Proper posture is something most of us struggle with. For as long as I can remember, my mom used to frequently remind me to stand up straight with my shoulders back. As a kid I never understood the importance of good posture. However, maintaining good posture has a lot more benefits than just looking better! What exactly is posture? It’s our bodies alignment/positioning in relation to gravity. Gravity is constantly exerting force on our body regardless of what position we are in. Proper posture places the body in position so that no area is overstressed, decreasing susceptibility to pain and injury. It applies to standing, sitting and laying down. Good posture will place the body in a position in which our body weight is balanced throughout our spine and lower extremities, decreasing stress on muscles and ligaments.

Some of the benefits of good posture include improved breathing, decreased spine and shoulder pain and decreased headaches.

Breathing: When it comes to breathing, being in a forward slouched posture affects our lung’s ability to fully expand as the muscles in the front of the chest begin to shorten. Sitting up straight with the shoulders back can improve our bodies oxygen intake! Oxygen is very important in all cellular processes in our body and can help to improve energy and healing.

Back Pain: Back pain is another big culprit of poor posture. While maintaining good posture, our body should be in a neutral position so none of the muscles or ligaments are being overwork, shortened or excessively lengthening. The postural muscles should be in an optimal muscle position to work correctly, expending the least amount of energy. If we are constantly in a poor postural position, changes will occur to the spine and musculature overtime including changes to the blood vessels, nerves and ligaments. This will disrupt our body from performing with correct biomechanics increasing the chances of injury and spinal wear down over time.

Headaches: Most people with poor posture operate in a position in which the head sits forward. Your head is equivalent to the weight of a bowling ball so when the head is positioned forward, the muscles must work much harder to keep your head positioned on your spine! This increased stress placed on the muscles within the neck and upper back causes them to tighten. When the muscles tighten, headaches can occur.

Shoulder pain: It’s one of the most common things us PTs treat! Improving posture will decrease the risk of shoulder pain and dysfunction. Majority of people will allow their shoulders to roll forward which occurs most often in a seated position. This forward roll decreases the space within the shoulder joint. It also causes the front muscles to shorten while the back muscles will lengthen. Decreasing the space within the shoulder joint alters the shoulders normal biomechanics and can cause pinching of several soft tissue structures leading to pain and increased risk of injury.

So, what exactly does proper posture look like? When looking at yourself from the side, your body should follow your head. All your major weight bearing joints should be in line with your ear. Imagine a line going from your head to your feet. Your shoulders, hips, knees and middle of ankle should be right in line with the middle of your ear. You should also have a slight curve within your low back.

Maintaining good posture can be difficult to do and rather fatiguing. You might notice a burning sensation in your upper back after a while when you try to maintain correct posture. This is due to the fact the postural muscles are endurance muscles. Not only do they need to be strong, but they also need endurance to avoid resorting back to the rounded shoulder forward head positioning so many of us are susceptible to. In order to build endurance of the postural muscles, we should perform exercises at a lower weight with high repetition. This will allow those postural muscles to continue to contract over a longer period. Below are several exercises to get you started on improving your posture.

EXERCISES THAT HELP IMPROVE POSTURE:

Rows: While pulling back on the t-band, squeeze your shoulder blades together. Make sure you avoid your shoulders from elevating while you pull. You can perform this exercise with resistance bands or on a cable system. Remember to perform low weight and high resistance. Aim for 30 repetitions and when that becomes a piece of cake, increased the resistance or cable weight.

Prone scapular squeeze with extension: While laying on your stomach, squeeze your shoulder blades together and then elevate your arms a few inches off the table. Lower the arms followed by relaxing the shoulder blades. You can eventually add in dumbbells when you can fly through 30 reps with no fatigue.

Doorway stretch: This is a great exercise to perform to stretch out the anterior chest muscles which often become shortened. You will stand in the doorway with your shoulders and elbows up at 90 degrees. You will then step into the door until you feel a gentle stretch in the front of your chest. Hold each stretch for 30 seconds and perform 3-5 sets.

Bilateral external rotation: To perform, hold T-band in each hand with your palms facing each other and then slowly pull your hands apart. Keep your elbows at your side while you pull. Aim for 30 reps.

Physio Ball Y’s: To perform, lay across physio ball. You will then straighten out your arms and raise them up in line with your head and then lower them back down. Make sure you keep your head in a neutral position. You can add dumb bell weights to make this exercise more difficult when ready. Again, aim for 30 reps.

