I have low back pain, now what?

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?


Who do I go see and more importantly how much does each option cost?

Who do I go see and more importantly how much does each option cost?

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).


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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.

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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.

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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

501-529-2010

Brian@pinnacledpt.com

Balance and the Golf Swing

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.

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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!

I utilize this technology to train a golfer on how to react to the ground and also to cue them how to work on balance movement control.

I utilize this technology to train a golfer on how to react to the ground and also to cue them how to work on balance movement control.

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.

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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.

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Balance is not only critical in the golf swing, but driving the cart as well!



References

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