Tag Archives: low back pain

What is Lumbar Stenosis?

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Unfortunately in our society Low back pain, and its associated problems, are very common stated by the National Health Institute and several research articles published in the Physical Therapy Journal. If you look on NIH’s site, you will notice there are a variety of reasons as to why Low back pain occurs. One common diagnosis is Spinal Stenosis of the low back.

Broken down, the word Stenosis means narrowing. When applied to the spine, Stenosis means a decrease of space in the spine.

lumbar spineThis narrowing of the spine typically occurs over time due to anything deceasing the space between the vertebrae and spinal canal. Some examples include: disc herniation, vertebrae stiffening, ligament thickening, bone spurs, arthritis, postural changes,  muscle strength and length imbalances.

Pain is caused by the stiffening into this position, and occasional pinching or irritation of the nerves and discs or vertebrae.

What can you do if you have Stenosis? See a Physical Therapist where you can learn exercises, to lengthen and strengthen muscles as well as assist you in getting your vertebrae moving more freely again.

To prevent it is best to start performing a daily stretching program, especially if you sit frequently, lengthening your hip flexors to avoid an anterior tug on the pelvis and spine.

For further details, and more pictures, visit NIH for their article on Spinal Stenosis.

 

Pain in the back Part II

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This post is part II about back pain from last week.

One note of caution, please do not use the below information to self diagnosis. The best thing you can do for yourself if see your health care provider or a Physical Therapist if your state is Direct Access. If you need a referral feel free to e-mail me.

As I mentioned last week, there are so many sources of low back pain. And, treatment depends on the structure(s) involved. For example, one exercise or treatment can help to alleviate one person’s low back pain, but totally flare up another person’s problem.

If you decide to see a health care provider regarding your pain they will use some tools to help evaluate the spine. Sometimes an X-Ray, MRI and CTscan are warranted.

source

Sometimes a Physical Therapist, Chiropractor or Orthopedic MD can look at your posture and use other objective measures to determine the root cause of your pain without any imaging.

In the meantime here are some commons sources (in no particular order) of low back pain:

Stenosis: Narrowing of the spaces between the vertebrae due to degenerative changes, disc protrusion, inflammation, osteophytes, scars, positioning of vertebrae.

Muscle strain or imbalances in strength and length of surrounding musculature

Ligament sprain- injury to a ligament(s) of the spine usually from a trauma

Disc degeneration- breakdown from repetitive movements over time, especially forward bending and lifting

source

Disc herniation-Any change in the disc causing it to bulge larger than it’s normal size. Then there are worsening degrees- a protrusion, then prolapse. Healing from these injuries, if there is an acute incidence can take a long time due to lack of blood flow.

Radiculopathy- Nerve pain originating from the spine, but can travel down your leg. There are a few reasons why this occurs and you should follow up with your health care provider to prevent nerve injury.

Segment Instability-too much motion between the segments of the spine

Segmental Hypomobility- too little motions with the vertebrae and facets of the spine
Osteoarthritis, Spondylosis, Degenerative Joint Disease  and other bony changes such as Osteophytes- degenerative changes of the spine leading to abnormal changes sometimes causing decreased motion and pain.

Compression fracture- fracture of the endplate of a veretbrae

Spondylolisthesis- forward placement of a vertebrae on another. Common with athletes such as gymnasts and volleyball players

SI instability- too much motion in the SacroIlliac joint causing pain, usually one sided

Scoliosis- abnormal curve of the spine

Facet Sprain/Joint Capsule Injury- inflammation and irritation usually from a traumatic injury leading to decreased motion and muscle guarding

Reference: Kisner, Colby. Therapeutic Exercise Foundations and Techniques 5th edition. Davis Company, Philadelphia. 2007.

With all these problems that can occur is it any surprise that there are so many incidents of low back pain??
Once you determine which structures are affected, then you can determine the best plan of care. If you do not figure out the root cause first you are at risk for making the issue worse….

 

 

 

 

Pain in the back

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For some reason over the past few weeks I can count on two hands the number of  people close to me who have called with some sort of back pain. I’m not sure what is going on with March to cause the pain to hit everyone at once. However, it prompted me to write about it since we only have one set of 24 vertebrae and their associated discs and nerves. Protect them.

