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Back Pain 

Back pain

 

Did you know that back pain ranks second only to upper respiratory illness as a reason for office visits to physicians? And, over 85% of all adults will have low back pain at some time in their lives.  Back pain may arise from several structures in the spine including:  ligaments, discs, facet joints, muscles, blood vessels and spinal nerves. At ELEVATE, our physical therapists are experts in treating back pain.  At our facillity, you will first receive a thorough spine exam by a board certified orthopedic physical therapy specialist with a doctoral degree in physical therapy. Once the exact cause of your back pain has been determined, our therapists will establish a comprehensive treatment program for you utilizing the most effective and revolutionary treatments available to treat your back pain and "get you back into life!"   

The most common causes of back pain are discussed below.  If you have any questions about how we can help you, don't hesitate to contact our office.  

 

Back Strain or Sprain 

The spine is a complex structure of bone and muscle, supported by cartilage, tendons, and ligaments, and fed by a network of blood vessels and nerves (see below). 

The back—especially the lumbar spine, or lower back—bears much of the body’s weight during walking, running, lifting, and other activities. It makes sense, then, that injuries to the lower back—such as strains and sprains—are common.

A strain is an injury to either a muscle or tendon. Tendonsare the tough, fibrous bands of tissue that connect muscle to bone. With a back strain, the muscles and tendons that support the spine are twisted, pulled, or torn.  A sprain is the stretching or tearing of a ligament. Ligaments are the fibrous bands of tissue that connect two or more bones at a joint and prevent excessive movement of the joint.  

Symptoms of a strain or sprain include:  

  • Pain that worsens with movement
  • Muscle cramping or spasms (sudden uncontrollable muscle contractions)
  • Decreased function and/or range of motion of the joint (difficulty walking, bending forward or sideways, or standing straight)

A back strain can be caused by:

  • Extreme physical exertion
  • Falling
  • Bending or crouching repeatedly
  • Lifting heavy objects if you are not in shape

It can also be caused by emotional stress, improper posture, being overweight, out of shape, or sitting in the same position for long periods of time.  Even a severe cough can result in a back strain.  Keep in mind that back strains are most common between the ages of 15-30 years old.  If lifestyle changes don't occur, the persistent stresses on the spine will result in more serious back problems such as herniated discs, pinched nerves/sciatica, osteoarthritis/degenerative disc disease, and compression fractures as age increases.                      


Disc Herniation

All of the bones (vertebrae) that form the spine in your back are separated by rounded, flattend discs that actually resemble a jelly donut (image below).  These discs normally have a firm outer ring (the annulus fibrosus) with a jelly-like substance (nucleus propulsus) forming the center.  When the discs are healthy, they act as shock absorbers for the spine, and they keep the spine flexible.   

Disc herniation
"Jelly" of the nucleus  migrating through the annulus to press on the spinal nerve.
                      

If the discs become damaged, however, the back of the disc commonly becomes weakened and allows the jelly to migrate out of the center to form a disc bulge.  Without the appropriate treatment, this process may continue and cause the disc to break open (rupture) resulting in what is called a herniated or slipped disc.  If the disk bulges far enough backward (see image above), it will press on the nerves that are leaving the spinal cord producing pain, numbness, and/or weakness down one or both legs.  This is commonly referred to as sciatica or lumbar radiculopathy.

                                  

Back Arthritis (Osteoarthritis/Degenerative Disc Disease)

Back arthritis or osteoarthritis is also known as degenerative joint disease (DDD). Healthy and arthritic spineIt is a wear-and-tear process in which the discs that cushion the vertebrae degenerate, or wear down. As we age, the water content in discs decreases.  As a result, the discs in the spine lose their pliability or flexibility.  This decreased pliability causes the discs to be less capable of performing their primary job as a shock absorber of the spine.  Beginning around the age of 40, the normal stresses placed on spine can become a burden to the discs resulting in the gradual wearing away of the disc especially in the areas of the spine that experience the most stress-the lower cervical and lumbar spine.  This process can cause pain and swelling; and, it may also result in the development of osteophytes, or bone spurs that can narrow the canal (stenosis) where nerves exit the spine causing pain, numbness, and/or weakness into the legs (See side image). 