Give these exercises a try and if you feel you need further help or have any questions or concerns, please don’t hesitate to reach out to us here at Rye Physical Therapy!

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By NICOLE CARVILLE, DPT – Rye Physical Therapy South

Spinal stenosis is an extremely common diagnosis that I see patients with daily as a Physical Therapist. Some patients present with x-ray or MRI findings diagnosing “lumbar spinal stenosis” at a certain spinal level. Other patients schedule a direct access appointment – if their insurance does not require a referral – and I am able to evaluate if they present with signs and symptoms consistent with spinal stenosis.

So, what is spinal stenosis?

By definition, it is caused by a narrowing of space around the spinal cord and is part of the natural aging process. It is often caused by degenerative osteoarthritis of the spine and is most frequently found at L4-L5, L5-S1 and L3-L4. It can be graded as mild, moderate or severe depending on the degree of narrowing. Other risk factors for stenosis include family history and genetics. It is most commonly reported by individuals over the age of 60 years old. However, it is important to remember that an image of your spine that shows stenosis does not mean that you will have pain from stenosis. Many patients have this diagnosis and have no pain for years, and others come to physical therapy with pain and we work hard to decrease and eliminate pain as much as possible.

What can spinal stenosis feel like?

The severity of symptoms that people experience depends on the degree of narrowing and the location which can lead to pressure on the spinal cord and nerve roots. Majority of patients who have lumbar spinal stenosis will feel pain in their lower back. However, some patients will also experience symptoms of pain, fatigue, weakness or numbness in the legs. These symptoms in the leg can also progress into something called claudication pain where there is a significant cramping sensation. This occurs when the nerves that exit from the lumbar spine and go down the legs have a lack of blood flow or have mechanical compression. Claudication pain is often associated with change in posture where bending forward from the back decreases pain and extending the back, standing and/or walking increases pain.

If spinal stenosis is degenerative, what can you do for me?

For patients that have spinal stenosis and are symptomatic, our treatment focuses on reducing pain as well as restoring function. This treatment includes manual hands-on treatment, exercise and modalities as needed. The exercises we do are flexion based, otherwise known as forward bending of the back. These exercises include range of motion, stretching and strengthening of the core and hips. In addition, we provide patient education with tips on sleeping position, activity modifications and what to avoid. The biggest emphasis is on avoiding spinal flexion, otherwise known as backwards bending. At Rye Physical Therapy we are also trained in Dry Needling techniques that many patients with stenosis find to be extremely beneficial for pain management. The goal of all our treatment interventions is to reduce irritation of both the spinal cord and nerves thereby reducing your symptoms.

What other treatment options are there?

In addition to physical therapy, patients can pursue medical interventions including oral medication and/or corticosteroid injections as well as surgical intervention if needed. Oftentimes, patients are managed with a multimodal approach where we combine multiple interventions.

Have you been diagnosed with lumbar stenosis? Or are you experiencing symptoms similar to the ones described above? Please give us a call at Rye Physical Therapy for an evaluation to discuss what you are experiencing and talk about how we can help you achieve your goals!

References:

https://www.ncbi.nlm.nih.gov/books/NBK430872/

https://www.welcomebackclinic.com/blog/Lumbar-Spinal-Stenosis-and-Neurogenic-Claudication.htm

https://pubmed.ncbi.nlm.nih.gov/34978252/

 

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By LISA WHELDON, DPT

If your child gets diagnosed with scoliosis you may be a bit taken aback. It can be unsettling to get a medical diagnosis with little explanation of what it is or how it can be treated. Scoliosis means that there is a change to the “normal” shape of the spine so the spine may have moved to the side or turned. This can alter a person’s overall trunk alignment and posture. The abnormal curvature of the spine can alter other areas of the body. This may include: shoulder height, hip height, pain in area of shoulders pelvis and hip, and painful movement patterns. As physical therapists we can often be an important part of the team to help a child with scoliosis.

