Low back pain, leg pain, sciatica, radiculopathy and your chores.


At Custom Physical Therapy we evaluate and treat multiple patients with a combination of low back pain only, low back pain with leg pain or just leg pain without back pain. The pain may be severe or tolerable, easily aggravated or relatively stable. The impact on the patients’ daily function may be substantial or minimal. How do we, at Custom Physical Therapy, approach such cases?

Looks like an angry sciatic nerve!

The first visit we do a comprehensive evaluation in which we gain insight into the potential causes of the symptoms, assess for limitations in range of motion, muscle weakness, determine where the leg pain is coming from and assess what types of movements and postures aggravate the symptoms and which ease them. We then put this information together to come up with a more specific diagnosis and determine the correct approach for treatment.

Front plank  a core exercise.

Day 1 treatment involves determining the most effective home program to begin the recovery process. This may include directional preference exercises which are used to reduce the low back pain and the leg symptoms by utilizing a single, very specific repeated movement regularly throughout the patients’ day. Other home exercises may include introductory core stabilization exercises in an effort to reactivate certain muscles that have been shown to shut down as part of the back pain process and we may incorporate stretching exercises. All our physical therapists will also use their hands-on approach for soft tissue and joint mobilizations to supplement the exercises and to help further reduce the symptoms.

Bending forward top to bottom, vertebrae by vertebrae may be home exercise given after the evaluation.

Together, the physical therapist and patient set up a specific, individualized treatment plan based on the patient’s goals and the recommendations for the best approach to achieve full recovery. It may involve progression of the treatment provided in the first visit to more advanced core stabilization exercises, functional training to simulate work or athletic activities, and temporary or permanent modification of certain postures or daily activities in an effort to prevent re-occurrence of subsequent episodes of pain.

Will it get better? Absolutely! Back pain improves and our job, as physical therapists, is to help you improve faster than you would on your own. I have seen many people figure out what to avoid and what to do based on the fact that it simply does not feel good to do things that hurt and it feels better to do things that reduce their symptoms. We utilize this approach supplemented by our advanced knowledge the spine anatomy, physiology and kinesiology – both normal and abnormal.

That deep achy back!
Alternate arm and leg extension, often called the “Bird Dog”, is frequently used to develop core muscle control and endurance.

A simple functional change can be modifying how you wash the dishes by squatting down instead of bending forward at the sink. Vacuuming is a killer sometimes but you can change how you do it so you can still keep those carpets clean. You just need to change how you do them. See the video of me washing dishes recently. In the video I change my posture to avoid sending pain down my right leg (while my wife takes the video!). I avoid sitting and presently lie on the floor in positions that reduce my symptoms. I also do my home exercises that really do help relieve the symptoms.

You should continue to live your life within the aggravating and easing factors you have learned from living with your pain on a day-to-day basis and those you discussed with the physical therapist at the time of your evaluation. No excuses to not remain active! Indeed, it is much more likely you will recover by being active and not permitting the symptoms to control your life.

A call to action!

If you have low back pain with or without leg pain or leg pain without back pain, or a radiculopathy or sciatica, the sooner you see a physical therapist about it the quicker your recovery. Call a physical therapy clinic near you and schedule an evaluation. You will be glad you did!

Yes! Research shows physical therapy reduces opioid use.


Physical therapy continues to gain support, through published research, for its roll in reducing the epidemic of opioid dependency. Early intervention for low back pain has been shown to be highly effective in reducing the pain and thus improving function as well as significantly reducing opioid use.

if you have low back pain give us a call at Custom Physical Therapy in Sparks, South Reno or Northwest Reno. Or swing by to chat with one of our phenomenal physical therapists.

ask your physician to send you for physical therapy before they prescribe opioids. We can help you!

Here is the info from the American Physical Therapy Association. Check it out

Source: http://www.apta.org/PTinMotion/News/2018/12/14/JAMAEarlyPTOpioids/?_zs=i8CfV1&_zl=AG1P5

Awesome video: Ankle Pain, Popping and Tendinitis.


(Cool 11 second video to watch!)

