Motion Stability's Blog


Natural Nerve Pain Treatments

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Brian Yee PT, MPhty, OCS, FAAOMPT

In Physical Therapy, nerve pain can be treated naturally through techniques called ‘neurodynamics’. According to a colleague of mine, Michael Shacklock in Australia, there are three major areas to address. This includes the mechanical impingement sites, the nerve itself, and the tissue the nerve innervates.

First, nerve pain can be caused by a tissue that pinches on it. This could be a herniated disc, a muscle spasm, or arthritic changes in the spine. Such treatments as mechanical traction or soft tissue massage around the pinched area of the nerve can alleviate the nerve pain.

Second, the nerve itself can become injured. Physical Therapists use manual therapy techniques to mobilize the nerve itself to reduce its pain and improve it mobility. Similar to having a knee surgery, it is important to calm the swelling and pain down while progressively improving the range of motion back to its normal length. Nerve is just as much of a connective tissue as ligaments or tendons are.

Lastly, when nerve pain occurs it becomes inflamed, a term called neurogenic inflammation. Like a hose spraying with water, when the nerve is inflamed it sends inflammation to its termination sites – such as muscle, joint, or ligaments. It is important to improve muscle or joint restrictions that surround the nerve to fully treat the nerve pain and its residual effects.

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Stretches for the Lower Back

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Brian Yee PT, MPhty, OCS, FAAOMPT

Pelvic tilts: Laying on your back with knees bent – rock your pelvis back – flattening your back against the bed and return to neutral, and if it doesn’t bother you progress to arching your back a small amount. Oscillate back and forth.

Knee to chest: Bring one knee up to your chest, stretching your hip and your back. You can progress to both knees to your chest.

Trunk rotation: Laying on your back with knees bent and together slowly let you knees go to one side – allowing your trunk to rotate. Switch to the other side. If that does not bother you, you can progress to have one leg straight and let the other knee hook over it – allowing the spine to rotate more. There should be a slow stretch in your spine.

Cat / Camels: On your hand and knees – you can arch your low back up and down. Focus on a slow stretch trying to move from your lower back and pelvis. Many times people arch their backs but move mostly from the mid-back or thoracic spine, which does not stretch the lower back as well.

Prayer stretch: On your hand and knees – sit your bottom down to your heels and reach out along the ground with your arms to stretch your lower back. Take your arms and trunk side to side to feel more of a stretch along your sides of your back as well.

Stretching should not increase your back pain or other symptoms you are experiencing. Please recognize as well that stretching, in certain cases, may be detrimental to your condition. Please consult with a qualified health practitioner, such as a Physical Therapist, to determine the proper stretching progressions.



Shin Pain When Running?

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Brian Yee PT, MPhty, OCS, FAAOMPT

Shin splints are very common in runners. It is usually due to some type of muscular imbalance such as tight calves, poor glute strength, and possibly poor footwear and running mechanics. Please consult with a Physical Therapist and also a running coach to assess your mechanics.



What Exercises Can Help to Alleviate My Lower Back Pain?

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Brian Yee PT, MPhty, OCS, FAAOMPT

Usually low grade/oscillatory exercises can help alleviate low back pain. This includes stretches such as knees to chest, knees side to side/trunk rotation, prone press ups (like a Cobra position in yoga), pelvic tilts/clocks. Please consult with a qualified health practitioner to assess your causes of low back pain to then develop a proper exercise program.



What are the treatment options for back pain?
Brian Yee PT, MPhty, OCS, FAAOMPT

Accurate diagnosis of the sources of back pain will indicate the type of treatment you should receive. However, after structural reasons of back pain have been ruled out (such as a herniated disc), the majority of patients are diagnosed with ‘non-specific low back pain’. 

What we find clinically is that traditional interventions such as medications and injections, although perhaps needed and based on a physician’s recommendation, provide short-term relief.

