Back Pain Prevention

Chronic low back painIf you suffer from lower back pain you are not alone. As someone who has suffered three episodes of intense LBP within the past ten years, I am among the millions of people who suffer from this condition. It is the number one reason to visit your doctor or miss work, and if you have never experienced LBP you are a in a significant minority. Back pain can range from a dull, constant ache to a sudden, sharp pain that makes it difficult to move. It can start quickly if you fall or lift something too heavy, or it can get worse slowly. Discs that sit between the vertebrae of the spine can rupture or break down. Muscles can strain or tear.

We use our back all day, throughout the day, and it can suffer extraordinary forces through our frequent bad habits while lifting, carrying heavy things, or even during sitting. Even if we think we are using the best posture and mechanics, we still can be setting ourselves up literally for a rude awakening.

So here are the best 8 ways to prevent LBP:

  1. Always warm up before exercise or other strenuous physical activity, including work activities that involve lifting or bending.
  2. Don’t slouch or lean forward when standing or sitting. Your back supports your weight the best when it is in its natural alignment.
  3. At home or work, sit in a chair with good lumbar support and proper position and height for the task.
  4. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support while sitting at your desk or even for long commutes. (Tip: Roll up a medium sized towel and wrap plastic wrap around it several times to hold it together. It will last longer and can work just as good as a $50 lumbar roll! I have one in my car!)
  5. Wear comfortable, low-heeled shoes if you need to be on your feet for extended periods.
  6. Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach strain2a-BBmuscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting. And ask for help when transferring heavy or odd shaped items.
  7. Limit excessive body weight around the abdomen. Maintain a diet with sufficient daily intake of calcium, phosphorus, and vitamin D, which will help to promote new bone growth.
  8. And last but definitely not least, if you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate at a faster rate.

Recurring back pain is often preventable and can often times become worse if we do not take care of our backs once an initial injury has occurred. If you have suffered a lower back injury, you need to take immediate actions to correct the reason you developed LBP in the first place and take proactive measures to eliminate these factors from occurring in the future.

Your best bet of preventing LBP from becoming chronic or recurring is to visit a physical therapist. Physical therapists are highly trained professionals who are experts in the musculoskeletal system. They can show you things such as weakness in your core muscles you didn’t think you had, faults in your lifting mechanics or posture, and even how the way you run or exercise can cause trips to the ER and years of pain.

Even if you do not have current LBP, I think you would agree that taking the time out of your day now is better than experiencing the symptoms in the future.

Remember:

“An ounce of prevention is worth a pound of cure.”  – Benjamin Franklin

Michael Phillip, PT

Physical Therapists – South Office

 

Specialization in Youth Sports: A Dangerous Game.

As an Athletic Trainer that has spent the better part of his career in the professional sports arena I am often times asked by well meaning parents what they can do to help their kid prevent injuries and get better at their chosen sport. They often times are taken by surprise when my answer is to give them the necessary rest and recovery period their bodies need to heal and develop their general athleticism by having them compete in sports or activities that are unrelated to their primary sport.  I am going to speak more directly about baseball because that is where most of my experience has been, but the principles can be applied to any sport you like such as swimming, soccer, volleyball, etc.

Due to many factors, just one of which is the continuing increase in the cost of higher education (I read once that college tuition costs are increasing at about 7% per year), many parents feel that to give their child a shot at a higher education they have to make sure that heir kid gets a full ride athletic scholarship. This leads them feel that they need to specialize and professionalize the child into a single sport at a very early age and focus all of their attention, year round, on that one sport. This has lead to a large increase in the occurrence of overuse and adult type injuries that require surgical intervention to repair, which the young athlete may never recover from. Dr. James Andrews, one of the premier orthopedic surgeons in professional sports and in particular Major League Baseball, stated in an article that half of injuries in youth sports stem from overuse and 30-40% of the Ulnar Collateral ligament reconstruction procedures ( the famous Tommy John procedure) he performs are on high school age kids even down to age 12.  Dr. Andrews recommends that kids take at least 2 months (3-4 months is preferable for overhead sport athletes) away from their primary sport to avoid these types of overuse injuries.

Another pressure that parents unfortunately run into is from the money vultures that have seen this trend of parents willing to do anything to make sure their kid succeeds, and they are more than willing to capitalize on this at the expense of both the well meaning parents and the kids. They get them with the promise of professional type instruction and maybe contacts to get them in front of college coaches and professional scouts. But they demand big dollars and full year round dedication to their program and their pocketbooks. Because of programs like this I often see kids who are competing on multiple teams during the same season.  The problem with this is that all of these teams are training like they are the only team the kid is participating in. A kid might pitch 6 innings for his high school team on Friday and 3 innings for his club team on Saturday then have to pitch at a college showcase on Sunday. Not even fully mature professional pitchers can maintain activity levels like that for very long without breaking down.

