If your body and spine has any underlying degenerative changes, pressure on the nerves may be increased and pain may be more intense with postural stress and fatigue.  Here are some common causes of back pain...

Spinal Stenosis- This is a narrowing of the spaces along the spine which increases pressure on the spinal cord and nerves.  Spinal stenosis symptoms may include leg weakness, numbness in the buttocks or the back of the legs, and relief by leaning forward.

Degenerative Disc Disease - With age, the protective discs between each vertebrae may have “wear and tear”, shrinking or loss of height due to loss of water, or bulging/herniated discs. The degeneration of the disc leads to pressure between the vertebrae and along the nerves coming out along the spine.

Hyperlordosis - Also known as “swayback”, this is an excessive curvature of the lumbar spine causing the stomach to stick out and the buttocks to become more prominent.  This increased curvature places pressure along the back of the spine. It also creates  a muscle imbalance between the abdominal muscles and back muscles, leading to core weakness and decreased spinal stability.  

Osteoarthritis - This is wearing of the cartilage along the bones in the joints, which affects the smooth movement of the bones and can cause pressure on surrounding nerves. 

Pinched Nerves or Sciatica -Pain from the nerves may be caused by pressure from any of the above changes in the bones, cartilage, or muscles surrounding the spine. ​

If you have been watching the Olympics this week you have seen stories of athletes performing remarkable feats while having some sort of injury.

How do they do that? High pain tolerance? Pure motivation? 

For us Non-Olympians, regular people, we frequently feel “fine” during the day, but then at night “it (back, knee, hip)  REALLY hurts”.   Does that sound more familiar to you?

Each of us perceive pain totally differently and there are multiple factors that affect our pain, besides just having a “high tolerance”.

Here are nine things you should know about pain. 

1. Pain is processed in the brain, not at the site of injury.  
We used to believe that pain originated within the tissues of our body. We now understand that pain does not exist until the brain acknowledges the signals from the nerves.  It is a warning sign that your body, or a specific part of the body may be in danger.  It is the way our brain and body communicate and serves as a defense against injury.  For example: Your hand is on the hot stove.  Your nerves send a message to the brain of extreme heat, you feel pain and you move your hand away quickly. 

2. The degree of injury does not always equal the degree of pain.
Think of a paper cut, those suckers hurt!!  That may hurt more than a broken bone because we have more sensory receptors in our fingertips than in bone. 

3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding(s) may not be the cause of your pain.
Advancements in imaging have been a powerful tool for modern medicine, but they are often give too much information.  For example,  multiple studies have shown that MRI of the back frequently find herniated discs in patients who don’t even have back pain.  See my previous blog that gives more information on MRI and false positives.

4. Psychological factors, such as depression and anxiety, can make your pain worse.
Pain can be influenced by many different factors, such as psychological conditions. One symptom of anxiety can be joint pain.  Some research notes that back pain is more common in those with anxiety or mood disorders than those without.  According to the Harvard Health Publishing “researchers have learned more about how the brain works, and how the nervous system interacts with other parts of the body, they have discovered that pain shares some biological mechanisms with anxiety and depression.”

5. Your social environment may influence your perception of pain.
Frequently, people’s pain level increases in a stressful situation, such as work or at a doctor’s office.  The pain signals may kick in as a form of “self-protection”.

6. Understanding pain through education may reduce your need for care.
According to a study of post-operative pain management, those who were educated pain expectations and management prior to surgery reported less severe pain during the first 24 hours postoperatively, experienced fewer and less severe pain medication side effects, returned to normal activities sooner, and used more nonpharmacologic pain management methods postoperatively compared with those who did not receive the education.​​  
This makes complete sense, because if we understand what is about to happen, the fear and anxiety levels are much less, and therefore pain perception is lower. 

7. Our brains can be tricked into developing pain in prosthetic limbs.
Also known as “phantom limb pain”,  patients who are recovering from an amputation can experience pain or tingling from the limb that is no longer there.  This confirms that pain in processed in the brain and it’s not always from the site of the injury. 

8. The ability to determine left from right may be altered when you experience pain.
Networks within the brain that help you determine left from right can be affected when you have severe pain. If you are experiencing pain, have you noticed your sense of direction is a bit off, or that you have difficulty focusing?  You can’t answer questions quickly, or you forget what you were going to get when you walked back into your bedroom?  Communication between your brain and your body is not always sharp when pain signals are involved and the experience of pain may not be exactly where the cause of pain is.  You may hear of this a radiating pain.   For example, people with a rotator cuff tear may feel the pain along the lateral side of their arm, not at the shoulder. 

