Category Archives: Back

McKenzie Method

McKenzie Method: Diagnosis & Treatment

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MECHANICAL DIAGNOSIS PHASE:
This system is based on the symptomatic and mechanical responses of patients to various repeated movements or static loading forces(that is a mechanical evaluation). It allows the classification of patients into broad, rather than tissue-specific, categories and thus leads to the formulation of treatment. Rather than seeking to make a diagnosis, which is the identification of a disease by the means of its signs and symptoms, The McKenzie system concentrates on syndrome identification. A syndrome is a characteristic group of symptoms and pattern responses characteristic of a particular problem. The system is now widely used to classify and treat patients with mechanical disorders.

PHYSICAL EXAMINATION PHASE:
• Explanation of problem to patient and reason for required exercise program
• Time scale
• The appropriate loading strategy, or strategies needed to manage the condition demonstrated to and practiced by the patient.
• The repetitions and regularity of exercise program explained to patient
• The expected pain response explained to patient

knee stretch

ASSESMENT PHASE:
• Symptomatic diagnosis
• Mechanical Diagnosis

PATIENT MANAGEMENT PHASE:
• Patient education component of management
• Information about the problem itself
• What patients can do to help themselves
• Information about tests, diagnosis and interventions
• Active Mechanical Therapy component:
• The specific exercises should be demonstrated to the patients, they should practice these, the expected pain response should be explained, as well as any warnings against lasting aggravation of their condition and as necessary progressions and alterations should be given.

This information was written by Hamilton Physical Therapy Services, L.P., an outpatient physical therapy group with five locations in Mercer County, New Jersey since 1978. Their modern state-of-the-art facilities are equipped to offer patients an excellent opportunity to reach their optimal functional abilities. Managed and operated by physical therapists mandates that patient care is our number one priority. For more information click here.

Backpack Safety

Backpack Safety 101

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It’s that time of the year again when the kids are heading back to school. Learn the proper guidelines and precautions about backpack safety in this week’s PTandMe blog post.

Size
• Should Not Extend Above Shoulders
• Should Rest In Contour Of Low Back (Not Sag Down Toward Buttocks)
• Should Sit Evenly In Middle Of Back

Fit
• Shoulder Straps Should Rest Comfortably On Shoulders And Underarms, With Arms Free To Move – Tighten Shoulder Straps To Achieve This Fit
• Tighten Hip And Waist Straps To Hold Pack Near Body
• Padded Straps Help Even Pressure Over The Shoulders

Weight Of Pack
• Should Never Exceed 15% Of The Child’s Weight To Avoid Excess Loads On The Spine

backpack

Lifting Of Pack
• Proper Lifting Is Done By Bending The Knees, Squatting To Pack Level, And Keeping Pack Close To Body To Lift First To Waist Level And Then Up To Shoulders

Carrying The Pack
• Keep Both Shoulder Straps In Place And Pack Centered
• Spinal Forces Increase With Distance From The Body’s Center

Posture
• Uneven Stresses On The Spine Can Cause Muscle Imbalances. This Can Lead To Pain And Possibly Functional Scoliosis.

aquatic therapy

Is Aquatic Therapy For You?

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Aquatic therapy offers an alternative environment for therapeutic exercise. If you have tried traditional physical therapy, or have restrictions on your physical therapy program, aquatic Therapy may be the perfect solution for your physical therapy needs.

Why Aquatic Therapy is Beneficial

Less pressure: The buoyancy of the water decreases the amount of pressure, or compressive forces, on your joints and spine. When you’re immersed in water up to your neck, the weight pressing down on your body is reduced by 90%. When the water is up to your waist, the pressure is reduced by 50%.

Reduced swelling: The pressure of the water helps to move fluid from the injured area back into the body. Decreased swelling is essential for regaining the strength and motion needed for recovery.

Ease of movement:
Water is an element that supports and assists movement. It offers a safe setting for regaining strength and joint range of motion.

Faster progress: Aerobic conditioning can often be performed in the water, even when it may be too soon or too difficult to do in the clinic. Staying stable in the water, challenges your core and balance. Plus, sports specific activity can begin earlier than on land.

old man swimming

Who Can Benefit From Aquatic Therapy

• Chronic pain patients requiring a more gentle form of therapy
• Patients at risk of falls due to balance and gait disorders
• Patients with severe arthritis or other weight-bearing restrictions
• Prenatal and postnatal patients
• Patients with general deconditioning
• Sports medicine and orthopedic patients requiring an accelerated component to their rehab protocol

This information was written by Life Fitness Physical Therapy, a privately-owned, outpatient physical therapy practice operating 14 clinics in the metro and surrounding Baltimore, Maryland area. Life Fitness Physical Therapy was founded in 2000 based on the core values of providing the highest level of customer service and clinical excellence in outpatient physical therapy. For more information click here.

