SNOW SHOVELING

HOPE YOU ALL HAD A WONDERFUL HOLIDAY WEEKEND! 

Snow shoveling is a repetitive activity that can cause muscle strain to the lower back and shoulders. Back injuries due to snow shoveling are more likely to happen to people who may not know that they are out of condition. Following these tips can help you avoid injuries:

• Lift smaller loads of snow, rather than heavy shovelfuls. Be sure to take care to bend your knees and lift with your legs rather than your back.
• Use a shovel with a shaft that lets you keep your back straight while lifting. A short shaft will cause you to bend more to lift the load. Using a shovel that’s too long makes the weight at the end heavier. Step in the direction in which you are throwing the snow to prevent the low back from twisting. This will help prevent “next-day back fatigue.”
• Avoid excessive twisting because the spine cannot tolerate twisting as well as it can tolerate other movements. Bend your knees and keep your back as straight as possible so that you are lifting with your legs.
• Take frequent breaks when shoveling. Stand up straight and walk around periodically to extend the lower back.
• Backward bending exercises while standing will help reverse the excessive forward bending of shoveling: stand straight and tall, place your hands toward the back of your hips, and bend backwards slightly for several seconds.
• If you or anyone you know is experiencing back pain, consult a licensed physical therapist.

LOW BACK PAIN: WHY YOU SHOULD GET PHYSICAL THERAPY FIRST

Over any 3-month period, about 25% of Americans will have low back pain. In most cases, it is mild and disappears on its own. But sometimes the pain lingers, returns, or worsens, leading to a decrease in function and quality of life.

In an era when back pain is often over-treated, due in part to unhelpful imaging scans (like x-rays) that may lead to unnecessary surgery, narcotics, and higher costs, physical therapy is a proven and cost-effective treatment option that you should consider as a first choice.

Studies show that early physical therapy for low back pain significantly lowers the total scope and cost of care.

Here's why you should consider getting physical therapy first:

Back Pain Often Leads to Missed Work and Overly Expensive Treatment

• According to the most recent news release (December 2014) Employee Cost Index from the Bureau of Labor Statistics, more than 200,000 incidents related to back injury were reported in 2013, causing an average of 7 days of missed work.
• Direct costs to treat back problems totaled $30.3 billion in 2007. Of that, $4.5 billion was spent on prescription medications. The average expenditure per person for treatment was $1,589, and $446 for prescription medications.

Physical Therapy Is An Effective, Cheaper First Choice

• Scientific research overwhelmingly points to the effectiveness of conservative treatments, such as physical therapy, for low back pain. Despite this, and published guidelines suggesting conservative treatment as the best first option, physicians still often order imaging scans (like x-rays), prescribe narcotics, and refer patients to other physicians, including surgeons.
• A September 2013 study found that there was no significant difference in outcomes between patients who chose spinal fusion surgery, as compared to those who chose the nonoperative treatment (physical therapy).
• An award winning 2015 study demonstrated substantial potential for lowered costs and reduced health care utilization for patients who received, and adhered to, early physical therapy for low back pain.

HERNIATED DISCS

When people say they have a "slipped" or "ruptured" disk in their neck or lower back, what they are actually describing is a herniated disk-a common source of pain in the neck, lower back, arms, or legs.

Anatomy

Discs are soft, rubbery pads found between the hard bones (vertebrae) that make up the spinal column. The spinal canal is a hollow space in the middle of the spinal column that contains the spinal cord and other nerve roots. The discs between the vertebrae allow the back to flex or bend. Discs also act as shock absorbers.

Discs in the lumbar spine (low back) are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine (neck), the discs are similar but smaller in size.

Cause

A disc herniates or ruptures when part of the center nucleus pushes through the outer edge of the dick and back toward the spinal canal. This puts pressure on the nerves. Spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain, numbness, or weakness in one or both legs.

Risk Factors/Prevention

In children and young adults, discs have high water content. As people age, the water content in the discs decreases and the disks become less flexible. The discs begin to shrink and the spaces between the vertebrae get narrower. Conditions that can weaken the disc include:

• Improper lifting
• Smoking
• Excessive body weight that places added stress on the disks (in the lower back)
• Sudden pressure (which may be slight)
• Repetitive strenuous activities

Symptoms

Lower Back

Low back pain affects four out of five people. Pain alone is not enough to recognize a herniated disc. See your doctor if back pain results from a fall or a blow to your back. The most common symptom of a herniated disc is sciatica—a sharp, often shooting pain that extends from the buttocks down the back of one leg. It is caused by pressure on the spinal nerve. Other symptoms include:

• Weakness in one leg
• Tingling (a "pins-and-needles" sensation) or numbness in one leg or buttock
• Loss of bladder or bowel control (If you also have significant weakness in both legs, you could have a serious problem and should seek immediate attention.)
• A burning pain centered in the neck

