The chronic pain caused by sciatica and lower back problems can cause long periods of inactivity, which only serve to worsen the symptoms over time. Continual back pain and symptoms of Sciatica can be debilitating, but luckily, there are chronic back pain and sciatica treatment options to help improve the pain.
Almost every activity involves some use or movement of muscles in the back. Merely getting out of bed can cause a flare-up of chronic pain. Continuous, unrelenting bouts of pain make getting around difficult and working nearly impossible. It is one of the more debilitating problems large numbers of people deal with daily. No matter what the cause, when your back hurts, it negatively affects every area of your life.
Physical therapy treatment is available to help get the pain under control and reduce the symptoms felt. Continuous treatment increases mobility, resulting in a much better quality of life. Treatment can include
Stretching and light aerobic exercise
Heat and cold packs for pain reduction
Spinal flexibility increasing routines
Modified activities planning, and more
Not only will these treatment options lessen your back pain, they will work to prevent pain from reoccurring. To further recovery from sciatica and lower back pain, physical therapy can teach you about improved lifestyle habits so that you will no longer be held back by your condition.
Contact the PT specialists at New Heights Therapy to find out more about lower back pain and sciatica treatment today! Be sure and sign up for one of our upcoming workshops available in both Portland OR and Vancouver WA. The workshops are completely free and offer helpful information on how to live a life free of chronic pain.
In last month’s blog post, we talked about the epidemic of running injuries. Running injuries occur in the majority of runners. Why? First of all, the number one predictor of injury is a history of injury. Often it is because the cause of the injury was never treated.
We find a weak core and hips in almost every runner we evaluate. Your legs will carry you pretty far, but if you don’t have a strong core and hips serving as a foundation, eventually those legs are going to wear out. Your first sign will be an ache in the knee, hip, and sometimes even in the back. Often, this is when people grab the Rock Tape, knee brace, or buy a new pair of shoes. This might give you some temporary relief, but it doesn’t really fix the problem. One of two things are going to happen, your pain is going to come back – with a vengeance- or you’re going to get pain somewhere else, because now you’re compensating for that pain and weakness. There’s a saying in physical therapy that applies well to runners, “where you think it is, it isn’t.” Treating the symptoms often does nothing for treating the problem.
The solution? Fix the problem of course! If you’ve worn out a tire because the alignment is bad in your car, does it make sense to just change the tire without fixing the alignment? No! You’re going to end up right back where you are. Same goes for your body.
Below are links to several exercises that every runner should be doing to gain and maintain core and hip strength. If you’re strengthening your core and hips, not only will you be helping prevent injuries down the road, but as you get stronger, you’ll be running farther, longer and easier!
These exercises are just a sampler of what is available. The best way for you to figure out where your weaknesses and malalignments lie is to get a running assessment done by a physical therapist. Find one who looks at your strength, balance and running gait – like us! Getting an assessment can help determine weaknesses, predict injuries and improve your form. So, get on it. Prevent those injuries before they happen and show the world what you’re capable of!
Headaches are one of the most common disorders of the nervous system, affecting approximately 47% of the global population. For three of the most common headaches; tension type headaches, cervicogenic headaches, and migraine headaches; several studies indicate that physical therapy can be a good treatment option.
Tension type headaches are the most common type of headaches and affect 38% of adults every year. Several studies indicated that these types of headaches respond well to specific exercise. In a study by Van Ettekoven and Lucas, patients performed exercises against an elastic resistance band in conjunction with manual techniques. They found that the patients had a significant decrease in frequency, duration, and intensity of headaches for up to six months after the program. In another study, Anderson and colleagues had office workers with frequent neck and shoulder pain perform 10 weeks of resistance training using an elastic resistance band. Their findings showed decreased frequency of headaches in these patients in response to as little as 2 minutes of daily resistance training.
Cervicogenic headaches affect 22-25% of the adult population. This accounts for 15-20% of all chronic and recurring headaches. These headaches are thought to arise from joint and muscle impairments of the neck. Two recent reviews looked at studies assessing the effectiveness of conservative physical therapy management on cervicogenic headaches. Both reviews concluded that neck spinal manipulation is effective in the management of cervicogenic headaches. In addition, one review also concluded that the most effective intervention for patients with cervicogenic headaches may be a combination of mobilization, manipulation, and neck and shoulder strengthening exercises.