Sciatica/Radicular Pain

In recent years, sciatica has become a "garbage-bag" term that people use to describe any type of buttock or leg pain without defining a specific cause of the pain.  Historically, sciatica has referred to leg or buttock pain, numbness/tingling, and/or weakness down one or both legs.  As nerves exit the spinal cord in the low back at their respective levels, they quickly 

converge to form the sciatic nerve-the largest nerve in the body (See image).  There is a sciatic nerve in both legs, and, as the image shows, the sciatic nerve extends down the back of the leg progressing on its path to the tips of the toes.  Along it's way, the sciatic nerve branches into smaller nerves.  These nerves supply the muscles of the legs and the sensation fibers to the skin. Because of the sciatic nerves, we are able to feel and move our legs. 

Sciatica (also called lumbar radiculopathy) occurs when one or more of the nerves that makes up the sciatic nerve is irritated.  This most commonly occurs at the area in the low back where the nerves exit the spine; and it is most commonly caused by a disc herniation, or bone spurs (osteophytes) that have developed as apart of degenerative disc disease (DDD/osteoarthitis of the spine).

Sciatica may include one or several types of symptoms depending on where and how badly the nerve is being pinched in the spine.  And, because the sciatic nerve supplies the muscles and sensory fibers from the low back down the legs, symptoms of pain, cramping, numbness/tingling/shocking, and weakness may occur from the low back down the length of the nerve's path in the leg.  The severity of symptoms varies from person to person.  Typically, the farther down the leg the symptoms are felt, the more serious the case of sciatica; and, if conservative treatment isn't sought promptly, symptoms may worsen, and they can become very debilitating requiring surgery.

At ELEVATE, our therapist have extensive experience treating patients with sciatica.  With the appropriate treatment program, most people suffering from sciatica see symptom resolution quickly and are able to return to their normal, active lifestyle.  If you have any questions about how we can assist you, call our office today.

Scoliosis

Scoliosis is a sideways curvature of the spine.  When viewed from behind, the spine should be straight (See below).  Any type of curvature to the side may indicate scoliosis is present.  There are several causes for scoliosis; however, the most common type, idiopathic scoliosis, has no specific identifiable cause.  With idiopathic scoliosis, the sideways curvature begins at childhood, and it may worsen as the child ages.  If the curvature becomes severe enough, the child may be treated with bracing or surgery to halt the progression of the curvature.Scoliosis of the spine

Many people have a milder form of scoliosis in which the curvature of the spine never progressed to the point that required treatment as a child or it may have developed later in life due to one leg being longer than the other, degenerative joint disease, or fractures.  Although these individuals may not have experienced back pain as a child, it is not uncommon for symptoms to develop at middle age.  This is due to increased stresses in certain areas of the spine due to the mal-allignment brought on by the scoliosis.  Because of the increased propensity of these individuals to develop back problems, they must make spine care a way of life.  This includes an appropriate exercise program to maintain spine mobility, spine strength, and muscle flexibility; a leg length assessment with possible lift to correct the curvature; and education in proper postures and lifting mechanics.

These treatments have been shown to be effective in helping these individuals manage scoliosis, decrease or eliminate chronic back pain, and decrease their risk for more invasive forms of treament. 

Osteopenia

Osteopenia refers to bone mineral density (BMD) that is lower than normal peak BMD but not low enough to be classified as osteoporosis. Bone mineral density is a measurement of the level of minerals in the bones, which shows how strong and dense the bones are. If your BMD is low compared to normal peak values, then you are said to have osteopenia. Having osteopenia means there is a greater risk that, as time passes, you may develop osteoporosis.

Bones naturally become thinner as people grow older because, beginning in middle age, existing bone cells are reabsorbed by the body faster than new bone is made.  As this occurs, the bone loses minerals, heaviness, and structure.  

This makes them weaker, and it increases their risk of breaking. All people begin losing bone mass after they reach peak BMD at about the age of 30. The thicker your bones are at age 30, the longer it takes to develop osteopenia or osteoporosis.

Osteopenia has no symptoms. Needless to say, regular physical examinations by your physician are important for early diagnosis.  If you have been diagnosed with osteopenia, the good news is that you do not have as much bone loss as those with Osteoporosis (when bones actually become porous). Osteopenia is a serious diagnosis, however, and you are wise to learn as much as you can about it. If you do not stop your bone loss, you will soon develop osteoporosis, and your risk of hip, spine, and hand fractures or a dowagers hump (hump back) will increase.