Low back pain

Exercise May Reduce Risk of Low Back Pain

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Low back pain is a common complaint that can last a few days or weeks or become a chronic condition with significant impact on well being. Treatments can vary depending on the cause.Chronic back pain can be difficult to successfully treat and it may take some time to find what treatment works best for each person. Since treatment is not guaranteed to work, prevention is the best option. Back pain is often the result of long term stress on the back such as poor posture, sedentary behavior, or regular strain on the back. Prevention will likely involve a number of different steps to reduce these stresses. However, existing studies have not found clear recommendations for the best methods to go about it.

Researchers wanted to investigate the effectiveness of a number of interventions for the prevention of low back pain. The study, published in JAMA Internal Medicine, found that exercise alone or in combination with education was most effective for preventing low back pain.

About the Study
The systematic review of 21 randomized controlled trials included 30,850 men and women without low back pain. The participants were randomized to 6 different prevention strategies, including exercise, education, exercise plus education, back belt, and shoe insoles. The control groups received no intervention, minimal interventions, or placebo.

When compared to the control group exercise was associated with:
• Fewer low back pain episodes in the first 12 months (in 4 trials with 898 people)
• Fewer sick days due to back pain in follow up 12 months or longer (in 2 trials with 128 people)
• Reduction in short-term (4 trials with 422 people) and long-term low-back pain episodes (2 trials with 138 people) when combined with education

Education alone, back belts, and shoe insoles did not appear to have any benefit during the trials.

man stretching

How Does This Affect You?
A systematic review combines the results of several smaller studies to arrive at one result. The benefit of this type of review is that it increases the number of participants which increase reliability of results. However the review is only as reliable as the studies that are included and the method used to combine the results. There were some flaws in every trial that were included in this analysis. For example, many of the included trials had a high dropout rate during the trial which decreases the reliability of their results.

Low back pain is often associated with an imbalance or weakness of certain back muscles. An exercise program will improve your physical fitness, strengthen your back muscles, and help you maintain a healthy weight. Regular physical activity may also help maintain a healthy weight which can also put strain on your back. Choose exercises or activities that you enjoy and will make a regular part of your day. For most people, this could include 30 minutes of moderate aerobic exercise per day.

Check with your doctor before starting any exercise program.

by Cynthia M. Johnson, MA

RESOURCES:
Family Doctor—American Academy of Family Physicians
http://familydoctor.org

Ortho Info—American Academy of Orthopaedics
http://orthoinfo.aaos.org

SOURCES:
Acute low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 2, 2016. Accessed March 22, 2016.

Steffens D, Maher CG, et al. Prevention of low back pain: a systematic review and meta-analysis. JAMA Intern Med. 2016 Feb 1;176(2):199-208.

Last reviewed April 2016 by Michael Woods, MD

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

back pain

Managing an Aging Back

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Most people at some point in their life will have to deal with a painful back. The time and intensity of the back pain is different for everyone, some will have had symptoms when they were in their teens, mid-life or in their golden years. No matter when you first start to receive symptoms more than likely these symptoms will increase in intensity and frequency as you age. Fortunately there are ways to manage back pain as well as counteract our aging process to prevent further problems from developing.

In the back there are many conditions which can develop. The important thing to remember is that not all back conditions are the same and what works for one condition doesn’t necessarily work for other conditions. This is important because in the age where answers are literally at your fingertips every piece of information on back pain needs to be taken with a grain of salt. In order to help manage your own condition it is important to really pay attention to what makes your symptoms better and what makes them worse. By being in tune with your body and what is going on with your symptoms you can take some beginning steps at managing your back pain.

As we age our body changes dramatically in all areas especially in the back and often once we understand how our back ages it is easier to understand your own symptoms.

1. JOINTS: As we age whether in our back or in other areas of our body our joints begin to break down. By breaking down we literally mean that the edges of the bone that interface with other bones change in shape and surface area. Some joints literally develop bone spurs or extra calcification of a bone surface as well as elimination of bone or jagged surfaces as opposed to flat rounded surfaces. With all the changes in the boney surfaces it causes movement between the surfaces to be less fluid or more restrictive resulting in stiffness, loss of motion and pressure put on other structures such as nerves.

2. MUSCLES: Our muscles during aging also begin to lose fluid and suppleness. As we age certain muscle fibers are lost which are more responsible for strength and power and we are left with more fatty tissue. Our muscles also lose elasticity and become more rigid and tight. This all in turns leads us to have a loss in motion, flexibility and strength.

3. DISCS: As discussed with degenerative disc disease and the conditions associated with the disease, the discs in our back literally shrink down. We lose the big cushiness of the fluid filled disc which unfortunately causes us to loose some shock absorption forcing more force.

With all of the changes described above there is an underlying theme of restricted motion and mobility in the spine. Therefore it is important to remember in order to counteract these changes we need to work on restoring and maintaining appropriate flexibility, mobility and strength. For example as described above our discs shrink which causes our joints to take more brunt of the force of the body. Therefore in order to prevent a constant break down of our joints our muscles must be flexible and strong enough to absorb this force and strain on our body.

