance the action of the abs to provide a muscualr brace for all movement.

Anatomy of the Back - Muscles

Spine Anatomy: Muscles of The Back

The major muscles on the back are Psoas Major, Quadratus Lumborum and the Erector Spinae group.

The Psoas Major is located deep in the back and attaches directly to the front side of the vertebral bodies and deep on the inner side of the thigh bone on each side of body. It acts as a primary flexor muscle of the hip joint, helping to raise the lower limb at the hip joint towards the trunk.

The Quadratus lumborum lies next to the Psoas Major and attaches on the side of the vertebrae, on the transverse processes of the vertebraes, and along the top ridge of the pelvis bones located at the lower sides of the trunk. TheQuadratus Lumborum acts to side bend the trunk.

The erector Spinae group is made up of the Interspinales, Intertransversarii Mediales, Multifidi, Longissimus and Iliocostalis. The spinal extensor muscles lie behind the vertebral column, attach directly to the vertebrae, and stretch its entire length segment to segment. Each layer of muscles has specific subdivisions in the neck, midback, and lower back regions. They work as a group to help the back extend or bend backwards. The erector spinae muscles secondarily contribute to lateral bending and rotation of the spine.

We will look at the muscles that help stabilize the back on the anterior side of the body, or the abdominal muscle group on Friday.

Spine Anatomy - Part 2 Intervertebral Discs

Spine Anatomy Part 2: The Disc

There are a total of 23 vertebrae in the spine and thus 23 discs located in between each vertebrae. The discs are soft tissue which helps to cushion between the vertebral bones inside the spinal column. They are made mostly of water, proteins and collagen. The disc function to facilitate movement, provide shock absorption, and help to create the spinal curves. The spinal curves along with the discs help to distribute the weight and force throughout the body. Discs are attached to the vertebrae above and below by cartilaginous end plates and they receive all their nutritional requirements through these cartilaginous end plates. They have any blood vessel attachments.

Disc specific anatomy:

The disc is named for its shape and function. It is a round shape, like a disc, and is made of the outer wall and the inner nucleus. The outer wall of the disc is called the annulus fibrosis. The design of this outer wall is made up of alternating direction layers of cells that are very strong and helps the disc to resist the huge loads and forces placed on it by all of our spinal movements. The inner section of the disc is called the nucleus pulposus. It has a soft jelly-like core that is saturated with moisture and is very flexible. The inner core of the disc is constantly hydrating and dehydrating as part of its normal day to day activity. As we age, the nucleus loses its ability to effectively hold moisture, thereby shrinking in mass, height and circumference. This harmless and expected process is called disc degeneration, also known as degenerative disc disease.

Spine Anatomry Part 3: Muscles of the Back

Spine Anatomy - Part 1: Bony Strutures

Bony Structures of the Spine

The function of the spine is to provide mobility and stability to the body so we can move.

The spine is made up of 24 bones called the vertebrae. They are the building blocks of the spine. The vertebrae are stacked one on top of the other like building blocks to form the spinal column. The spinal column provides protection for the spinal cord to allow for transmission of neural signals between the brain and the body. In between each vertebrae is the disc which provides cushioning and shock absorption.

The spine has three natural curves that gives the spine an "s" when looking at the spinal column from the side. The cervical spine, or neck, curves inward. The thoracic spine, or upper and middle back, curves outward. The lumbar spine, or lower back, curves inward. These natural curves of the spine have a very specific function to absorb shock when you are upright during sitting, standing, walking, running, jumping and all daily activities. These natural curves help to distribute forces It is important to maintain the natural curves in your spine to prevent lower back and neck strain. The natural curves in your spine are considered "Neutral Spine" and is basically proper posture. In addition, the natural curves of the spine put the muscles in the position where they work the best.

I am having technical difficulties with photos...so this entry will be continued with some graphics. But I think I covered the basics of the bony structures of the spine. It will be further illuminated with graphics.

Causes of Low Back Pain

Wednesdays topic. Causes of low back pain.

There are so many websites that talk about this issue, and the one I liked the best is WebMD. So I included the points I felt were the strongest and included it here for your info. Check out the website for more info!

Low Back Pain - Cause

Most low back pain is triggered by some combination of overuse, muscle strain, and injury to the muscles, ligaments, and discs that support the spine. Many experts believe that over time muscle strain can lead to an overall imbalance in the spinal structure. This leads to a constant tension on the muscles, ligaments, bones, and discs, making the back more prone to injury or reinjury.

The causes of pain in the low back, or lumbosacral region, tend to add on to one another. For example, after straining muscles, you are likely to walk or move in different ways to avoid pain or to use muscles that aren't sore. That can cause you to strain other muscles that don't usually move that way.

The most common causes of low back pain are:

• Injury or overuse of muscles, ligaments, facet joints, and the sacroiliac joints.
• Pressure on nerve roots in the spinal canal. Nerve root compression can be caused by:
  • A herniated disc, often brought on by repeated vibration or motion (as during machine use or sport activity, or when lifting improperly), or by a sudden heavy strain or increased pressure to the lower back.
  • Osteoarthritis (joint degeneration), which typically develops with age. When osteoarthritis affects the small facet joints in the spine, it can lead to back pain. Osteoarthritis in other joints, such as the hips, can cause you to limp or to change the way you walk. This can also lead to back pain.
  • Spondylolysis and spondylolisthesis, vertebra defects that can allow a vertebra to slide over another when aggravated by certain activities.
  • Spinal stenosis, or narrowing of the spinal canal, which typically develops with age.
  • Fractures of the vertebrae caused by significant force, such as from an auto or bicycle accident, a direct blow to the spine, or compressing the spine by falling onto the buttocks or head.
  • Spinal deformities, including curvature problems such as severe scoliosis or kyphosis.
• Compression fractures: Compression fractures are more common among postmenopausal women with osteoporosis, or in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.
• Infomation from WebMD: Please see website for more information and details.

Infomation from WebMD: Please see website for more information and details.
www.webmd.com/back-pain/tc/low-back-pain-cause

Fridays topic: Spine Anatomy Part 1 - Bone Structure

Introductions

Hi all. I am Physical Therapist and I have a Doctorate of Physical Therapy. I received my Doctorate from Simmons College in Boston MA. I have practicing Physical Therapy in several venues, primarily private Physical Therapist owned orthopedic outpatient clinics. However I have also done inpatient work in a couple of hospital settings. When I started out I first thought I wanted to work with kids, but that turned into wanting to work in a sports therapy clinic and eventually I found myself working more and more with people who have back pain. Even the inpatient experience I had working in the hospital was primarily post operative patients who had back surgeries.

Back pain, especially low back pain is so prevalent. It seems like everyone has some bout of low back pain at some point. And everyone is looking for a quick fix. People...THERE IS NO QUICK FIX! I have been working with low back pain for a while now and I have not found any quick fix. All the hype about the quick fix is propaganda. There is a solution to lower back pain, but it is exercise and lifestyle changes. This takes time and work. Hard work. The solution to low back pain takes exercise, weight loss, diet changes, habit changes, finding new movement patterns and sticking to these changes. Not only until the back pain goes away but for always! Sounds daunting, huh? Here's the thing though, if it works and you feel better why go back to the way that made your back hurt. Why choose pain? So once you find something that helps you feel better, it should be a no brainer to stick with it!

Okay, I think you all get a sense about how I feel. Which is ultiamtely my intention, to introduce you to my philosophies reagrding this issue. So, welcome to my world!

Upcoming topics: Wednesday - Causes of low back pain.

Doctor of Physical Therapy

Helping people find relief