Ever had Back Pain??

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! 

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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

   

   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!).

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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.

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. 

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:

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 . . . Hopefully 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 to
  • 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 swelling
   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)

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 . . .     

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 tear

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?
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 . . .

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 

 

Life Gets in the Way!

If I had a dime for every time I made this excuse . . .

I’d be rollin’ in dough!

A perfect example is vacation right?

We have a routine that keeps us doing t
he things
that keep us healthy ~ eating right, exercising, taking our vitamins, etc. Then we go on vacation! We relax, indulge, pamper, overdo (or under-do), and return home feeling like we need a vacation from our vacation before we return to work. Because we are tired and have lots of laundry or yard work to catch up on we skip returning to our regular routine until we realize we have been back for a month and still haven’t gotten to the gym or studio . . .

This can happen with the holidays, projects at work, illness, renovations or any number of other things that make it easy for the majority of us to set aside our commitments to our heath and wellbeing and focus on outside things.

Do you find yourself in these examples?

(I hope I am not alone~heeheehee)

I think of this because our family is currently on a college touring road trip. And I have 8 hours in the car . . . We have toured 5 campuses in 5 days, from Iowa to Pennsylvania! Driven 1,288 miles (not including the 1700+ it to get to the first campus ~ #roadtrip) and walked 21.8 miles!

It was good exercise but not complete exercise. We were all missing the flexibility component of our routine, as evidenced by our taking every opportunity to stretch ~ in line at the gas station, during the standing portions of the tours, and while in bed!  We are now done with the college tours and starting the family vacation portion of our road trip . . . so what did we do when we got to Mackinac Island?? Walked around a lot the first afternoon and rested from our college touring ~ its actually quite tiring! Yesterday we slept in and then rented bikes! We were so excited to not be walking that we road the entire island and then some! The circumference of the island is 8.2 miles, but we also wanted to see the interior and only had yesterday left (as I write we are traveling to Two Harbors, Minnesota to spend five days with family).  So . . . we biked around the island sightseeing, returned to the hotel to get our swim suits, biked to a place to swim in Lake Huron and back to the hotel again ~ A total of 20 miles (gasp). Needless to say the legs were jello, the joints were achy, the spirit was blessed and the mind was clear!

I know the rest of the week holds hiking and water activities, shopping and more. Of course there is the long drive home as well (sigh). So what will happen when I get home?

Back to the same routine of 3 day a week strength training, 3 days a week walking the dog, 10-15 minute of yoga and foam rolling, cooking healthy meals, taking my vitamins?

Or will I let life get in the way?

Stay tuned . . . I’ll give an update September 1st!

Olympics 2016 ~ #TeamUSA!

Have you been watching the Olympics this year? 

We are college touring (my son is a senior) and vacationing for the entire two weeks so I have only been catching the sports I love at the end of the day or via Sirius XM!

What are your favorite events?

Mine are gymnastics, beach volleyball and soccer. This year I did get into the swimming a bit too! Wow, we have some phenomenal athletes! #TeamUSA.

Another sport I have been following is mixed doubles Badminton!?! I know kinda random but . . . a former PT Aide that I worked with is an Olympian in this sport! I am so proud of her just being an Olympian and Athlete. She posted a picture of herself on Instagram using gradient compression pumps on her legs for recovery 🙂

In addition, Kerri Walsh Jennings and April Ross are sporting their kinesiotape and Michael Phelps has had cupping. What’s that you ask?? Stay tuned below for a link to my colleague’s blog post!

All of this had me thinking . . . I kinesiotape a few of my athletes for competition and many people come to ask me on the sideline “Does that stuff really work? What does it do??”

So here’s the scoop . . .

What is kinesiotaping?

Kinesiotaping is a technique used by Physical Therapist, Athletic Trainers, and Athletes to improve muscle performance or decrease pain during sport. It can also be used to decrease swelling in certain circumstances. It is a light elastic tape that is applied to the body to facilitate or inhibit muscles or move swelling. It is not rigid and therefore allows the body to move through its full range of motion during sport.

Does it really work?

