Posted on 6/4/2019 by Victoria Trueba, MOT, OTR/L, CHT
Finger sprains are very common. They can cause torn ligaments and broken bones even if you don’t see an obvious deformity and are still moving your finger. Earlier treatment allows you to recover faster, identify a more serious injury to your finger and begin the most successful treatment. Whether it’s a basketball player who jammed his middle finger against the ball, an employee late to work who slammed the car door on her finger or a dog leash that became tangled and pulled on a finger, digital trauma is nothing to shake your finger at!Case in point: Mrs. F, a teacher’s aide working with children with special needs. One particular morning as the class was completing an arts and craft project, Mrs. F went to help a student who was becoming increasingly upset. As she was attempting to help the student, he accidentally grabbed Mrs. F’s finger instead of the crayon. Without thought, Mrs. F pulled away and her middle finger got twisted. She recalls the intense pain and immediate swelling she experienced after the injury; however, she thought the pain would go away on its own and that ice would help with the swelling.As the days went on, Mrs. F’s middle finger was not improving. It remained swollen, tender to the touch and she noticed bending and straightening became more limited. Her grip had been affected, and daily tasks such as grabbing the steering wheel and writing became challenging. Mrs. F remembers thinking, “But it was just a finger sprain!”Our fingers contain three joints, with the most commonly sprained joint being the middle knuckle. Our joints also have many ligaments, which serve as a type of checks and balance system that allows both mobility and stability. When Mrs. F was finally evaluated by an orthopaedic physician four weeks after her injury took place, she was diagnosed with a grade 1 injury to a ligament on the side of her joint – the culprit of her limited mobility. Grade 1 ligament injury is detected when there is localized pain and tenderness over the involved joint, noticeable swelling and possible bruising.Depending on the grade of the strain, different treatment options are available. In Mrs. F’s case, a grade 1 injury is less severe on the scale of 1 to 3. As the severity increases to grade 2 and grade 3, the integrity of the ligament is further injured, which results in a less stable joint and a need for prolonged immobilization. In some cases, these injuries may require surgery.We were able to treat Mrs. F’s grade 1 injury with 7-10 days of immobilization in a custom removable splint for eight weeks. This allowed the swelling to go down and the ligament to begin healing. Afterward, she wore fabric buddy tapes around her index and middle fingers to protect the middle finger from a sideways force. Needless to say, don’t be fooled by a ‘simple’ finger injury! Although Mrs. F had a grade 1 injury, she was still significantly affected in her ability to complete daily activities. By the time she began therapy, she had lost a considerable amount of motion in her finger and had begun finding ways to grip without using her middle finger. Even a low grade strain may require therapy due to stiffness, weakness, swelling and hypersensitivity to touch. Make sure to have an injury evaluated in a timely manner and get the appropriate treatment to avoid deficits in doing the things you love most.
By: Victoria Trueba, MOT, OTR/L, CHT. Vicky is an occupational therapist and certified hand therapist with Select Physical Therapy in Trinity, FL.
Posted on 7/20/2017 by NovaCare Rehabilitation and Select Physical Therapy
The dog days of summer are upon us, but you don’t have to stop exercising outside just because of the warmer temperatures. NovaCare Rehabilitation’s Paul Hansen, ATC, from our Minnesota community, and Select Physical Therapy’s Andy Prishack, P.T., ATC/L, center manager, from the Fair Oaks, VA center, explain how to keep safe while enjoying some of your favorite summer activities.
• Avoid exercising between the hours of 11 a.m. to 3 p.m. as that is considered the hottest part of the day. Limit high intensity workouts to either early morning or early evening hours when the sun’s radiation is minimal.
• Stay hydrated by drinking a glass or two of water before you head outside. If possible, carry a bottle of water or even a hydration pack and take a drink every 15 minutes even if you’re not thirsty. The easiest thing to do is pay attention to the color of your urine. Pale and clear means you’re well hydrated; if it’s dark you need to drink more fluids.
• Wear clothing that’s light in color, lightweight and has vents or mesh. Microfiber polyesters and cotton blends are good examples. The lighter colors will help reflect heat and the cotton material will help with the evaporation of sweat.
