Bad Medicine!.......... for low back pain

Maybe Bon Jovi was right with Bad Medicine!  Does your clinician follow the established guidelines to treat low back pain (LBP) or are you receiving "bad medicine"?  A recent study from the Journal of American Medial Association - Internal Medicine, stated that " Despite numerous published clinical guidelines, management of back pain has relied increasingly on guideline discordant care."  The results of this 2013 showed:

No change in physical therapy referrals

Increase in narcotic usage

Decrease in NSAIDS and tylenol usage

Increase in diagnostic imaging (such as CT scans and MRI)

Increase in physician referrals

Physical therapy and the usage of NSAIDS were considered as GOOD coordination with the LBP guidelines and evidenced based.  Physician referrals, diagnostic imaging, and narcotic usage were considered BAD coordination with the guidelines.  This looks like the health care system is doing everything along the BAD track doesn't it?   So,is your clinician following the guidelines, that have been set by proven and established research, and may lead to better outcome for our patients with LBP or are they following Bad Medicine!   Here is another link to physician guidelines in the clinic regarding the treatment of LBP from the American College of Physician.  At Pursuit Physical Therapy, you never have to question your quality of care.  Your treatment is always what is best for you!  If you have LBP, call Pursuit Physical Therapy at 407-494-8835 or visit our website at www.PursuitTherapy.com for more information about how we can help your LBP.  

Fit Body Boot Camp Orlando and Injury Prevention

Are you a member of Fit Body Boot Camp Orlando?  Fit Body Boot Camp is a new fitness and weight loss training method that is sweeping the nation.  I had the opportunity to attend a training session at the Orlando location, and I love the training style!  This is the perfect workout: high intensity, total body involvement, functional movements, cardiovascular, and overall a short duration (30-45 minutes).  This is the perfect workout to help you lose weight, decrease body fat, and maintain muscle, and you don't have to plan anything!  Just show up and the trainers will take care of the workout.  I thoroughly enjoyed the workout even though my legs were sore for days!  Great job to Kerry and Andrea for opening a great gym, for their community involvement, and for spreading health and fitness throughout Orlando.

Proper biomechanics and flexibility is going to be essential to help prevent injuries from occurring with this type of training.  Just for example when squatting or even with a deep squat, you must have the proper flexibility and strength to complete the task with proper form.  When form and biomechanics become poor, this may increase the risk for injury.






Below is an example of a functional deep squat that you should be able to perform without any compensation.  How many of you can perform this?

This training may also predispose people to getting many overuse injuries such as knee pain, foot pain, and other tendinitis injuries.  Proper stretching, warm-up, and again flexibility will all be essential to help also decrease injury rates.

So what can you do to help prevent injury when training hard to reach your personal goals?  Here are 5 strategies you can do to decrease your chance of injury:

1)  Warm-up prior to high intensity workouts.  A simple 5-10 minute light warm-up should be fine.

2)  Stretch involved muscles.  Such as calves, hamstring, and quad muscle.  Stretching should be done for a 30-90 second hold!  If you do not like to stretch foam rolling is also a great way to reduce trigger points in muscle, increase flexibility, and decrease pain.

3)  Avoid Over Training.  Especially, if you have just started working out.  Slowly progress yourself to 3x a week and continue until you can perform training 4-5x a week.  Weight loss from decreased body fat does not occur over 1-2 sessions.  If it does, it is probably just water weight.  It takes a long time(> weeks) and your are changing your lifestyle so there is no rush to over train.

4)  Be aware of joint pain vs muscle pain.  Muscle pain is OK and this is just something that comes with exercise and training.  FUN FACT:  The muscle soreness the day after the workout is not lactic acid build up.  Lactic acid is removed within hours after your exercise.  The soreness the day after is called DOMS (delayed muscle soreness) and it is caused from muscle damage from exercise with is necessary for your to get stronger.  If you experience joint pain consult your local medical professional, example Pursuit Physical Therapy!, sooner rather than later.  The sooner the better and the more chronic the pain is the longer it takes to get back pain free!

5)  Follow a healthy diet with plenty of sleep.  It is amazing to see how the body feels and heals as you continue to train hard, when you eat healthy vs bad.  Has anyone ever done the same workout multiple times but when you happen to drink alcohol and eat bad after, how much worse and sore you feel the next day?  There is a difference.  Eat as a function of attaining your goals!

I hope these can help you decrease your injury risk and allows you to keep training at Orlando Fit Body Boot Camp!  For more information about Fit Body Boot Camp Orlando visit their website at http://www.fitbodybootcamp.com/fl/orlando-fitness-boot-camp/ and check out their client appreciation night on August 2nd here.  Pursuit Physical Therapy and Dr. Ron Miller will be there to answer any questions regarding proper training techniques, current pain and symptoms, and to perform free functional assessments.

