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

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

http://www.customphysicaltherapy.wordpress.com/

Reasons to Choose Custom Physical Therapy


5 Simple Things to do Before a Knee Replacement.


Pre-operative conditioning!

Vital in determining the post-operative outcome of a total knee replacement.

Ask anyone who did the right things before surgery.

Sharine came in to see us for a single visit to learn what to do and then exercised daily until the day before her knee replacement.  “After watching my Mother and my husband go through knee replacements I took the advice from Andre’ and my surgeon to exercise and strengthen the muscles in my legs as well as other parts of my body. I am now about 3 1/2 weeks after surgery and I must say it has helped me. I am told that I have reached goals that others do not reach this soon. You MUST exercise before your surgery and I would recommend you start at least 6 weeks before.”  Her husband, Bob, had a knee replacement without pre-op instruction.  “Eight years ago I had a knee replacement. I was dismayed at how weak my “good” leg was!  I had the good fortune to be treated at Custom Therapy.  I learned that anyone having this surgery should or must exercise weeks before the event to ease the recovery period.  My wife just had her knee done.  We went to André 6 weeks prior for his counsel.  He examined her and recommended a course of pre-surgery exercise.  Having done without myself and seeing her result and progress I cannot recommend more strongly that others should absolutely follow this advice.”

  1. Ride a bike daily.

Bike riding creates controlled movement in a non-weight bearing position so will be less traumatic to the joint than walking or any other weight bearing exercise.

  1. Stretch hamstrings and calf muscles.

This helps get/keep your knee straight.  Painful knees are typically kept in a slightly flexed position for comfort which shortens these muscles. 

  1. Stretch your knee into full extension.

It can be done sitting in a chair with your heel on a coffee table or ottoman or lying face down on your bed with the edge of the bed just above your knee. 

  1. Pull your heel to your butt.

This will maximize your knee flexion.  The more range you have before your surgery, the more you will regain afterwards. 

  1. Strengthen your quads.

Your goal is to maximize your quad recruitment pre-operatively; this makes it easier to contract them after the trauma of the surgery.  A simple quad set, SAQ, or SLR (my favorite) is what is needed.

Your Call to Action:

  1. If you are planning on having a total or partial knee replacement consult a physical therapist as to what you need to do preoperatively to maximize your post-operative outcome.
  2. Forward this post to someone you know who may be having a total/partial knee replacement.
  3. Please post your comments regarding your experience with having or not having preoperative exercises and how they helped you. 

It is not osteoporosis that causes fractures.


We all know someone who has had a bone mineral density test and been diagnosed with osteopenia or osteoporosis.  This means they have lower than normal bone mineral density and hence their bones may be more fragile.  This in itself does not necessarily cause fractures but does need to be addressed.

A comprehensive, multifaceted approach to the treatment of osteopenia and osteoporosis will have a significant impact on bone density.  Clearly there are suitable medications one can take which your physician can address (beyond my scope of practice for sure).  I am sure you have all seen the numerous commercials on TV for these medications with that classic … “Ask your doctor about Boniva (or whatever medication they are advertising)” at the end.

The predictive value of bone mineral density measurements has been called into question in that it can under or overestimate density by 20% to 50%.  If it underestimates the density of the bone, you may receive unnecessary treatment.  If it overestimates bone mineral density you may not receive the most effective treatment.  So, what should you do?

Recognize that it is the fall that causes fractures and not the osteoporosis or osteopenia.  So if you address the physical limitations causing falls you will reduce the frequency of falls and thus reduce fractures.  75% of fractures occur in people without osteoporosis.  80% of low impact fractures occur in people who do not have osteoporosis.  Yes, it is the falls.

Preventing falls among older adults reduces the incidence of fractures, sometimes by over 50%.  Scientific evidence supports a reduction in fall frequency through strength and balance training, followed by reductions in the number of psychotropic drugs, dietary supplementation with Vitamin D and calcium and, in high risk populations, assessment and modification of home hazards.

This is where physical therapy is involved.  A fall prevention program should include targeted strengthening and stretching, static and dynamic balance training, posture modification, home hazard removal and of course an ongoing home exercise program which should be completed on a daily basis.

How do you know if you, a friend or a family member may need a fall prevention (and hence fracture prevention) program?  Answer “YES” to one of the questions below and you should consult with a physical therapist.