The long and short of it is that to avoid injury and give your kid a legitimate chance at achieving their full potential , their training regimen must  incorporate the necessary amount of rest and recovery. For throwers specifically, that means taking the ball away from them for a time. You don’t have to not do anything, but mix it up. Play basketball or soccer, or something. If your child develops as a more rounded athlete, they will make themselves better at their primary sport and probably remain a lot healthier too.

Jeremy Moeller, ATC

Athletic Trainer

Synergy Manual Physical Therapy

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

Practical Strength Training and Stretching Tips to Help You Prevent Pain and Injury on the Slopes: Part 2

skiing bannerNow that ski season is nearly over, you may be wondering why we’re posting the second part of this blog.  Well, as PTs we figure it’s never too late to teach folks how to avoid pain and injury—and by now you may have discovered that a full day of skiing or boarding is leaving you with some aches and pains as you start your Monday morning.  So, that makes you a particularly captive audience!  Training (before you ski/board) and Recovery (during the day and before you get in your car to drive home from the mountain) are both important when you’re hitting the slopes.  Here are some tips:

Training

Before and During Ski Season:

Everyone knows that squats and lunges are the key to enduring a full day on the slopes.  But did you know that your quads and gluts aren’t the only muscles that are important to keep strong to ensure an epic day?

  1. Hamstring to Quad ratio:  Don’t neglect your hammies.  Research suggests that the hamstrings should be at least 50-80% as strong as the quads.  Skiing and boarding will naturally work your quads, so during ski season it’s important to continue to strengthen your hamstrings.
    1. Hamstring Curls on a Swiss Ball (see YouTube video)
    2. Hamstring Curls with a cable or theraband  (see YouTube video)
    3. Straight Leg Dead Lifts  (see YouTube video)
  2. Spine and Pelvis Stability:  Abdominals support spine and pelvis.  Latissimus Dorsi support spine and shoulders.  Skiing and boarding will naturally work your gluts, so during ski season it’s important to continue to strengthen your abs and lats.
    1. Swiss Ball Crunch (see YouTube video)
    2. Lat Pull Downs

Grasp tubing with arms wider than shoulder width.  Lean back slightly.  Depress shoulder blades.  Then pull elbows toward waist.

Recovery

During and Après Ski

If you can squeeze a few moments of stretching into your day (while in a lift line or when you’re taking a hot cocoa break) your body will feel much better by the time you get to the last chair.  And since most of us drive (at least a few miles) to get to the slopes, it’s also important to loosen up before you get in the car to drive home.

Kelli Crosby, PT, COMPT

Owner

Synergy Manual Physical Therapy – South Office

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

Practical Self-Care Tips to Help You Prevent Pain and Injury on the Slopes: Part 1

Everyone knows that squats and lunges are great exercises to help you handle the steep and deep.  But did you know that preventing injury on the slopes starts in your bedroom?  Keep reading to find out the three things I teach my patients to prevent pain on the slopes—or even while doing yard work—these tips will help you prevent pain before it begins.

1. Preventing pain on the slopes starts…in the bedroom

The things you do to your body while you sleep at night, determine how your body performs the next day.  If you sleep in a twisted position all night long, it’s not hard to imagine why your back fails you during your 4th run on a powder day.  Sleep position is a common topic at our clinic because it can impact everything from neck pain and headaches to low back and buttock pain.  Here are some things to consider when you hit the sack:

If you are a stomach sleeper:

In order to breathe you must twist your neck to one side.  This is not an ideal position for your neck for a prolonged period (imagine sitting at a desk all day in that position—definitely a violation of ergonomic principles).  So, my usual tip to patients is to try to sleep on your sides or back, if at all possible.

If you are a back sleeper:

Make sure your neck is supported with a pillow that is not too thick or too thin, in order to maintain neutral alignment of the spine.  Try putting a pillow under your knees if your back bothers you in this position.

If you are a side sleeper:

Don’t sleep in a twisted position like the photo on the left below.  Also, the pillow choice advice above applies here too.

2. Preventing pain on the slopes starts…in your chair

We treat so many desk jockeys at our clinic it’s no wonder that when the weekend includes 6-8 hours of skiing (and sometimes falling), Monday arrives with pain.  Even if you don’t sit at a desk for a living, you most likely sit for prolonged periods using a handheld device—gaming, facebook, checking email, etc.  It is absolutely necessary to undo what you’ve done all week, such as prolonged sitting or slouching (ahem), if you want to reduce pain on the weekend and be ready for a powder day.