The fibula and tibia of the lower leg join the talus, one of the 26 bones in the foot, to create the ankle joint. There are, therefore, many places to experience ankle pain, foot pain as well as popping during our daily functional activities such as walking or running. Add in all the tendons which cross the front of the ankle, the well known Achilles tendon at the back of the ankle and the two peroneal tendons passing immediately below the lateral maleolus (outer ankle bone) as well as the tibialis posterior and flexor tendons of the toes passing around the bottom of the medial maleolus (inner ankle bone) and we now have possibilities of a tendinitis and tendon tears.

Today at our Custom Physical Therapy clinic in Sparks we had a fantastic example of peroneal tendon subluxation (popping over the lateral maleolus) and the patient permitted us to video it. Clearly we had fun watching the peroneal tendon popping over the lateral maleolus! Check it out here!

In this case it was not painful but you could see how it may result in tendinitis (inflammation of the tendon) if it the popping continues.

If you have concerns about foot or ankle pain, feel free to call us (775-331-1199) or, better yet, swing by any of our three Custom Physical Therapy clinics (Sparks, South Reno or Northwest Reno) to ask one of our 9 physical therapists to take a quick look and give you some advice.

Custom Physical Therapy looking for a Physical Therapist.


Custom Physical Therapy is seeking an outdoorsy, mountain biking, hiking, Lake Tahoe loving, skiing, camping, life loving outpatient orthopedic physical therapist to join us in Reno, Nevada.


We love what we do and are expanding because of the experiences our patients have and the absolutely amazing people who work at Custom Physical Therapy. Yes, I am biased but it’s totally true.


If you are a PT or know of someone who is a PT or a new grad and may be interested in working with us, contact me at (775) 813-2332 or ameintjes@usphclinic.com.

I’d love to chat with you.

André

(Aka owner/physical therapist/chief goofball)

A huge need for changes worldwide as to the excessive sugar consumption. Try consuming only natural sugars that are consumed with double the amount of fiber. This prevents the spike in blood glucose and thus the large insulin response that ultimately changes the sugar to fat.


https://www.wits.ac.za/news/latest-news/research-news/2016/2016-04/ssb-tax-home/sugar-facts/

“Is this a model or is it the real thing?”


I had the pleasure of meeting with one of our local orthopedic surgeons, Dr. Benjamin Bjerke, and the Zimmer-Biomet rep, Christina Escobar, to talk Mobi-C Disc Replacement technology and surgical technique developed by Zimmer-Biomet. Incredibly interesting.

Seeing the prosthesis, my first question was, “Is this a model or the real thing you are showing me?” It was much smaller than I anticipated!

Mobi-C_neck image_9-2016.pngMobi-C_hand-image_1_2016.png

Secondly, I found the specificity of the patient suitable for this intervention impressive – someone with neck pain and or radiculopathy (pain down the arm originating from nerve root compression in the neck) without much cervical spondylosis (degeneration of the discs and joints in the neck) and good vertebral alignment. The Mobi-C can replace discs at one or two levels of the cervical spine between the third and seventh cervical vertebrae.

So lets take a look in more detail.

Anatomy and Pathology of the Neck

  • The cervical spine has discs between each bone that provide cushioning for movements and body loads. The discs and bones in a healthy neck allow bending from side-to-side and front-to-back, and turning left-to-right. Disc problems can start from over-use, an accident, or just the wear and tear of daily life.  When a disc degenerates it becomes thinner and provides less padding to absorb movement.  Degenerated discs can also bulge (herniate) and pinch the spinal cord or nerves, which causes loss of feeling, weakness, pain, or tingling down the arms and hands. Below  you can see the normal cervical spine anatomy and adjacent is a graphic of what a spine with pathology may look like:

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Treatment Options

  • Before artificial discs were available, patients would traditionally receive an Anterior Cervical Discectomy and Fusion procedure to alleviate the pain from a herniated disc. In a fusion surgery, the disc is removed and either a bone spacer or a plastic implant is placed in the disc space to restore disc height and remove pressure on the pinched nerves or spinal cord.   A metal plate and screws is placed on the front of the vertebral column to hold the implant in place.  The result – a segment that no longer moves, or is “fused”.  The potential downside of a fusion procedure, in addition to the loss of motion, is that it can create additional stress on the spinal levels above and below it.  This can cause degeneration at those levels and potentially result in another future surgery.
  • An artificial disc like Mobi-C is an option instead of a fusion that will also be placed inside the disc space to restore height and remove pressure on the pinched nerves. However, the Mobi-C device is designed to allow the neck to maintain normal motion and thus limit adjacent levels from degenerating, possibly preventing future surgeries.