If you have osteopenia, your doctor can determine if you need treatment with prescription medication. The decision to treat is made on a case-by-case basis, depending on each individual. The diagnosis of osteopenia can be an eye-opening wake-up call to make certain lifestyle changes.  Lifestyle modifications are an important part of the prevention and treatment of osteopenia and osteoporosis. These lifestyle changes include a safe weight-bearing exercise, quitting smoking, not drinking excessively, and ensuring an adequate daily intake of calcium and vitamin D. If dietary intake is not adequate, then supplements may be prescribed. At ELEVATE, our professional staff, which includes physical therapists with orthopedic specialties and a registered dietician, has extensive experience in helping patients with osteopenia make the required lifestyle changes necessary to slow, halt, and in many cases reverse bone loss related to osteopenia.  If you have any questions about what we can do to help, don't hesitate to contact our office.

Osteoporosis and Compression Fractures

Osteoporosis is a disease of the bones. It happens when you lose too much bone, make too little bone or both. As a result, bones become weak, and they can break from a minor fall or, in serious cases, even from simple actions, like sneezing or bumping into furniture.

                           Osteoporotic bone becomes porous like a honeycomb

Osteoporosis means “porous bone.” If you look at healthy bone under a microscope, you will see that parts of it look like a honeycomb. If you have osteoporosis, the holes and spaces in the honeycomb are much bigger than they are in healthy bone (See above). This means that your bones have lost density or mass and that the structure of your bone tissue has become abnormal. As your bones become less dense, they also become weaker, and they are more likely to break. 

Compression fracture due to osteoporosis

Breaking a bone is a serious complication of osteoporosis, especially when you’re older.  A recent study found that elderly women who break a hip after a fall are five times more likely to die within one year than women the same age who do not.  Fractures related to osteoporosis can occur anywhere but they most commonly occur in the hip, the spine, or the hand.  Spine fractures due to osteoporosis occur when the vertebrae begin to break or collapse.  This type of fracture is called a compression fracture (See above).  Broken bones can cause severe pain that may not go away without treatment. With osteoporosis some people lose height and become shorter.  As the disease progresses, it can also affect your posture, causing you to become stooped or hunched (See below).  

 

A comprehensive treatment program for osteoporosis should include "bone-friendly" medications, nutrition counseling, a safe weightbearing exercise program to improve bone strength, and a fall prevention program to improve balance and decrease the risk of fractures related to falls.  While your physician will determine the appropriate medication regime for you, our dietician and physical therapists can work to provide you with the other components of your comprehensive osteoporosis treatment program. 


 

Post Surgical Rehabilitation

Spine surgery is a major undertaking.  Most people who elect spine surgery do so due to the debilitation brought on by the pain or weakness that back problems can produce.  Many times, spine surgery is very effective in eliminating these severe symptoms; in many cases, however, it may not eliminate all symtoms or disability completely.  Rehabilitation is an important part of helping patients get the most possible benefit from their spine surgery. Essentially, rehabilitation can help patients recover from spine surgery as quickly and completely as possible.

Physical therapy or post surgical spine rehablitation can be thought of as alignment and balance for your body. If you buy new tires for your car, they won’t last as long if they are not aligned and balanced and the new tires will be a waste of money. Spine surgery is like new tires, and a physical therapist’s role is to do the alignment, balance, and engine tuning to make sure that the effects of the surgery are as positive as possible.

At ELEVATE, our physical therapists have extensive experience in post surgical spine rehablitation. There are several ways that we will assist you in getting back into good physical condition and heal from your back surgery.

1. Pain Control after Spine Surgery        

Controlling pain is an important first step in allowing you to regain your strength, as it is very difficult to complete a rehabilitation program if one is in a great deal of pain.  While a certain amount of pain is common in the recovery process, there are several means that we use at ELEVATE to help minimize and eliminate pain, such as:       

  • 830 Cold Laser
  • Moist heat and ice application
  • Ultrasound and electrical stimulation
  • Certain types of movements
  • Electrical devices (e.g. TENS units)
  • Education in postures/positioning to decrease the strease on the spine

Many of the techniques for back pain relief are simple and easy to learn and can be done at home or at work throughout the day. 

2. One-on-One Training after Spine Surgery

At ELEVATE our therapists will develop a training program tailored for you, taking into account the your specific surgery, body type and tissue conditions.