Most medical research says there is no significant difference between use of tape and other treatments BUT . . . Athletes say YES it totally works!  Ultimately, you need to decide for yourself. Ask your Physical Therapist if kinesiotaping is appropriate for your problem and if so have him/her tape that area to see if it helps ~ reduce pain, swelling, make moving easier.

What does kinesiotaping do?

• For use on muscles, the tape gives your body signals to either use a muscle more or less.
• For reduction of swelling the tape lifts the skin and fascia to create movement of the fluid so it drains away from the swollen area.
• For pain it lifts the skin and fascia to decrease the pressure on a muscle that is in spasm.

How do I know what kind of tape to buy?

Your Physical Therapist may be able to recommend the tape that is best for you. The major differences between the brands are patterns of wave forms, color options, and adhesive none of which affects the function of the tape but each person will have different preferences in brand of tape so use which every you like best!

Are they side effects?

• You can have skin sensitivity reactions such as itching, redness, and the like.
• If worn for many hours after sweating it can cause a rash from trapped sweat under the tape.
• If you have latex allergies the tape may irritate your skin.
• If the tape is close to the neck, head, armpit or back of the knee you can have dizziness, nausea and a general feeling of not being right ~ if this happens it will happen within 5 minutes of applying the tape, REMOVE THE TAPE IMMEDIATELY and the symptoms should be reduced greatly if not gone within 5 minutes. Kinesiotape should never be applied in the armpit or back of the knee.

Can I tape myself?

Yes . . . But, you will want to know what to tape and how to tape it. Speak to your Physical Therapist about your specific issue.  There are lots of YouTube videos available to teach you how to tape yourself but to avoid injury, and understand the purpose of taping, make sure they are done by reliable sources. Better yet check with your PT.

Do you have any Kinesiotaping stories to share? Comment below!

Did I answer all your questions? If not comment below or email me . . . drroxi@zptforinjury.com

Look forward to hearing from you! Be well, Roxi

P.S. here’s the cupping blog my colleague wrote!

“If I Tell You it Hurts . . .

. . . You Won’t Let Me Play!”

Its a complicated subject really . . . PAIN

There are may different kinds of pain and each structure in our body hurts differently depending on why it is hurting!

I have heard these words many, many times and my biggest concern is twofold:

1. Kids not telling their parents they are in pain because they really fear that their parent won’t let them play and they want to keep playing! OR WORSE
2. Mom/Dad/Coach saying “suck it up” and play through it while turning to the parent next to them to say kids are “too soft” these days.

Ever experience either of those scenarios? I have seen it first hand on the fields!

How do we find a middle ground?

Well first we need to look at the type of injury ~ how did you wind up with pain?

If you have an acute injury:

• You probably have lots of pain, some swelling and are not in the mood to play ~ follow those instincts!
• If you are feeling better in a few minutes try playing again ~ you’ll know if you need to stop.

If you have a chronic injury:

• You probably have intermittent pain and of varying intensity.
• This is the most confusing pain to deal with because there is no simple answer . . .
• You may be able to play through the pain BUT that doesn’t mean you should . . . you could be doing more damage to the injured tissues.

If you don’t have an injury at all:

• Your pain could be the start of an overuse injury that develops slowly or you happen to “just notice” one day – see acute and chronic injuries above . . .
• Your pain could be just from regular muscle use and totally normal ~ when you play through it you will feel better and better.

Next we need to consider the tissues involved in your injury ~ Muscles, Tendons, Ligaments, Bone. All of these tissues send different pain signals and heal at different rates.

Muscles can be sore from normal exercising, when you are sick in bed or just from growing! These types of pain feel sore or achy and you can play through them if it feels good to do so.the healing time of muscles can range from a few days to several weeks depending on the type of injury.

Tendons are sore when you are growing or when you have overused the muscle that is attached to that tendon. This kind of pain is more sharp, like a pinch or a stab and also intense achy. You can play through this pain ONLY IF it feels better when you play 🙂 If it hurts to play then DON’T 😦 Tendons healing phase is about 10-12 weeks.

