Ever had Back Pain??

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On Halloween last year I was crippled with spasms in my back. Not the kind of spams that constantly hurt but the kind of spasms that literally, well . . . spasm! They come in waves triggered by any little barely perceptible movement.

My 17 year old son drove me to the doctor, helped me into the office and helped me pick up my meds all while panicking inside because he had never seen his mother immobilized by pain.

I couldn’t move! Couldn’t breathe! Couldn’t believe . . . It was my hip flexor!


There are two muscles that blend together to form your hip flexor muscles. The iliacus  (il-ē-AK-us) and the psoas (SŌ-az). Together they are referred to as the iliopsoas (il-ē-ō-SŌ-az).


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  • The iliacus runs from your pelvis to your femur.
  • The psoas runs from your spine ~ vertebra and discs ~ to your femur. It is the only muscle that connects your legs to your spine!


For more detailed info check out this video! 


They are primarily responsible for lifting your knee up toward your chest or your foot off the ground. BUT they also play a role in stabilizing or moving your spine and pelvis in various situations . . . for example:

  1. The psoas helps to stabilize your spine
    imgres-1
    Iliacus Stabiliing
    1. when you are sitting especially without back support
    2. or when you are carrying or holding something on the opposite side of your body
  2. The psoas can move your spine ~ either bending to the side or curling up
  3. The iliacus helps to stabilize the pelvis when you are standing on that leg and the other leg is extending behind you.
  4. They both work when you are performing a sit up (and you thought that was working your abs didn’t you!).

Whenever I see someone with back pain, I always look at the hip flexors to make sure they are as they should be ~ strong, flexible and being used appropriately. Nine times out of 10 they are not, regardless of the origin of the back pain. And at least 50% of the time they contribute to or are the source of the back pain! Why?

Well lets first consider the origin of these muscles ~ they attach to the vertebra and the discs in the spine, they are very deep muscles not near the surface of your hip or abdomen ~ so it is logical from an anatomical perspective that this would cause the back to hurt.

The way that the core muscles attach creates a system of stability around the spine and pelvis assuming that everything is as flexible and strong as it should be . . . for reference your core muscles include the abdominals, the gluteals, the hip flexors, back extensors, and if we are getting detailed all the muscles that function at the hip and spine.

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If your abdominals and glutes aren’t helping to stabilize your back when you lift, bend and twist then the hip flexors have to help too much and are overused. This pulls your lumbar spine forward (Lumbar Lordosis) and impacts alignment.

If your hip flexors or back extensors are too short or tight they can pull your spine forward increasing the arch in your back and compressing your joints and disc. Again this pulls the spine forward (Lumbar Lordosis) changing alignment. images-3

So how do you injury your hip flexors?

  • Athletes or active folks usually do something traumatic like straining them while kicking a ball, they over use them when walking up a hill or lifting incorrectly.
  • Sedentary people may overuse them when sitting too long, standing or sitting with improper posture or lifting incorrectly.
  • Finally some people are just built in a way or have developed movement habits that tax or activate hip flexors preferentially over other more appropriate muscles and then eventually . . . ouch! (This is me :D)

Now that you know the different components affecting the hip flexor, you see that there may be a few different sites or locations of pain, but let’s talk about one specific source ~ the muscle itself. When you injure or overuse a muscle it develops these little pesky muscle knots called trigger points . . . these guys send all kinds of signals all kinds of places and make you think the pain is located in one place (Your Back) when it’s actually coming from another (Your Iliopsoas!). This is referred pain:psoas21

Why does one person feel it in the back and another in the front ~ its based on how we are wired.

If you have postural imbalance, weakness or tightness, and overdo a sport/activity or stay still too long, you create movement dysfunction which only feeds the beast!

So . . . are you surprised, confused, feeling pretty smart because you already knew this?

If you have this type of problem I will be discussing how to deal with it so stay tuned . . .

If you know someone with back pain share this post.

I invite you to comment below . . . and email, text or call with questions!

drroxi@zptforinjury.com

424.247.6987

Be well! Roxi

“Help!” Continues . . . So you’ve had ACL Reconstruction, Now What??