Scoliosis is a relatively common condition that can affect “2% to 3% of the general population, and is more common in females than males APTA”. Adolescent idiopathic scoliosis (AIS), the most common type of scoliosis, is diagnosed in children aged 10-18 years. Idiopathic means no identifiable cause is known, but 30% of children with AIS have some family history of the condition. Other types of scoliosis include congenital, neuromuscular, and early onset (infantile and juvenile). Congenital scoliosis is when a deformity to the bones of the spine happens during baby’s development in the womb. Neuromuscular scoliosis is caused by the nervous system and can occur in conditions like cerebral palsy (CP) or muscular dystrophy. Early onset scoliosis is diagnosed from birth to 3 years of age or juvenile scoliosis diagnosed before age 10. Both of these onsets have an unknown cause.

Physical therapists can even be involved in the screening and initial diagnosis of scoliosis (although an x-ray from an orthopedic physician can truly confirm). Upon screening of the patient, the PT can discuss what activities are difficult for the child due to their current condition. They will evaluate the patient’s ROM and then assess strength and flexibility of the surrounding muscles. Upon evaluation the therapist can then create a program to address areas of impairment. If there appear to be movement limitations then some gentle stretching may be appropriate to improve the child’s mobility. Areas of weakness are often an issue so the therapist would provide a proper strengthening program. This program could include exercises to strengthen weak back muscles, core, shoulders and hips.

Manual therapy can also be a part of the treatment plan. We are trained professionals to restore mobility and ROM in a joint. This can include joint mobilizations, manual stretching, and soft tissue mobilizations to gently restore motion. Education is also an important part of treatment. If a child doesn’t pay attention to their posture and they are hunched over looking at tablets or the computer (which is common at this time) they can exacerbate the curvature. Unfortunately, scoliosis isn’t really “preventable” but educating on the condition and body movement is an important piece of the puzzle.

Typically, the goal of therapy is to do things to work on the muscle imbalances from the curvature. If a child has tight hamstrings, then we would stretch that area out in the clinic and provide the patient with proper exercises to improve the muscle length of hamstrings. Providing patients with tools to self-treat and maintain gains made in therapy is critical. Then to address areas of weakness is another important piece. Core strengthening can be important for any spinal condition. Creating a core strengthening program that the patient can perform in the clinic and then continue with following discharge is another component. Physical therapy doesn’t end once the patient is discharged from the clinic. It is important for the parent and child to remember the program created by the therapist be maintained and may even require updating/progression periodically by the therapist. So, if your child is diagnosed with scoliosis physical therapy is a viable option for treatment. Contact Rye Physical Therapy at 603-929-2880 to learn more.

Source: https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-scoliosis

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When I meet a new patient as a Physical Therapist, I sit down, start their evaluation by asking about their current condition. Then I review their medical history and medications before we get started. It is important to me to get a solid picture of who they are and what preexisting conditions they have before I get their heart rate up and start exercising. During this process, I often see “Osteoporosis” on the list of preexisting conditions. Most of the time I ask, “When were you diagnosed with osteoporosis? Are you on any medication for bone density? Have you ever received PT for this condition?” More often than not, the answers are, “I’m not sure. Maybe at one point in time. No, definitely not”. I often end the conversation there as the patient sitting in front of me is likely there for a different reason, but at some point during a treatment session, I will ask if they have any interest in preventing future osteoporotic fractures and building their bone density. The answer is usually, “I didn’t know you could do anything other than take medication”.

So, what is osteoporosis?

“Osteoporosis [is] defined as a skeletal disorder characterized by decreased bone strength and increased susceptibility of fractures”.

Changes in bone density and bone structure

These changes occur for a handful of reasons including, but not limited to gender, early menopause, medication use, increased caffeine consumption and smoking history. The literature shows that there are 54 million Americans diagnosed with osteoporosis (2006). Why do we care about this? One in two women and up to one in four men over the age of 50 WILL break a bone due to osteoporosis. The most common fractures associated with osteoporosis include hip, wrist and vertebral compression fractures. Statistics show that 90% of hip fractures occur due to osteoporosis and fracturing your hip is associated with a 50% increased risk of mortality during the year following fracture! Moreover, wrist fractures due to osteoporosis are just as common as hip fractures and vertebral compression fractures are twice as common as hip fractures. All of these fractures can lead to chronic pain, decreased quality of life and decreased mobility.

Vertebral compression fracture

Most of these fractures occur from simple movements that we do in our day-to-day life and fracture risk can be decreased just by changing our habits. The vertebral compression fracture pictured above is most at risk with the movement pictured below where you round the spine forward and reach to pick up something.