Posture 101:

Roll your hips forward to reduce pressure on your buttocks and restore the natural lordosis of the lumbar spine.  Don’t stick your chinforward or let your upper back and shoulders roll forward.  Instead pretend the hair on the crown of your head is being pulled upward toward the ceiling

Ergonomics 101:

For Pete’s sake don’t sit on the couch like this!  A laptop should only be on your lap if you are using it for less than 30 minutes; otherwise you need to create a docking station at a desk or table.  In general: sit up straight, support your low back, get the monitor at eye level, and make sure you are typing with your elbows at a greater than 90° angle.

 

3. Preventing pain on the slopes starts…in the home

Whether you realize it or not you are doing things every single day that make your back a target for injury.  Every time you bend improperly to unload the dishwasher or pick up your socks off the floor you are setting yourself up for pain on the slopes.  Don’t curve your back when you bend forward, instead bend your knees and hips and keep your back straight.

There you have it. Now you know simple things that you can change in your daily routine to keep you from setting youself up for a rough day on the slopes. The best way to keep injury and painfree on the slopes is to make sure that your postures and body mechanics off the slopes are not putting your musculo-skeletal system at risk.  This post is a part 1 in a series of 2 blogs that will help you prevent pain and injuries during your winter weekends on the mountains. Stay tuned to our blog or Facebook page to see the second part of this series on injury prevention. In the meantime, stay safe out there and stop in or call us if you have any questions on prevention or a current injury!

Kelli Crosby, PT, COMPT

Owner

Synergy Manual Physical Therapy – South Office

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

Functional Movement Screen: Assessing your injury risk before it happens

You are in great shape. You train hard. And you feel invincible! But even the top elite athletes get injured. Why is this? As most people train or workout we do the exercises or activities that we feel will benefit us the most given our sport or goal that we are trying to achieve. If you are a running you are likely working your legs the most, getting those quads strong, hamstrings loose, and glutes powerful. But we often get tunnel vision when it comes to our training regimes and do not look at our bodies as a whole functional unit. This is when injuries can occur and where a complete functional movement screen (FMS) can help to identify those areas your body is weak or restricted, putting you at risk for an injury down the road.  If you are able to identify and address these limitations early on, it can lead to improved performance and decrease your chances of an injury substantially.

What is a Functional Movement Screen?

A Functional Movement Screen is a patented assessment system that has been used by trainers, coaches, and physical therapists for years to evaluate the injury risk in elite and collegiate athletes. It is a tool and assessment that focuses on key functional movements that will address issues in mobility, stability, and combined movements to give us a look at how your body functions as a whole. On the FMS website they describe their system as:

“FMS is the screening tool used to identify limitations or asymmetries in seven fundamental movement patterns that are key to functional movement quality in individuals with no current pain complaint or known musculoskeletal injury.

These movement patterns are designed to provide observable performance of basic loco motor, manipulative and stabilizing movements by placing an individual in extreme positions where weaknesses and imbalances become noticeable if appropriate mobility and motor control is not utilized.”

What movements does the FMS look at?

The assessment looks at 7 key movements that look at both mobility and stability of the body in a functional way that directly corresponds to everyday and athletic movement patterns. See the picture below for the 7 tests.

For a more in-depth look at the test and movements performed during an FMS test you can click on this link or copy and paste it into your browser: http://www.advanced-fitness-concepts.com/fms.pdf

How do I get assessed using the FMS?

This is typically a screening tool that until now only select trainers and therapists are have been using, and has not been widely used to assess the public. But at Synergy Manual Physical Therapy we have recently brought in and trained our therapists to be able to perform and properly assess individuals using the FMS system at our North office. So to kick off this new service that we will be providing to the Colorado Springs community we will be offering the assessment for FREE at our North office (see below for details). This is a one-time offer that is open to everyone in the community and is beneficial for all age groups and activity levels.

 

Knee Pain and Your Kinetic Chain

The knee joint needs to be trained and strengthened properly to avoid excess wear and tear (arthritis) on the joint that can eventually lead to knee pain. Running, hiking, agility training, yoga, and even strength training improperly can create or increase improper knee mechanics leading to pain or even arthritic conditions. On the flip side, performing proper balanced exercise routines can help reduce knee pain and slow down the production of arthritis in the knees. Decreasing knee pain or joint break down can also help regulate energy expenditure, increase overall performance, and slow down the production of arthritis.