  1. Do you have difficulty going from a sitting to a standing position?
  2. Have you fallen without a known precipitating event?
  3. Have you fallen more than once in the past 6 months?
  4. Does it take you longer than 13 seconds to get up from a seated position and walk 10 feet?
  5. Do you have osteopenia or osteoporosis?
  6. Are you unsure if you would benefit from a fall prevention program?

Do your own assessment and decide if you, a family member or a friend may need to address balance issues with a physical therapist.  You will be glad you did.

Antibiotic treatment of Low Back Pain


I recently came across an interesting pair of research papers in which low back pain was treated with antibiotics successfully.  This research is published in the European Spine Journal April 2013, volume 22, Issue 4, pages 690-696 and 697-707.

This concept took me by surprise.  Dic herniations can apparently become infected with the bacteria from plaque in your teeth and from acne.  The link between dental hygene and cardiovascular disease, and I think diabetes (not sure), has previously been documented so I do not think this premise is a far stretch.  The authors investigated nuclear disc material from patients who underwent surgery for annular tears and removal of visible nuclear tissue.  43% of patients had evidence of infections.

They then treated patients with chronic low back pain and vertebral bone edema with antibiotics for 100 days (that’s a long time).  The antibiotic treatment significantly improved the chronic low back pain when compared to placebo.

Well!  I am somewhat taken aback but realize this is very interesting and may explain some cases of low back pain that do not progress as well as they should.

Your call to Action:

  1. What do you think of this?
  2. If you are a healthcare provider, post your comments please.
  3. Forward this onto someone who may have some comments and have them post their thoughts to our blog.
  4. Have an incredible week!

Swelling and Knee Function


The most read post on this blog deals with “Swelling, Effusion, Edema and Bruising – What’s the difference?”.  I will take the concept one step further and discuss how knee swelling or joint effusions impact your ability to control your knee extension when you walk.

So, you injure your knee and develop swelling inside the joint.  You may notice your knee giving way.  That means when you transfer weight onto your injured leg the knee buckles.  This is due to the quadriceps (front of your thigh) not contracting efficiently and hence not controlling the knee in extension.  Knee extension is vital in walking because it stabilizes the leg to accept the transferred weight from the opposite leg when you are in stance phase of gait.  If the knee is unable to go fully straight while stepping onto it you have difficulty swinging the other leg through to take another step.

This happens because of the swelling (and possibly pain too) within the joint.  A neural reflex is set up by distension of the joint structures.  It passes through the spinal cord and back to inhibit the quadriceps.  It is then difficult to contract them at the right time and with sufficient speed during the gait cycle.  Hence, unsafe walking and difficulty going up and down stairs, for example.  You may notice immediate deterioration of your ability to contract the quadriceps following injury with a joint effusion.

To regain quadriceps function and hence to restore normal and safe walking you must control the swelling (see earlier post on this topic), avoid increasing it by careful activity modification and do specific exercises to regain normal quadriceps function.  Physical therapists will instruct you in specific neuromuscular reeducation exercises to restore the quadriceps recruitment pattern.  Such exercises may include seated quad sets, straight leg raises or short arc quad recruitment.  These may be done with neuromuscular electrical stimulation (not TENS – that’s for pain and totally different type of current form) to facilitate recruitment of the muscle.  In addition, you will be given terminal knee extension exercises in standing such as straightening the knee against a wall with a towel roll behind your knee against the wall or fully extending your knee against tension created by an elastic sports cord.

So, controlling swelling in a joint is necessary to regain function of the muscles moving that joint.  This process is used in all knee injuries that result in joint effusions as well as in all postoperative rehabilitation, for example, following ACL reconstruction, meniscus repairs and debridement as well as total knee replacements.

What have you found helpful in the past?

What worked for you?  What didn’t?

Post your comments here so other people can learn from your experiences.  We would love to here from you.

Knee Pain! Osteoarthritis!


To my fellow Boomers out there ….. How are your knees doing?  We are an active sector of the population and we want to remain that way for the health benefits (and the fun!) thereof.  Knee pain due to osteoarthritis, whether one or both knees, has a dramatic impact on a person’s ability to continue with their chosen active lifestyle and, if it gets painful enough, may impact activities of daily living such as getting into and out of a car or a chair, cooking a meal or simply walking.

 WHY KNEE OSTEOARTHRITIS?