It’s actually alarming the statics I came across while researching for one of the many reports in Grad school.  In the United States, 70-85% of the population has had at least one episode of low back pain (LBP) sometime in their life.1  Chronic low-back pain (CLBP) is the most common cause contributing to a large number of lost work days and disability claims.2

Some of the main causes are sitting, or standing for long periods of time, and lifting.  In a nutshell, it’s the repetitive  or static motions over and over again that get you in the end (or more accurately the back). Yes, these are mostly job related. But, that is another topic. Hopefully, The Occupy (City name) Protests have got this covered for now.

Even athletes or sport enthusiasts are at risk for low back pain if they only perform one  sport all year round. For example, only running or only cycling, Ahem.

How do you prevent yourself from becoming a statistic, or how do you reduce your back pain? If you perform  one motion, or stay in a static position for long periods you need to reverse the position the second you get home. For example,  if you sit for long periods, or are a cyclist or runner perform hip flexors stretches and hip strengthening. Check out those posts for more details.

If you stand for long periods through the day perform knee to chest. If this is too intense bend the bottom leg.

If you workout frequently, cross train (and perform the above after a workout)! If you cycle, try the ellipitcal once in a while. It gets you upright, and stretches those hip flexors, and at the same time forces you to use your glutes. If you want to learn the science behind this concept Tina from Carrots ‘N’ Cake, wrote a great summary on why the glutes are over powered by the hip flexors due to altered reciprocal inhibition from sitting for long periods.

Does this seem too simple? Well, do you stretch after you sit for a long period, every time? And, after every bike ride? It is the consistency of performing these stretches and strengthening over the long haul which really makes the difference.

If you think about, it will click for you. You’ve worked your job for how many years, how many hours a day? That is a lot of hip flexor shortening time. You have to commit to reversing the shortening length of those muscles.  The good thing is the time sitting does not have to equal the time stretching. Phew! You just have to be consistent to feel results.

How do you know you are getting results? The stretches will become easier, or a friend or family member might comment that you actually seem taller or are standing more upright. Hmm.

If you currently have back pain, this gets a little trickier. There are different causes of back pain, and a variety of types. Stay tuned for Part II next week.

1. Williams K. et al. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005, 115: 107-117.

2. Tekur P et al. Effect of short-term intensive yoga program on pain, functional disability, and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med. 2008; 14(6):637-644.Br med J 1995;310:151-

3.  Rasmussen-Barr E, Nilsson-Wkmar L, Arvidsson I. Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain. Man Ther. 2003; 8(4):233-241.

Baby Got Back

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One of the keys to my mental sanity is working out.  My husband knows. If I miss too many sweat sessions I suddenly find myself wearing my mean girl pants. And I’m a NY Italian. Enough said.

There are so many great things you can do to keep your body and heart in shape. With the expansive internet you can find a variety of workouts you can do at home or in a  gym. But how do you know if they are good, or safe for your body?

I see so many people in the physical therapy clinic with injuries from a one time incident at the gym or in a class. Or,  the injury occurs from the repetition of performing a workout that wasn’t so great for their body over and over again. It’s somewhat of a catch 22, you need ( yes need) to workout, but you don’t want to over do it, or perform exercises wrong.

I’m going to add another component of Body Tips, and have a workout review and add in a playlist.

Here are two Glute routines. One is for the gals by Women’s Health Magazine and one for the guys from Men’s Fitness.

Up first is the Women’s cause the model shows much better form, and actually I would recommend this one for both genders over the Men’s Fitness  but I’ll get to that.

It’s quick and dirty, targets the main muscle groups of the Lower Extremity in 20 minutes, or 7 exercises, plus you will definitely get your heart rate up on this one. Nice bang for your buck. This routine is for the advanced exerciser. This risk of performing some of these moves if you aren’t strong enough yet, there is potential injury to the knees or low back. So if you are a beginner stay tuned, I will review one soon.

If you are an intermediate, you can perform these exercises without the dumbbells. This routine also has a video for extra instruction. This lower extremity strengthener would be good to supplement a running program to prevent any knee injuries.

Ok, the Men’s. Exercise one of this routine has potential for back injury if you arch through the back to bridge up. I would substitute that one with exercise 7 from the gals, which will reduce your likelihood of injuring your back. Exercise 2 of the Men’s form could be improved, the knee is way over the foot. A good exercise though.  Keep the knee more perpendicular to the foot by taking a larger step back. You might need to use a lighter weight then you would think.  Exercise 3 from the men is ok, just make sure not to arch the back with this one.

Here is a 30 minute play list from Rockmyrun.com, The Sun Run. Great motivating mix that I actually do listen to on my morning runs. The length of this playlist should be perfect for the 20 minute glut routine.