Stretching and strengthening are always good to increase joint performance and improve joint mechanics. Closed chain exercises (squats, lunges, and leg presses) are more functional for lower extremity joint strengthening. However, these exercises done improperly can create increased pain.  Ideally you should be performing these exercises with your weight in the heel and the base of the big toe to engage gluteus maximus which helps support knee function while decreasing forces being distributed in the knee joint. Two additional open chain exercises (exercises done without your feet planted on the ground) that can increase glute strength are the clamshell and side lying hip abduction (see pictures). Lastly, hip flexor and calf stretches held for 30 seconds or longer can complete a great routine for the biomechanics of the knee.

Mechanically the knees, feet, ankles, hips, and spine all coordinate to provide the linear motion and disperse the impact during walking or running so individual joints do not take all of the gravitational forces. Structurally, if all these joints are coordinating their movement and muscle firing patterns, then in theory no pain should exist and arthritic production will decrease.  If there is stiffness or tightness in spine or other lower extremity joints, it can lead to excessstress and impact on the knee joint during running, walking, or even standing. This is why when assessing a runners form, we typically begin in the hip and lower spine and move down the kinetic to the foot, then reverse this and assess the ankle/foot on up ensure the runner is able to maintain the proper lower extremity mechanics. To read more on the kinetic chain during running check out this article on RunningMechanics,com, “Running Injuries and Kinetic Chain Disruptions.

Decreasing knee pain can simply take a few extra steps to improve function and lower extremity mechanics. With these additions to a training regimen the lower extremity joints will perform better, improve knee pain and reduce the breakdown of the knee joint. So if you are suffering from knee pain, rather than just “running through it”, try a few of the tips I suggested above. If this doesn’t help within a few weeks stop by one of our clinics for a thorough assessment by one of our physical therapists trained in running and gait mechanics. We look forward to helping you!

- Brett Barnes, PTA

Synergy Manual Physical Therapy

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

A Hip Flexor stretch you’ll truly love

Whether you run long distance, sit in a chair all day, or find yourself somewhere in between, our challenging modern lifestyles guarantees you may find yourself with tight hip flexors or living your life with an anterior pelvic tilt.

When your hip flexors become overly tight, everything may seem out of sync.  You may feel like you walk funny, can’t run without knee pain, your lunges and squats are “off”, and your low back may ache or fatigue easily.  Sound familiar? You may have tight hip flexors.

Hip Flexor Anatomy and Biomechanics

The hip flexors are a group of muscles on the front of the body that crosses the hip.  These muscles include the iliopsoas group, and the quadriceps group (specifically the Rectus Femoris).  The hip flexors work in concert with your legs while walking or running and are responsible for flexing (bending) your hip, or drawing your thighs toward your torso. Sitting up, kicking a ball, marching, and lifting a leg to climb a ladder are all activities that involve your hip flexors.

Issues and Symptoms

You might imagine that your hip flexors get tight from overuse, while this is true, your hip flexors can actually get so tight from underuse that they stop or inhibit other muscles in your body from working.

You may have tight hip flexors if you feel discomfort in the front of the hip that feels worse when moving your leg toward your chest or if you have difficulty taking your leg behind your body and feel your low back working in order to do so.

Chronic sitting also leads to short and tight hip flexors. Tight hip flexor’s pull on the pelvis rotating it forward (anteriorly).This changes your posture by causing excessive curvature of the lower back (lumbar lordosis), a protruding belly (we all want that right?), knee dysfunction, and altered weight bearing through the spine.  Tight hip flexors can even inhibit your glutes from activating when you walk. If this happens, not only can your bottom become flat and flabby, but back pain and or discomfort generally follow.

A true stretch for those tight hip flexors

Hip flexor stretching has become very popular in the fitness and sports performance world, and rightly so.  However, this seems to be one of those stretches that either is performed incorrectly or too aggressively.

So here’s a stretch for those hip flexors that has increasingly become one of my favorites. IT is the half-kneeling hip flexor stretch. It is a true hip flexor stretch because when done correctly it truly stretches the hip flexor and doesn’t just torque your body into hip and lumbar extension.