Hi! We are continuing our discussion on ACL tears and last post we talked about what to do if you think you have torn your ACL. Today we will discuss Rehabilitation and all the questions you should ask your Physical Therapist and Orthopaedic Surgeon and the answers they may give you . . .

If you missed the first part you can read it here Help! My daughter tore her ACL . . . We think??

So you’ve had surgery . . . 20150625__701135-s500-phHopefully you are feeling like you made a great choice ~ I don’t suspect you are necessarily happy with needing surgery and the coming rehabilitation but now that your joint is stable again proper healing can begin ~ its uphill from here baby!

I suspect you have the lots of questions tho . . .

  • How long do I have toimages-8
    • take meds
    • use the crutches
    • wear a brace
    • keep icing
  • When will it stop
    • hurting
    • being so swollen 
  • When can I get back to
    • sports
    • school/work
    • walking normally
  • Is this normal???

First lets talk about some common things you may be surprised by or concerned about that your  surgeon may not have mentioned . . .

  1. You may have a LOT of pain and swellingtherapeutic-drugs-monitoring-19-638
    1. STAY ON YOUR MEDS AS LONG AS YOU NEED TO!
      The pain and anti-inflammatory medication is needed to manage the pain and swelling along with frequent icing for the first days after surgery. If you do not take your medications regularly they will not build up in your system enough to control the pain and swelling.
    2. It is okay to use the ice machine that was sent home with you as much as you need. It doesn’t really freeze your knee just keeps it cool and comfortable.
    3. elevate your leg as much as you can during the day.
  2. You may bruise ~ tearing your ACL and Surgery are both internal injuries that can cause bruising.
  3. You may have trouble sleeping ~ Because of the pain and swelling, you may not be able to find a comfortable position.
  4. You may feel nauseous
    1. This should only last a day or two 
    2. if it lasts longer the pain medication may not be sitting well in your stomach. Speak to your physician about a different medication.
  5. You may feel more tired ~ everything you do may require more effort.
    1. Getting in/out of the car
    2. Walking with brace and crutches
    3. You may have trouble lifting your leg
      1. It will be heavy and your muscles may not be working well.

Lastly, you will (sometime in the rehabilitation process)images-6

be frustrated at the speed of recovery,

be concerned about your progress,

be anxious to get back playing your sport,

be sad that this is taking sooooo long,

be angry that this happened!

Allow yourself to have these feelings, sit with them, embrace them, accept them and move through them ~ it’s a part of the healing process.

A typical rehabilitation protocol looks like this:

Phase 1

  • Control pain and swelling with ice, medications and exercise to create optimal healing conditions.
  • Keep muscles working with exercise to avoid atrophy.
  • Introduce joint range of motion with exercise to prevent stiffening of tissues.
  • Continue wearing brace until you have adequate quad muscle control to protect ACL ~ usually 2-6 weeks depending on surgeon.
  • Use of crutches as needed when walking ~ usually only 1-2 weeks.

Phase 2 ~ continue with above and . . .

  • Introduce coordination exercises if haven’t already.
  • 6 weeks is a key healing time requiring protection of graft ~ at this point many people are feeling better and assume they can doing things that could put the graft at risk for tearing.
  • Toward the middle and end of this phase introduce balance, agility and coordination.

Phase 3 ~ continue with the above and . . .

  • Increasing speed with balance, agility and coordination
  • Remediate movement pattern dysfunction to prevent future injury.

Phase 4 ~ Return to Sport

  • Typically return to practice with a specialized knee brace at 8-9 months and playing in games at 9-12 months.
  • All making sure that you are using normal movement patterns and are cross training the opposite movements as well to reduce your risk of future injury

So there you have it  . . . The Nutshell Version of ALC rehabilitation!

Have I answered your questions? Created more? Post below and let me know . . .

Speak with you soon! Roxi

Help! My daughter tore her ACL . . . We think??

So I get a text from a friend of mine . . . and my heart sinks . . . she tells me her daughter may have torn her ACL during a soccer game his weekend! She writes “If you have time can you call me about Marie’s ACL and what questions we should ask the surgeon?”

