When it comes to low back pain, we are told that sitting for too long is not good for our backs. Why is that the case? What does sitting do to our low back?
There are low back pain studies that have been conducted that measure the pressures in the spinal discs with various activities. One study in particular 1, involved a 45 year old male who had a pressure device inserted into his L4/L5 disc. This allowed researchers to measure the amount of pressure change in a variety of different activities. Running, sitting in various postures, lifting with both good and bad mechanics and even stair climbing were measured. What we observed from this study is that there are different pressures that the disc undergoes with differing positions. You may be asking, how is this relevant to me?
What is critical to remember with patient’s is that if we treat a large group of people who have low back pain with the same interventions, we are going to help some people and we will not help others. This is where subgrouping comes into play. Subgrouping is when we take a history from the patient about their issue. From experience and research we have found certain subgroups of patients have certain characteristics and presentations. It makes logical sense that if we can subgroup patient’s with low back pain, that we can offer them more specific interventions that will better address their impairments. This is much more effective than just giving everyone the same interventions and only some people get better. More on the subgrouping in next weeks article!
Low back pain treatment can revolve around the reduction of your pain. When you go see a practitioner it is often because you are in pain, which is an unpleasant experience. When we are given medication, offered injections, or prescribed a specific treatment, one of the goals is to help reduce your pain. Physical therapists often take a similar approach to low back pain. There are often movements/positions that make your pain better and some that make your pain worse. There is a phenomenon called peripherilization and centralization. Some patient’s have low back pain that is associated with radiating pain that goes down the leg (sciatica). One of our goals with this type of patient is to help centralize their pain. If we can take the pain out of the leg and move it toward the center of the back we can predict that the patient has a good prognosis (they will get better with our interventions).
When it comes to treating low back pain there are studies that will show sitting is bad for your back and just as many studies that show sitting and standing create similar stresses on the back. You may now be asking, “What is the best position?” I will tell you that in my opinion it is somewhere in-between. I advise my patient’s to not go longer than 1 hour without getting up out of your chair or if you start in standing, sitting down. This variability will help to off load some of the structures that could be affecting your back. Set the alarm on your phone so that you have to get up and move around.
You may already know intuitively that one position is better for your back because the other causes pain. Another concept that needs to be addressed is the concept that not all hurt = harm. As I am writing this, I am coming up with more ideas for blog posts! More on the hurt = harm later!
The moral of the story when it comes to low back pain and in that matter, reducing the risk of developing low back pain is that you need to move your body. Motion = lotion is what I tell my patients.
If you found this article helpful, share it with a friend. If you need more specific advice, call or text me at 501-529-2010, or you can shoot me an e-mail at Brian@pinnacledpt.com. My name is Dr. Brian Murphy, I am a physical therapist and owner of Pinnacle Physical Therapy located in Little Rock, AR.
Thanks and here’s to helping you reach your PINNACLE!
5507 Ranch Dr, Suite 203
Little Rock, AR 72223
Wilke, Hans–Joachim, et al. "New in vivo measurements of pressures in the intervertebral disc in daily life." Spine 24.8 (1999): 755-762.
When it comes to low back pain, there is no shortage of providers you can go see. You can see your primary care physician, a chiropractor, a massage therapist, a physical therapist, a yoga instructor, an orthopedic physician and even a neurosurgeon.
You may be asking, how do I then decide who is the right choice for me?
Some people want to avoid medications, surgery, and injections at all costs. This narrows the field of potential practitioners off the bat. If you are to see a physician, very likely you will be prescribed medication, given some kind of diagnostic test (X-ray or MRI) and then prescribed physical therapy. The involvement of specialists (orthopedic spine physicians and neurosurgeons is often not the first line of defense).
Some practitioners offer more conservative approaches to treatment of low back pain. Massage therapists offer soft tissue work and stretching to address pain and limitations. Yoga instructors offer movement based interventions. Some pure Chiropractors believe that disease processes stem from a malalignment of the vertebrae (bones in your spine.) Their treatment is thus geared toward adjusting the spine so that the nervous system can function properly.
