Category Archives: Spine Health: Neck and Low Back Pain

Do you suffer from neck or low back pain without any injury associated? Lets talk about it and how you can manage it..

Lumbar Herniated Disc

Between each vertebrae of the spine contains a disc that separates each vertebrae. (with the exception of the first 2 levels of the cervical spine) Each disc acts like a jelly donut. When you bend forward the “jelly” will push posteriorly and when you bend backwards the “jelly” will push anteriorly. These “jelly donuts” act as a cushion and help allow for movement in the spine.

If the disc becomes inflamed, damage, or begins to degenerate you may experience a variety of symptoms. These symptoms are: back to the center of the back, loss of motion with bending/turning, pain, numbness or tingling into the leg, weakness and muscle spasm. The levels most susceptible to injury in the lumbar spine are L4-L5 and L5-S1.

What exactly is a disc herniation?
A disc herniation happens when the walls of the disc became torn and the “jelly” can push out and place pressure on nearby structures. When this happens the “jelly” is usually pushing out in a posterior and lateral direction. This direction is where the spinal nerves also exit out into the body. The further the “jelly” of the disc pushes out the more severe the symptoms can be.

What causes a disc herniation?
Wear and tear of the spine
Prolonged sitting or bending (this causes the spine to flex pushing the contents of the disc posteriorly”
Sudden fall or trauma
Repetitive bending and twisting motions (as in construction or any job that allows for constant lifting)
Smokers are also more susceptible to disc degeneration

What are the symptoms of a disc herniation?
Pain in the back (right or left side, or across entire back)
Pain into the right or left buttocks
Pain into the right or left leg
Feeling of numbness, tingling or burning into the back, buttock, or leg
Muscle spasm
Changes in posture (severe herniation’s can cause a visible shift)
Loss of motion (usually loss of ability to bend forward)
Reduction in reflexes

How to treat a disc herniation?
Treatment will vary depending on if the issue is acute or chronic and if the herniation is mild or severe. Treatment options range from: rest, medication, ice, lumbar brace, or exercise regimen designed by a physical therapist. Some MDs recommend spinal injections. The worst option is surgery if all other conservative options fail. Of course an x-ray, MRI, or CT scan may be performed. You may also undergo an EMG to check for any nerve involvement.

When to consider surgery?
Surgery is usually considered if the disc is not responding to conservative care. Signs of a worsening or non-responsive disc are: increase in radicular pain, development of further weakness into the leg, loss of control in bowel and bladder, or an increase in numbness.

How can Physical Therapy help?
During your first visit you can expect your therapist to put you through a series of motions to try to determine the cause of the pain. There will also be an assessment of strength to check for any muscular imbalances. You will also have an assessment of flexibility because shortened muscles can lead to imbalances putting you at more of a risk of susceptibility to disc problems or low back pain in general. Your physical therapist will also assess your posture and get an idea of your day-to-day activity to try to determine if any repetitive stresses may have led to your problem. After the initial assessment your therapist will come with a treatment plan including manual therapy and therapeutic exercise to address and impairments and functional limitations found during the initial exam. Physical therapy treatment can range from 4-12 weeks followed by a home exercise program. It is very important to follow-up and maintain your home exercise program after discharge from physical therapy.

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Cervical Radiculopathy

Radiculopathy is a term used to describe a chronic condition that has caused injury to the spinal nerves. The spinal nerves originate at the spinal cord and are considered peripheral nerves once they exit out into the body. They are responsible for sensation and motor function of the body.

Nerves that exit the cervical spine provide sensation and motor control to the neck, shoulders, and arms. Injury to these nerves can result in symptoms of pain, numbness, tingling, weakness, and possible a change in reflexes. In the cervical spine the most commonly affected areas are C4-C7 because this is where the greatest movement occurs resulting in higher frequency of degeneration.

