Happy New Year

 

Happy New Year from KB Fitness!!!

Don't spend another year limited in what you can do because of pain!

Take the initiative to help yourself or a family member get rid of lower back, neck or knee pain!

 

 

 

  Order a Strength On Demand Physical Therapy Home Exercise DVD Today at

www.strengthondemand.com

 

 

Make sure you stick to your New Year's Resolution of being pain free!!!

 

 

This Tip Eliminated Most of My Back Pain

In previous posts, I mentioned how I had been diagnosed with a herniated disc at L4-5 ten years ago, and that I am still aware that this is my weakest link.  I can feel the ache first thing in the morning, and must avoid any type of flexion activities for the first hour that I am out of bed.  I focus my  training sessions on core recruitment and stabilization while training full body movement patterns.  To my knowledge I was maintaining a stable trunk and was protecting my lower back.  However, the day after my training session, I would feel an increase in lower back soreness and felt that I had to be extra cautious with certain activities to prevent an increase in pain.

The majority of my training deals with multi joint movement patterns rather than isolating muscles.  I make sure to do squats, lunges, and deadlifts, and ensure that I incorporate a proper hip hinge rather than spinal flexion when lowering myself.  But there was one technique that I had not focused on while performing these movement patterns until recently.  And since doing so, my lower back pain has dramatically improved.  I have spoken about "gluteal amnesia" in the past.  One of the causes of this "amnesia" is that upon performing a squat, we use our hamstrings to extend our hips and our lumbar extensors to extend our spines while transitioning from the squat position to tall standing.  Using the spinal extensors to do this compresses the spine, causing more back pain.  This is most likely why I would wake up the following day in more back pain.  Incorporating the gluteals to extend the hips while returning to a standing position from a squat will help reverse this "gluteal amnesia," and save the back.  So I decided to try this a few days ago.  To do this takes concentration but is not too difficult.  All you do is "spread the floor" with your feet.  So when performing squats, as I descended and ascended, I was gripping the floor with my toes as I was pushing my feet isometrically outward, as if I was attempting to spread the floor.  This technique engages my glutes which extends the hips, bringing me into the upright position while taking the strain off of my spinal extensors (and reducing spinal compression).  I decided to incorporate this throughout my day, not just during training sessions.  I initiated getting out of a chair by "spreading the floor."  Squatting down to pick up my daughter, I did the same thing.  This morning I woke up with almost no lower back soreness. 

Try this technique and you will be amazed at how your back responds.  I was taught that my "lower back is like a bank account.  There is only so much money in it.  So use it only when you need to."  To do this, we must use proper and efficient movement patterns to eliminate unecessary stress on the spine.

Merry Christmas

Merry Christmas From KB Fitness!! 

 

 

Have a safe, happy and healthy holiday!!!

Lower Back Pain and Radiating Symptoms

If you have been suffering with Lower Back Pain and radiating symptoms into your legs, you may want to know why this is happening and what you can do for relief. 

This video may help: Lower Back Pain Radiating Symptom Management

Incorporating The Bridge

Incorporating The Bridge

 

The bridge is a common exercise prescribed to clients suffering from lower back pain.  Many of these  patients commonly present with crossed-pelvic syndrome (weak glutes and abs, tight hamstrings and hip flexors).  They have overworked hamstrings and underworked gluteals.  Upon performing the bridge, most will initiate the extension movement by firing their hamstrings, instead of their glutes.  Our goal is to teach them how to engage their gluteals first.  This will carryover into functional activities such as squatting.  Start by teaching a "Glute Set."  To do this, you have your client lie on their back and clench their butt.  The cue "pinch a dime" works well.  Then perform this same technique with your client lying on his/her back with their knees bent and feet flat on the floor.  "Pinch a dime" again.  Repeat this without any actual lifting of the pelvis until it is performed without hamstring contraction.  Palpate their hamstrings to ensure this.  Then, have them perform this technique and lift the hips off the floor.  If the hamstring are still firing early, having your client attempt the bridge with their toes touching a wall may help.  In this position, upon attempting the lift, gently ask your client to push their toes into the wall as if trying to extend the knees.  Contracting the quadriceps here, will inhibit the hamstrings from firing, and the glutes will do the work.  Have your client repeat this until it becomes habit.  Then check out the quality of their squat and see if it has improved.    

Rehab Devices That Make Life Easier: Bed Rail

Rehab Devices That Make Life Easier: Bed Rails

 

Occasionally, I will see patients who have been injured by falling out of bed.  Either they roll out of bed in the middle of the night, or upon attempting to transfer out of bed in the morning, they lose their balance and fall to the floor.  Sometimes this is due to the low height of the mattress, which makes it difficult to stand. 

 

Here are a few of the common bed rails.  There are different styles.  Some of them are retractable so that at night they run the length of the bed to prevent rolling out.  In the morning, you or a caregiver can retract it so that you can easily transfer out of bed.

 

The wooden panel is placed under the mattress so it stays in place



Rehab Devices That Make Life Easier

Rehab Devices That Make Life Easier:

Walkers

 

Last entry discussed the two common types of canes, standard and quad.  If someone needs more assistance when walking, a walker should be considered.  There are many types of walkers to choose from.

The Standard Walker provides a stable base of support as it has 4 legs.  To prescribe appropriately, the user must have strong arms to support their body weight when pressing down on the handles during gait.  This walker is used many times by patients with weight-bearing precautions.  For example, if someone is not supposed to fully weight bear on 1 leg, they will need to use their arm strength and opposite leg strength with this walker in order to walk.  Because there is a weight bearing precaution, the walker of choice should not have wheels so that the walker will be less likely to roll forward uncontrollably.

