Motion Stability's Blog


Natural Nerve Pain Treatments by charlestlee

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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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What are the treatment options for back pain? by charlestlee
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.



What Exercises for My Core Can Help Prevent Lower Back Pain? by charlestlee
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.



Stretches for lower back pain? by charlestlee

image source: teraputics.com

Brian Yee PT, MPhty, OCS, FAAOMPT

The most common muscle that is strained on the side of your back is the quadratus lumborum (QL). The QL attaches from the side and bottom of your rib cage to the top of your pelvis. There is a right and left QL and when it contracts its side bends your spine, as well as extends the back.

Lets say your right QL feels tight – to stretch this:

1. While sitting place a thick book or half foam roll under your opposite / left hip.

2. Lean to the left, away from your painful side, fulcruming over the roll and left hip.

3. Slightly bend forward and rotate towards the right. Keep your right hip bone on the seat.

4. You should feel a nice stretch on the right side where the QL muscle is.

This stretch should not cause increased back pain or nerve symptoms down the leg. Please consult with a qualified health practitioner to display proper technique.



How do I manage my back pain on a daily basis? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

First, remain positive. Many people dealiing with chronic back pain can become discouraged and even depressed that their pain does not let them do what they want to do. This can lead to a fear-avoidance belief that takes them away from doing activities that they physically should be able to do. 

From there it is important to establish 2-3 activites during the day that cause back pain – such as sitting, standing, or household activities such as vacuuming. It is just as important to determine the time in which the pain begins. Many patients will complain of pain with a prolonged/sustained activity after 10-20 minutes. What this means is that the muscle endurance of your body is fatiguing quickly and pain begins 10-20 minutes later as increase stress to your spine is occuring.

Like a marathon runner who is hurting and conditioned to run 2 miles. The runner knows well enough not to run 20 miles thereafter, as they will end up hurting themselves. They will instead train to run 2-3 miles until they can condition themselves to increase their distance without hurting worse.

Likewise, with chronic back pain, it is important to stay active, but stay just short of the time that your pain exacerbates itself. As a physical therapist can teach you ways to decrease your pain and improve your stability and movement, slowly you will be able to improve your time in activities that used to hurt you early on. As things progress, you will gain the confidence to do things you couldn’t do before with less pain. We call this ‘pacing’.



Can physical therapy strengthen weak bones? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

Physical Therapy can focus on improving bone strength through proper prescription of exercise base therapy to properly gauge the intensity and load on a patient with weaker bones, such as osteoporosis, fractures, atrophic diseases. This could be through aquatic therapy, anti-gravity support systems, and other modified weight-bearing exercises. It is important to have an experienced Physical Therapist to know how to properly dose the intensity/duration of exercises to stimulate proper bone growth/density without over or under doing it.


How can I prevent repeat ankle sprains? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

It is important to improve ankle dorsiflexion after an ankle sprain. Research indicates a loss of ankle mobility with chronic ankle sufferers – primarily in ankle dorsiflexion – which is the motion you need to walk correctly. Reserach also indicates a change in muscle control patterns not only in the ankle but also up the kinetic chain, such as a loss of hip control.
Therefore:
1. Improve ankle dorsiflexion: calf stretching, seeing a Physical Therapist to mobilize your ankle and decrease swelling.
2. Ankle stability: ankle circles, resistance bands to strengthen lateral/medial ankle musculature/tendons.
3. Ankle proprioception: standing balance exercises as indicated
4. Hip stability: primarily with gluteus maximus and medius exercises. It is important to find a specialized Physical Therapist that can specifically help facilitate you gluteal muscle patterns.
5. Specific training for sports/function: proper footwork in your sports can help decrease you chance of ankle sprains as well.