• Feeling nauseous, dizzy or exhausted, along with moist and flushed skin are symptoms of heat exhaustion. Stop what you’re doing and get out of the heat. Remove or loosen any tight clothing and apply cool, wet cloths. Slowly drink a half-glass of cool water to rehydrate yourself and continue doing so every 15 minutes until you feel better.
With the temperature rising, many are also headed to the nearest body of water with kayaks, surf and paddle boards. Water sports are an excellent way to get in exercise and challenge our upper body strength and balance. Heather Wnorowski, P.T., from NovaCare Rehabilitation’s Sewell, NJ center, has a few tips to keep in mind for the water sports novice and seasoned pro.
• Always get in an adequate warm-up. While the temperatures may be warm, it doesn’t mean our muscles are. Dynamic stretching is a great way to get your blood circulating and muscles warm before hitting the water.
• Since water sports are heavily dependent on our shoulders, it’s important to strengthen your postural and rotator cuff muscles in order to avoid repetitive stresses and impingements of the shoulder.
• Don’t forget the rotational mobility of your mid-back! Kayaking and other paddle sports involve a lot of thoracic spine rotation in order to propel you forward. Make sure you’re able to twist from side to side without pain before heading out for a day on the water.
• Last but not least is balance! Balance is an important part of maintaining an upright position while on the water. Practice standing on one leg at home. Once you’ve mastered that, try standing on a foam cushion and closing your eyes. Make sure you have someone or something nearby to hold onto in case you lose your balance.
Have a great summer and be sure to stay safe out in the heat!
Posted on 8/23/2017 by Colleen Boucher, P.T., DPT
Wearing proper clothing, getting the right amount of sleep and practicing proper stretching techniques are vital to an athlete’s success. But, just as is important is eating the right foods. A proper diet will allow athletes to remain active, maximize function and minimize risk for injury. Eating the right foods will also address factors that may limit performance such as fatigue, which can cause deterioration in skill or concentration during an event.
Using guidelines from the American College of Sports Medicine, we believe practicing these tips will help athletes remain active in their favorite sport. What and when you eat prior to physical activity makes a big difference in the way you perform and recover.
Eat three to four hours before your workout and make sure you’re eating food that not only contains adequate amounts of proteins and carbohydrates, but also provides sustainable energy, speeds recovery time and boosts performance. Early fatigue caused by malnutrition can result in improper mechanics, creating predisposition to injury.
Athletes should eat a diet that gets the bulk of its calories from carbohydrates, an athlete’s main fuel. Eating foods such as breads, cereals, pasta, fruit and vegetables will help to achieve maximum carbohydrate storage.
Re-fueling after exercise is just as important. Eating protein, carbohydrates and a small amount of fat after activity prevents the breakdown of muscles and can lead to better next-day performance. While protein doesn’t provide energy, it is needed to maintain muscles. Focus on incorporating foods with high-quality protein, such as fish, poultry, nuts, beans, eggs and milk.
Practicing proper hydration is equally important in reaching your optimal level of success. Athletes, especially those participating in high-intensity sports, should drink fluids early and often. An easy way to ensure you’re properly hydrated is focusing on the color of your urine. A pale yellow means you’re getting enough fluids, while a bright yellow or dark color means you need to drink more. We encourage athletes to:
Drink 17 to 20 ounces of water two to three hours prior practice.
Drink 7 to 10 ounces every 10 to 20 minutes during activity.
Drink 7 to 10 ounces of water after practice for every two pounds of body weight lost.
Drinking the right liquids is also a key factor in an athlete’s diet. Milk is preferred by many athletes as it provides a good balance of protein and carbohydrates. Sports drinks are great for replenishing electrolytes, which are lost when you sweat. If you’re losing a lot of fluid as you sweat, it’s a good idea to dilute sports drinks with equal amounts of water to ensure you’re getting the right balance of fluid and electrolytes. If possible, drink chilled fluids, which are more easily absorbed than room-temperature liquids and can help to cool your body.
Finally, avoid extreme diets as they increase the risk of micro-nutrient deficiencies. Vitamin and mineral supplements aren’t necessary if your diet includes a variety of nutrient-dense foods. Often, these supplements require supervision and monitoring for safety and effectiveness.