9. There is no way to know whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way. While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or compare pain tolerance among people. We cannot compare how someone “feels” pain.  Pain experience may even vary in the same person depending on what is going on around them. 

If you have pain that limits your movement or keeps you from taking part in work, daily living, and other activities, call us for a free 30 minute consultation to find out how we can help. 504-313-6502 

Here are 7 tips from a Physical Therapist to help you "Age Well" and enjoy the Golden Years.  

1. Chronic Pain Doesn't Have To Be The Boss of You.  According to the Centers for Disease Control and Prevention (CDC), in 2016, an estimated 20.4% (50 million) US adults experienced chronic pain. We focus our treatments to address chronic pain without addictive pain medicines or medications that make so drowsy you can’t function.  A physical therapist-supervised exercise program addresses mobility, strength, and pain management while moving and at rest, improving your overall quality of life.  We help you be the boss over your symptoms.
2. You Can Still Build Muscle Strength When You Are Older.   Just because you have gotten weaker or lost muscle mass with age doesn’t mean you can’t build strength with what you have.  Multiple research studies have shown increased strength and actual muscle cellular growth with resisted training.  Sometimes, the biggest challenge is getting over our own belief that you are “too far gone” or “too old”.  Our physical therapist and personal fitness trainer can get you started at the right place and give you the right amount of push to build strength. 
3. Surgery is Not Always the Answer.  The phrase “At some point, you will need surgery” is probably overused by physicians.  If you aren’t at the point where you need surgery now because you can’t function, there are always non-invasive, non pharmacological options.  We can help you figure out what might work best for you. 
4. Exercise and Strength Decreases the Risk of Falls. According the the CDC, approximately 1 in 4 adult over the age of 65 had a fall last year.  Falls can affect someone physically and well as decrease confidence in one’s own safety which leads to more inactivity.  But falls are not a normal part of aging, they are a part of deconditioning, therefore - they are PREVENTABLE!!  
5. Bone Strength DEPENDS on Physical Activity and Weightbearing.  Osteoporosis or “frail bones” are a result of many factors, but without tension placed on the bones you can be confident that they will decrease in density.   According to the National Osteoporosis Foundation it affects more than ½ of American women and ¼ men over the age of 50.  
6. Our Hearts Desire Exercise.  Heart disease is the #1 cause of death in the US, and exercise has been proven as the top way to prevent it.  For those who are already suffering from heart disease or high blood pressure, appropriate exercises guided by a physical therapist or exercise physiologist is one of the treatments to improve your health. 
7. Our Brains Crave Exercise.  This past week, one of my patients spoke of her previous visit and exclaimed “My brain felt clearer than it has in months after I finished my session !” Yes!  Increased blood flow to the brain helps us think more clearly as well as regulating mood.  In addition, people who are physically active, including in the later years, have a decreased risk of dementia and Alzheimer's.  

So what’s the common denominator here?  Exercise and Physical Activity.  

If you need some guidance to get started, keep active, or just need a push to the next level, call for help at 504-313-6502 or leave us some information and we will call you!  Physical Therapists are Movement Experts and our fitness trainers can also set you up with a program and some accountability!
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Last week I spoke on WWL about the importance of hip strength and how to do a quick screen at home to see if you have significant hip weakness.  Enjoy! 

​Over the last month our routines have all changed.  Our communities have responded by keeping in touch virtually, not just for work, but for just about EVERYTHING!  Work, school, church, shopping, conferences, exercise classes, webinars, doctor and PT visits, social get togethers, even wine tasting parties… you name it and someone is doing it virtually.
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In one respect, I have welcomed the slower pace of not rushing place to place every day. We are so lucky to have this technology that is keeping up “together”, but I have certainly seen a physical cost.  I like to call it “fanny fatigue”.   And I mean that literally.  I’m tired of sitting so much, and daily I’m hearing more and more stories from clients about pains that have started since increasing their computer time.  On top of that, the change from crazy schedule to stay at home was so quick, that no one had a chance to set up their home office properly and ended up sitting in kitchen or dining room chairs that are not made for long term sitting.   

​In my own house we have dealt with elbow pain, neck pain, and back pain.  You can see why...