Early Physical Therapy Treatment for Low Back Pain: Better Outcome and Cheaper?

When you have low back pain (LBP) who should you go see to receive great patient care, to resolve your LBP, and how much will it cost you?  Well, a recent research study showed when experiencing LBP, early physical therapy treatment shows a good outcome and it is more cost effective thus reducing medical costs.  It also showed a decrease in surgery rates, injections, number of physician visits, and a decrease in opioid medication usage.

This sounds good to me!  If you have LBP, consult your physical therapist to see what is the best treatment option and to help get you out of pain now!  Pursuit Physical Therapy will get you in to see a specialist as soon as possible and you will see a board certified specialist.  Call us at 407-494-8835 or visit www.PursuitTherapy.com for more information.

Can You Tell Me Where Your Low Back Pain is Coming From?

Where is your low back pain (LBP) coming from?  This is an MRI of a 56 year old male with LBP.   Many patients come to me with spine pain and the first this that they tell me is ..... "well I have degenerative disc disease", " I have a herniated disc", "I have a bulging disc", etc.  Usually I come back and say " Well, I have a bulging disc at L5-S1 too and I don't have low back pain."  Their facial expression is usually disturbed and surprised!  This is what my lumbar spine looks like and what a normal spine should look like (as compared to the first picture).

For those that do not know what we are looking at this is an MRI image of a lumbar spine.  The last disc before the sacrum starts is L5-S1 and this is the most common area of LBP.  To the left is the front of the body and the right is the back.  You can see that my L5-S1 does not look the same as the other discs above it and it is not as bright.  So some degeneration is going on there, but it doesn't mean that you have to experience pain.  This may be normal degenertion that occurs from stress to the spine, weightllifting, and from playing sports.  I usually tell my patients that you can take 10 people with LBP, put them in an MRI machine, and their MRI will have positive findings, such as a herniated disc, degenerative disc disease, modic signs, osteoarthritis, etc.  You can then take 10 people WITHOUT LBP, put them in an MRI machine, and their MRI will have the same positive findings!  Research has shown ( from a highly respectable journal and from a high quality study) that these abnormalities seen in MRIs do not strongly correlate the underlying pathology and cause of your LBP.  This means that there are false positives with MRI and with most LBP, you may not need an MRI right away.  This is when you can get started with physical therapy and treatment right away!  Why do you need to see a physician with complaints of LBP and get diagnosed with LBP, and then get referred to a specialist?  Research has shown the cost effectiveness, improved outcomes, and more efficient treatment with the early treatment of LBP with physical therapy services.

In Florida, you have direct access to physical therapy so you can begin you treatment early and there is no need to wait for weeks to begin treatment.  If you do not respond to physical therapy or if you present with red flags, then you can be referred to a spine specialist for more diagnostic testing and possibly warranting an MRI.  Contact Pursuit Physical Therapy today for your LBP and start treatment now!  407-494-8835 or www.pursuittherapy.com.  We also have a Patient Perspective page for information for patients regarding LBP and physical therapy.  Feel free to consult with us regarding your LBP and what is the best treatment for you!  Remember just because you have a herniated disc or a positive MRI finding doesn't mean you have to have LBP.  Even this person was asymptomatic and did not have LBP!  Look how far the spine has slipped forward in the picture below!

Physical Therapy for Acute Low Back Pain? Can This Work?

Lets review this example of low back pain (LBP), that I happened to go through over the past 4 days.  So, for some reason, I decided to go to the gym on Tuesday and perform deadlifts as a part of my workout, which I haven't done since last year.

So later that day, after working at a skilled nursing facility and driving to my other job, I noticed an increase in LBP with strong muscle spasms.  Pain is a good thing (yes, it is very important!) and it tells you that something is wrong.  I always tell patients to "listen to your body", and if you are doing a certain task or position and you have increased pain try to avoid this, stop that activity, or attempt to complete it in a different position.  It is accepted in the research that acute LBP will spontaneously resolve in 4-6 weeks, but who wants to wait that long?   I know what caused my pain and that starting treatment with physical therapy with acute LBP as soon as possible will show better outcomes, decrease unnecessary testing, decrease the cost of healthcare, and I can start my treatment now!    So I was flexion sensitive, meaning I probably injured my low back during the deadlift during a flexion activity, driving also increased my pain (a flexion position again), and I know that prolonged sitting, bending forward, and any lifting would all increased my pain.

 I attempted to avoid these position as best I can, but as I was seeing patients, my work required me to be in some of these positions.  So I began treatment by myself throughout the day ... by doing prone press ups!