Neck

As with pain in the lower back, neck pain is also common. When pressure is placed on a nerve in the neck, it causes pain in the muscles between your neck and shoulder (trapezius muscles). The pain may shoot down the arm. The pain may also cause headaches in the back of the head. Other symptoms include:

• Weakness in one arm
• Tingling (a "pins-and-needles" sensation) or numbness in one arm
• Loss of bladder or bowel control (If you also have significant weakness in both arms or legs, you could have a serious problem and should seek immediate attention.)
• Burning pain in the shoulders, neck, or arm

Diagnosis

To diagnose a herniated disc, your doctor will ask for your complete medical history. Make sure to tell him or her if you have neck/back pain with gradually increasing arm/leg pain. Tell the doctor if you were injured.

A physical examination will help determine which nerve roots are affected (and how seriously). A simple X-ray may show evidence of disc or degenerative spine changes.

MRI (magnetic resonance imaging) or CT (computed tomography) (imaging tests to confirm which disc is injured) or electromyography (a test that measures nerve impulses to the muscles) may be recommended if the pain continues.

Treatment

Nonsurgical Treatment

Nonsurgical treatment is effective in treating the symptoms of herniated discs in more than 90% of patients. Most neck or back pain will resolve gradually with simple measures.

• Rest and over-the-counter pain relievers may be all that is needed.
• Muscle relaxers, analgesics, and anti-inflammatory medications are also helpful.
• Cold compresses or ice can also be applied several times a day for no more than 20 minutes at a time.
• After any spasms settle, gentle heat applications may be used.

Any physical activity should be slow and controlled, especially bending forward and lifting. It is extremely helpful to partake in physical therapy, as all strengthening movements will be monitored and safe. This can help ensure that symptoms do not return-as can taking short walks and avoiding sitting for long periods. For the lower back, exercises may also be helpful in strengthening the back and abdominal muscles. For the neck, exercises or traction may also be helpful. To help avoid future episodes of pain, it is essential that you learn how to properly stand, sit, and lift.

If these nonsurgical treatment measures fail, epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. These injections are given on an outpatient basis over a period of weeks.

Surgical Treatment

Surgery may be required if a disc fragment lodges in the spinal canal and presses on a nerve, causing significant loss of function. Surgical options in the lower back include microdiskectomy or laminectomy, depending on the size and position of the disk herniation.

In the neck, an anterior cervical diskectomy and fusion are usually recommended. This involves removing the entire disc to take the pressure off the spinal cord and nerve roots. Bone is placed in the disc space and a metal plate may be used to stabilize the spine.

For some patients, a smaller surgery may be performed on the back of the neck that does not require fusing the bones together.

Each of these surgical procedures is performed with the patient under general anesthesia. They may be performed on an outpatient basis or require an overnight hospital stay. You should be able to return to work in 2 to 6 weeks after surgery.

TA MUSCLES AND BACK PAIN

WHAT IS IT?

You may not have heard of the transverse abdominis (TA) muscle, but it's an important muscle that acts as a stabilizer of the low back and core muscles. It is one of the main core stabilizing muscles of the lumbar spine. A weak TA is often indicated in low back pain. If you're looking to alleviate lower back pain, strengthening your TA muscle may be the ticket.

WHERE IS IT?

The TA is the deepest layer of abdominal muscles and runs between the ribs and the pelvis, horizontally from front to back. When activated, the TA muscles create a deep natural "corset" around the internal organs and lumbar spine. This activation flattens the abdominal wall, compresses the viscera (internal organs), supports the internal organs and helps expel air during forced exhalation. One major function of the TA muscles is to stabilize the spine and pelvis during movements that involve the arms and legs.

WHAT HAPPENS WHEN YOUR TA ISN'T BEING UTILIZED

If the TA muscles are weak, the abdominal wall will begin to bulge forward and the pelvis may rotate forward and increase lordosis (inward curvature) in the spine. This can result after pregnancy and may also be associated with weight gain or lack of exercise.

A recent study shows that weak TA muscles may be to blame for lower back pain. Lack of strength, in this case, is a lesser concern compared to an inability to activate. Decrease in activation is caused by sedentary lifestyles, where the brain essentially "shuts off" the TA in response to lack of use.

When activities are added into sedentary lifestyles, like gardening or dog walking, back pain is the result because the brain-musculoskeletal relationship does not recognize the difference in activity until afterward.

This reason is essentially the same concept behind soreness. The body can complete many activities, some will just simply cause soreness because the body isn't used to being challenged in that manner. 