By: Colleen Boucher, P.T., DPT, center manager from NovaCare Rehabilitation’s Sicklerville, NJ center. Colleen has been a part of the NovaCare team since 2001 and enjoys treating all types of patients. She has a strong interest in vestibular rehabilitation and concussion management.
Posted on 10/24/2018 by NovaCare Rehabilitation and Select Physical Therapy
Every October, the American Physical Therapy Association (APTA) hosts National Physical Therapy Month to recognize how physical therapists and physical therapist assistants help restore and improve motion in people's lives.
This October, the APTA’s focus is once again on the risks of opioid use and how physical therapy is a safe alternative for managing pain.
The APTA wants you to #ChoosePT… and so do we.
According to a recent study, researchers found that patients who started physical therapy within three days of receiving an acute low back pain diagnosis were less likely to use advanced imaging, specialist care and opioids than those who started physical therapy later.1
In another study, physical therapy as a first treatment strategy resulted in 72 percent fewer costs for the patient within the first year. Patients were less likely to receive surgery and injections, and they made fewer specialists and emergency department visits within a year of primary consultation.2
Even before seeing your doctor, you can determine your need for physical therapy and choose which physical therapist you want to help manage your care. It's an important point that many patients who go on to receive successful physical therapy treatment don't know.
Whether you have neck pain from sleeping badly, lower back pain from gardening, an ankle sprain or tennis elbow, our team of experts can create a plan of care specific to you and your rehabilitation goals.
To give you an idea of the importance and value of physical therapists, we've put together a list of how we can help.
Five Ways We Can Help Assess Your Pain Management
- Physical therapists are trained diagnosticians. Seeing a physical therapist before you see a doctor, get an X-ray or start medication is a great way to get a jump-start on an injury or condition. You do not need a physician’s referral to start physical therapy with our clinical experts... visit or call today.
- Physical therapists can help with a cardiovascular program and improve your sport performance. Wish you were a runner but get out of breath on the way to the mailbox? Want to take your game to the next level on the field? Start now with a physical therapist and/or athletic trainer!
- Physical therapists treat balance disorders. If you or a family member has had issues with falling and/or dizziness, make sure it isn’t something more complex. A balance test with a physical therapist is a great way to put aside fears, improve strength and coordination and lessen symptoms.
- Physical therapists treat neck pain and headaches, too. We can isolate the tightness in cervical muscles and figure out what may be causing tension headaches. By getting to the root cause of headaches, physical therapists can often stop them before they start.
- Physical therapists can survey your jobsite. Wonder if your desk and chair is the right height? Is the floor hurting your feet from standing all day? Talk to your employer about onsite ergonomic evaluations and then talk to us. Physical therapists can evaluate your worksite and make recommendations that will reduce pain and the chance of injury.
Our licensed physical therapists will work directly with you to get you on the road to recovery. Contact a center near you today to request a complimentary consultation and experience the power of physical therapy.
Posted on 3/8/2018 by Joshua Cramer, DAT, LAT, ATC, CES, CSCS
Injuries can happen at any time to anyone. Whether playing your favorite sport, working on the job or living your daily life, it’s important to get the proper treatment when an injury occurs, and that starts with the evaluation process.
During an evaluation, a clinician will discuss a patient’s medical history, discuss goals and specific needs, inspect for abnormalities, tenderness or deformities and test musculoskeletal health. All of these components are essential to making a proper diagnosis, but they rarely provide the whole picture. These evaluative techniques focus on the area of the patient’s chief complaint, but what if the issue is in a different region or system in the body?
To design more effective treatments, it is important to look at the body as a whole – the upper and lower body, the front and back of the body and the limbs. This is where postural and functional assessments come into play.
Functional movements are essentials movements found in activities of daily living. They usually involve multi-joint movements in numerous directions, which place demand on the body's core muscles. Our clinical team frequently include functional movement screens in the evaluation process, which are designed to examine these daily essential movements and help identify limitations and dysfunction, reduce the risk of injury and improve efficiency and performance. Functional movement screens also include a detailed report and customized corrective exercise program.
There are a handful of functional movement tools available to clinicians. Some of the more popular are through the Functional Movement System, which is divided into two main parts: the Functional Movement Screen (FMS) and the Selective Functional Movement Assessment (SFMA). Another popular functional movement tool is Fusionetics.