The right and wrong way to pick something up

Wrong!

Below are two better options for picking up an object off the ground. The first image utilizes a squat to get down to the ground where the spine is straighter. This is a strategy we will work on and build the strength to be able to get down to pick up the object on the ground. The second image is the Golfers reach where you pivot on one leg and have hand held support on a sturdy object nearby. This is a helpful strategy to pick up a purse off the ground or to pick up a piece of clothing off the floor. In this picture, I have my hand on the black table to steady myself. However, balance is important for this strategy and is another skill we will work on in the clinic.

The literature clearly states the seriousness of an osteoporosis diagnosis and the importance of taking action to both decrease your future fracture risk and build your bone density. Patient’s cannot always feel the changes in their bones or detect increased fracture risk until it is too late. However, the good news is that Physical Therapy can help! There are three pillars of treatment for osteoporosis:

1. Exercise (PT!)
2. Diet
3. Medication

When you decide you are ready to start, we will go over all three pillars and refer you to additional health care providers based on your needs – such as a Nutritionist to discuss diet changes or an Endocrinologist/Rheumatologist to discuss medications if you are interested. We will discuss modifiable risk factors and safe body mechanics like those pictured above for all of your activities around the house.

The physical therapy pillar of osteoporosis treatment will include postural training, walking drills, balance training, site specific strengthening for the back, hips and spine, core strengthening and resistance training – all designed based on your prior level of exercise, activity and goals. The sooner you get started, the safer your spine, hips and wrists will be from a life changing fracture. At Rye Physical Therapy, we are prepared to walk you through this education and create a bone building exercise program that is tailored to your specific needs.

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By DYLAN CHISHOLM, DPT

Many people at some point in their lifetime will encounter a situation where they experience neck or low back pain. Neck and low back pain can significantly impact quality of life and make activities that were once enjoyable debilitating and unfulfilling. When someone experiences spine related pain the question to ask is “who do I see that can make my back and neck pain go away”? Two of the primary options for conservative treatment of low back pain and neck pain include seeing your local chiropractor or local physical therapy. So, who should you see?

It is important to first understand the similarities between both of these conservative treatment options for your spine pain. Both PT’s and chiropractors primarily focus on the reduction of your pain patterns through use of manual interventions to restore function and mobility to allow you to be able to do the daily activities that you enjoy. PT’s and chiropractors also go through extensive schooling requiring doctoral level entry to deliver optimal care to each patient they treat.

So, how does physical therapy and chiropractor differ, and which treatment option should I seek?

First, chiropractors primarily perform spinal manipulations often called “adjustments” on patients with goal of restoring alignment and your spines self-awareness, known as proprioception. Often individuals with back pain go to their chiropractor, get seen for ten minutes, and go home feeling great. However, after a few days, their pain often returns, and they need to go see their local chiropractor again.

Physical therapy will focus on identifying the limitations and dysfunction in the musculoskeletal system that may be contributing to your spine pain patterns. PT will perform a thorough evaluation of how your spine moves, including identifying any dysfunctions in muscle flexibility, joint mobility, strength and neuromuscular deficits including sensation and reflexes. From there, PT will work with you on how to properly gain segmental mobility through your spine with the goal of restoring functional mobility to get you back to doing the activities that you enjoy. Physical therapists in the state of NH are permitted to perform spinal manipulations, similar to that of a chiropractor.

Cervical manipulation by a physical therapist for neck pain and stiffness

However, with PT we use these adjustments as a compliment to other interventions with the goal of addressing the dysfunctional movement patterns and changing the way you move, which over time will lead to long term pain relief. These additional interventions include use of manual therapy and soft tissue mobilization to improve tissue pliability and reduce joint and muscle inflammation, therapeutic exercises specifically targeted towards your goals and your pain patterns to provide support to your spine, dry needling to address deeper muscle binding and pain and electrical stimulation to block your bodies pain signals to get you feeling better before you leave.

Physical Therapists don’t want you to have to come back every 2 weeks if we can educate you on treatments to get you feeling better ALL the time!

Physical Therapist applies instrument assisted soft tissue work for muscle pliability

Physical Therapist applies electrical stimulation for pain modulation

At Rye Physical Therapy, our skilled licensed physical therapists are able to perform many of the skills that chiropractors use to get their patients feeling better, however that is just one component to the treatment services we provide. You get the benefits of feeling better leaving PT, like you would going to a chiropractor, with the goal of attending PT for 4-8 weeks and then not having to keep coming back to address your pain!