Add in an activity like gardening or dog walking, and the brain will not recognize the body needs the TA until even months down the road.  This is the main difference between muscle soreness and back pain related to TA activation; many muscles on the extremities are operationally responsible for specific movements - for example, the elbow is mainly bent by the biceps. The TA is not responsible for core strength - the obliques and rectus abdominus are more useful as far as actual strength goes. However, the small aspect of keeping the viscera stable and contained, as well as keeping the pelvis and spine stable, cannot be done without the TA.  This will eventually result in back pain, and the back pain will continue until the TA is retaught to fire. It is for this reason that it is just as important to train the brain in activation as much as it is in training the muscle, itself. 

DOES THIS SOUND LIKE YOU?

Talk to your doctor about chronic back pain, and make sure to mention any changes in your activity levels or daily routines.  Ask them to recommend you to Champion Performance and Physical Therapy, as that is a sub-specialty of ours. It takes diligence to train your body to activate and strengthen your TA, but with the right guidance, it is possible to continue your activities pain-free. 

DOES BAD POSTURE = BACK PAIN?

First thing's first:

Bad posture does not necessarily imply back pain.  Some people are naturally born with protracted, rounded shoulders, hyperlordosis, or hyperkyphosis (excessive curvatures) of the spine. When this happens, the body makes adjustments to accommodate the forces that act on it during daily activities, such as sitting, standing, and lying down. 

Next question:

Without any physical limitations or deficiencies, however, bad posture being correlated with back pain brings a question similar to that of "what came first - the chicken or the egg?"  You must decide which scenario better fits your situation.

Back pain can cause a negative shift in posture to accommodate and relieve the pain - back pain comes first.

OR

Poor posture, including slouching, rounded shoulders, head and neck, cause increased stress on the muscles of the back, causing pain. 

Thirdly:

Bad posture, without any anatomical limiting factors, is typically caused tightness of certain muscles, mixed with weakness of others.  In addition to muscular deficiencies, there are likely going to be some joints that are misaligned within the spine.

Let's start with the muscles.

A mixture between hip flexor tightness and pectoral tightness, along with scapular weakness and core weakness are 8/10 musculoskeletal cause of poor posture.

Tightness in these areas are more likely to come from more stagnant lifestyles; which doesn't necessarily mean sedentary, more along the lines of many activities may cause similar positions. 

For example: a business man who works a desk job is also an avid cyclist. Sitting in a desk chair all day, then cycling many miles in a hunched position, then come home to eat dinner seated, unwind seated, would mean their lifestyle is positionally stagnant. 

In other words, you may be an active person living an decently active lifestyle, but if you sit and think about it, many of the activities you partake in involve the same anatomical positions. Keep in mind, some are more prone to problems related to this than others. 

Misaligned Joints:

Almost every single muscle of the body inserts onto a bone. Keep in mind, your skeleton is simply a lever system controlled by the muscles. Your bones don't move, your muscles pull on your bones to make them move. 

So with that in mind, picture a person with half of their muscles tight, and half of their muscles weak. All of those tight muscles are pulling hard on their bony insertion points, and when their muscular counterparts are too weak to keep the bones in place, the joints will become misaligned. This can cause over-stretching of the weaker muscles, and nerves to get pinched underneath the tighter muscles.

Ergo, how bad posture can lead to back pain. 

Lastly: 

How do you naturally combat this?

1. Ensure good joint alignment.

When you bend down to put a dish away, make sure you lower your body with your legs, and activate those glutes.  They're relatively speaking to strength, some of the most influential muscles in your body. Keep your knees over your ankles, and shoulders over your knees when squatting down.

2. Ensure good core activation.

Make sure when lowering your own body down into a squat, picking/lifting any objects, and even sitting and standing, that you are keeping your core tight. Not sure what this means? Lay down on your back, look down at your belly button. Next, find your hip bones - these mark the start of the front of your thighs. Place two fingers just on the inside of each of those hip bones and say "SSS" short and quick.  Feel that contraction? That's your core. Keep it contracted. The stronger it is, the less back pain you'll have. 

3.  Work on your movement.

Be very aware of the movements you perform on a daily basis that cause pain or discomfort. Your physical therapist will want to know, and they'll give you exercises to relieve the tension on some muscles, and to strengthen others. 

4.  Vary your posture. 

Mix it up! Sit at a desk 8 hours per day? Stand every couple.  It's best for brain function to take a 5 minute break every hour, and it's best for musculoskeletal function to change positions every 20 minutes or so.  This does not mean sitting to standing, maybe just sitting back in your chair to sitting forward with your hands or elbows on your desk. Most people slouch in their chairs without even noticing, so make sure to adjust your position frequently if you plan to stay seated throughout most of your day. Another option that helps from slouching is avoiding using the backrest of the chair. 

Questions? Call or set up an appointment with our wonderful staff - we're all specialized in problems such as this!