The FMS is a screening tool which takes the patient through a series of basic movements with the intention of determining if the patient is at risk for injury. Its role is to impose minimum standards on movement patterns. The movements include:
Stepping over a hurdle
Reaching behind the back
Core test – the patient starts on his/her hands and knees and touches the elbow to the knee
The SFMA is a full-body assessment broken down into two parts, the top-tier and the breakouts. The top tier helps determine if movements are functional versus dysfunctional and painful versus non-painful. The breakouts determine the type of dysfunction a patient may suffer from. The movements consist of:
Various neck movements
Reaching behind the back
Hip flexion (bending forward)
Hip extension (arching backward)
Hip rotation (twisting)
Single leg stance
The SFMA will help define what type of dysfunction exists, whether that’s stability and motor control dysfunction, joint mobility dysfunction or tissue extensor dysfunction. Once the clinician determines which dysfunctions exist, he/she will set up an individualized treatment protocol to correct the faulty movement pattern and treat the injury and prevent future occurrences.
Fusionetics is designed in the same manner, but is web-based. It is a series of 10 exercises that determine whether someone is susceptible to certain injuries due to form and body mechanics. At the end of the Fusionetics assessment, the system will provide patients with corrective exercises. Each patient can create a free account with Fusionetics and access the results and corrective exercises from any computer, tablet or smartphone.
These screenings and assessments can be done on both injured and healthy individuals to identify movement and stability deficits. As you continue to play your respective sport or go through your daily routines, keep in mind that proper functional movement is a necessity. It is just as important to treat your body properly when you’re healthy as it is when you’re injured.
By: Joshua Cramer, DAT, LAT, ATC, CES, CSCS. Josh has been with NovaCare Rehabilitation for five years and serves as the head athletic trainer for Germantown Academy and the Philadelphia Freedoms. He is certified in various manual therapy techniques and has treatment expertise in shoulder injuries and concussion.
Posted on 3/16/2018 by Stephanie Wilkins, MSEd, ATC, and Leah Friedland, M.S., ATC
Concussions are a great concern throughout the world of sport and especially in the high school setting. They can impact the student-athlete not only on the field, but also in the classroom and their daily lives. As athletic trainers in the high school setting, when a concussion has occurred, we are involved in the entire process, including:
We help with education, implementation of proper concussion protocols and serve as an advocate for the student-athlete in their sport, classroom and life.
Education – Despite the growing awareness and concern that is present in the media over concussions, we find that coaches, parents and athletes are often still uninformed about the seriousness of concussions and the proper way to handle them. A concussion is a traumatic brain injury that is caused by either a direct force/blow to the head or a force transmitted through the body to the head. As high school athletic trainers, we find ourselves explaining to coaches that “getting your bell rung” is the same as sustaining a concussion, and that it is not something that can be ignored. “This wasn’t a big deal back when I played sports, and I turned out fine,” is not an acceptable way of viewing this issue.
We are seeing now that, decades later, people are experiencing abnormal brain function and lasting damage as a result of previous head trauma that might not have been managed properly. Concussion education is not intended to scare people, but rather to inform and stress that concussions should be handled appropriately and taken seriously.
We must also work to change the team attitude around concussions and urge athletes and coaches to take responsibility for their well-being and the well-being of their teammates. The culture of not reporting concussions for fear of sitting out or being made fun of must not continue. High school athletic trainers are in the unique position of helping create this cultural change within sports programs and we strive to do this by forming relationships with our coaches, parents and student-athletes that are based on trust and compassion.
Baseline Testing – Every concussion is different; even in one person, different concussive episodes can present in different ways. Symptoms of a concussion include:
Appearing dazed or confused
Nausea and vomiting
Imbalance… and more
There are few objective measures available to diagnose concussions, so it’s important to have a baseline evaluation for each athlete to help determine return-to-play.
We perform this evaluation at the beginning of the season to obtain a baseline score, i.e. an athlete’s “normal” level of functionality. If the student-athlete sustains a concussion during that season, a second test will be administered. This second test occurs when they are symptom-free and have completed the return-to-play progression.