There is growing research and clinical attention on trying to diagnose or sub-group ‘non-specific low back pain’. This can include movement dysfunction, fascial restrictions, muscle control dysfunction, myofascial trigger points, psychosocial variables, pelvic pain, nerve referred pain, or internal/systemic issues such as referred pain from internal organs or hormonal/vitamin deficiencies.

It is important to find a clinician that is able to differentially diagnose the various contributing factors of back pain, and then be able to provide effective treatment for those sources – and then coordinate with other practitioners that can address other needed areas. Especially in chronic low back pain management, a multi-disciplinary team of health practitioners is usually needed.



When Doing Squats, How Do I Avoid A Stiff Back?

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Brian Yee PT, MPhty, OCS, FAAOMPT

If your squatting is causing your low back to feel stiff it indicates that either your form, the amount of load or repetition, or the sequence of muscle contractions are incorrect and not safe for your back. With your form – there are many proper ways to squat, but people we see that have back pain or stiffness after lifting typically let the back arch or round too much. It may be the angle your squatting at, but it may also mean that your spine is more structurally unstable than you may think it is. Have a qualified practitioner observe your form to look for any inefficiencies.

In regards to load or repetition – even if your form is perfect eventually your back can wear out due to excessive weight or overdoing the number of times that you squat. I would recommend finding out the repetition, sets, or weight that you feel like you back just begins to stiffen. Next time you do squats, do less than that so your back does not stiffen. As you improve your form and the proper muscle sequence you should notice that you can increase your weight and repetitions gradually without worsening your back stiffness.

Most importantly – back stiffness can occur with squats due to improper muscle sequence. With a squat, the trunk and back muscles should all activate to provide stability to your spine. The muscles that should provide the most power and movement in the squat are your gluteal / buttock muscles. The primary joint that moves in the squat should be the hip – which is controlled by the glute muscles. But what we see are patients that use their knees or back more – causing the quadriceps or back muscles to be used more. This develops an improper sequence of muscle firing patterns and ultimately places more stress on your back as your form and coordination of movement is inefficient. You should contact a skilled health practitioner such as a Physical Therapist to assess the strength and control of your hip, back, and leg muscles if your back stiffens while squatting.



What Exercises for My Core Can Help Prevent Lower Back Pain?
Brian Yee PT, MPhty, OCS, FAAOMPT

First – generally there are different roles of muscles in your trunk. Typically the smaller ones closest to your spine are considered ‘local’ muscles. Such muscles as the transversus abdominis, diaphragm, pelvic floor, and lumbar multifidus provide segmental control of your lumbar vertebra. Real-time ultrasound imaging can be used to visualize the proper contraction of these muscles as we cannot see these muscles from the superficial skin. So first step in core stability is to ensure that the smaller muscles are engaging properly. Then you have ‘global’ muscles which are the larger muscles – such as rectus abdominis, obliques, paraspinal muscles. These muscles are designed for power and stability at higher loads. Core stability exercises should integrate the function of the ‘local’ and ‘global’ muscles in proper sequence.

Once that is established, any asymmetries of the muscles should be determined. In back pain patients, it is very common to have one side of the oblique muscles contracting properly while the other side does not. This causes an imbalance of forces on your trunk and can cause increased torque to your spine – eventually leading to back pain due to excessive torsional stresses in your daily function or sport.

Once the asymmetry is addressed, integration of muscles from above and below the core need to be assessed.  The old saying ‘the knee bone is connected to the hip bone’ goes too with the muscles in your body. Such lower leg muscles as the gluteal muscles in your hip or the latissimus dorsi in the mid back affect the way your core muscles in daily function and sport. People with back pain, typically have an improper tone and sequence of these muscles working together. Over time this places increased stress on the back – regardless of how strong your core is.

As you can tell, there is a lot to consider when training your core. To recommend a standard protocol of exercises to help your back is not specific enough. A proper assessment of your muscle control and movement patterns should be assessed by a qualified movement specialist – such as a Physical Therapist – to determine what the appropriate level and progression of exercises for proper stability and prevent back injury.