I can speak the most intelligently about physical therapists. We are movement specialists who address our patient’s impairments to help them stay active and pain free. A good physical therapist looks at the movements of your whole body to see if there are compensations in the normal patterns of movement, to find muscle weakness, to find joint restrictions, tight muscles, poor balance, and assess how a patient’s environment and activities may be affecting their pain and limitations. From there, we start to address those impairments and very often pain subsides and we can ramp activity back up.
Another difference I see in good practitioners is the ability to help patients with low back pain become independent. If you are constantly receiving care and are not taking an active role in your own recovery and health, I think you are not being properly cared for. I don’t know too many practitioners that you can take on vacation with you to help you when your back gets flared up. Because there are so many factors that play a role in a patient’s pain a very multimodal approach to intervention is indicated.
Brian, what do you mean by multi-modal approaches in low back pain treatment? I mean that there has to be a combination of manual therapy (hands on techniques) and active exercise. I do not believe in passive approaches to care. I am not going to stick you on a TENS unit (thing that makes your skin tingle) with an ice pack for 15 minutes while I catch up on notes. What in life has come easy to you without having to put in work or effort? I am telling you now that dealing with your body is no different and in fact often is harder work.
I don’t like to give generic advice and exercises, but there are recommendations and movements that are well researched that can help reduce the risk of injury and also help alleviate current pain that may be stemming from your back. This advice does not mean that you should not go see a skilled medical provider that will employ the above mentioned approaches to your care.
Over the next weeks I will be providing this information on how you can get back to doing the things you love, after all, we can all live with some pain, but when it starts to interfere with our hobbies and interests, we have to say enough!
If this advice and these movements help you, please feel free to let me know. Write it in the comments below.
I appreciate you reading and let me know if I can be of further service to you.
Here’s to helping you reach your PINNACLE!
Dr. Brian Murphy , DPT, OCS, ATC, PES, TPI II Medical
Owner of PInnacle Physical Therapy
5507 Ranch Dr Suite 203
Little Rock, AR 72223
In treating patients with low back pain, it is not uncommon for me to have them come in with a very well researched, self-made diagnosis. We can thank Google for so much of the information we have at our finger tips today. It is so easy to look up what WebMD or Mayo Clinic says about our condition.
I am going to tell you know that there is no substitute for a skilled medical provider. Physical therapists have a huge asset on our side, TIME. We have time to sit down and let you tell us your story. The reason I say this is because there are clear things that come from the history section of the examination that will point to a more serious condition that may be masking itself as low back pain.
“Dr. Murphy, I am convinced that my low back pain is from a spinal tumor, can you please tell me I am wrong?”
I am now going to go into discussing the possible more serious pathologies that could be related to low back pain. This article is meant to ease your mind about the slim chance of you having one of these more serious issues.
”Brian, how do you know whether I have something more serious? I am convinced that I have cancer!” Some of the things we do include administering a questionnaire about your general health. It could ask questions about your 24 hour pain patterns, previous history of cancer, when you saw your primary care physician last, signs of tingling and numbness, coordination problems and history of any recent trauma. All of these questions clue us into then asking further questions to determine if your pain is of mechanical nature. What I mean by that is basically are you appropriate for physical therapy care because we are mechanical/movement specialists.
The first condition I will discuss is cancer. Spinal cancers are rare and can be picked up quite easily on plain film X rays. If you have not had an X ray performed before you come in to see us we will ask questions about your age, previous history of cancer, any recent weight loss, your pain patterns (what makes it better, worse, 24 hour response). Quite often pain stemming from cancer is constant, there is nothing you can do to make it go away, it will wake you up at night and keep you up for hours.
The next condition that I will discuss is a stress fracture or spinal fracture. There are some clear indicators that this may be a possibility when a patient comes into our clinic. This patient is typically a 50+ year old female, who has a recent history of a fall or motor vehicle accident, she has pain and tenderness in her back and she may have been using corticosteroids. With Arkansas being a direct access state, we may see this patient before they had films in the ER or at their doctors office. In this case, we would refer them out to get X rays of their back to rule out this condition.
