While 80% of all US citizens will experience some level of low back pain during their lives, 10.2% (2006 US Survey) of all adults in this country have suffered from chronic low back pain that limits activity for an extended period of time.As a physical therapist that specializes in treating the spine, I often have chronic low back pain patients that struggle to understand why their condition exists.Many clients arrive for an evaluation after years with severe bouts of low back pain that comes and goes with minimal cause or explanation.Trips to the doctor for medication, days missed from work, and visits to various types of practitioners are common with this diagnosis. My experience has found that some of these chronic low back pain patients have spinal instability as the source of their condition.
Spinal instability or excessive vertebral segmental motion is a possible cause of chronic low back pain.General wear and tear, previous injuries, and congenital abnormality of the vertebrae can be factors that lead towards instability.Looking at the spine with the muscles removed, there is a beautiful structure that is present which allows for movement, but also provides stability from one spinal segment in relation to its neighbor (above or below).The discs, ligaments, and vertebrae themselves provide this passive stability.Compromise to these structures can lead to instability or an excessive amount of movement.The muscles of core and deep spine provide protection and smooth movement between the vertebrae and the low back in general, which is termed dynamic stability. When passive stability is lacking, dynamic stability is in greater need.However, dynamic muscular stability of this level is often lacking in spinal instability patients.With these individuals, acute low back pain bouts arise when an activity, such as shoveling snow or even bending over to pick up a pencil from the ground, overloads the available passive and dynamic stability.
Perhaps the most common form of low back instability is an anterior spondylolisthesis or a slippage forward of a lumbar vertebra in relation to the vertebra below it.This diagnosis can be picked up through a detailed and specific physical therapy evaluation and then confirmed with a specialized x-ray of the lumbar spine.A spondylolisthesis has various grades, depending on the degree of slippage measured on the image. A mild or even moderate spondylolisthesis is best treated with specific core stabilization exercises and teaching the patient how to safely lift, given this diagnosis.Higher grades of spondylolisthesis may require surgical spinal fusion to stabilize the segments. Many patients go years or decades without understanding the true source of their chronic low back pain.In some cases, instability or spondylolisthesis is the culprit lurking in the shadows.
As the founding owner of Excel Physical Therapy, David Coletta, MPT, CMPT strives for our clinics to deliver unprecedented excellence with patient care in the Gallatin Valley. David established Excel PT in 2001 on the principles of specialization, advanced education and customer service. David specializes in the treatment of back and neck pain, spinal issues, whiplash, headaches, TMJ/jaw pain, and postural dysfunctions.
Learn why your posture matters, how it can lead to health concerns, and what you can do to improve yours now.
Please bring your older kids! Learning to optimize posture at an early age can have life changing results.
With the popularity of personal electronic devices, poor posture is an increasing problem. People of all ages are at risk for developing a multitude of musculoskeletal problems, including neck pain, back pain, headaches, shoulder impingement, elbow tendonitis, thoracic outlet syndrome, TMD, etc.
David Coletta, MPT, CMPT specializes in the treatment of back and neck pain, spinal issues, whiplash, headaches, TMJ/jaw pain, postural dysfunctions and professional bike fitting. As the founding owner of Excel Physical Therapy, David established Excel PT in 2001 on the principles of specialization, advanced education and customer service. He enjoys finding long-term solutions for his patients — solutions that involve a fine-tuned combination of manual manipulative therapy and a targeted exercise program that address even the most difficult patient presentations.
Although tinnitus, or ringing in the ears, can be a sign of serious brain pathology, tumors, and hearing loss, this condition can also be often diagnosed by your physician as idiopathic tinnitus. Such a diagnosis indicates no known or verifiable cause to the ringing in your ears. Ruling out the more concerning problems through brain imaging, neurological testing, and hearing tests is helpful, but often leaves the patient with no real answers about how to decrease or eliminate the annoying sound. One theory regarding the source of idiopathic tinnitus centers on the musculoskeletal system as a trigger for ear ringing. (more…)
How a specialized physical therapist utilizes manual therapy, patient education, exercise, and dry needling techniques to treat neck pain.
How improving posture can alleviate neck pain.
Which exercises are most effective in self-treatment of neck pain.
Other self-treatment techniques.
There also will be time at the end of the seminar to speak with David regarding your specific neck problem.