Migraine headaches are reported by approximately 15% of the population. These headaches are believed to come from the blood vessels and the nervous system. Migraine headaches are usually managed using medication such as Propranolol and Topiramate. There are some patients, however, who do not tolerate medication due to side effects or who prefer to avoid medication for other reasons. For these individuals, manual therapy may be an alternative treatment option. In 2011 Chiabi and colleagues performed a systematic review of seven studies on manual therapies for migraine treatment. These included two massage studies, one physical therapy study, and four chiropractic spinal manipulative therapy studies. Treatments included massage, trigger point therapy, myofascial release, soft tissue work and stretching, postural correction, exercise, relaxation, mobilization, and manipulation. They concluded that the current studies suggest that massage therapy, physical therapy, relaxation, and chiropractic spinal manipulative therapy might be as efficient as medication (Propranolol and Topiramate) for prevention of migraines.
Physical therapy treatment for patients with headaches will vary depending on the type and origin of the headaches. At New Heights, we treat headaches using many different techniques including specific neck and shoulder strengthening exercises, stretching, postural correction, and manual techniques such as graded mobilization, myofascial release, augmented soft tissue mobilization (ASTYM), muscle energy techniques, and tender point therapy.
Diastasis rectus abdominis (DRA) is a structural impairment of the muscular and connective tissue of the abdominal wall which presents as a separation of the abdominal muscles along their midline. It is measured as the distance between the right and left sides of the abdominal muscle grid (the “six-pack”), and is referred to as the inter-recti distance (IRD). Measurement of IRD in the clinic is generally made by hand or with calipers. Criteria for the diagnosis of DRA vary, but IRD is generally considered abnormal if it exceeds 2 fingers width at rest, measured at or just above the navel. DRA has been linked to support-related pelvic floor dysfunction and lumbopelvic pain. One study in 2009 found that 74% of women seeking physical therapy for abdominal or lumbopelvic symptoms exhibited increased IRD and had significantly greater pain than those without DRA.
Risk of pregnancy-related DRA is about 27% during the second trimester and peaks in the third trimester at 66-100% due to the baby’s increase in size. Luckily, there is some research which suggests that exercise during pregnancy may mitigate the occurrence of DRA. In 2005, one such study looked at the effect of abdominal strengthening on the presence and size of DRA in pregnant women. Eight women who participated in a prenatal exercise program of abdominal muscle strengthening, pelvic floor exercises and education were compared to 10 non-exercising women. They found that only 12.5% of the exercising women exhibited a DRA as compared to 90% of the non-exercising women.
Incidence of DRA decreases postpartum but is still present in as many as 39% of women six months postpartum, and some women still have not fully recovered one year postpartum. DRA-related abdominal instability can be especially limiting during this time, as women return to previous normal activity in addition to the load of caring for their child.
Integrity of the anterior abdominal wall is essential to stability, posture, breathing, trunk movement and support of internal organs. Specific abdominal exercises are used to narrow the IRD and help prevent future separation. In two recent studies, ultrasound measurements were used to assess the effect of active abdominal contraction on DRA in post-partum women. Both studies concluded that IRD was reduced with regular, static abdominal contraction. In another study, researchers used ultrasound to measure IRD at rest and during abdominal exercises in 84 women during and after their pregnancy. Their results support the notion that conservative abdominal exercises consistently produced a significant narrowing of the IRD.
It is important that women with DRA receive individual supervision and assessment so that adjustments can be made based on each patient’s reaction to exercise as well as rate of improvement.
New Heights Physical Therapy Plus has physical therapists with the training, skill, and knowledge to assist your clients with DRA during and after their pregnancy.
Prevalence of low back and pelvic pain during pregnancy has been estimated to be as high as 90%. It is so common that many obstetricians consider it a normal finding in pregnancy. Many women also consider pain to be an inevitable and normal part of pregnancy and do not seek treatment, despite significant limitations in day to day activities. As many as 80% of pregnant women report that back pain affects daily activities such as walking, rolling over in bed, getting out of a chair and getting out of bed.