The final condition I will discuss today is called Cauda Equina Syndrome. This condition stems from the nerves that come out of your low back. This condition can cause serious damage to those nerves which can be a problem because those nerves give energy to your bowel and bladder! Once again, the history here is critical. One of the hallmark symptoms of this condition is bowel and bladder changes. We ask the patient if they have had issues initiating or voiding their bladder. The patient feels that they did not expel all of their urine. The patient often has saddle paresthesia, tingling and numbness around your anus and genital area. Another thing we do as physical therapists is perform a thorough neurological examination. The nerves that come from your low back give strength to key muscles in your lower legs, it gives sensation to the skin and it also controls your knee jerk and achilles reflexes. We will test all of these things to see if everything is working smoothly. We of course do not want to see a decline in any of the functions of these structures.
In the state of Arkansas you can see your physical therapist directly without seeing a physician first. We are very skilled Doctors with advanced training in neuromusculoskeletal pain and should be at the forefront of your mind when determining who to see concerning your pain and limitations.
At Pinnacle PT, I offer a free 20 minute discovery visit either in my office or over the phone. I listen to your story and ask you relevant questions to see if you are appropriate for my care. I also make appropriate referrals to medical providers I trust in the community if you need to be seen by a physician for something that I am not able to treat. All too often we just ignore our pain because we are scared and think that it is just going to go away. Don’t let your pain get any worse, because often that will lead to compensation and development of pain in other areas and a further decline in your function.
E-mail me today at firstname.lastname@example.org, or call/text me at 501-529-2010 and let me help you get through this trying time!
Here’s to helping you reach your PINNACLE!
The sport of golf is very unique in that it involves one of the most complex movements of the human body. Mastery of the golf swing requires balance, flexibility, strength, power, coordination, rhythm, and stability. When determining the objectivity of these characteristics we can look at golfers of varying skill levels. Very proficient golfers have characteristics that are different than the recreational golfer. There have been studies that have compared these differences. One particular study looked at 257 healthy male golfers.1 In this study they compared the characteristics of different skill levels; the skill levels that they compared were <0 handicap, 1-9, and 10-20. What they found in regard to balance in particular was that very efficient golfers, < 0 HC showed much better single leg stance balance during certain conditions that were tested on a Kisler force plate at a frequency of 100 Hz. This is a device that allowed researchers to introduce a certain force and see how the golfer reacted to that force. That date is then collected and compared across the different groups.
Why is balance important in the golf swing?
Technology today is allowing researchers and golfers to determine how the ground is utilized during the golf swing. Have you ever seen a long drive player hit a golf ball? They literally leave the ground! Pieces of equipment like the Boditrack allows us to see the transfer of weight during the different components of the golf swing. What we are finding is as the club is being taken away, in this instance for a right handed golfer, there is a center of pressure shift onto the trail right leg which peaks when the club shaft is parallel to the ground. Before the player even gets to the top of the back swing we see the pelvis start to turn as we come into the downswing. There is a rather quick transition of weight onto the lead leg. This center of pressure shift requires balance to keep the body within its base of support. When you think about how quick the golf swing happens, it is critical to control all the moving parts and momentum that is created along with the shifting of the weight. This all takes balance!
How does the body balance?
There are three main systems involved in balance. The first is your visual system. Your eyes take in information that is then sent to the brain through the optic nerve. This information is interpreted by the brain and the brain sends commands down the spinal cord to tell your body what to do. The inner ear functions in a similar way. There is fluid that moves in your inner ears. Surrounding certain parts of where that fluid flows are hairs. According to how those hairs react to the movement of the fluid information is once again sent to the master controller, the brain. Our last system that aids in our balance in our joints. Our joints have certain cells which react to changes in pressure, stretch, or their environment to send signals up to the brain for the brain to interpret. The brain will then send signals back down to tell your body to fire a muscle or step to avoid a fall.
Can balance improve?
One particular study2 looked at balance as one of the variables they tested to see how it reacted to practice. In this study, which was conducted over 8 weeks, there was a statistically significant change in the patient’s balance after the training was completed. The training did encompass more than just balance work, but also included flexibility work, strength work to upper and lower body, as well as some aerobic exercise. There are numerous other studies that show how training and challenging the various systems can help with balance will improve a person’s ability to prevent falls as a result of a loss of balance.
