Physical Therapy

I evaluate and treat many patients with low back pain or sciatica, and one of the most frequently asked questions from patients who have recovered is, "What do I do first if this terrible pain strikes again?"

Usually during treatment, I speak with my patients about prevention of future problems. Low back pain tends to be an episodic condition, and many patients experience episodes from time to time. Part of their treatment focuses on postural correction and simple exercises to prevent problems in the future.

But when low back pain strikes suddenly, many patients are confused about what to do. Rest assured, there are usually a few simple emergency back pain self-care strategies to quickly get you moving again is an episode of sudden onset, acute back pain strikes.

The first step: Don't panic. Most low back pain tends to get better with just a few exercises. These typically involve lying face down, propping up on your elbows, and performing press ups for your back.

If you have acute low back pain, be sure to check out Emergency Self-Treatment for Low Back Pain. Remember, a visit to your doctor or physical therapist is always a good idea when acute low back pain strikes.

A new study published in The Lancet indicates that high doses of some common medications used for pain and inflammation can increase the risk of heart attack by as much as thirty percent. These anti-inflammatory medications include popular drugs like ibuprofen and diclofenac.

A recent analysis of studies that examined high doses of prescription levels of diclofenac and ibuprofen showed increased risk of having a cardiac event like a heart attack. Don't worry; the occasional ibuprofen for minor aches and pains is still safe, but there are increased risks that come with increased doses of anti-inflammatory medication.

So often I meet with patients who are taking high doses of anti-inflammatory medication, and occasionally they report that the medication is only minimally helping. The patient still is in pain, but continues to take the medication.

But remember that not all pain is caused by inflammation. Many times pain in your body is caused by mechanical stresses. Try this experiment: start bending your finger backwards as far as you can. Go a little further, and you should feel pain in your finger joint. Release your finger, and the pain should go away. That's mechanical pain, and no amount of anti-inflammatory medication will help that pain.

I understand that these medications are effective, but perhaps a trial of physical therapy first, or soon after starting anti-inflammatory medication, is in order. That way, the inflammatory healing process will be well underway, and the mechanical stresses that may be causing the pain can be examined by your physical therapist. Then, short term and long term management strategies can be prescribed to help manage your condition, and high doses of medication can be limited.

As always, speak with your doctor before adjusting any medication that you are taking.

Hockey players are tough.

Last week during the National Hockey League game three Eastern Conference finals between the Boston Bruins and the Pittsburgh Penguins, Gregory Campbell dove to block a shot. The puck hit him on the side of the leg.

Campbell got up, but was clearly hurting. He remained on the ice for 40 more seconds, working on the penalty kill shift and breaking up a couple passes. When the puck was cleared from his defensive zone, Campbell hobbled over to his bench, and the trainers went to work checking him out.

Turns out Campbell had broken his fibula. Of course he was out for the game is out for the remainder of the playoffs. But for those 40 seconds, he showed a lot of guts and heart, playing with a broken leg. (Kids, don't try that at home.)

Hockey players are tough, but they are not superhuman. Gregory Campbell will have to go through the normal steps to mend his injury. His fractured leg was reduced and immobilized, and he will likely go through rehabilitation to help improve his range of motion and strength once his fracture has healed.

Quick Links:

• Physical Therapy After a Fracture

When I first became a physical therapist, I worked in a local hospital in the acute care department. I would evaluate and treat people in the hospital, and occasionally I would spend some time in the intensive care unit (ICU) and the cardiac stepdown unit.

Many patients would questions me when I came to evaluate them after cardiac surgery. Patients lying in bed with tubes, lines, and wires coming from their body and hooked up to machines would wonder how we would ever complete a physical therapy session. How could anyone with so much stuff attached to their body be able to get out of bed and walk down the hall?

It is possible. You simply have to know where to hook everything. The IV machines are portable, oxygen canisters can hook to a wheeled walker, and a Foley catheter bag had a hook that would hang from the walker (or my pocket). It would take a little time and creativity, but with a little effort, most patients are able to manage a little functional mobility shortly after a cardiac event or cardiac surgery.

Quick Links:

• Read more: Phase One Cardiac Rehabilitation

A question that many patients ask me is how to measure exercise intensity. How do you know if you are exercising too vigorously, or not hard enough?