Low back and pelvic pain during pregnancy also has significant repercussions post-partum. Risk of return of pain in a subsequent pregnancy has been estimated at 85%. One study found 20% of women with back pain during pregnancy reported residual pain three years later and 10% of women with chronic low back pain link the onset of their pain to pregnancy. This is unfortunate, since several studies have shown that simple interventions for pain during pregnancy such as exercise, education and manual therapy techniques can significantly improve pain and function during pregnancy and prevent persisting and chronic pain post-partum.
Exercise combined with education (in anatomy and physiology, posture, pain, normal pelvic changes, self help management, ADL modifications) has been found to be an effective treatment for pregnancy related lumbar, pelvic, and symphysis pubis pain. In 2014, Van Benten et al reviewed 22 randomized controlled trials on the effectiveness of physical therapy interventions in treating lumbopelvic pain during pregnancy. They concluded that exercise combined with education had a positive effect on pain, disability and/or sick leave. In one of the reviewed studies, Shim et al provided education and an exercise program to a group of 56 women with pregnancy related lumbar and pelvic pain. After 12 weeks, the women in the intervention group reported an almost three point decrease in pain. Education and exercise were also provided to late pregnancy subjects with symphysis pubis pain and dysfunction in the study by Depledge, et al. They found that after only one week of education and exercise, average pain decreased by 31.8% and disability decreased by 38.6%.
Osteopathic manual techniques, practiced by osteopathic physicians and physical therapists, have also been shown to be effective for pregnancy related back pain. Licciardone et al compared the effect of the addition of 5-7 sessions of osteopathic manual techniques (soft tissue, myofascial release, muscle energy and range of motion mobilization) to usual obstetric care in 146 women with late pregnancy back pain. They found that back pain decreased and back specific functioning deteriorated less in those women who received the manual techniques.
Low back pain, pelvic pain and functional limitations because of pain should not be considered an inevitable or normal part of pregnancy. Intervention during pregnancy can decrease pain, improve function and reduce the risk of persisting and chronic pain. Physical therapy at New Heights Physical Therapy Plus provides safe and effective customized assessments and interventions in all stages of pregnancy and post-partum.
In June, we will be welcoming a new physical therapist, Julie Burtis. Julie specializes in women’s health and will be splitting her time between the West and East clinics. She will be giving a lecture on Postpartum Rehab at New Heights (East Clinic) on June 29th from 6-7PM.
Plantar fasciitis is most commonly associated with pain in the dense, broad tissue across the sole of the foot (known as the plantar fascia).
Facts on plantar fasciitis
More than 1 million visits per year to US physicians are because of pain in the sole of the foot
Plantar fasciitis can happen to both sedentary and athletic people
It happens twice as often in women as it does in men
Is believed to be caused mainly by repeated microtrauma from chronic overload (lifestyle or exercise)
Risk factors for plantar fasciitis include:
Occupations that require prolonged standing
Poor footwear (Come to our Foot Health lecture on February 3rd!)
Weakness in the foot muscles
Decreased ankle range of motion
Physical therapy is the preferred treatment for plantar fasciitis and includes instruction in specific stretching and exercise, manual techniques and education about footwear and changes to activity.
Several studies have found that specific stretching and strengthening is helpful for plantar fasciitis. One study looked at a group that was using a standing stretching technique for the Achilles tendon and a group that was stretching the sole of the foot (the plantar fascia) in a sitting position. After 8 weeks, those who were stretching the plantar fascia while sitting had better patient satisfaction, less pain and were able to do more. But, two years later when the researchers followed up with these same study participants, they found that those participants who were doing the seated stretch to the sole of the foot remained improved AND that those who were doing the standing stretch to the Achilles tendon had also improved. Another group of studies indicate that the painful tissues in the sole of the foot have decreased blood flow and this makes healing the tissues difficult. Specific physical therapy exercises can be used to put tension through the plantar fascia tissue to stimulate healing of the tissues.