In our high school, we implement two different tools for baseline testing. With more than 800 student-athletes, we prioritize the high risk contact sport athletes (like those participating in football or soccer) and administer baseline tests to those sports. The first test is ImPACT®, a computer neurocognitive exam that tests word and image recall, reaction time, motor speed and symptom report. The alternate test we use is C3 Logix. In addition to a neurocognitive exam, C3 Logix includes a balance and vision component. It is more comprehensive and time intensive, whereas the ImPACT® Test is more easily administered to a large team all at once.
We don’t use ImPACT® or C3 Logix to diagnose concussions, but rather as a tool to monitor their healing process and identify any potential problem areas.
Evaluation and Diagnosis – The most important aspect of concussion management in the high school setting is communication. We’ll discuss concussion management with both the student-athlete and parents/guardians to discuss next steps and answer any questions they may have
Next, we communicate with our Concussion Oversight Team (COT). The COT is a multidisciplinary group of individuals who help manage the student-athlete’s post-concussion care. It includes the athletic trainers, team physician, school nurses, athletic director and school counselors. We also email the coach and physical education teacher. This is our opportunity to provide athletic and/or academic accommodations as needed. The counselors and nurses are vital for helping communicate with the student-athlete’s teachers.
Occasionally, a student-athlete will require academic accommodations. These are specific to each individual and can include wearing sunglasses to help with sensitivity to light, postponing quizzes or tests, limiting use of computer work or leaving class early. Most students don’t require academic accommodations, but all are excused from gym class and athletics until their symptoms have resolved and they have completed the return-to-play progression.
Follow-Up – Oftentimes, parents will ask, “Does my son/daughter need to go to the doctor or the emergency room?” The emergency room is rarely indicated unless there are signs and symptoms of a brain bleed. This will be evaluated at the time of the injury and, if there is concern, a referral to the emergency room will be made.
Research shows that most concussions resolve within 7-14 days. Our protocol recommends following up with a physician if the symptoms have not resolved within 7-10 days. And, referral to an appropriate health care provider is essential. When possible, we will refer to a concussion specialist who works with these cases on a normal basis. The average primary care physician will not have expertise in concussion management. We will sometimes recommend following up with an ophthalmologist if the student-athlete is having difficulty with vision or physical therapy due to vestibular problems.
As athletic trainers, we take care to be as best prepared to diagnose and treat concussions as possible. We put a strong emphasis on communication with the athlete, parents, coaches and school in order to return the student-athlete safely to school and sport. Concussion research will continue to evolve over the years to come, just as we will continue to adapt and update our management protocols to keep student-athletes safe and active.
By: Stephanie Wilkins, MSEd, ATC, and Leah Friedland, M.S., ATC. Stephanie and Leah serve certified athletic trainers for NovaCare Rehabilitation in Chicago, Illinois, and currently work at York Community High School. Stephanie also serves as the sports medicine program director and helps manage other sports medicine contracts around the Chicago-land area.
Posted on 1/2/2019 by Grant Shanks, P.T., OCS
For many patients recovering from injuries and surgeries, a period of immobilization in a cast or sling and/or restrictions on weight-bearing and activity is necessary to ensure proper recovery and tissue healing. Immobilization and lack of use comes with a significant cost, though: decreased muscle strength and size, known medically as atrophy.
Even after the restrictions are lifted, it takes months to recover to pre-injury levels of strength and ability. However, recent research has led to exciting advancements in what is possible when it comes to regaining muscle strength, size and ability following injury and/or surgery. The development of Blood Flow Restriction training has opened up new doors for patients and the therapists who treat them.
What is Blood Flow Restriction (BFR) training?
Blood Flow Restriction (BFR) training uses external pressure – via a tourniquet – to reduce (restrict) arterial blood flow to working muscles and completely occlude (block) venous blood flow return to the heart. By doing so, one can achieve substantial hypertrophy (muscle growth), strength and endurance changes while using significantly decreased loads/weight. The gains in these areas of performance are consistent with what is typically observed with heavy load lifting.
To this point, the American College of Sports Medicine has shown that optimal muscle strength and hypertrophy can be achieved by lifting at high intensities, defined by their research as: eight-to-10 upper and lower body exercises, performed two-to-three times per week for six-to-eight weeks at intensities greater than 65 percent of the individual’s one repetition maximum (RM). Certainly, this is not possible for the immobilized/injured/post-surgical patient. Utilizing BFR, these same gains in strength and hypertrophy have been observed using only 20 percent of an individual’s one RM and in just two-to-three weeks.