The rolling walker provides faster and smoother mobility for people who do not have any weight bearing precautions of their legs and are more steady when walking and changing direction.

The three wheel walker is for people who need the assist of a walker, but are able to walk and negotiate obstacles confidently and safely.  This walker allows quicker direction changes.  Brakes are present for safety so that the walker does not "get away" from the user.

 

  

 

The 4 wheel walker is also used for the more highly functioning person who is unable to walk without the support of a walker, but wants to be able to walk with some quickness and be able to make  safe direction changes.  This walker is good for those who present with good balance, but have trouble walking long distances, as it offers a seat as well as brakes for safety.

 

 

 

The Hemi Walker is used by patients who have difficulty using the arm and leg on one side of their body, particularly stroke patients.  It can also be beneficial for people who need assistance with their balance but are unable to hold a walker with 2 hands due to an injury to 1 arm.  The wide base provides balance and stability and this walker can be maneuvered using only 1 arm.  Although it is maneuvered using one arm, it provides more support than the quad cane of the previous post. 

 



Rehab Devices That Make Life Easier

Rehab Devices That Make Life Easier:

Canes

During Physical Therapy assessments, patients and their family members ask me for advice on which type of device they should use to walk safely.  In regards to canes, the most common are the straight cane and the quad cane.

STRAIGHT CANE

QUAD CANE

The main differences between these two types of canes are that the Straight Cane is used mainly for people with balance deficits, while the Quad Cane assists with balance deficits and lower extremity weakness and instability.  The straight cane should only be prescribed to a patient who has slight balance deficit and needs just a little extra support (wider base of support) when walking.  The straight cane is not a weight bearing device, so if your patient or family member seems to be pressing heavily down on the cane when walking in order to safely navigate their environment, the straight cane is not the appropriate device.  

The Quad Cane is a weight bearing device.  Many people recovering from stroke present with one-sided weakness and benefit from this type of cane in order to prevent buckling of their knee.  The only con is that all four legs of the quad cane must be placed on the floor/ground at the same time in order to be safe.  You should not walk and place the back two legs on the ground, followed by the front two legs of the Quad Cane.  It is sometimes more difficult to coordinate this action, and many times patients will trip over the Quad Cane.  

Take home message: A straight cane is only for people with slight balance issues while a Quad Cane assists with balance and weight bearing (supports the weak leg).  

Rehab Devices That Make Life Easier

Rehab Devices That Make Life Easier

Lift Chairs & Seats

 

 

Many of my patients, mostly the elderly, have a very difficult time transferring from a seated to a standing position.  This is usually due to weakness of the leg muscles and/or arm muscles (you need your arms to push up from the chair).  There are some common devices on the market that help with this activity.  However, I do find that if people have a choice between 'working' to get out of a chair versus having the chair do the work for them, they choose the easier way.  Unfortunately, if you don't use it, you lose it.  The less you rely on your legs to help with the transfer, the weaker they become.  I always advise my patients to only use a lift seat/chair if they can not get out of a chair any other way.  If it takes a little work to do the transfer on their own, as long as it is still safe, they should do it without mechanical assistance.    

Cheaper of the two options, the seat lift can move from chair to chair and is purchased based on body weight

 

 

The chair lift is expensive but sometimes Medicare will cover a portion of it.  This will actually raise you up until you are almost standing

 

 

 

 



Rehab Devices That Make Life Easier

Rehab Devices That Make Life Easier

 

We tend to take for granted the ability to perform life's daily activities.  As a Physical Therapist, much of my treatment time is spent educating patients and their families on what they can do to make their lives less stressful, particularly when performing activities such as bathing, walking, changing position, and toileting.  Today's device is the Grab Bar.

   

These can be purchased at your local hardware store and can be installed in your shower to assist you with safely entering and exiting the bathtub or shower.  Many people rely on their bathroom towel rack.  However, many times leaning on this with your body weight  may pull it out of the wall, leading to an injury due to falling to the floor.  Suction cup grab bars are also sold.  However, I have heard both good and bad about them.  Many times they have to be re-applied every few weeks due to loss of suction.  It is because of this that I would not always trust the suction grab bars to support someone who has a very difficult time getting in and out of the shower and places a great deal of their body weight on them. 

 

Grab bars can also be used to assist getting in and out of your garage...

Or getting on and off of the toilet...

 

If you have a family member who presents with generalized weakness, is recovering from a surgery or is medically compromised, Grab Bars may make their life easier and will decrease their risk of future injuries.



Body Awareness

Body Awareness

 

Most people who are suffering from low back, knee, neck or other common conditions can greatly reduce their symptoms by simply correcting their posture, body mechanics, lifting techniques, etc..  However, this is not so simple.  Many people do not have the body awareness needed to perform correction techniques merely upon verbal cues by their trainer or therapist.  When I am faced with this client, I will allow them to rely on a mirror for feedback as well as providing them with manual cues.  Nowadays, everyone has a cell phone with camera capabilities.  I have taken pictures during a session and either emailed 'before' and 'after' photos to my clients for further education or I print out the photos to use during their sessions for visual feedback.  After educating my clients using these tools (mirror, photos, manual cues), I assess the carryover by removing those tools.  Once they are able to correctly perform the task at hand, I remove the external cues so that they further develop body awareness.  My goal is to ensure independence with body awareness.  After all, your client will not always have a camera, a trainer/therapist or a mirror available when performing daily activities.