Balance is not only critical in the golf swing, but driving the cart as well!
1. Sell, TC, et. al. Strength, flexibility, and balance characteristics of highly proficient golfers. Journal of Strength and Conditioning Research. 2007;21(4):1166–1171
2. Lephart, SM. et. al. An eight week golf specific exercise program improves physical characteristics, swing mechanics, and golf performance. Journal of Strength and Conditioning Research. 2007;21(3):860–869
Frozen shoulder syndrome is a condition that effects people’s ability to do their daily activities. This article is a resource for education and guidance on what to do if you think you have this condition. It does not take the place of a skilled assessment by a highly trained medical professional (ME!). Feel free to use the information, but if you are not seeing progress I would like you to reach out to me so I can hear your story and be a further resource for you.Read More
As we age unfortunately we loose muscle mass, which means we get weaker. You can’t avoid this decline but you can make it more gradual. Do you know the recommendations, the frequency, the specifics, the science, and do you have a resource you can talk to in order to find out more. Now you do. Read this article and let me know if you have any questions.Read More
The golf world was set ablaze again with the sight of Tiger Woods with Kinesiology Tape on his neck.
The rumors started flying, he is hurt, what is going on, is he done for good this time?
I wanted to write about Kinesiology Tape to give you some more information about where it came from, what it does or reports to do, and if it is beneficial.
Where did it come from?
Kinesiology Tape was developed KT in the 1970’s by a Japanese chiropractor named Dr. Kenzo Kase. It is made of tightly woven elastic fibres, which can be stretched to approximately 120% of their original size. This elasticity is similar to that of human skin.
The Kinesio Taping Method first gained recognition outside of Japan in the 1988 summer Olympics in Seoul, South Korea. Introduction to the USA occurred in March 1995 in Portland, Oregon at the Northwest Athletic Trainers Association Annual Clinical Symposium. Europe was next to find the value of Kinesio Tex Tape in 1996. The technique is used by Physical Therapists, Occupational Therapists, Certified Athletic Trainers, Massage Therapist, Doctors of Chiropractic, Medical Doctors, Nurses, and Acupuncturists all around the world. https://kinesiotaping.com/about/what-we-do/
What does it do?
Some of the purposed benefits of KT tape include: normalization of muscular function, increased vascular and lymphatic flow, reduced pain by neurological suppression, corrected joint misalignment, relieved abnormal muscle tension, and increased proprioception.
All of these fancy words basically mean that it can help decrease pain by having an effect on your nervous system, it can help with the process of ridding your body of bi products that are harmful to you, and it can help with stimulating your body to help heal itself.
Is it beneficial?
There is conflicting evidence as the effectiveness of KT tape in doing what it reports. The problem with research is that often times it is done in an environment that is more controlled. This means that it is under conditions that are not always the same as a person may experience in the real world. There are better ways to structure a research study to leave it with as little bias as we can, but the scientific process is far from perfect.
There is a term called placebo that I feel is beneficial to define and explain. A placebo according to Wikipedia is a substance or treatment that has no intended therapeutic value. We often know of this term from studies on drugs. A control groups is often given a placebo drug which can just be a sugar pill and it acts as a way to compare the results of the patient's who are actually receiving the drug under the study. The problem with a sham or placebo taping is that any tape that touches the skin has an effect on the body which is hard to determine. We have nerves in our skin that send signals to the brain which can have an effect on the brains response (thus the purported effect on the nervous system)
There is a very specific way that is taught on how to apply the kinesio tape. The direction of the taping, the amount of pull, the goal of the tape, the results of the evaluation and the goal of what the tape is helping to do all need to be taken into consideration as to the value they bring to help the patient reach their goals. When I treat a patient, if they mention a prior treatment or approach that was beneficial to them, I know that they have a psychological attachment to that treatment because they found it beneficial before. I am sure going to use that treatment, because I know there is value attached. The mechanism of KT tape may just be psychological in nature, if you think it works it does. The brain and nervous system, our beliefs, our feelings, our past experiences all play a large role in the physiological response of our bodies to treatment.