Ligaments and bones are sore when you are growing or when you have injured them (see acute and chronic injuries above). These kinds of pain are typically deep achy or very sharp and intense. You should not play through these types of pain because you can be doing more harm than good. Bones take about 2-3 months to heal and ligaments continue to heal for up to a year.

Another thing to consider . . . “Growing Pains”.  Remember above that I mentioned pain can be related to growth . . . layer on top of that the repetitive actions of some sports or the frequency with which your child participates in that sport and/or an acute injury and you have the makings of a perfect storm. How do you tease out what the pain is from in order to decide if it is okay to play through or not?

Like I said, Its a complicated subject really . . . PAIN.

Bottom line: IF it hurts to play DON’T and see your Physical Therapist for guidance.

What kind of injury or pain does your child have? Reply to this post and tell me about your situation!

Have questions? Comment and ask away! I love to answer questions ~ yes I’m a nerd!

Look forward to hearing your story . . .

Should I Ice or Should I Heat Now?

There is a great debate about heat versus ice for pain. Everyone has experiences and recommendations that guide their decision making. My hard and fast rule: use which ever sounds like it would feel better! There are many reasons I have this rule but the biggest is: if it doesn’t feel good it is not going to help! If you are still unsure, here are some basic guidelines you can use to help you decide . . .

Ice is best used within the first 72 hours of an acute injury:

An Acute Injury is when an event happened and you knew immediately that you were injured or something wasn’t right.

• if you have bruised your knee running into a opposing team player,
• twisted your ankle landing from a jump shot,
• strained your back or shoulder throwing from the outfield . . .

ICE IT!

Heat is best used when you have muscles that feel tight or sore and stiff:

• if you slept funny and woke up with a stiff neck,
• if you walked a lot yesterday and today your hip is sore,
• if you were working in the garden over the weekend and midweek you have a backache . . .

HEAT IT!

There are also some conditions that prefer one over the other.

Conditions that like ICE:

• Tendonitis
• Ligament Sprain
• muscle strain
• Swelling

Conditions that like HEAT:

• Arthritis
• stiff joints
• back aches
• muscle spasms
• stress, anxiety

DO NOT USE HEAT IF

You have an open sore, stitches, infection, blood clot, cancer, circulation problems or sensation problems.

DO NOT USE ICE IF

You have circulation problems or sensation problems, aversion to cold.

And those are just some of the reasons my rule is: USE WHICH EVER SOUNDS BETTER! Always ask your PT for clarification about your specific situation if you have questions!

Annual Exams

How many of us have annual exams by our physicians, ophthalmologist, dentists? Most of us are so busy that these appointments rarely top the priority list but does that mean they are not important? Absolutely not! I am embarrassed to admit that altho I work in the healthcare profession I see my dentist for a cleaning yearly (although it should be every six months), my internist every year to year and a half for a wellness exam and I can’t recall the last time I saw an ophthalmologist – but it is on the top of my list currently!!

The other person we should be seeing for regular exams is our Physical Therapist. Physical Therapists are your movement specialists. We are the experts in normal and abnormal body mechanics, re-education of normal movement and functional movement training. The Vision of our professional association states PT’s are  “Transforming society by optimizing movement to improve the human experience.” http://www.apta.org/Vision/

Reasons to see a physical therapist include:

• Injury including muscle or tendon strain, ligament sprain, fractured bones, pain, and many more.

• Post surgery including ligament reconstruction, tendon repair, joint replacement and many more.

• Chronic or recurring injury or disease that limits your ability to function or move the way you want.

But have you ever thought about seeing a PT for:

• A fitness consultation

  • Improving flexibility, strength, endurance

  • Improving balance, coordination

• Enhancing sports performance

• Injury prevention

• A postural consultation

“Physical therapists have the education, experience, and expertise necessary to provide a broad health screening to allow tracking the patient’s health status over time.” www.apta.org/AnnualCheckup/

 The goal of ZPT is to be your PT for life! You have a medical doctor, a dentist and an eye doctor. Why not have a doctor of physical therapy?

Click here to inquire about annual exams!

Be Well! Roxi