Osteoarthritis affects 25 million North Americans and is symptomatic in 13% of people aged 55 years and older.  It has been shown to be the most frequent cause of functional disability including being dependent on alternative forms of mobility due to the tremendous pain with walking.  Ouch!  The prevalence of osteoarthritis is rapidly increasing due to two main factors.  Firstly, the aging of the American population (that includes us!) is increasing the share numbers of people older than 55 years.  Secondly, the rapidly increasing obesity in our population is increasing the rate of joint degeneration.  One study reported 83% of males who had knee osteoarthritis were obese compared to 42% of males without it.  Wow!  Now there is a statistic that says a lot and leaves nothing to the imagination as to what we need to do to address the issue.

WHAT IS IT?

Osteoarthritis is the joints response to structural damage caused by mechanical problems.  It is the body’s attempt to repair a joint under unusual stress and often leads to a stable, pain free joint.  If this process fails (is insufficient for the magnitude of mechanical stress placed on the joint) the knee becomes symptomatic and hence functionally debilitating.

MECHANICAL STRESS YOU SAY?

Pathological mechanical stress of the knee joint may be due to:

  1. Increased overall load through the weight bearing joint surfaces (e.g. obesity).
  2. Reduced load bearing surface area thereby increasing the pressure (same force through a smaller area) exerted through the joint (e.g. misaligned joint: bandy or bow-legged).
  3. Repetitive impulsive loading of the joint (e.g. trauma, doing moguls).

Obesity increases the overall load through the joint and overwhelms the joint tissues resulting in osteoarthritis.  Being bandy or bow-legged reduces the weight bearing surface area in the knee joints (shifts it from throughout the knee to one side or the other of the joint) and results in excessive wear and tear of the joint on the outer or inner surfaces respectively.  Sustaining a serious injury to the knee in which ligaments are torn and the joint surfaces are banged together in the injury may initiate the osteoarthritic “repair” process as well.  Thus, when stress on the joint tissues exceeds their physiological tolerance breakdown ensues and osteoarthritis begins.

HOW CAN WE ADDRESS THE CAUSATIVE FACTORS?

Weight loss in an effort to attain a normal body weight for your frame is paramount in reducing the forces through the knees.  Walking results in a force through the knee equal to 3 – 4 times your body weight each step.  If you lose 20 – 50 pounds in an effort to attain your normal weight, you reduce the forces through your knees by 80 – 200 pounds each step you take!  Talk about happier knees!  An 11.2 pound weight loss over a 10 year period has been shown to reduce the likelihood of developing knee osteoarthritis by 50%.

For misaligned knee joints (those of you who are bandy or bow-legged) there are unloading braces to modify (increase) the load bearing surface and hence reduce stress to the one side of the affected knee.

In all osteoarthritic knee joints muscle weakness, joint stiffness and poor balance are factors.  Muscles around the knee joint serve to cause movement in bending and straightening the knee, can reduce mechanical stresses to the joint by absorbing loads applied to the limb (e.g. cushioning during landing a jump or when skiing) and stabilize the knee joint during daily tasks of walking, running, lifting and carrying to name a few.  Patients with knee osteoarthritis are 20% to 40% weaker in their quadriceps than people without the condition.  As the disease worsens the knee muscle activation patterns become less efficient and less specific and joint proprioception (the brain’s ability to know what is happening at the joint and react accordingly) is suppressed.  A well constructed, evidence-based physical therapy program will improve strength, range of motion and proprioception and result in improvements in physical function, pain and quality of life.  Modifying the mechanical problems causing the osteoarthritis together with addressing the inflammatory and pain aspects of the disease process through pharmacological intervention from your physician can result in an 86% success rate in improving your function.  Who would not like that!?

All our physical therapists at Custom Physical Therapy have undergone specialized training for treating osteoarthritis.  The therapists work as part of a team comprised of you the patient, your physician and the physical therapist.  Using physical therapy interventions to modify the mechanical factors impacting the progression of osteoarthritis together with the physician addressing the pharmacological aspects and the patient being compliant with an exercise and stretching program (see our very first post on this blog) as well as brace use, if prescribed, the team of patient-physical therapist-doctor minimizes the effect of the disease process on your function.

YOUR CALL TO ACTION!

  1. If you are overweight start a simple lifestyle change that entails weight loss (Call Joe Dibble, dietician at Sierra      Strength and Speed, for a consult.  He is really knowledgeable and practical.)
  2. Call Custom Physical Therapy so we can evaluate your      arthritic knees and set you up with appropriate treatment.
  3. Forward this post to someone you know who has sore      knees or you think may be interested in the information.

You are encouraged to call Custom Physical Therapy to talk to one of our accredited physical therapists about your knee pain.  You may be a candidate for this customized evidence-based program specifically developed to improve your function which deteriorated due to knee osteoarthritis.