Doc I have low back pain but I think it might be Cancer! Help!

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.

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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.

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“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.

Let a skilled Physical Therapist interview you to assure you that you don’t have a more serious life threatening condition.

Let a skilled Physical Therapist interview you to assure you that you don’t have a more serious life threatening condition.


”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 large, white blob just behind the bones of the neck is a spinal tumor.

The large, white blob just behind the bones of the neck is a spinal tumor.

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.

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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.

Changes in bowel and bladder function are a major red flag and often require immediate surgery to maintain the normal function of your nerves.

Changes in bowel and bladder function are a major red flag and often require immediate surgery to maintain the normal function of your nerves.

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 brian@pinnacledpt.com, 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!


5507 Ranch Dr Suite 203  Little Rock, AR 72223

5507 Ranch Dr Suite 203

Little Rock, AR 72223



Lions, and Tiger, and KT tape, O My!

The golf world was set ablaze again with the sight of Tiger Woods with Kinesiology Tape on his neck. 

https://ftw.usatoday.com/2018/07/tiger-woods-kt-tape-neck-stiffness-reaction

https://ftw.usatoday.com/2018/07/tiger-woods-kt-tape-neck-stiffness-reaction

 

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/

https://www.wsj.com/articles/SB10001424052748703465204575208193178227952

https://www.wsj.com/articles/SB10001424052748703465204575208193178227952

 

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. 

http://ispeventcenter.com/blog-post/positive-thinking-a-gamechanger/

http://ispeventcenter.com/blog-post/positive-thinking-a-gamechanger/

 

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! 

Brian 

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How Do I Hit the Ball Further? Work your Butt!

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.

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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.

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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!

This is the starting position. 

This is the starting position. 

You want to pull the knees apart (the band around the knees provides additional contraction of the hip and core musculature) then lift your butt off the floor. 

You want to pull the knees apart (the band around the knees provides additional contraction of the hip and core musculature) then lift your butt off the floor. 

If you are having pain with this exercise you can reach out to me at brian@pinnacledpt.com or over the phone at 501 529-2010. My website pinnacledpt.com tells more about my philosophy as a Physical Therapist.

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Thanks and Here's to Helping You Reach our Pinnacle!