How does BFR work?
While the exact mechanisms are not completely understood, it appears to be a combination of factors related to muscle physiology:
Decreased oxygen to the muscle causes a build-up muscle-building metabolic products.
A preferential recruitment of larger, fast-twitch muscle fibers.
An increase in growth hormone and stem cells following exercise with BFR.
Increased muscle protein synthesis via the extreme “muscle pump” following BFR.
BFR Leg What kind of device/equipment is used for delivering BFR?
By definition, anything that restricts blood flow is a tourniquet, which is considered a medical device and falls under FDA Class I regulations. In order to determine how much blood flow restriction to create in a limb (upper or lower extremity), an individual’s limb occlusion pressure (LOP) must be determined. In order to do this, a Doppler is used to assess for the presence or absence of a pulse.
Once enough pressure has been created by the tourniquet, the pulse will be absent. This amount of pressure is the LOP and then the working pressure is a percentage of this amount – either 80 percent for the lower extremity or 50 percent for the upper extremity. Machines that have a built-in Doppler are considered the gold standard. A hand-held Doppler could also be used.
Who would benefit from BFR?
Patients who are recovering from surgery to the upper or lower extremity and cannot bear weight, move their extremity and/or have been weakened by conditions may be good candidates to receive BFR. Some conditions include:
Total joint replacements
Rotator cuff repair/injury
Upper extremity fracture
Lower extremity fracture
Knee arthroscopy (knee scope)
Achilles tendon repair/injury
Shoulder labral repair/injury
Hip labral repair/injury
How do I know if BFR is right for me?
Your physical therapist will be able to go through the indications (reasons to perform) and any possible contraindications (reasons not to perform) BFR with you.
BFR is a new and growing area of rehabilitation, strength and conditioning and not all physical therapists have been trained and educated on the matter. Contact your local Select Physical Therapy or NovaCare Rehabilitation center to see if BFR is available.
By: Grant Shanks, P.T., OCS, area sports medicine coordinator for Select Physical Therapy in Tennessee. Grant also serves as center manager of our Mt. Juliet location.
Select Physical Therapy and NovaCare Rehabilitation are part of the Select Medical Outpatient Division family of brands.
Posted on 3/25/2019 by Mike Montez, M.S., ATC, CSCS
With an aging workforce, increasing health care costs and a continued demand for physically demanding jobs to be completed by humans, more and more companies are looking into providing their employees with access to an onsite injury prevention specialist.
The injury prevention specialist role is often filled by a National Athletic Trainers’ Association Board of Certification certified athletic trainer whose unique training, skills and abilities make a great fit for the job. Athletic trainers perform skills including immediate injury triage and care, biomechanics assessment, health and wellness education and strengthening/conditioning of active individuals.
Onsite athletic trainers work with industrial athletes who might be delivering online purchases, assisting with luggage at the airport or even cleaning a hotel room. The main goal of the industrial athletic trainer is injury prevention. Just like in sports, industrial athletic trainers “keep the worker in the game.”
Many individuals don’t know when to use ice or heat, how to stretch a tight muscle, basic nutrition needs for a physical job or even how lack of sleep can affect the body’s ability to heal, decrease motor coordination and increase blood pressure. That is where the role of the industrial athletic trainer comes into play.
Employees suffering a wide array of pain or discomfort from work-related and non-work related activities can seek out care from the onsite injury prevention specialist. Care may include assessing the individual, developing a plan of care and attempting to conservatively manage the issue through a combination of ice, heat, soft tissue massage, prophylactic, non-rigid taping and the application of a topical analgesic.
More often than not, an employee’s symptoms resolve within a few visits. If not, the industrial athletic trainer will discuss potential next steps in the process which could include following up with a doctor for further treatment. The industrial athletic trainer also serves as a referral source for other available services which may include dentistry, registered dietitians, follow-up with the employee’s primary care physician/specialist or even psychological consults.
Think of the industrial athletic trainer as a one-stop shop for all your health and wellness needs while on the job. The service is free (paid for by the employer) and is designed to keep the workforce healthy, happy and safe!
For more information regarding services for the industrial athlete through the Select Medical Outpatient Division’s WorkStrategies Program, please call 866.554.2624 or email [email protected] today.