David Coletta, MPT, CMPT has specialized in the treatment of back and neck pain, spinal issues, whiplash, headaches, TMJ/jaw pain, and postural dysfunctions for over 15 years. David received his masters in physical therapy from Mount St. Mary’s College in Los Angeles, California. He enjoys finding long-term solutions for his patients — solutions that involve a fine-tuned combination of manual manipulative therapy and a targeted exercise program that address even the most difficult patient presentations. A considerable amount of David’s training from leading physical therapy clinicians has occurred through the North American Institute of Orthopedic Manual Therapy (NAIOMT). He has completed advanced certification in manual therapy (CMPT) with NAIOMT and has received advanced training in dry needling techniques for the spine and extremities. David is also a Certified Clinical BikeFit Pro Fitter.
At Excel PT of Bozeman and Manhattan, we are dedicated to providing our patients with the highest level of physical therapy treatment. Our physical therapists focus on evidenced-based practice, rigorous continued education in specialized areas of treatment, and weekly research-based study to allow our patients to quickly and effectively achieve the best results. To further ensure preeminent physical therapy services and patient care, each of our patients are directly treated by our licensed, specialty certified physical therapists – without interaction from assistants or aides.
There is no doubt that leg length differences (LLDs) exist, but a lack of agreement exists about diagnosing the condition, their functional importance, and how to treat them. How many of us have been to the physical therapist, massage therapist, or chiropractor and were told that our legs were not of equal length? Lying face up on the exam table, we ponder what to do about this recent revelation.
Most experts agree that 0.5 centimeters (1/8 inch) or less of leg length difference is not significant. Furthermore, most clinicians agree that mild to modest discrepancies should not be corrected in the absence of pain or dysfunction. If it doesn’t hurt, then don’t fix it. But what if the difference is causing problems? How reliable is a clinician’s assessment of your LLD?
LLDs can be either anatomical or functional. An anatomical LLD is present because of a structural (bone; cartilage) difference, comparing one leg to the other. For example, an individual may have broken a bone in his or her leg at a young age, creating a disturbance in the growth plate, ultimately leading to an alteration in that bones final, mature length. A functional leg length occurs when a limb only presents longer or shorter because of being forced into this position by changes in muscles or other soft tissues of the low back, hips, or feet. Tight muscles in the right side of your low back can draw up the right leg, making it present as shorter.
Clinically, physical therapists can pick up a LLD by looking at your leg lengths in standing and lying down with the use of visual inspection and tape measurement. There have been several studies looking at the accuracy of LLD clinical assessment and the evidence seems to point towards our ability in picking up these discrepancies. However, clinical accuracy is limited. I can say “Mrs. Jones, your left leg is around 1 to 1.5 centimeters longer on the right.” I cannot say “Mrs. Jones, your left leg is exactly 1 centimeter longer on the right.” Only obtaining an x-ray or CT-Scan of the legs can give you a fairly accurate number on LLD.
Most of us are walking around with some type of LLD, which is more likely functional, rather than anatomical. Don’t be surprised if someday you are told that one leg is longer or shorter than the other. In the presence of pain, a LLD can be addressed by placing a heel lift in the shoe or adding to the sole on the outside of the shoe. Use caution when correcting a LLD. A good rule of thumb is to correct for no more than ½ of the suspected LLD and only make an alteration of 3 to 5 millimeters at one time. Wait several weeks to month a month before trying additional lift height. Your physical therapist or other health care professional can assist you in this process.
To reach David Coletta, MPT, CMPT with any LLD questions, please contact him at “david at excelptmt dot com” or call our Excel Physical Therapy Bozeman office at 406.556.0562.
Proper Computer Ergonomics for a Healthy Neck & Back
Using computers have become a normal part of most people’s daily lives. For many of us, sitting at a desk top or laptop computer can last several hours every day. Do you suffer from neck pain, upper back pain, or headaches? Could poor posture at the computer be a contributing factor to such complaints? A 2012 study (Cho et al) found that 254 surveyed Chinese office workers, between 25 and 40 years old, working 3+ hours per day at the computer, had a 71%-76% prevalence of neck pain and a 60%-64% prevalence of upper back pain.