Plantar fasciitis is made worse by standing and walking for long periods, especially in poor footwear. Physical therapy provides education specific to each client to help them make changes to their specific activities. Clients also receive recommendations for changes to footwear such as arch supports to reduce stress on the sole of the foot and shoes with thicker, well cushioned soles. Foot pain often changes how you walk and this can cause tissue tenderness, pain and tissue imbalances in the legs. Manual techniques can be used to address the tissue tenderness and pain associated with foot pain and the tissue imbalances from changes in walking.
Plantar fasciitis is a debilitating condition which can take a long time to heal, often 6-18 months. New Heights Physical Therapy can provide targeted treatment and education to promote healing of tissues and faster return to normal function.
When we become injured or sick, it is often in our nature to think there is a one-solution fix. We see our primary care physicians or our physical therapists in hopes that they alone will rid us of our ailments. However, this is not always possible and although our healthcare team plays a critical part in our healing process, there are often behaviors we practice outside the clinic that stand in the way of optimal recovery.
Here at New Heights, our PTs have identified a number of barriers that prevent optimal recovery. The top five were:
Inactivity or TOO MUCH activity
Other barriers include environmental toxins and lack of sleep. All play a part in our body’s ability to repair itself. Processed foods, pushing through pain and not giving our bodies enough time to heal can lead to chronic inflammation which in turn leads to degeneration and loss of function in the affected area. Factors such as chronic stress or anxiety cause our bodies to be in a constant state of tension, inhibiting the healing process.
Because our PTs recognize these and many other barriers, New Heights’ Portland Clinic is hosting wellness classes and lectures that focus on a holistic health approach. Every month, we invite experts from around the Portland-Metro area to come and share what they know. A majority of these offerings are free and open to both patients and the community.
This fall’s highlights:
Dr. Tyna Moore, ND, DC, will be leading a lecture about gut health and how the foods we eat can either promote or inhibit reactions such as inflammation
Dr. Kathy Alvarez, MD, will be speaking on stress management and the importance of understanding the effects stress has on the body
There will also be lectures on osteoporosis, concussion awareness, sports injury prevention, bike fittings and many others
In addition to the monthly lectures, weekly wellness classes have been developed to help relieve stress and promote healing. Our new yoga instructor, Heather Beckett, will be leading Yoga Steps every Monday, for those new to yoga or recovering from an injury. She will also be leading a Dynamic Yoga Flow class on Wednesdays for those ready for a bigger challenge. Furthermore, group acupuncture and CHILL classes provide more opportunity to de-stress, while MELT classes work to rehydrate to your connective tissue, reduce inflammation and increase joint mobility.
Our goal in providing these classes and lectures is to help build an awareness for the intricacies of our bodies and to recognize that in order to reach optimal health we must take care of multiple systems. Our hope is that you will take control of your health by joining us. For more information about our wellness classes and lectures visit our online wellness class schedule or call 971-339-3405.
References: U.S. News & World Report, American Psychological Association
October is breast cancer awareness month, and for women who have had breast surgery, coping with issues that arise from surgery scars can be trying and difficult. It is important to know that although the development of scar tissue is a part of the normal healing process after breast surgery, it isn’t necessary to suffer with scars that cause pain or reduce function.
Scar remodeling is a gentle physical therapy technique that can help decrease pain, improve range of motion, and restore normal mobility and function. Scar remodeling therapy is especially helpful for women who have had breast surgery, such as breast reconstruction, reduction, mastectomy, biopsy, or lumpectomy.
New Heights Physical Therapist Gema Sanchez specializes in scar remodeling for women who have had breast surgery. Women who are concerned about the appearance or mobility of post-surgery scarring, or who have limited shoulder shoulder motion, will benefit from receiving therapy with Gema, who has over 25 years outpatient therapy experience.
Gema is passionate about helping women return to their full, normal lives without pain and with the best appearance and mobility of reconstruction and surgical scarring possible.
Free consultations are available. Call today to schedule an appointment with Gema.
We’re at about mile 18 on the new clinic marathon, and while our efforts are yielding some beautiful results, there’s still some distance to go. At this point in the project, New Heights owners Kevin Poe and Donna Gramont have to dig deep and call upon the lessons they’ve learned in physical therapy to see them through the daily grind. Turns out rehabbing a building isn’t much different than rehabbing a body, it requires the same grit and determination. They offer up these five tips for turning pain into gain to help you reach your recovery goals.