If you’re experiencing any low back, neck or mid back pains and are looking to get evaluated by one of our skilled doctors of physical therapy, give us a call today! 603-929-2880

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By Kate Dulac Serodio, DPT, OCS

As a Physical Therapist, I see a lot of sleeping injuries. Sleeping injuries? Yes, literally sleeping injuries!

Injuries that occur while you’re sound asleep or are a result of laying in the same position night after night. We often don’t value the time that we’re sleeping because, well, we’re asleep. But even though you’re not consciously aware of what position you’re in, you’re potentially positioned poorly and laying in a position that increases your risk of injury.

We all have a position that is our go-to position. WebMD acting reports that 63% of people sleep on their side, 16% on their stomach, and only 14% on their back. The thought of changing this is not a welcoming thought for most. On a daily basis, I preach the need to modify “your go-to position” and sleep in the ideal position that allows your body to be in the best resting position that doesn’t cause impingements and allows for gravity to actually do something positive for you, stretch you while you’re asleep.

If you have a neck, shoulder, or back condition or just want to make sure you never do its time you address your sleeping habits. I truly believe this is the #1 most basic modification you could ever do for yourself. So, what is the winning position? As you may have guessed is, yes, your back! This means that 79% of you need to make a change. Even the 14% of the back sleepers will need to make one modification as well. Sleeping on your back ensures that your neck is in alignment with your body with minimal rotation. Your shoulders are being pushed back by gravity and actually help open up your chest. Your low back is also in somewhat of a neutral position without any rotation. The low back will also require a little more help to maintain that ideal resting position, you need to put a wedge under your knees. Not only will a triangular wedge open up your spine and allow for proper fluid circulation and disc nourishment but it also prevents you from rolling over!

So, as you can imagine, I often get a kickback on why is it bad to sleep on your side or stomach, let’s take a look at a few sleep methods…

The Side Sleeper:

If you have Shoulder issues and neck issues, this is the worst position of all! Let’s start with the neck, its very unlikely that you’ll keep your head in alignment with your spine, it’s going to be cranked up or down or rotated creating impingement on either side of your neck, possibly resulting in disc pathology or irritation to the facet joint where you wake up and can’t turn your neck. Next, take a look at your shoulder! That is a rotator cuff accumulative injury. Every night laying on that shoulder. What does that do? That makes the muscles in the front of the shoulder really short and elongates the back of the shoulder muscles. That’s 8 hrs in that position! Do you think a little pec stretch that you might be doing daily for 3 min will combat 8hrs of that position, absolutely not.

Now let’s look at the back, your spine is going to rotate and compress on the nerves that come out of the spine and you’ll end of with one side being tight and the other elongated. Again, just adding to the imbalances.

The Stomach Sleeper:

This position is the absolute worst for your neck or if you have TMD! Most likely you’re asleep looking to the same side every night, resulting in muscle imbalances and joint irritation. One morning you’ll wake up and probably have some tingliness in your hand or inability to rotate your neck. Your shoulders won’t have the benefit of having gravity open then up like they do when you’re on your back but instead cont to rotate forward, again, not helping your posture. Your low back will be arched and in extension compressing the disc space and bones, not allowing for the disc to fill back up with fluid while your rest.

So there you have it, you need to sleep on your back! Whether you have back pain, neck pain, or shoulder pain or you simply want to make sure you never do! And if all that isn’t convincing enough, according to the aesthetic surgical journal, sleeping on your back will help prevent wrinkles!

Here is the type of wedge I recommend. This will place your low back in the perfect position. The wedge will also make sure you stay in this position all night, not allowing you to migrate back to you go to position

Buy Yours Here

Rezilient Professional Stretching targets the muscles in your body that have become super tight from years and years of you sleeping on your side or stomach. A side sleeper will often have tightness in their upper trap, pecs, and hip flexors. Also if you’re a side sleeper you’ll often have a tight lateral fascial line and anterior line (the connection of fascia/tissue that connects all the muscles on the side of your body and all the muscles on the anterior Rezilient targets these muscles in ways that most will struggle stretching independently.