Key Points to the Half-kneeling hip flexor stretch

  • There is a difference between a quadriceps stretch and a hip flexor stretch. When your rationale for performing the stretch is to work on stretching the hip flexor, focus on the psoas and not the rectus femoris muscle.
  • Keep it to a one joint stretch.  Many people want to jump right to performing a hip flexor stretch while flexing the knee.  This incorporates both the rectus and the psoas, but I find that there are far too many people who cannot perform this stretch appropriately. They compensate by usually stretching their anterior capsule too much or hyperextending their lumbar spine.
  • Stay tall. Resist the urge to lean into the stretch and really extend your hip.  Most people are too tight for this, trust me.  You will end up stretching out your anterior hip joint and abdominals more than the hip flexor.
  •  Incorporate a posterior pelvic tilt.  Contract your abdominals and your glutes to perform a posterior pelvic tilt.  This will give you the “true” stretch you are looking for. Most people won’t even need to lean in a little; they feel it immediately in the front of their hip.
  • If you don’t feel it, squeeze your glutes harder.  Many people have a hard time turning on their glutes while performing this stretch, but it’s key to this stretch.
  • Use your hands to guide your hips.  I will usually start this stretch with my hands on my hips so I can feel the posterior pelvic tilt.  Place your fingers in the front and your thumbs in the back and cue them to posteriorly tilt to make your thumbs move down.
  • Engage your core.  Once you can master the posterior pelvic tilt, progress to assist by cueing core engagement. Do this by placing both hands together on top of your front knee and push straight down, or hold a “massage” stick or dowel in front of you and push down “into the ground”. The key is to have your arms straight and to push down with your core, not your triceps.

So there you have it. The half-kneeling hip flexor stretch is a great stretch for those tight hip flexors and requires no equipment other than your own body. This works great for those with low back pain, hip pain, and postural or biomechanical issues related to having too much anterior pelvic tilt.  Give it a try and if you still need guidance, stop by and talk to one of the therapists atSynergy Manual Physical Therapy.

 – Albert Song Levingston, LPTA  

Synergy Manual Physical Therapy

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

Hamstring Injury Prevention

Hamstring injuryWe all know about the dreaded hamstring pull or strain. We fear that feeling of a sharp pain in the back of our thigh as we are running down the field or about to cross the finish line. The recovery can take months and the loss of playing or training time can be priceless. So what can we do about this? Can we actually prevent the invisible sniper from targeting our hamstrings? Good questions, but the answer is not so straightforward.

We know exactly what hamstring injuries are. We know how to treat them once they are torn or strained. But what we still, as a medical community, have yet to nail down is exactly why they occur and what we can do to stop them. We do however have some very good advice. So if you really want to decrease your odds, the best advice out there is a proper warm up!

What should I do for a warm-up?

Our bodies work best when the blood is flowing and the body has some clue on what you are going to require it to do. So before you do any physical activity I would suggest at minimum a five to ten minute warm up. This can include light jogging or riding a stationary bike prior to participating in a run or other light-to-medium activity level event. But if you are going to be participating in a competitive sport, an intense workout or other physically demanding event you need to be performing a dynamic warm up routine that includes several exercises and stretches prior to the actual activity. The Fédération Internationale de Football Association, or FIFA, has released a great guide called the “+11” that has been used by soccer clubs around the world for injury prevention and warm ups. You can their Injury Prevention Guide by clicking the link and it is free to download. And just because it was made for the sport of soccer does not mean it will not translate well into other sports or events! I also found this great website article: “Try This Full-Body Dynamic Warm-up to Prep for Any Workout”  that has pictures, descriptions, and videos to other dynamic exercises you can use to warm up.

Other than warming up, is there other things that may prevent a hamstring injury?

Yes, anything that places undue stress on your hamstrings will be putting them at risk for a tear or injury. This can come from un-obvious places like your core muscles, ankles, or the way your position your body when doing an activity. For example, if you have a weak core then your hamstrings may be placed under increased stress as they try to stabilize your hips when running. Or, if you have a stiff ankle that does not allow for one of your ankles to go through the full range when doing an activity, your hamstring maybe responding by tightening up. During sporting events or intense activities your body really needs all systems to work together. If one system is not working properly, than other systems will be placed under stress to compensate. This is when injuries occur.

How about stretching?

This can, and probably will, be another whole blog post in itself! To sum it up here, stretching is not all it was once thought to be in terms of a tool to enhance performance or prevent injuries. Recent literature and studies suggest that while stretching is good for improving flexibility it has not shown to reduce the rates of injuries. It was thought that injuries occur when you stress the muscle to the limits of your flexibility and then it tears. However, most injuries to the hamstrings occurs during the normal ranges, and not at the extremes. So should you stretch, yes! But your muscles should be warmed up and you may not want to rely solely on stretching to prevent hamstring injuries as we once did in the past.

So while there is nothing you can do to absolutely prevent hamstrings tears or pulls, there are things that you can do to reduce your odds. Not only will these tips and techniques help prevent hamstrings injuries, it can also reduce your odds of other injuries as well. So warm-up properly and don’t let that sniper take aim at your hamstrings!

- Synergy Manual Physical Therapy Team

North Office (map)

4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)

600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112