Image_40a_v02_2016.pngImage_61b_20pct_2016.png

 

Since Mobi-C cervical disc replacements are preferred over fusions because they preserve movement in the spine, lets take a look at this video to see what happens in the spine when a patient with the Mob- C implanted flexes and extends his/her neck versus a two level fusion:

Cervical disc replacement procedures are anticipated to experience rapid growth in the near future, due to multiple factors:

  • A growing library of clinical evidence demonstrating the long term safety and efficacy of cervical disc replacement.
  • Cervical disc replacement is being shown as a superior treatment to fusion for use at two cervical levels.
  • Better outcomes of cervical disc replacement over fusion such as reduced re-operation rates, reduced adjacent segment degeneration rates and surgeries, as well as a faster return to work.
  • Most patients return to work within six weeks of surgery. In the U.S. Mobi-C clinical trial, the return to work time was 20.9 days shorter for Mobi-C patients compared to fusion patients for two-level surgery and 7.5 days shorter for Mobi-C patients compared to fusion for one-level surgery.

What about physical therapy after the Mobi-C disc replacement?

  • Wear a neck collar to lessen neck movement for around a week after the surgery.
  • Avoid heavy lifting, repetitive bending, and prolonged or strenuous activity for up to 6 weeks after surgery.
  • When your surgeon releases you to start physical therapy the physical therapist will do a comprehensive evaluation to assess your cervical, scapular and shoulder range of motion as well as cervical, arm and trunk strength. Based on the data collected, you will be given specific exercises to address any deficits to ultimately improve your function. You may start of with cervical isometrics and progress to upper thoracic and arm strengthening exercises as well as neuromuscular reeducation of the deep neck muscles. The physical therapist will also utilize soft tissue mobilization techniques to limit scar formation and address any myofascial pain and muscle trigger points, present from inactivity. You will need to participate fully by being totally compliant with the home exercise program you are given by the physical therapist at your very first visit.

Successful outcomes are determined by multiple factors which include choosing the right surgical procedure done by a skilled surgeon, following post operative activity limitations and brace use as well as being totally compliant with physical therapy instructions and exercises. It is a 3 person team that makes your recovery work: you (and your home supporters), the surgeon (and their staff) and the physical therapist (and their clinical team members).

Thank you to Zimmer-Biomet for help with supplying me with information and photographs.

Just Move to Improve!


The problem?

80% of us work in sedentary jobs in a longer full time work week which averages 47 hours. In 1960 only 20% of jobs were sedentary in nature. The problem with this trend is that our muscles and joints love movement through their full range of motion so being motionless for all those hours each day leads to the sensation of “tightness.”

We all get tight after prolonged immobility and, repeated day after day (the desk job at work then sitting watching TV each evening) our “envelope of function” becomes limited. Over time, our joints develop smaller ranges in which they can move and hence we become susceptible to overuse injuries or pain as a consequence of prolonged end range tension (stress) on our muscles, ligaments and joints. Anyone had low back pain at the end of a work day that’s gone the next morning?

The solution?

Once daily, move your joints through their full range of motion. Actively stretch your muscles and ligaments by following the specifically designed 10 to 15 minute “movement program.” It is that simple. As I mention to my patients, “motion is lotion.” Could you do it two or three times a day? Sure thing – it may improve your productivity and cut your work week down to 40 hours instead of the 47 because you feel better during your day!

Flexion in Standing

Bending forward top to bottom, vertebrae by vertebrae is one great movement to do each day.

We must maintain our youthful joint, muscle and ligament pliability and movement as we age to limit the guaranteed onset of general stiffness which is part of getting older. This means the younger we are when we start such an exercise routine, the more likely we are to limit this aspect of aging. In doing so, we will have a better quality of life because of our healthier joints, muscles and ligaments.