There are a few different ways to tell if you are exercising at an appropriate intensity. Measurement of your heart rate is a simple and effective way to measure exercise intenisty. Simply place a finger over your radial pulse and count the number of beats you feel over a 10 second span. Multiply your number by 6 and you have your heart rate in beats per minute.

In general, you should exercise at an intensity of 65-85% of your age related estimated maximal heart rate. Sounds tough, but just subtract your age from 220, and you will have an idea of your estimated maximal heart rate.

Other simple ways to measure your exertion level is with a Rating of Perceived Exertion (RPE) scale or the Borg scale. Both are simple ways to get an idea if you are exercising too hard, or not hard enough. The RPE scale is from 0-10, with 0 indicating no difficulty at a task, and 10 indicating heavy, heavy work. The Borg scale is similar, but the scale runs from 6-20.

If you are exercising with someone, simply have a conversation. The Talk Test is a way to know how hard you are working. If you cannot talk during exercise, then you are exercising too hard and you need to lower the intensity.

A visit to your physical therapist can help you determine the best way for you to measure your exercise intensity.

Quick Links:

• Read more: Measure Your Exercise Intensity

Occasionally I treat patients who ask me about the benefits of acupuncture. I know there is some varied evidence about acupuncture, and I have met some folks who anectodtally have had some benefit from it. Other patients of mine have tried it and have found it to be pretty ineffective.

A study published online in the Physical Therapy Journal has examined the effects of adding acupuncture to a rehab program Read More...

Last year, I wrote a blog post about a patient who fractured her ankle and was wondering when she could run again after her fracture (and subsequent surgery) had healed. The post has been quite popular, and many folks who have suffered similar injuries have written about their rehab and their personal story.

My patient had been doing well, and she was back to running short distances, but her ankle range of motion (ROM) continued to be quite limited, and this prevented her from really taking long strides while running and walking fast. She elected to have another surgery last month to remove some hardware from her ankle.

Since her surgery, she has started physical therapy once again for gait training and to help improve her ROM and ankle strength. Her ROM appears to be progressing nicely, and it looks like the surgery was successful in helping her regain a few extra degrees of motion around her ankle. Hopefully that will equate to improved function related to running.

Quick Links:

• Physical Therapy after Hardware Removal
• When Can I Run after an Ankle Fracture?

This morning I was working with a patient who had hip pain and weakness and was performing hip strengthening exericses. She was performing a single leg bridge exercise to strengthen her gluteus medius, and she asked me what the name of the exercise is. I told her I called it the single leg bridge exercise.

The patient stated that she felt the exercise was like a push up becuase she was pushing her bottom up while doing the bridge. She said that maybe she should call it a push up. I told her that a push up is already an exercise to strengthen the pectorals and arm muscles.

Then my patient came up with a new name for the single leg bridge exercise. As she was raising her tush into the air into the bridge, she told me the name of the exercise: The Tush Up.

If you are attending physical therapy and have Medicare as your insurance, you may notice your physical therapist spending a few extra minutes talking to you about your current level of function. He or she may be collecting information about your current functional status to report to the folks at Medicare as part of something called Functional Limitation Reporting.

Functional Limitation Reporting, or FLR for short, is a part of the Middle Class Tax Relief Act of 2012 and it requires that your PT collect information about your functional status at various points in your rehabilitation. He or she must also deterine a functional prognosis for you during your episode of care.

What's great about FLR (sarcasm coming right up) is that your physical therapist must collect information and report to Medicare about your function, but he will not be paid anything extra for his efforts. In fact, starting July 1st, 2013, claims sumitted by your PT to Medicare without the necessary FLR information will not be paid at all.

There is a house in my neighborhood with a small house-shaped box near the driveway. The house has a little door on it and a sign indicating that it is a tiny library. Inside the house are about 20 books that one can borrow. There is no library card or keeping track of the books. It simply works on the honor system.

I stopped by the little library the other day with my children, and each one chose a book. My son picked out a book called Bone Poems by Jeff Moss. It is a great book with many different poems that are inspired by the dinosaur bones in the American Museum of Natural History.

My favorite poem: 206. It tells how the human body contains approximately 206 bones. The Tyrannosaurus rex has quite a few bones as well. Guess how many. About 206-same as us. Pretty interesting.

Quick Links:

• Related: Fracture Management in Physical Therapy