"If You Keep Picking At It, It Will Never Heal"

"If You Keep Picking At It, It Will Never Heal"

Recovering from a lower back injury is similar to any other injury.  If you fall and cut your knee, the healing process will be postponed if you constantly pick at the scab.  When you are rehabilitating from lower back pain, the more frequently you irritate the injury, the longer it will take to heal.  This means that you must protect your spine during everyday routine activities.  

Stu McGill describes your lower back as a savings account, advising you not to "spend" it frivolously.  If you continue to unnecessarily involve/mobilize the spine in activities that do not require its involvement/mobility, then when you do "need" the spine, it will not be there for you at 100%.  

One example of this is...click here for full article

Common Physical Therapy Questions

Common Physical Therapy Questions

 

As a Physical Therapist, I have heard certain questions frequently over the years.  This past week, I have been treating numerous patients following a Total Hip or Total Knee Replacement Surgery.  Many of these patients have trouble lifting their operative leg into bed when transferring from the sitting to the supine position.  My previous post explains how using the S.O.D. Stretch Strap can assist the patient with maintaining independence while performing this technique.  However, most patients do not have a strap so soon following their return home from the hospital.  They accept the fact that they can't lift their leg and rely on a family member to lift it into bed for them.  Even weeks after surgery, they may rely on someone else's help for this.  When the family asks me if this is normal, I tell them that the weakness is normal.  However, it is not only muscle weakness that is the cause.  The patient must begin to redevelop the motor pattern to lift their leg into bed by practicing it over and over.  Many times, if I perform the leg raise while cueing the patient to assist, after a few times, the patient is amazed at how quickly the movement returns.  It is as if they must re-establish the brain-leg connection in order to perform the task again.  I advise family members to assist only after the patient has made an effort first.  This will help the patient recover quicker and will prevent the family member from injuring themselves in the process of helping.

 

I have also been working with many Worker's Compensation patients who have injured their backs.  Most of them tell me that they bent over to pick something up and felt it "go out" at that moment.  After weeks of successful therapy, including core stabilization activities, body mechanics and lifting education,  I usually get the same question:  "When can I go back to lifting like I used to, without having to think about it?" 

 

And I answer them with: "Never.  You should have never lifted like that to begin with.  That's why I have been teaching you body mechanics and lifting techniques.  It is your goal to establish new posture and body mechanics so that you don't have to think about it the next time you are required to bend to lift something."

 



 



So although most of us have rarely thought about how we are to lift something off the floor, if we are taught the correct way to do it, and practice it repetitively, our new habit will minimize the risk of lower back injury in the future.  Just because we have been lifting a certain way all of our lives, does'nt mean that we have been doing it correctly.  The older we get, the higher the chance that poor lifting techniques will catch up with us. 

 

Posture and Spinal Compression

Posture and Spinal Compression

 

Posture is one of the very first things I assess when working with a client, especially one who presents with lower back pain.  A majority of the clients who I treat for lower back pain require postural reeducation due to maintaining a slumped or flexed posture. 

 

Keeping this posture throughout the day results in tight anterior muscles, such as the pectoralis, and stretched out, weakened scapula retractor muscles (middle traps).  When we analyse this posture, we can see that the head is anterior, the shoulders are anterior and protracted and the lumbar spine is flexed.  This places an anterior weight distribution to our upper body.  What stops us from continuing to flex forward and eventually falling on our face?

 

The answer is our spinal extensors which run longitudinally up and down our spine.

These long extensors contract in order to limit any more flexion, thereby stopping us from completely flexing forward.  However, the constant engagement of these muscles actually compresses the vertebrae, creating more lower back pain!  You can feel these hardened muscles by palpating the lower back of your clients.  If the muscles on either side of the vertebral spinous process feels "hard as a rock," then you can assume these muscles are "on" all day, and this is part of the reason for their lower back pain.  Keep your hand on these muscles and ask your client to contract their glutes ("clench"), retract their shoulders and tuck their chin.  Now see if these muscles "soften" to your touch.  By relaxing these muscles, you are reducing the amount of spinal compression and eventually the pain will diminish. 

Now certain activities require you to flex forward, such as shaving.  Many of my clients complain of increased lower back pain when shaving or doing the dishes.

  With this, I spend time educating them in performing a hip hinge and a lunge position rather then flexing forward from the spine.  This usually helps immediately.  Others will ask me if they should purchase a posture brace.  I am not a big supporter of these braces, as they do the work for you.  You rely on an external support device to maintain your posture rather than your own muscles.  Therefore, the muscles that need to be strengthened and those that need to be stretched are not really getting what they need, and the person wearing the brace never develops the body awareness to maintain proper posture.  Although not much substantial evidence exists regarding kinesiotape, I find that it does provide the proprioceptive input that "tells" you to maintain the neutral spinal posture rather than the slumped position.  In my experience, upon applying kinesiotape, these lumbar muscles relax and the pain diminishes.

 So first, assess your client's posture.  Second, palpate the longitudinal spinal extensor muscles on either side of the vertebrae.  Third, have your client squeeze their glutes, retract their shoulders and perform a chin tuck.  Assess what the muscles feel like now.  Teaching your client to maintain this posture will be one of your client's main goals during everyday life as well as during resistance training.  For more information on posture and body mechanics, check out the DVD at: www.lowbackpainvideos.com