So what is the best thing to do?  
Here is a short list of small changes that can make big improvements for your posture when working on the computer and avoid the aches and pains that come with prolonged sitting and repetitive movements. 

1.  Adjust the height of your monitor so that you can look straight ahead.  Ideally, the top line of the text on your screen should be at eye level.  You may need to be creative and stack some books for boxes to bring your screen up.  Your monitor should be about an arms distance away from your face (20-40 inches away). 

2. Support your low back with a back rest if your chair does not have one already.  You may use a pillow or a towel roll to fill in the curve of your back.  I tell my clients if you can slump down and roll your shoulders forward, you do not have enough back support.  The back support will back it easier for you to sit straight and have your arms by your side instead of reaching forward.

3.  Adjust the height of your chair or keyboard so you have a 90-110 degree angle at the elbow.  This will allow your wrist to lay flat (neutral position).  

4. Your feet should be flat on the floor to provide support for your back.  After adjusting you chair to fit the desk or table height, you may find that you need a small stool or box under you feet to keep them flat.   You need to have a small gap between the back of your knees and the chair seat. 

Need some help figuring your space out? 
Telehealth and virtual PT can make this super easy and convenient!  With a phone camera (and some help in your house), a physical therapist can look directly at your specific set up and make recommendations to improve your positioning, relieve stress from painful joints, and exercises to get you back to work  (or school, or wine tasting...) pain free!  

It’s mid January, which is about the time that resolutions start to fall off.  Some research suggests that by February each year, 80% of resolutions have already been broken.  Making a new habit is hard enough, but especially hard if you have other challenges or pain to overcome.

Or maybe, you didn’t even make a new resolution because you are resigned to inactivity due to back pain?  So far this year (and it’s only the first full week), I’ve had clients tell me that..

• I can’t walk all around the park anymore
• I can’t travel to visit my family
• I can no longer run in races
• I can’t work more than 4 hours

Some of those people feel resigned to this "new normal”, but NO, it doesn’t have to be a new normal.  The truth is, there is always something you can do to improve the way you are moving right now.  Back pain (or knee, or hip, etc) should not limit your goals for the year or stop you from making healthy habit resolutions.  Here are a few tips to help you start the year off right! (And keep it going for 12 months!!!)
 
1. Get Your Joints Moving!!

Movement is the key! Moving you to better health!  These are phrases spoken in our clinic frequently.  But when your joints are stiff, movement is often a challenge.  It’s important to gain movement in the joints before strengthening, or else you will start compensating and create a whole new problem.  Sometimes a hot shower is enough to get you moving, or maybe it’s getting back to a stretching program that has been helpful in the past.   If you have a chronically stiff back, I recommend you see a movement expert (like a physical therapist) to learn a safe way to regain mobility before you start a strengthening program.
 
2. Pace Yourself! 

We all tend to get very excited about new goals and jump in full force.    How many of us have felt SO motivated with a new workout and then couldn’t move the next day?  (I did it last week). Even when you have a good, safe exercise plan, “overdoing it” will could cause muscle soreness, inflammation, or re-injury to the low back.  Our muscles provide support around the spine, but with an exercise routine those muscles are not prepared for, they will easily fatigue and fail to provide the necessary support your body needs for optimal function.

 3. Stay Hydrated

One of the biggest mistakes that could be contributing to your pain and zapping your energy is being dehydrated. Dehydration can cause muscle aches, pains, fatigue, and dizziness.  Recovery after a workout is delay with dehydration.   Try to drink water throughout the day and avoid excess caffeine, including coffee, tea, alcohol. 
 
4. Get Assessed by an Expert.

Your first thought may be to see your doctor before starting a fitness plan.  While that’s not a bad idea for medical clearance, not all medical doctors are fully experienced at evaluating back pain.  Medical doctors will send you for imaging and look for serious problems, like broken bones, but they do not take the time to assess your movement in detail and look and muscle imbalances.  A specialist physical therapist will assess you in detail and will be able to give you more specific information on how your pain may affect any exercise or activity that you want to start.  A physical therapist can make recommendations of how to customize your plan, give you reasonable expectations, and send you off towards your new goal with decreased risk for injury.  If you need help trying to figure out a way to start – click here to schedule a free discovery visit with me to create a resolution you can stick with.
 
Happy New Year – Keep moving toward better health!!!