We know that when we think about positive things, they tend to happen in our lives. I feel that this holds true in medicine as well, we can't forget how powerful the mind is in healing our bodies.
Remember that I am always here to be a resource for you. My name is Brian Murphy, I am a doctor of physical therapy and owner of Pinnacle Physical Therapy in West Little Rock, Arkansas. Please e-mail me if you have any questions: Brian@pinnacledpt.com or shoot me a call or text to 501-529-2010.
Thanks and here's to helping you reach your PINNACLE!
Orthopedic physical therapy is the specialty practice of evaluating the patient’s body and its movements. As a physical therapist we specialize in optimizing movement which may be altered from a variety of circumstances. One way happens to people who maintain habitual postures. When you think of someone who sits at a desk or performs repetitive tasks, they are predisposed to abnormal forces which can lead to musculo-skeletal pain or limitation. Physical therapists can help modify the work environment to help minimize forces while at the same time make the patient more tolerant to those forces so that there is not tissue breakdown and therefore pain.
As an orthopedic physical therapist we also specialize in helping people who are having joint issues. As we age there can be degenerative changes that occur in our joints. The joints that come to mind first are of course the knee and hip. In those situations, physical therapists help a patient to develop a plan that will prevent limitation in daily activities as well as hobbies while at the same time help them with pain management and prevention of surgery in a very holistic way which is proven by research to help in most cases.
Another way an orthopedic physical therapist can help a patient, which in my opinion is the most effective is in injury prevention. We are trained to do thorough assessments of your nervous and musculo-skeletal systems to see if they are performing optimally. I bring up the example of doing your yearly physical with your primary care doctor. We all know the value of having a physician listen to our heart, check our blood pressure, perform blood work and check in on our internal systems to ward off disease and help cure our ailments. Why not also have a yearly checkup with your movement specialist who can help you stay active in a noninvasive way by warding off potential injuries before they happen and sideline you from doing the things you enjoy.
There is a great resource for consumers of health to educate themselves on their options when it comes to treating pain and limitation. There is a movement called GetPT1st which highlights in more detail the benefits of seeing an orthopedic physical therapist. I urge you to check out this resource and see if physical therapy will be right for you.
If you are in the Little Rock area, there is an orthopedic clinic specialist which is a credential that very few physical therapists have in the country let alone the state. He is willing to help analyze your movement, educate you on a specific plan of care catered to your needs, and empower you by teaching you what you need to do at home to get the best timely outcome.
Check out www.pinnacledpt.com and Dr. Brian Murphy for more information.
This swing flaw has to do with the alignment of the plane of the shoulders compared to a line drawn straight up through your spine.
As you come into your backswing you should not see the lead shoulder raise up, thus widening this angle.
- This can lead to poor power into the ball
- Club is out of position and a compensation movement has to happen in order to get the club face on the ball. This leads to inconsistent ball striking.
Shortened latissimus dorsi musculature or stiffness in the spine can lead to an inability to turn the upper body independently of the lower body.
Try this exercise to stretch your lats!
Both the hips and shoulders have to demonstrate great flexibility and movement. In order for you not to compensate elsewhere it is critical that the shoulders and hips both have the movement ability to help you get into an aggressive position at the top of your backswing without demonstrating the flat shoulder plane.
Try this exercise to make sure your hips are rotating effectively.
Remember that none of these exercises are meant to cause pain. You should also seek the advice of your primary care physician before starting any new exercise program. If you are having pain, you can reach out to your local TPI professional for a golf specific assessment. I can be reached at pinnacleDPT.com, over the phone at 501 529-2010, or at email@example.com.
Thanks and here's to helping you reach your pinnacle!
As a Titleist Performance Institute Medical Provider I get asked the question, “How do I improve my driving distance.” The answer from my perspective as a movement and musculoskeletal expert is that you have to have a combination of flexibility and stability. The body is made up of regions that are meant to be very mobile, think of your shoulder, and other regions that are meant to be stable, think of your low back. Stability is often attained by strengthening key regions of your body that help to generate power and help transfer that power into the ball.