Managing your back as you age can be possible but requires many steps and hard work. It isn’t something that can be done in two days or two weeks it takes a long in order commitment to change your body. It took a lifetime for your body to age so it isn’t realistic to expect a change in the aging process in a few weeks. Key aspects in managing your low back are:

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1. FLEXIBILITY: As we mentioned motion and stiffness is a key factor in our aging process therefore it is extremely important to make sure our muscles stay as lengthened as possible. Some of examples of these exercises are: press ups, long thoracic rotations, SKTC, DKTC, and corner stretch. Remember these are key exercises for the back but it is important to keep all muscles flexible as all of our joints in our body break down.

2. CORE STRENGTHENING: This is a term which has been widely popularized in the last few years. It specifically describes strengthening the muscles which are responsible for controlling your entire spine. This means these muscles help to absorb the shock and forces put on your spine and body by preventing them from going to your joints. Another term also associated with this is lumbar stabilization exercises. Which means working on strengthening both sides of the spine at one time in order spread the force out evenly throughout the back. Some basic examples of these are: bridges with a squeeze, prone alternating arms and legs, seated marches with and without arms on ball, and supine alternating arm to legs.

3. POSTURE: As we age our posture is certainly affected. As a society we tend to be very prone to sitting and slouching forward and as we age this process is enhanced by the changes in our body which force us more into a forward flexed or “hunched” position. Therefore in order to retaliate against this it is important to work on key exercises which work on extending or maintaining the proper position of the spine. Some of these exercises are described in our stretching exercises but others are: scapular squeezes, extension over a roll, and standing hip extension.

When dealing with back pain it is important to remember that exercising is a key to help manage and control your current symptoms as well as prevent further symptoms. Unfortunately we can not take back the changes that occur as you age but we can change certain aspects of your body to help minimize these effects. By making a commitment to work with your back and body as it ages you can truly change the way your body will perform specific movements and how these movements will affect your body. In exercising with a problematic back it is important to remember that discomfort and general soreness is normal but true pain is not. You need to listen to your body and pay attention to how certain symptoms are affected by your new exercise routine.

If you have had symptoms for a long period of time and they aren’t changing with exercises or are getting worse it may be time to seek formal medical attention. This is especially important if symptoms are beginning to travel into your leg or symptoms are advancing to more neurological signs such as tingling/numbness in your feet/leg and weakness or giving way of your legs. This is a sign that symptoms are progressing and are becoming more neurological.

Physical Therapy can be a successful tool in combating back pain. In going to physical therapy you will have a formal evaluation in order to determine your condition and based on this condition an appropriate treatment strategy. This often will occur with appropriate modalities in order to help with the inflammation of muscles and nerves as well as help reduce pain. Once pain has gotten under control you will be instructed on specific exercises/activities that will be beneficial to your back. You also will be given specific tools to help reduce the inflammation of certain structures and improve the overall condition of your back. Your therapist should also work with you to set you up with a program in which you can continue to perform while you are at your home.

spine rehabilitation

Spine Rehabilitation and Its Benefits

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31 million Americans experience low-back pain at any given time. Back pain is the most common cause of loss of activity among adults under 45. It’s estimated that over 80% of all American workers suffer back pain at some time during their careers. From chronic to acute back pain, physical therapists are highly trained to accommodate the spine rehabilitation needs of a variety of patients.

COMMON BACK PROBLEMS SEEN BY PHYSICAL THERAPISTS INCLUDE:

COMMON CAUSES OF BACK PAIN:
Poor Posture and Body Mechanics
Poor posture is when your spine’s normal curves are either increased or decreased. This puts uneven stress on your spine and all of the supporting tissues. This uneven stress leads to pain and dysfunction and increases the likelihood of injury. The most commonly seen poor posture is a flat low back. Losing your natural low back curve is a major risk for back pain.

Poor Lifting Techniques
Poor lifting techniques is another cause for back problems. The forward bending position with your legs straight puts a great deal of stress on the muscles and ligaments of your back. The discs in your back are also under tremendous strain in this position. This position can increase your chances of ligamentous and muscular strains. It also increases your chances of getting a bulging or herniated disc.

Poor Physical Fitness
Poor physical fitness also contributes to potential back problems. Poorly conditioned muscles lack the strength and endurance that conditioned muscles have. They become fatigued much sooner and cannot provide the type of support a well conditioned muscle can.

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WHAT DOES A SPINE REHABILITATION PROGRAM INVOLVE?
Physical therapists provide a comprehensive approach incorporating manual therapy, prescriptive therapeutic exercise and modalities. A program will improve the patient’s physical condition and symptoms. Therapists also provide the patient with movement awareness, knowledge of safe positions, functional strength, and coordination. All of this promotes the management of low back pain (LBP).

TREATMENTS OFFERED INCLUDE:
• Comprehensive Evaluation with an emphasis on determining the source of the problem.
• Individualized & Specific Exercise Programs
• Manual Therapy (hands-treatment)
• Modalities as Needed
• Progressive Home Program to help restore independence and self-management

GOALS:
• Improve Mobility
• Knowledge of Safe Positions
• Movement Awareness
• Functional Strength
• Coordination

If you have back pain that is prohibiting you from doing the things you enjoy, take the first step towards your recovery and contact your physical therapist.