Here’s an example of some of the stretches our team can do for you, to alleviate your pain and help you be resilient.

To find out more call Kate at Rye Physical Therapy, or fill out this contact form.

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Does Pre-Covid-19 seem like forever ago?  We’re now in week 4 and many of us are feeling like it’s been an eternity.  We no longer have our luxury at work desks, chairs, and routines.  But instead we’re left in our personal homes with our new work stations consisting of high top stools, a recliner, the couch, kitchen table, or your home office chair which you’re sure is the reason you’re now having some weird pain/sensation on the outside of your leg.  To make our working conditions even more complicated many of us have children that interrupt you with every other thought.  In fact, this tiny paragraph took me an hour to write secondary to the constant interruption and demands of the children’s online learning and my newly appointed position of Head of Homeschooling.  I miss the day when I had no idea what a zoom meeting was! 🙂

We are all on the struggle bus together!  We have no idea how long this ride will be but hopefully we can get off at the next stop, May 4^th, right?  In the meantime, I’d like to help you with a simple adjustment you can make to help you get rid of your back or leg pain and or prevent it from ever happening.

Many of us, including myself, are experiencing sciatic pain.  Sciatic pain can present itself in many ways.  You could have pain anywhere from localized to your back to all the way down your leg to your foot.  The pain could be mild to severe and present itself as numbness, tingliness, burning or a pulling/tight feeling.  Nerves are complicated and don’t always make sense.  But if they’re starting to talk to you it’s very important that you don’t ignore them as they will soon become very angry and make sure you have no choice but to listen.  Anyone that has had a severe case of sciatica knows what I’m talking about.

So, what can you do to keep your back and sciatic nerve happy?

Above is a video I made, showing you 3 tIps on things you can change immediately in your home office or living room! (ALSO EXPLAINED BELOW)

TIP #1 Sit on a wedge or pillow: this increases the angle at your hips and decreases the neural tension on your sciatic nerve.  Sitting at a 90deg will actually put more pull/strain on the nerve.  The goal is to have your knees lower than your waist putting you more into a standing position vs sitting.  You should feel an immediate relief in your back and if you have any leg symptoms going on they should also be reduced or completely eliminated.

TIP #2  Don’t sit so long!  Set a timer for 20minutes.  Or drink so much water that your bladder puts you on a timer.  Your body isn’t meant to be in any one position for longer than 20minutes.  You’re asking for trouble if you go beyond this time.   Get up and move/change positions or how about you stretch!

TIP #3  stretch? Yes, one the best things you could do for your back to prevent constant disc bulging from sitting is to do the opposite of what you’ve been doing for the past 20+minutes.  Yes, stand up and simply arch backwards.  Repeat 20x

STAY SAFE & HAPPY!  We are open if you need us… just call!

(image of woman sitting image above by freepik – www.freepik.com)

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By Jess Leberman, DPT – Hampton Clinic ~

Low back pain (LBP) is a significant condition in the general population making it the leading cause of daily activity and work related limitations and absences. It is estimated the lifetime prevalence of non-specific low back pain is 60% to 70%. LBP places a significant burden on individuals, families, and work places. For that reason, LBP is consistently the most commonly treated condition by outpatient physical therapists.

Frequently, patients visit emergency departments or primary care physicians with complaints of low back pain that is addressed with imaging and possible medication prescription. Imaging such as x-rays and MRIs often show abnormalities within the spine. Common findings on imaging of the lumbar spine include; disk degeneration, facet degeneration, and disk protrusion, which, can be interpreted as causes of back pain. In many cases these findings on imaging result in medical or surgical intervention that may or may not alleviate the symptoms. But how come when addressing these abnormalities found on imaging, does it not always alleviate the pain?¹

Research Findings

Brinjikji W, et al studied the age-specific prevalence of the following imaging findings in asymptomatic individuals: disk degeneration, disk signal loss, disk height loss, disk bulge, disk protrusion, annular fissures, facet degeneration, and spondylolisthesis (a slipping of vertebrae).

The table below displays the percentage of individuals without Lower Back Pain that displayed changes on imaging;²

So what does this all mean?