The gluteus maximus is a muscle that is very active in the forward swing which is the phase from the top of the backswing until when the club is horizontal. Studies have shown that for a right handed golfer there is 100% activity in the right gluteus maximus muscle.
A simple exercise to help strengthen this muscle is below. The top picture is your starting position and the bottom is your ending position. You can perform 10 to 15 repetitions and hold the end position for 5 to 10 seconds. This is a great way to strengthen your glutes which will allow you to hit the ball further!
If you are having pain with this exercise you can reach out to me at firstname.lastname@example.org or over the phone at 501 529-2010. My website pinnacledpt.com tells more about my philosophy as a Physical Therapist.
Thanks and Here's to Helping You Reach our Pinnacle!
All of those dedicated hours in the pool to get ready for your next big meet. Have you ever wondered why your shoulder hurts when you swim? I am going to write a series of blogs discussing some of the causes of shoulder pain in swimmers and what you can do about them.
Anatomy of the Shoulder
Anatomically the shoulder joint is a very unstable joint. I equate it to a golf ball sitting on a golf tee. The ball is the head of your humerus (upper arm bone) and the tee is the glenoid fossa ( socket which is part of the scapula or shoulder blade). The shoulder relies heavily on ligaments, muscles, and cartilage to help provide stability.
Impingement is when the humerus glides upward and causes stress on structures that sit under your acromion (part of your shoulder blade). There are a lot of pain sensitive structures that lie under this subacromial space, namely your rotator cuff musculature and your bursa sac. The rotator cuff is the musculature that helps to perform certain movements of the arm and shoulder blade as well as what helps to provide stability to the joint. A bursa sac is a fluid filled sac that helps to dampen forces and helps the shoulder joint move more freely. During the recovery phase or above water portion of the swim stroke the arm is going into a flexed and internally rotated position. This position along with the force of the water during hand entry puts a lot of stress on the shoulder joint and its surrounding structures.
The supraspinatus muscle (shown below) and its tendon are often affected in impingement of the shoulder.
This muscle plays a key role is stabilizing the head of the humerus to prevent it from migrating upward into the acromion. This muscle along with others are susceptible to fatigue as the swimmer's practice progresses. This is where performing specific dry land training exercises helps to strengthen and build the endurance of those muscles.
Try this exercise: It has shown a large level of contraction in the supraspinatus muscle. Make sure you are using a weight that you can perform 2-3 sets of 15 to 20 repetitions. Don't raise your arms straight ahead, but angled out slightly.
If you can't seem to get a handle on your shoulder pain. Give me a call or shoot me an e-mail and I will be able to do a thorough assessment to find your impairments that are leading to the true cause of your pain.
Click on Pinnacle Physical Therapy below to head to my website for more information about me and my practice. Please like my FB page 'Pinnacle Physical Therapy.' I will be posting some cool videos on there specifically to keep Central Arkansas Swimmers healthy!
As you can see from the above picture, the golf swing is a very complex movement that requires the body to have strength, power, flexibility, balance, mobility, motor control, and stability.
What better practitioner to seek treatment from than a Physical Therapist who is TPI Medical II certified?
What is TPI?
TPI is the worlds premier player development center located in Oceanside California. They offer advanced equipment fitting methods, detailed swing analysis, and science based player conditioning.
TPI has also been doing research on thousands of golfers to find what swing characteristics are optimal and which ones lead to injury. Not only do they look at the swing but they have coined the term body-swing connection.
They teach medical professionals how to assess the golfers whole body to determine if there are physical limitations that are leading to current or eventual injury, are bleeding power from their swing, or are not optimal to play their best golf.
The TPI Screen
The TPI screen is made up of 16 specific assessments that are correlated with a players ability to make an optimum swing. The skill of your Physical Therapist at Pinnacle Physical Therapy in this specific assessment along with his past experience allows Brian to formulate a plan to attack your limitations.
You no longer have to be playing golf in pain!
A quote by one of the best swing coaches in the business sums it up well. "If you are in the business of coaching, physically training or medically evaluating golfers, TPI Certification should be mandatory." - Butch Harmon