Causes of Radiculopathy
Anything that presses onto the nerve can be a caused of radiculopathy such as:
Herniated Discs
Trauma
Muscle Spasms
Degenerative joint and disc disease

Symptoms
The symptoms will depend on which nerve is affected and where that nerve travels to; common symptoms are as follows: note some of these symptoms can travel down as far as the hand
Pain and weakness
Numbness and tingling
Muscle spasm
Loss of motion when turning the head, or looking up and down
Loss of the normal curvature of the cervical spine known as a lordosis
Pain with activity that is relieved with rest

Common pain patterns in the cervical spine

C2: pain in the back of the head, headaches
C3: behind the eye or ear pain
C4: upper shoulder pain, base of neck
C5: upper arm pain
C6: thumb pain or weakness, also index finger and side of arm
C7: middle finger pain and/or weakness
C8: ring and littler finger pain and/or weakness

*Some of these symptoms are mistaken for carpal tunnel, especially in the hand. Carpal tunnel pain is usually LOCALIZED to just the hand and only involves the thumb, index, and middle finger

Treatment Options
Rest, medication, ice (acute injury), cervical brace, steroidal medication, epidural injections, physical therapy or chiropractic care
Treatment options will vary depending on the severity of your symptoms
If conservative care does not help or ease or symptoms then you may be a surgical candidate in the future

How Physical Therapy Can Help
At physical therapy your physical therapist may use manual techniques such as soft tissue massage and joint mobilizations to improve flexibility, reduce spasm, reduce pain, and improve range of motion to the cervical spine. You should also expect to perform exercises that will help strengthen to cervical muscles to provide stability to the spine and to decrease overall stress to the cervical spine. The exercises will also help to improve posture in order to reduce stress in sitting, standing and sleeping.

Some CORE exercises to shed off those extra pounds!

If you are like many of the millions of Americans who tuned into the Super Bowl this year and ate everything in sight then no worries! Here are some core exercises you can perform at home with no equipment required to shed off some of those extra pounds and to tighten up those core muscles

All exercises are to be performed at your own risk. If you have any medical conditions and you are unsure about any of the exercises presented here please consult with your doctor or physical therapist.

Start by holding for 10 seconds and performing 10 times. Increase the hold time as the exercise becomes easier for you to perform.

Start by holding for 10 seconds and performing 10 times. Increase the hold time as the exercise becomes easier for you to perform.
Start by holding for 10 seconds and performing 10 times. Increase the hold time as the exercise becomes easier for you to perform.
Perform 3 sets of 10. Increase to 3 sets of 12, etc as the exercise becomes easy.
Perform 3 sets of 10. Increase to 3 sets of 12, etc as the exercise becomes easy.
Start of "dying bug"
Start of “dying bug”
Second step to "dying bug" Perform 3 sets of 10. Increase to 3 sets of 12, etc as the exercise becomes easy.
Second step to “dying bug” Perform 3 sets of 10. Increase to 3 sets of 12, etc as the exercise becomes easy.
Start of "Quadruped Bird Dogs"
Start of “Quadruped Bird Dogs”
Second Part to Bird Dogs. Perform 3 sets of 10. Increase to 3 sets of 12, etc as the exercise becomes easy.
Second step to Bird Dogs. Perform 3 sets of 10. Increase to 3 sets of 12, etc as the exercise becomes easy.
Same as Bird Dogs except LEGS ONLY. You can start here if the exercise above is too difficult
Same as Bird Dogs except LEGS ONLY. You can start here if the exercise above is too difficult
A bridge performed with a physioball if you have one. Perform 3 sets of 10. Increase to 3 sets of 12, etc as the exercise becomes easy.
A bridge performed with a physioball if you have one. Perform 3 sets of 10. Increase to 3 sets of 12, etc as the exercise becomes easy.
Squats. In order to make squat exercises more difficult hold the squat for 10 seconds. Perform 3 sets of 10. Increase to 3 sets of 12, etc as the exercise becomes easy.
Squats. In order to make squat exercises more difficult hold the squat for 10 seconds. Perform 3 sets of 10. Increase to 3 sets of 12, etc as the exercise becomes easy.

REMEMBER, for all exercises you should make sure you are tightening your abs.

ENJOY!

Physical Therapy BEFORE surgery?

Although this has become a common treatment plan for surgical patients many patients consistently ask me.. why? If you’re about to let someone cut into your body to repair something wouldn’t you want your joint to be functioning at its maximum capacity before someone grabs a scalpel?

1-2 months of physical therapy before surgery can mean full range of motion and improved strength before going under the knife. The stronger your are before surgery and the better your joints are moving before surgery means for a happy and less pain-free recovery later.