Well simply put, imaging of the lumbar spine does not tell the whole story. There is a large proportion of people who display abnormalities within the lumbar spine on imaging, however, present with no low back pain. Based on the research, it can be suggested that more than 50% of those 40 years and older without Low Back Pain display disk degeneration or bulging meaning that even in a younger population changes within the lumbar spine. The research validates the statement that changes seen on imaging of the lumbar spine are considered normal in all age groups and may not be the direct cause of pain. These findings lend itself to the question, if I have general low back pain, is it necessary to get x-rays or an MRI? At Rye Physical Therapy our Doctors of Physical Therapy specialize in evaluating low back pain, diagnosing the cause and assessing the need for further imaging.

Choose PT first for low back pain!

Contact Hampton PT for a Free Discovery Visit (or sign up online)!

References

1. Duthey B. Background Paper, BP 6.24 Low back pain. World Health Organization. March 2013. https://www.who.int/medicines/areas/priority_medicines/BP6_24LBP.pdf. Accessed May 28, 2019.
2. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811–816. doi:10.3174/ajnr.A4173

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by Katherine Younes, PT, DPT- Rye Physical Therapy – Hampton, NH Clinic

Do you have a nagging pain that radiates down the back of your leg? These are the symptoms that everyone refers to as “sciatica”. Did you know that these symptoms can be a pain pattern referral coming from your lumbar spine? This is a condition referred to as lumbar radiculopathy.

• There are several factors that can cause referred pain into one leg:³
  • Herniated/Bulging disc

    • irritates/pinches nerve root at the lumbar spine

  • Degenerative Disc Disease

    • natural process that occurs with aging that causes a decrease in disc height which can irritate/pinch nerve root at the lumbar spine

  • Spinal Stenosis

    • narrowing of spinal canal compresses/irritates nerves of lumbar spine

  • Piriformis Syndrome

    • tightness of the piriformis can result in pinching/irritation of the sciatic nerve as the nerve is located right under the piriformis muscle

    • these symptoms can replicate lumbar radiculopathy symptoms

  Symptoms You May Feel:

  • -Pain is typically located in 1 leg

    • -Pain will radiate down the back of the hip/buttock and into the leg, can go as far down as the lower leg and foot

    • -Pain will worsen with sitting or standing

    • -Pain described as sharp, shooting

    • -May or may not experience numbness/tingling

  How can physical therapy help?

  Research has supported the use of physical therapy and application of the traditional lumbar stabilization exercises with mobilization treatments for the sciatic nerve to improve the function and health of patients.¹ “Both hamstring stretching and nerve mobilization can be usefully applied for the therapy of patients with lower back pain and sciatica related symptoms.”²

  At Rye Physical Therapy, we have several treatment options to address your symptoms, such as neuromobilization treatments, soft tissue massage, dry needling, lumbar traction and exercise. Also, in conjunction with previously mentioned treatments, we also provide spinal manipulation to the appropriate candidate. If your symptoms do not radiate below your knee, you are a candidate for spinal manipulation. We can provide education about position modifications for your desk, car and furniture at home, as well as proper transitional mobility treatments and lifting treatments to reduce symptom exacerbation and risk of further injury.

  Here are a couple exercises you can try to address your symptoms.

  Bridges: While lying on your back, both knees bent, tighten your lower abdominals, squeeze your buttocks and then raise your buttocks off the floor/bed as high as you can comfortably, however do not go high enough to create arch in your low back. Hold and then lower yourself and repeat.⁴

  Piriformis Stretch: While lying on your back and leg crossed on top of your opposite knee, hold your knee with your opposite hand and bring your knee up and over across your midline towards your opposite shoulder for a stretch felt in the buttock. Hold for 10 seconds, repeat 10 times.⁴

  If you have any questions regarding this condition feel free to call or stop by one of our two Rye Physical Therapy locations in either Hampton or Seabrook, NH to speak to one of our physical therapists.

