Thanks so much for your question Penny!

Inversion therapy is one of those modalities that becomes more popular from time to time, and for some people it definitely provides some relief.

For those of you who are unfamiliar with inversion, it is basically a procedure where the recipient lays on a table which tilts into an upside down position, causing gravity to provide essentially the same benefits as traction would in a physical therapy office. Take a look at the photo below.

For the right patient, it can provide some relief by stretching the muscles, and enlarging the space in between vertebrae- allowing more room for nerves which may otherwise be being compressed.

For the wrong patient, it can be problematic. First of all, patients with any blood pressure issues, family history of stroke, or other brain issues should avoid inversion therapy altogether, as the increased pressure can increase the likelihood of stroke or even death. People with damaged discs can actually worsen their condition with inversion therapy. Even if you have no known issues such as these, absolutely consult your own physician before trying this or any other new modality.

Again, thank you for your question. Please feel free to submit your questions regarding back and neck pain here to the backwords blog- text or video are welcome.

Best,

Andy

.

In my ‘One Thing’ series, experts in back pain from various fields share their one best piece of advice for preventing or eliminating back and neck pain. Today, physical therapist Meghan B. Tierney, PT, MPT, OCS shares her one thing. Meghan is the founder and proprietor of  One Physical Therapy and Wellness in Bryn Mawr PA.

Back Together DVD program now available from Amazon. Click here to order!

Thanks for visiting,

-Andy

If you are an Osteopathic Physician, Chiropractor, Massage Therapist, or other type of body work specialist- purchase an adjustable height table (well worth the investment), and vary the height throughout your work day. Certainly there is a range of height appropriate for the patient you have on your table, but by moving it around, you will prevent yourself from structural compromise over time.

Stop back tomorrow for tips on making commuting a back friendly endeavor!

-Andy

Today, Bob Campbell, Physical Therapist from Rasansky Physical Therapy shares his ‘one thing.’ His clip is based on the observation (shared by many practitioners) that lots of patients will give up on their home exercises once their pain resolves. Remember- most back & neck pain is the result of lots of cumulative effects- and that some of these, if not most, are lifestyle issues. If you do not address the lifestyle issues which caused you back pain after you have been treated, your pain is not likely to stay away for long.

Thanks for checking in,

-Andy

I was seeing a 32 year old mother of 3 for her back pain- let’s call her ‘Sue’- and after seeing her weekly for about 8 weeks, I managed to get her essentially pain free. We discussed her workout regimen, some home exercises I wanted her to do, some ergonomic things she could do around the house, and a few other things before I sent her home.

When I get someone to the point they are feeling pretty good, my goal is to see them for occasional maintenance, perhaps every 6-9 months- with the option of them coming in sooner if they ever had an exacerbation. I never got into the whole ‘I need to see you every week for the rest of your life’ thing (the exception being some of the professional athletes I work with who put themselves in harms way pretty regularly.) I booked Sue for six months, and she was so happy for her relief.

I came into my office one morning about 3 weeks later, and there was Sue- looking none-too-happy with me.

I asked Sue what brought her in. She had full return of her pain, and was incredibly frustrated by her setback. I didn’t want to discuss this in the waiting room, and scare off other patients, so we went back into the treatment room.

Had she fallen, been injured, over did it in the gym?  No- none of the above- her pain was back and she was pissed.

She got up on my treatment table and I began to palpate her spine. Lo and behold, her spine was right back where we had started. It was as though I had done nothing at all. It was at this point, I pursued a different line of questions….

Had Sue taken any of the ergonomic suggestions we discussed for her house? No.

Had Sue been doing any of the specific exercises I had prescribed to help keep her back moving? No.

Had Sue changed her child care situation to involve her husband a little more, so she wouldn’t be the only one picking them up? Nope.

Basically, she left my office the previous visit feeling great- did none of the things we discussed to help maintain her wellness, and was really annoyed when her pain came back.

Here’s the bottom line: If you are going to a Chiropractor, Osteopath  -or anyone else who does manual medicine or body work- you are wasting your time and money if you don’t address the lifestyle issues which caused your back pain in the first place. Back pain is not just a structural  thing. I talk about the pain triad with many of my patients- that is the essential 3 things which I feel contribute to back pain. They are as follows:

Structural issues: These are what they sound like- problems associated with basic structure and function. These things can usually be measured or imaged with x-rays or MRIs, and they can usually be fixed with manual medicine, therapy, and addressing underlying ergonomic concerns.

Psychological Amplifier: This is the part of your mind which gets frustrated or annoyed with the effect back pain has on your life, and can actually make it worse.

The Learned Neurological Response: This is the part of your central nervous system which controls modification of your normal body mechanics in order to find less painful ways of functioning following an injury or compromise, and sometimes has a difficult time resetting once the structural cause of pain has been addressed.

Almost all of my patients have each of these factors contributing to their discomfort- perhaps to different degrees, but they are all there.

For you to really control your back pain, rather than having it control you- you need to look into each of the components of your back & neck pain, otherwise you will forever be at the mercy of physicians and therapists to find relief from your discomfort- and throwing money out the window. Really- give this some thought the next time you experience an exacerbation. Take your practitioners suggestions and information- and use them!! This is the only way you will find lasting relief.

Best,

Andy

One week to the Philadelphia Flower Show- Spring is four weeks away!

A recent update to guidelines by the American Academy of Neurology based upon a study by the University of Kansas Medical Center suggested that a commonly used treatment modality, TENS, was not effective in the treatment of chronic low back pain.

TENS therapy has been in wide use for over 40 years, and many patients have reported benefit from it. The study implied that there was no clear benefit, but that the clinician should use their judgement to determine if it should be used on a particular patient.

Now, I do not use TENS in my office- however, pretty much all of the physical therapists I refer to do, and the patients I have spoken with frequently see benefit from the treatment. So what are we supposed to make of this study? Well, first of all- pain is a subjective issue. Unfortunately, there is really no way to objectively quantify pain. If a patient is telling me they are getting relief from a treatment that has no down side, I am ok with continuing it. The issue for you is going to be coverage. Up until now, it has been reasonably easy to obtain a TENS unit if you had a complaint of back pain. WIth these new guidelines, it will be harder to get a home unit, and I suspect physical therapist will cease to get paid when they perform it in the office. It will be interesting to see how this pans out.

A Quick Thought on Sneakers

A patient came in last week with complaints of low back pain which occurred when they were jogging. Now, there are lots of potential causes for back pain with exercise activities, but this patient’s pain developed over the course of several weeks without a change in their exercise regimen, and no injury or trauma.

As I went through his history, complaints, and physical exam- I eventually got to the topic of footwear. Was he wearing shoes appropriate to his sport? Yes. How old were his shoes? About 18 months….

Since he was running indoors on a treadmill, his shoes looked pretty much new- so he never thought to replace them.

Current shoe technology can do much to absorb the shock of sports activity- however, like all things, they can eventually wear out. Quality footwear, with good supportive arches, and shock absorption will prevent the impact of exercise from being transmitted up through your body and into your spine. If you work out regularly, it is probably a good idea to replace your sneaker every 6 months or so.

Feedback on Donna’s Piece Last Week

Thank you so much for your very kind thoughts on my wife Donna’s contribution last week- I forwarded all of your comments to her. She is already working on her next contribution. I cannot wait so see what she posts!

We are getting ready for more snow here in Philadelphia. Stay warm, and as always, be well.

-Andy

Philadelphia Flower Show- Every February, reminding us that the winter will end, eventually...