Here is a brief list of common surgeries that can benefit greatly from pre-operative physical therapy

  • Torn rotator cuff/labral repair – improve shoulder motion and strength before surgery to return to daily activities with improved ease after surgery
  • Total Knee/Hip Replacement – a stronger knee is a happier knee/hip after surgery, especially in populations over 50 where for some there can be significant weakness
  • Lumbar Discectomy/Fusion – a strong core before surgery means more support for your back after surgery
  • Cervical Discectomy/Fusion – improvement in posture and flexibility in the neck can reduce stress to the cervical spine
  • Meniscus or ACL repair – depending on the severity of injury there can be a severe loss of motion/swelling before entering surgery. It pays to have good range of motion and to get swelling under control before surgery – both of which can be achieved with pre-operative physical therapy

So- before you let someone convince you to go under the knife immediately, think about the potential that pre-operative physical therapy can do for you in the long run.

A bit about Sciatica..

Many people suffer from general low back pain- however have you or someone you know experienced burning pain down your leg that is either constant or comes and goes associated with low back pain? You are most likely suffering from symptoms of Sciatica.

So what is Sciatica? Sciatica is a symptom (pain) that radiates along the sciatic nerve which can cause pain anywhere from your low back, hips, buttocks, and down your entire leg. Sciatica usually only affects one side of the body and rarely affects both legs at the same time.

Sciatica can be caused by any of the following conditions that you may or may not have heard of:
herniated disk, bone spur in your spine, stenosis or spondylolisthesis.

Symptoms of sciatica can also be caused by prolonged sitting, a job that requires frequent bending, pregnancy and obesity.

Common symptoms of sciatica can include:pain extending from the low back down the entire leg, numbness or tingling into the leg/foot/toes, weakness into the affected leg, constant pain on the affected buttock, and pain that worsens when moving from a sitting to standing position.

The good news is most sciatica can be resolved with conservative treatment such as physical therapy. It is important to consult with your physical therapist for a full exam in order for them to provide movement positions to relieve symptoms of sciatica. However, in some cases sciatica can be completely debilitating and requires surgery.

Normally I would include exercises to help ease symptoms of sciatica however depending on the condition that is causing your sciatica you may respond to positions putting you into flexion or extension which is why it is best for you to contact your local physical therapist for any advice.

However, if you are experiencing difficulty sleeping due to symptoms of sciatica then you should sleep on the unaffected side with a pillow placed between your knees to keep your spine neutral. You should try your best to AVOID the fetal position as this can worsen symptoms as the night goes on.

Also, if you notice any pain that only comes on with prolonged sitting it is best to use a lumbar support to try to avoid the onset of symptoms.

***If you or anyone you know are experiencing symptoms of sciatica following a recent injury OR are experiencing any difficulty with bowel/bladder then you should consult your MD immediately.***

Another idea to take stress off of your low back..

As I have probably mentioned several times we spend most of our time in flexion. If your back pain is persistent and you have tried what I have talked about in a previous post here’s another idea to try to alleviate your pain.

Let’s recap, here is one way to try to relieve back pain,

Standing Back Bend

Image

If you have been sitting for a long period of time or spend much of your time bent forward performing labor intensive work then you can try the exercise in the picture above. As shown, all you have to do is stand and place your hands on the back of your hips and bend backwards 12-15 times. The first few back bends may hurt but it should feel better after a few repetitions. If after a few reps your back pain becomes worse than STOP.

However, in this position we are still weight-bearing and at times we will feel no difference in our pain or possibly feel worse due to the fact that in weight-bearing we place the greatest stress on our discs. So how can we do this same exercise and not be weight-bearing?

Prone Press Ups

Image

As you can see in the picture above he is extending his back while on his stomach. In this position you are not weight-bearing therefore taking pressure off the discs in your back. To achieve this position start on your stomach with your hands under your shoulders. Push up extending your elbows until they are completely extended as shown. Do not pick your hips up off the floor/treatment table when trying to perform this exercise. When you achieve this position EXHALE before returning on your stomach. An EXHALE will cause your hips to sag taking even more pressure off your back/discs. As before perform 12-15 repetitions. If your back pain has reduced but did not completely disappear feel free to do more. Again, STOP if the pain gets worse.

Hope this helps for some of you. I perform the exercise on my stomach weekly as I get left-sided low back pain myself. It is a good way to reinforce extension in our spine even if you are PAIN FREE due to the simple fact that we are usually in a FLEXED position.

Please remember these are simple tips and all exercises are to be performed at your discretion. it is always advised to see your MD or physical therapist if you have SEVERE pain before attempting anything.