Tip #1: Begin with the end in mind.
Donna and Kevin envisioned a bigger space for patients and staff to work their recovery, which led them to purchase the former Montavilla Sheet Metal building, a treasure trove of raw materials. In their mind’s eye, they pictured the rubble of lumber not laid to waste, but instead transformed into desks, tables, cabinets, and other furnishings for the beautiful new clinic.
What do you imagine for your recovery? If you’re rehabilitating a broken ankle, picture yourself on campus walking to class or taking a hike with a friend. A powerful first step is placing yourself at the finish line having achieved your goal.
Tip #2: Learn some new skills.
Kevin didn’t know how to weld and Donna had never built furniture before, but both knew that they were capable of learning. Yes, they were operating outside their comfort zone, but they also knew the furniture wouldn’t build itself. They asked friends and family for help, and with some trial and error, they gained the necessary skills to make the furniture.
What new skills do you need to learn to reach your goal? Pilates? Strength training? Our therapists excel at educating patients about their injury or condition. Lean on them and bank some knowledge that will help you achieve your goal.
Tip #3: Show up and do the work.
Every.darn.day. Donna and Kevin realize they can’t carry this heavy load forever, but until the new clinic opens in December they have committed to working hard every day in order to realize their dream of a new clinic.
Recognize that physical therapy can be hard, challenging work. But it’s a matter of fact: you’ll realize your recovery goals sooner if you commit to your therapy plan and do your home exercises. Sometimes life just doesn’t offer shortcuts!
Tip #4: Find the Zen in the work.
Planing, sanding, joining, and staining a thousand board feet of lumber would be enough to drive anyone mad, but Donna resists the urge to resist, and settles into the work itself. By finding a peaceful zone in which to work she ensures that she isn’t expending unnecessary energy that would be better spent accomplishing her goal.
Pay attention to when you feel overwhelmed and frustrated during your recovery. Try to accept your current reality and work with what is, not what isn’t. You may find that things will soften and shift, ultimately moving you closer to your goal.
Tip #5: Prepare to Celebrate!
You better believe there is a big party planned in early 2015 to celebrate the opening of our new clinic, we can hear the champagne corks popping now! We want to share this with you, our valued patients, whose health and well-being is the reason all of this is hard work is happening.
We recommend that you celebrate every small achievement you gain during your recovery! It’s easy to lose sight of how far you’ve travelled and the ground you’ve regained. Take a moment to pat yourself on the back for all the hard work you’ve put in and the results you’ve achieved. Let the sparks fly!
By Trent Corey, PT, DPT New Heights Physical Therapy Plus, Vancouver, WA
In the line of work that I do, I am very fortunate to be able to treat people who have a variety of physical ailments, ranging from ankle sprains and lower back pain to cervical whiplash. Though all of my patients bring a set of challenges, there is something very different about the runners that I treat. As I myself have been a runner for over 20 years, with much of that time spent injured, I know how hard it is when an injury prevents me from getting out on the trail or roads.
It is estimated that 82% of all runners suffer injuries during their running career. Though I don’t claim to know everything about the subject of running injuries and mechanics, I certainly know enough to help most of my runners get back to full capacity. Here are a few “take home” tips that if each injured runner actually listened to and followed, would significantly reduce the number of commonly occurring running injuries.
Pay attention to what got you injured.
This may sound elementary, but some runners actually have no idea what they did that brought them to my clinic. Usually it’s due to a “Training Error”, a term that basically means too much too soon: Ramping up speed, distance, or both at a rate their body was unable to handle.
Back off the running for a little while.
Focus more on your imbalances, muscle weakness and tightness instead of plugging along on the same old run. I frequently see people continue to run the same distance and pace, wondering why they aren’t getting any better. Now, if you do not hurt during or after your run, or things are not getting worse with longer runs, then fine, you are on the right path. However, there is an element of addiction in running (and other endurance sports) that is unlike anything I’ve seen with other injuries. Runners need their fix, and no matter how often I tell them to slow down or cut back, they keep coming back for more of the very thing that injured them in the first place. A physical therapy evaluation will identify patterns to work on; the key is to replace the old habits with new ones that make you stronger and more aligned as a runner, so you will be able to run for the months and years ahead. Isn’t that worth a brief decrease in mileage in the short term?