Being a Physical Therapist, I get phone calls, texts and emails like this frequently. I also have personal experience with kids sports injuries. You see the moment they go down and pray its nothing serious, you cringe or gasp, your heart pounds as you calmly reassure yourself that everything is going to be fine. Most of the time they get up and keep playing, other times they walk off and rest, but the worst is when they are carried off or god forbid an ambulance is called!

Deep breath . . .     imgres-2

Once the adrenalin rush has subsided, your child is comfortable, and you’ve had a chance to process the injury then you reach out to people you know, who have experience, for advice . . . What’s next?

So after sympathizing greatly with her, I asked my friend:

  1. What happened? Was it a contact or non contact injury?
  2. Did Marie hear or feel a pop? Is her knee swollen? Can she put weight on it? Does she have full range of motion? How much does it hurt? Does it buckle?
  3. Has she had any imaging ~ X-ray, MRI?
  4. How is she feeling emotionally? How are mom and dad doing?
  5. How can I help? What do you need or want from me?

And I listen . . . Any healthcare provider you choose should ask similar questions and then listen.

Then she asked me:

  1. What could be wrong in the knee? Is it the ACL?
  2. Does she need surgery? Could she get away without it?
  3. What should I ask the orthopedic surgeon?
  4. How soon could she play? Is this going to affect her permanently/forever? Will it limit her ability to play soccer going forward? And as an adult?

As you can imagine this conversation is a little different for everyone . . .

The Nutshell Version: What You Need to Know About ACL Injury.

The Mechanism by which an ACL tearhqdefault

  1. Cutting and planting moves (with rotation) or quick change in direction ~ non contact injury.
  2. Getting hit in a manner that pushes your femur backward or your tibia forward past the point at which the ligament can hold ~ contact injury.

You may hear or feel a pop, and the knee joint will probably swell up, it may or may not hurt much past the initial injury.  In order to confirm it is actually a tear in your ACL and not injury to muscle, knee cap or meniscus instead, you need a clinical evaluation by a Physical Therapist or an Orthopaedic Surgeon and an MRI.

The ACL or Anterior Cruciate Ligament is a ligament which connect the femur to the tibia. If it tears completely it makes the knee joint unstable to correct this there are two options:

  1. Surgery to reconstruct the ligament and restore joint stability.
  2. Physical Therapy to train the muscles to maintain joint stability in any and all activities in which a person wants to engage ~ from standing and walking to sports performance.

The general recommendation is surgery IF . . .

  1. You have a complete tear and it impacts other structures like other ligaments or the meniscus.
  2. You want to return to a high level of athletic play.

Surgical options include:

  1. Allograft ~ a cadaver tendon is used to reconstruct the ACL
    • PROS:  Only one location in the knee to heal, better motion, less time in operating room
    • CONS: chance of rejection of graft since it is not your own tissue. Higher failure rates, slower to adapt to person body.
    • Recommended for: older patients
  2. Autograft ~ your own patellar or hamstring tendon is used to reconstruct the ACL
    • PROS: no chance of issue rejection, its your own tissue so it doesn’t have to adapt, its stronger and lower failure rates
    • CONS: have two sites to heal the ACL and patellar or hamstring tendon. This may slow the recovery time as it can create tissue irritation at the graft harvest tendon location.
    • Recommended for: younger patients, athletes

When you see the Orthopedic Surgeon you should ask the same questions my friend asked me . . . once you know the diagnosis ask these questions:

  1. Is surgery needed? What are the options?20150625__701135-s500-ph
  2. What kind of surgery do you recommend or what kind of graft will you use?
  3. Can I have Physical Therapy before surgery?
  4. What happens after surgery? How long do I have to wear the brace? Use crutches? When can I start physical therapy? Sleep or walk without the brace? Return to sports?

For answer to those last questions see my next post coming this weekend . . .

. . . The Nutshell Version: What You Need to Know About ACL Rehabilitation!

Until next time . . . CiA13cRXEAQaiLr

Roxi

Patellar dislocation VLOG?!?!?

Hello! I am trying my hand at video blogs because . . . why not! I spend time talking to people all the time about questions they have, why not answer some in a more personable fashion than on the phone or via text!

So here is my first . . . Click this link!

This Vlog is about knee cap dislocation ~ the who, what, where, when and why (although not entirely in that order) 🙂

Hope you enjoy . . .

Click here to see the video