Since I was flexion sensitive, I would treat my LBP with repeated extension.  Many people with acute LBP fall into a directional preference and you can treat this with repeated motion with good research to support this.  I would perform at least 1 x 10 of prone press ups every hour to help me get through my day.  When I got home I usually sit in my chair, send some emails, and watch TV with my wife, but I knew that sitting would increase my pain, so I decided to do this.

I watched TV and checked my emails in this position, and by the time I was done I had no LBP!  This remained throughout the night and the next morning, and I was able to do a run/walk the next morning with only some muscle tightness.  I continued throughout my workday to perform at least 1 x 10 prone press ups every hour and was able to get through my day without exacerbating any symptoms.  On the 3rd day, I was able to return to the gym and perform basic strengthening during a light workout.  I could say that on the 3rd day I was pain free with no muscle spasm with no increased pain with flexion activities or prolonged sitting.  I know that this case will not work for every case of LBP, but this is a perfect example with acute LBP how early access and treatment with physical therapy can greatly help your pain and show a great outcome faster than the standard.  Physiopedia is a great online resource regarding physical therapy and LBP.  Pursuit Physical Therapy also has posted free information regarding LBP on their patient perspective page that reviews how LBP with effect their treatment and care.  Don't wait 4-6 months until your acute LBP to resolve, call Pursuit Physical Therapy at 407-494-8835 or visit us at www.pursuittherapy.com and start your treatment today!

Are you ready for the Masters!

In honor of the Masters this week, we are posting about the golf swing and pain all week.  Checkout the Pursuit Physical Therapy facebook page for our daily golf posts.  How do you decrease low back pain with your swing?  What impairments are common with LBP?  What are the most important muscles during the golf swing?  Feel free to ask any questions you have.  Also check out our website under specialty programs to see our golf swing program, V1 golf swing analysis, and Titleist Performance Institute screen to get you to a pain free golf swing!

Is an Epidural the Best Treatment for my Spinal Stenosis?

Getting an epidural or injection is a very common practice to treat low back pain, especially with lumbar stenosis (or a narrowing of space along the spine that is associated with increased age).  A recent study looked at long term outcomes with epidural injections in patients with lumbar stenosis and showed:

** Injections were associated with significantly less improvement at 4 years among patients with spinal stenosis

** Injections were associated with longer duration of surgery and longer hospital stays

 Lumbar stenosis is a complex diagnosis, but physical therapy has shown promising outcomes and can be attempted as a first line treatment approach.  Contact Pursuit Physical Therapy today and see if physical therapy is the right treatment to help your spinal stenosis!

Do I need to warm up before golfing?

A recent review of golf injuries reported that 50% of golfers do not warm-up prior to playing golf.   They went on to report a significant decrease in injury rates by 60% in golfers who stretched and warmed up for at least 10 minutes before playing.    Don't forget to warm up for 10 min prior to golfing to help prevent injuries.  If you need any ideas for warm-up look at the Pursuit Physical Therapy YouTube Channel and click on the golf playlist for warm-up exercises.

Pain and Motor Control: A Must Read for All Physical Therapists

Todd Hargrove wrote an excellent review in a 4 part series from a course that Paul Hodges and Lorimer Moseley held recently.  I already posted the links on the facebook page once, but this information regarding pain and motor control is so good that I had to post it again.  If you are a physical therapist and have never read any of Hodges's or Moseley's work, this is a must read!  This is truly great work!  I wish that I could have gone to this course and I hope it comes to Florida someday soon.  Below are the links to each review:

Part 1  Motor Control

Part 2  Neurotags, Disinhibition, and Sensitization

Part 3  Body Matrix and Neglect

Part 4  Nociception

What is Chronic Pain?

Treating patients with chronic pain is very difficult and researchers are continuing to understand the mechanism of chronic pain.  This is a great short video is understanding chronic pain and how patients perceive pain.

The Great Prone Press Up!

The prone press up is a great tool to help with low back but it needs to be performed correctly.  Dr. E reviews the prone press up and the correct way to implement it in patients with low back, with flexion sensitivity, and who respond to repeated extension.

http://www.themanualtherapist.com/2012/07/top-5-fridays-5-considerations-for.html

Biopsychosocial approach to treating Chronic LBP

What is Physical Therapy?

What is physical therapy?  can physical therapy treat my injury?  who is considered the best person to see to treat me?  What can I do for my low back pain?  All of these questions can be answered for you.  Visit pursuittherapy.com/about-us and see what Pursuit Physical Therapy is all about and what we can treat.

Patient Perspectives

any patient that wants information regarding their injury, Pursuit Physical Therapy just started a patient perspective page to allow patients to download free information regarding their injury. click on the link and enjoy the information.

Direct Access to Physical Therapy

A picture is worth a thousand words!