Get your hips and butt working for you.
I would say that about 90% of the runners I treat have weakness and/or tightness in the hips (usually both). This compromises your ability to stand on one leg as you transfer your weight forward during gait. There is a great article about this in the April 2014 issue of Running Times magazine. I have an awesome routine that I give to patients that will get those butt muscles firing, as well as get all major muscle groups lengthened such as hip flexors, gluteals, adductors, quads, and hamstrings.
Do your core work.
I don’t care if it’s Pilates, Yoga, planks, or P90X, this is a crucial part of stability in gait. If you are weak in your core, then you set yourself up for a whole host of problems throughout your system. We need to start thinking of ourselves as athletes, not just sedentary people who run. My runners get a healthy serving of core stability exercises that start from the most basic “neutral spine” positions to more dynamic stability movements on the ball, foam roller, or other unstable surfaces.
Get better at standing on one foot.
I heard once from an online running coach that all runners should be able to stand on one leg for at least 3 minutes. Try it. It’s hard to do if your feet and hips are not strong. Also, it’s amazing how bad people’s awareness of their bodies are, especially the injured ones. Practice single leg balance for at least 2 minutes while brushing your teeth is a great way to improve body awareness and alignment for running.
Check yourself out on video.
This doesn’t have to be complicated, and since having a video camera is so common, it’s very easy to capture. All you need is about 30 seconds (or less) of running at normal pace viewed from the side and from the back. Even without training in biomechanics, you are usually able to see things about your stride that don’t look quite right. By doing the exercises and body focuses that we work on in therapy, you can recheck your form again in a month or so to see if you notice a difference. Of course, we also do some basic video analysis in the clinic using an iPad so you can see what we see in your stride and what needs work. A good article about this was written in the Jan/Feb 2011 issue of Running Times.
Feel the Chi:
I highly recommend the book Chi Running, by Danny Dreyer. Its simple approach to running stride is less about force and more about flow. The basics include posture focuses such as leveling your pelvis, then leaning yourself forward while picking your feet quickly off the ground, not pressing. The stride rate, or number of strides per minute is usually more than you’re used to, but it helps take pressure off the muscles and joints, since you are using gravity to pull you into a controlled fall forward. These are just the basic concepts, but it can help you run further with much less effort. Chi Running also has an App on iPhone that you can use to get your mind around this new concept.
Runners who develop chronic tendonitis (now officially classified as a tendonosis), may benefit from a type of therapy called ASTYM. Tendonosis is the break down in connective tissue strength and elasticity due to repetitive loading and inflammation cycles. ASTYM uses special instruments to help stimulate growth factors in chronically inflamed and scarred down tissues, helping to remodel new tissue growth that will be stronger once healed. What’s great about ASTYM to runners is that it is important to exercise regularly to load the tissue, because this helps your body to stimulate a new stronger tendon or muscle.
Work out your tissue yourself.
ASTYM can be painful, but very effective, and so is massage if you can afford to go regularly. Another tool to become familiar with and use frequently is a foam roller. In general, the more sensitive an area is, such as your calf or butt muscle, the more you need to massage it.
Persistence, persistence, persistence!!!!
One of my greatest challenges as a physical therapist is managing patients’ expectations about recovering from an injury. When patients come back after a week or two, or even at the second visit, and wonder why they aren’t any better, I usually remind them that this problem has been brewing for quite a while so a couple of quick exercises will not be enough to snap them right into perfect running form with no more injuries. There are important things that must be done in therapy, and it takes up to 6000 repetitions of any movement for it to become ingrained as a habit without conscious focus. Keep in mind the three goals of therapy: To improve muscle strength and flexibility, develop balance in the right places, and most importantly, train your nervous system to work correctly by feeling the optimal way to put one foot in front of the other. This is like running to the horizon—you may never get to the ideal, but keep working at it by tuning into your body. Your body will be glad you put the effort in to gain healthy new habits to keep you running for a long time.