• Citations:
  1. (1)Jeong U-C, Kim C-Y, Park Y-H, Hwang-Bo G, Nam C-W. The effects of self-mobilization treatments for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain. Journal of Physical Therapy Science. 2016;28(1):46-50. doi:10.1589/jpts.28.46.
  2. (2)Lee J, Kim T. The treatment effect of hamstring stretching and nerve mobilization for patients with radicular lower back pain. Journal of Physical Therapy Science. 2017;29(9):1578-1582. doi:10.1589/jpts.29.1578.
  3. (3)Sciatica Symptoms – Spine-Health. https://www.spine-health.com/conditions/sciatica/sciatica-symptoms
  4. (4)HEP2go – Build a HEP Home Exercise Program For Free, https://www.hep2go.com/exercises.php

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By Kristin Keafer, DPT, Hampton Clinic

The prevalence of low back pain across America and the entire world is growing out of control. A recent survey taken by the APTA (American Physical Therapy Association) reports that nearly two thirds of Americans experience low back pain, and 37% do not seek professional help for pain relief. According to the World Health Organization, low back pain is the leading cause of activity limitation and work absence throughout much of the world. This is imposing a high economic burden on individuals, families, communities, industry, and governments. So… Let’s do something about this! Prevention of these injuries is the best place to start. Let us attempt to keep your back safe this winter by discussing some simple tips.

Back to the Basics: Correct Lifting technique

While finishing stacking your wood for the winter, it is important to start with correct lifting treatments. Many people believe they know how to lift with proper mechanics, however still manage injure their low back. It comes down to more than just “bending your knees.” Let‘s go over some easy rules to remember.

~ Always bend at the hips, not the back. Bending just your knees will not ensure a safe lift. If only the knees bend, the back is still at risk for curving causing a low back injury. Think about keeping your chest upright, pointing forward. This will help to keep your back straight, while your hips and knees actually do the bending.
~ Do not twist. Always lead with your hips when changing direction rather than your shoulders. It is important to turn your body as a whole and place your load directly in front of you. This is true when picking up an object as well as putting down an object.
~ Keep the load close to your body. The farther away an object is held from your center of gravity, the more force it requires to hold it up. Muscles and structures in your low back are responsible for keeping your body upright. If they are stressed with too much load far away, there is risk of injury to any and all of these structures.

Shoveling Snow

One common cause of low back injury during the winter in New England is shoveling snow! There are several factors that contribute to this. This is a repetitive activity that places stress to the low back over a prolonged period of time if done incorrectly. Secondly, many people want to save time by twisting and throwing snow for faster clearance. You must stay to the basics of lifting that we discussed above to keep your low back safe from injury. Here we will go over some additional tips for shoveling specifically.

Preliminary advice
~ Warm up with a short brisk walk or marching in place to increase blood flow to muscles before strenuous activity.

• ~ Choose a shovel that is lightweight with a plastic blade. This will reduce the overall weight you will be lifting. 
• ~ A shovel with a curved shaft or adjustable handle will allow the blade to be on the ground while minimizing the possibility of painful bending.

• Lifting with a shovel

  • Whenever possible, try to push the snow to one side rather than lifting it. Be conscious of minimizing your forward bending and twisting while doing so.

  • Refer to above easy tips to lifting 1-3 as guidelines to ensure proper technique. Use a split stance and power from your legs to lift.

  • ~ Keep your load light rather than trying to lift a load that is too heavy for you. If required to lift heavy snow, grip one hand on the shaft of the shovel close to the blade with the other hand on the handle. This will allow you to keep the heaviest part of the shovel close to your body and center of gravity.
  • ~ Avoid twisting the back and extending your arms to throw the snow. Rather, walk to the area you want to deposit the snow and align your body facing forward to dump. Always pivot your body as a whole. Do not allow your shoulders to face a different direction than your hips.
  • ~ Pacing yourself is important. Take a break for 1-2 minutes every 15 minutes to avoid overworking and stressing the low back. If the snow is deep, remove a few inches from the top rather than trying to remove the entire depth at one time. It may even be a good idea to remove snow over a period of a few days if possible to reduce overall stress to structures in the spine.

  • Many of you have already injured your back in the past and find that it still bothers you during tasks like this each year. You may benefit from a formal evaluation of your back pain and one-on-one education for injury prevention with one of our skilled physical therapists. Rye Physical Therapy at both our Hampton and Seabrook locations offer a variety of manual treatments including Dry Needling, Graston Technique, Neural Mobilization and Spinal Manipulation that should help to get you back on your feet! Feel free to contact us with any additional questions. 

  • REFERENCES:
    Wendel, Erin. Most Americans Live With Low Back Pain – and Don’t Seek Treatment. APTA.org, News Release. 2012.Priority diseases and reasons for inclusion: Low Back Pain. World Health Organization Website. https://www.who.int/medicines/areas/priority_medicines/Ch6_24LBP.pdf

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