By: Mike Montez, M.S., ATC, CSCS, WorkStrategies coordinator for Select Physical Therapy’s Southern California community. He serves as the site supervisor with our OnSite Program at Delta LAX and offers more than 15 years of experience. He is a graduate of Cal State University Long Beach.
Posted on 9/13/2017 by Andrew Piraino, P.T., DPT, OCS, CSCS
Low back pain is common. It’s so common that about 80 percent of adults will at one point experience this condition. It ranks among one of the top reasons to see a physician and costs the United States more than $100 billion dollars every year.
When faced with an episode of low back pain, it’s easy to go into crisis mode. You may be routed through various specialists and receive various imaging tests, such as X-rays and MRI. These tests can reveal scary findings, such as “herniated discs,” but don’t panic.
First, many of these findings are normal. Researchers have found that in adults without low back pain, two of out three have an abnormality at one disc or more. This makes imaging of limited use, unless something like a fracture is present that needs surgical management. Physicians agree; the American Academy of Family Physicians recommends against any imaging for low back pain for the first six weeks unless serious signs are present, such as trauma.
Often, you may be referred for physical therapy. You may have some familiarity with various exercises and hands-on treatment provided by therapists. But why is physical therapy unique, and what exactly does it do?
Physical therapists today are doctoral-level trained specialists in human movement, completing four years of undergraduate education, three years of doctoral training and often further residency or fellowship training in addition to board certification. Poor movements and postures can cause low back pain and, therefore, physical therapists are optimally equipped to address the cause of the problem rather than treating the symptoms. Just like the song lyrics to ‘Dem Bones,’ each area of the body affects another, which is what physical therapists are trained to observe and address.
For example, take a truck driver who has worsening low back pain with sitting in his truck and bending (pictured below). While a massage at his back area makes him better temporarily, his pain always returns several days later. A physical therapist may look at this driver and find he has tight hamstrings (the muscles on the back of the thigh). Every time he straightens his right leg to reach his pedal, his tight hamstrings pull his back into a bent position (Figure B). And so, all day long, as he drives, his back is bent over and over while he operates the gas and brake pedals. Try sitting up straight and then straightening your knee. You may find it’s hard to do!
Low Back Pain
A - Driver at rest.
B - Driver's hamstring pulls on his pelvis and bends his back whenever he tries to use the pedal.
C - Driver after physical therapy treatment to improve his hamstring flexibility... no more dysfunction!
While physical therapy may provide hands-on treatment to alleviate pain, it would also include exercise to decrease stiffness of his hamstrings, which would allow him to move without causing his back to compensate every time (Figure C). Therefore, our truck driver is able to sit and drive all day without pain. Rather than seeking symptom relief, he now knows what caused the pain, and the exercises and positioning to prevent it from returning.
This is a simple example, but it appreciates the entire body’s contribution to movement and pain, rather than focusing on the area of pain alone. Hopefully this demystifies what physical therapists do, and how they work to optimize each person’s movement and prevent their painful condition from returning!
If you are experiencing low back pain, please call one of our conveniently located centers in your area to experience the power of physical therapy today! For more information and to watch a brief informational video, please click here.
Andrew PirainoBy: Andrew Piraino, P.T., DPT, OCS, CSCS, treats at Select Physical Therapy in Pasadena, TX and is involved with our orthopaedic physical therapy residencies at the market and national level. He completed doctorate and residency training at the University of Southern California in 2012 and 2013, respectively, and is board certified in orthopaedics. Andrew specializes in orthopaedic movement dysfunction across the lifespan, from young, recreational athletes to adults with complex multi-system involvement.
Posted on 3/5/20 Haley Taffera
Whether it’s on the athletic field, a job-site or in one of our outpatient centers, our athletic trainers are counted on to be the frontline support for injury prevention, treatment and ongoing management of care for athletes, workers and patients and customers. In honor of National Athletic Training Month, we asked our National Director of Sports Medicine John Gilmour, M.A., ATC, to share how our incredible team of athletic trainers makes an impact in the lives of thousands of people across the country on a daily basis. View the video here...
Be sure to visit our Facebook, Twitter and Instagram pages throughout the month of March as we recognize and celebrate our colleagues.