We will focus on muscle fascilitation in areas where the muscles may need special retraining to gain strength and provide stability following the back surgery. This type of exercise therapy will focus on:

  • Muscles in the incision area
  • Muscles that may have been weakened by nerve problems before the surgery
  • Small muscles that work around each vertebra and help stabilize the spine. Most people (even those without spine problems) do not use these muscles very often. However, if these small muscles are trained properly, they can provide excellent stabilization to the muscles that can protect the spine and protect the newly operated area to prevent future problems.

Individualized physical therapy will also help with areas where your mobility and flexibility have been limited by spine surgery. We can help the joints and the muscles involved regain the movement in relation to your individual body type and allow you to return to the activities you enjoy.

3. Exercise for Recovery after Spine Surgery

Exercise is vital to getting better after spine surgery.  It is the key to eliminating fatigue, getting you back to activity safely, and avoiding re-injury. Ultimately, exercise is critical both in helping the body heal from the original injury and in preventing (or minimizing) future episodes of back pain.

At ELEVATE, our physical therapists will develop an individually tailored exercise program based on knowledge of the exact type of spine surgery, and the forces that are most beneficial for the your spine under different conditions. There are many choices of exercise available for you and we will work with you to esablish a comprehensive exercise program that you will enjoy and continue to do on your own at home to maximize your function after spine surgery.

4. Education about Exercise following Spine Surgery

Because most back problems result from the culmination of a lifetime of poor posture and lifting mechanics that have gradually injured the spine, patient education is an important part of the post surgical rehabilitation program.  During your time at ELEVATE, you will receive extensive education in safe postures/positioning, lifting mechanics, and activities to avoid which are not safe for your spine.  Also, during your treatment sessions, you will have plenty of opportunity to ask questions of your therapist. Your therapists can explain exactly what changes have occurred as a result of your specific surgery, and what can be done to maximize the benefits from that surgery.

Your success in recovery from spine surgery depends on your willingness to work hard at home as well as with your therapist. Ideally, the surgery will take you a great deal of the way on the road to recovery, and then the patient and therapist team can work together to make the recovery the best possible.  Let us help "get you back into life!"


Growing Pains in Children

"Growing pains" is a harmless condition of unknown cause that affects 10 to 20 percent of growing children. It is somewhat more common in girls than boys. As children experience growth spurts most commonly between the ages of 3 to 15, it's not unusual for the muscles in the legs to tighten up.  This decreased flexibility can result in foot and ankle pain, calf pain, knee pain, hip pain, thigh pain and even back pain. 

Growing pains are characterized by the symptoms listed below.
  • Occurs in children 3 to 15 years of age. 
  • Pain can occur in one or both legs, foot and ankles, knees, hips or back.  Pain in the arms is less common, but may occur in conjunction with leg pain.  
  • Pain occurs in the evenings and night time, often causing awakening during the night; however it can occur during the day or after activity.
  • Children may complain more frequently in the nights following days during which they are very active. 
  • If not treated pain may occur for months or years, as frequently as almost every night, often with symptom-free intervals of weeks or months. 
  • Children with growing pains have normal physical exam results. The results of X-rays and lab tests, although usually not needed, are also normal.
As stated above, growing pains may persist form months or years if not treated.  However, with the appropriate rehab program, most growing pains resolve within a matter of weeks.  At ELEVATE, our therapists have over 15 years of combined experience working with school age children who have growing pains.  If you have any questions about how we can help your child return to a normal pain-free life, call our office today.  

Fibromyalgia

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.  Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.  Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Research shows that women are much more likely to develop fibromyalgia than men.  In addition, many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

Although there is no cure for fibromyalgia, there are effective treatment options available.  At ELEVATE, our therapists have extensive experience in assisting fibromyalgia patients manage this disorder and return to a normal, active, lifestyle.  Here we belive a comprehensive approach is best.  We first, recommend that fibromyalgia patient's speak with their physicians about medications that can help control symptoms.  While your physician works with you to establish the appropriate medication regimine, our physical therapist will utilize the most effective and revolutionary pain control modalities available to decrease pain.  These may include:  830 cold laser, moist heat, ice, ultrasound, electrical stimulation, postural/positional education, and relaxation/stress-reduction techniques.  In addition, exercise has been shown by research to be effective in helping reduce the symptoms related to fibromyalgia, and we have seen this first hand.  As a result, you will be placed on a very specific exercise program individually tailored to your specific needs. Don't let fibromyalgia keep you down.  Call our office today!