The videos of the exercises are on the Custom Physical Therapy YouTube Channel. Follow this link to get started:  Rage of Motion Program    They should be done in order and only 10 repetitions of each one.

Battling El Nino with Your Core in 10 minutes.


El Nino is arriving with massive amounts of snow and rain, right? We all hope for drought relief but with the forecasted “big winter” comes the need for strength and control of your hidden muscles to weather (pun intended) the wet, cold, white, slippery Reno-Sparks-Lake Tahoe area.

A generally accepted definition of “the core” is the muscles from below the neck and above the upper thigh (shoulders to hips). The importance of these muscles is in injury prevention, maintaining erect, “regal” posture and providing a base for functional strength (the ability to push a heavy door open, get in and out of a car, stand up out of a chair or lift a box form the floor to a counter). Training all the core would take all day if you try to isolate each muscle individually. So, do 3 exercises and get nearly all of them done in less than 10 minutes!

“YTWL” – shoulder and back muscles.

Keeping your body straight over a therapy ball beneath your lower abdominal-pelvic area and feet against the wall, raise your arms in 4 different planes noted by “YTWL”. Arms overhead at a 45° angle between head and shoulders, in line with shoulders, elbows tucked into your sides flexed 90°, and finally rotation of shoulders up with upper arms at shoulder level. No therapy ball? Just do it off the corner of your bed.

The Y of the YTWL Series

The Y of the YTWL Series (see YouTube channel for video)

Front Plank – abdominals, butt and shoulder.

Lying prone, support your body in a straight line from shoulders to ankles resting on your elbows and toes. Pull your navel in and up (“make yourself skinny”) and pinch your glutes together while rounding out your shoulders. Hold this position for up to a minute (must have perfect technique the entire hold). Repeat three to five times.

Front plank

Front plank (see YouTube channel for video)

Clamshell Progression – Hip muscles.

Lay on your side, knees bent to 90° and hips at 45°, one leg atop the other. Rotate your hip out by lifting your top knee while keeping feet together, 10 times. Rotate foot up keeping thighs together 10 times. Lift top leg parallel to bottom and rotate 10 times around the axis of the femur. Straighten your hip, keeping knee at 90° and rotate 10 times around the femurs axis. Tough people, repeat 3 times on each side.

Clamshell # 4

Clamshell # 4 (see YouTube channel for video)

To see a video of each exercise on our YouTube channel, go to The El Nino Core Program .

El Nino dump your snow, your rain and whatever icy weather you care to bring us. Our core is now ready for shoveling snow, lifting and carrying sand bags (hope not!) and preventing falls when slipping on ice. Bring on those pressure changes that make my back ache – El Nino we got the work done before you came!. See you when you arrive, that’s if you don’t chicken out again!

The Custom Physical Therapy Challenge Rules


If you dare ….. get fitter, stronger and healthier with the monthly Custom Physical Therapy Challenge.

Every month we will have a daily series of exercises to do for anyone and all who would like to join us. Employees, friends and family may join in.

Here are the rules:

  1. You complete all repetitions of each exercise every day and check it off the schedule of exercises.
  2. If you miss a day you may double up the next day – not advisable particularly towards the end of the series.
  3. It is purely the honor system.
  4. If you complete all exercises for the entire month you let us know by faxing the checked schedule to Custom Physical Therapy (775-331-1180) or emailing it to us with your name on it and contact number: customptchallenge@gmail.com
  5. Prize: $50-$75 gift certificate from a local business (Previously: Great Full Gardens Restaurant, 1 hour massage).

Exercise technique can be seen on our Youtube Custom Physical Therapy Challenge Channel. Here is the URL:

Let us know how you like it and what you would like to challenge in future months. For example, an arm challenge, butt challenge, core challenge, chest challenge, aerobic challenge, rope jump challenge.

If you have any concerns about doing the exercises and need help modifying them feel free to call us at the Sparks location: 775-331-1199. You can also email us with questions: customptchallenge@gmail.com

Have fun, be safe and get strong!

The Custom Physical Therapy Challenge Department

www.custom-pt.com

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