To Sit or to Stand, that is the question?

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?

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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?


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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!

Matching  interventions to patient’s with specific presentations allow for better outcomes.

Matching interventions to patient’s with specific presentations allow for better outcomes.

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).

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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.

It may get awkward if you are doing a head stand in the office, but tell your co-workers to join in!

It may get awkward if you are doing a head stand in the office, but tell your co-workers to join in!

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

Brian@pinnacledpt.com

Reference

  1. Wilke, Hans–Joachim, et al. "New in vivo measurements of pressures in the intervertebral disc in daily life." Spine 24.8 (1999): 755-762.



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

Orthopedic Physical Therapy

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.

What impairments do you have that keep you away from your passions?

What impairments do you have that keep you away from your passions?

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.

Not interested in taking medications, getting injections, or having surgery. A physical therapist is a great option to help you get back to doing the things you love. 

Not interested in taking medications, getting injections, or having surgery. A physical therapist is a great option to help you get back to doing the things you love. 

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.

http://getpt1st.com/why-physical-therapy/

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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. 

Dr. Brian Murphy, DPT, OCS, ATC, PES   Owner of Pinnacle Physical Therapy in West Little Rock, AR

Dr. Brian Murphy, DPT, OCS, ATC, PES 

Owner of Pinnacle Physical Therapy in West Little Rock, AR

Swing Flaws and Body Limitation Impairments: Over the Top

Over the Top

This swing characteristic is very common in higher handicap golfers. This commonly occurs with overuse of the upper body on the downswing portion of the swing. The player brings their club from outside to in and does not keep in in the slot. The slot is the intended swing path of the club that is ideal to put the club face squarley on the ball. 

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Shot Implications

If you have this swing characteristic it is common for you to pull the shot if your clubface is square and for you to slice the shot if your club face is open at impact. This fault makes it very difficult for you to consistently strike the center of the club face when you make contact with the ball. 

Body Limitations

This swing characteristic can be seen if you have a hard time with disassociation. Disassociation is huge in the golf swing; this is the ability for you to keep one area of your body stable while moving another part of your body. Their is an ideal sequence to moving the parts of your body during the downswing. If for instance you have stiffness in your hips or pelvis and they are not moving effectively, it is not uncommon to see a golfer using more of their upper body to swing the club, this often leads to the over the top swing fault. 

A proper weight shift is also critical to prevent this swing fault. A right handed golfer shifts their weight from the trail leg the lead leg very early in the downswing. If you have poor balance, or decreased core and glute strength it will force you to not shift as effectively and you end up coming over the top. 

Exercises/Corrections

There are drills you can perform to help with disassociation, and mobility of the upper and lower body. 

The Bretzl : http://www.mytpi.com/improve-my-game/swing-characteristics/over-the-top_v2

The stretch above is a great way to work on your mobility and the stretching of key areas in your body that need mobility to make a powerful golf swing. 

If you need any advice, please feel free to reach out to me at Brian@Pinnacledpt.com, by phone or text at 501-529-2010. I offer a FREE phone consultation to see if I can help you with your impairments so that you can return pain free to this things you enjoy.

Thanks and here's to helping you reach your Pinnacle! 

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Prevention Strategies for the Injured Swimmer

"Coach, I just did my thousand warm up and my shoulder is killing me, what should I do?"

There are a lot of factors that go into determining why a swimmer is injured. I wanted to give you some tips and ideas on what you can do to try and treat these injuries on your own. 

Tip 1: The best strategy is to avoid injury before it comes! You must have a solid flexibility, strengthening, and endurance training program under your belt that you are performing consistently! 

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*Stay tuned for my video series that is going to give you this exact program! 

Tip 2: Careful monitoring of training volume, intensity, and duration will go a long way in calming down an injury. Complete rest is rarely indicated because of the deconditioning that develops. Certainly looking at adjusting the above parameters for a short time will give the athlete time to allow the healing process to be effective. 

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Tip 3: Specifically for the shoulder, avoidance of using hand paddles is a good idea as these put more stress on the shoulder. Avoiding or limiting the painful stroke is also a good idea. Modification of the dry land training program will prevent continued stress to the injured area. 

Thank you Lord, I don't have to use paddles today! 

Thank you Lord, I don't have to use paddles today! 

Tip 4: Application of ice to the affected area helps to reduce pain and inflammation as well as proper use of anti-inflammatory drugs when appropriate will help reduce pain and improve function. 

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Tip 5: Have your coach take a look at your swim mechanics. Ensuring that you are swimming with correct technique goes a long way in avoiding increased stress to structures in your body that can cause pain. 

I hope these tips are helpful for you and keep you swimming and performing at your best. 

If you are still struggling to get your injury under control please reach out to me anytime at brian@pinnacledpt.com, or call me at 501-529-2010.

Come back next week for the start of the video series on exercises that you MUST be performing!

Thanks and Here's to Helping you Reach your Pinnacle! 

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Swimmers, Why Do Your Shoulders Hurt?

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. 

Shoulder Impingement

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. 

The shoulder joint from the back (left picture).  Shoulder joint from the front (right picture). And looking at the glenoid fossa (where the upper arm bone joins with the shoulder blade)

The shoulder joint from the back (left picture).  Shoulder joint from the front (right picture). And looking at the glenoid fossa (where the upper arm bone joins with the shoulder blade)

Impingement Explained

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. 

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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. 

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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!