How often do we find ourselves stuck in postures such as this? Poor positioning, most often producing a forward head, causes undue stress on the neck and upper back muscles and joints. Over time, the soft tissues cannot bear the burden without developing tightness and inflammation. Such complaints lead to pain and a visit to the physical therapist, massage therapist, or doctor in search of relief.
A proper desktop set-up starts with a higher quality supportive computer chair, which securely supports the lower back lordosis, has great deal of adjustability, and comes with padded arm rests (forearm rests on padding). A large computer screen, with the top edge placed just above eye level, is optimal. The keyboard and mouse should be easily accessible to the hands so that the elbow can rest under the shoulder. The ultimate goal is to have the ear, shoulder, elbow, and hip almost in a perfect vertical line.
If the top of your desk is too high, then your keyboard and mouse can be placed on an adjustable external tray that is secured underneath this surface. Obtaining proper ergonomics can be a good deal more challenging with a laptop computer, but purchasing an external keyboard and mouse or a laptop stand can be helpful. These and other computer ergonomic products can be found online at ergopro.com
My Personal Bout with Acute Neck Pain: The Onset ~ Part 1 of 3
The Onset
Evaluating and treating individuals with neck pain has been my specialty over the past 15 years. I have literally treated over a thousand people suffering from this affliction. Recently, neck pain became a much more personal issue, as I experienced the sort of agony which some of my patients deal with. For the past 20 years, my neck has been intermittently stiff, with the occasional inability to turn my head for a day or two and what felt like an acute muscle spam, but there has been nothing of serious concern. This was different. While still in bed, I opened my eyes in the morning and noticed neck stiffness when turning over. Could this be one of those mornings where there would be trouble turning my head? Better to get up slowly. I sat up and immediately felt a rush of nauseating pain sweeping into my low neck and then shooting into my left shoulder blade. I don’t have time for this I thought. Into the shower for some hot water on the neck and down the hatch with 600mg of Ibuprofen. I drove to work applying traction to my neck with both hands and steering with my elbows and knees. A smarter man would have just stayed at home and called in sick. But I had patients that depended on me.
Luckily, this was my short day of the week at work. My neck pain steadily grew worse and by 2PM I was stuck with my head down and turned to the right, avoiding the worst ache. I utilized a home traction unit from work and had to go very slowly and gently not to aggravate my symptoms. That night, I managed about 2 hours of sleep, constantly readjusting to avoid pain.
The next morning, I called a physician friend of mine and he prescribed me a round of oral steroids. After 3 days, my neck pain slowly started to improve and within 1 week I was 75% better and training on my road bike for short periods. Unfortunately, this progress did not last.
8 days after the initial onset, my symptoms suddenly returned in the morning and were even worse. At this point I had to be honest with myself about the serious nature of my neck problem. My symptoms included weakness in the left arm, severe pain behind the left shoulder and into the shoulder blade, severe neck pain, numbness in the left hand, and I could not extend my neck or turn to the right. This was a very familiar presentation, a cervical radiculopathy. It had to be a disc bulge in my low neck that was inflaming and compressing one of the spinal nerves. Megan Peach, DPT, here at Excel PT did a great job at treating my acute problem, but my presentation was too severe to benefit from PT at that time. I decided to make an appointment with a local orthopedic specialty physician.
My Personal Bout with Acute Neck Pain: Recovery ~ Part 2 of 3
Recovery
As a physical therapist specializing in treatment of the spine, I had a great deal of experience with the physicians at Bridger Orthopedic & Sports Medicine. This seemed like a good place to seek advice and help for my agonizing condition. I called Christine, a patient care coordinator at Bridger, and she was kind enough to get a same day appointment for me with Dr. Speth and Bryce Wiley, PA-C. They performed a very thorough evaluation and determined that I most likely had a cervical radiculopathy. I was in for a cervical MRI the next day and Bryce called to inform me that the imaging revealed a left C5/C6 disc bulge with compression on the C6 nerve root. There was also some cervical arthritis present in the mid to low neck.
Again, the patient care coordinators (Christine & Shane) quickly scheduled me for a cervical steroid injection with Dr. Slocum at the surgery center, just below Bridger Orthopedics & Sports Medicine. Dr. Slocum was kind enough to come downstairs between seeing patients and perform a transforaminal steroid injection in the neck. During the procedure, I took the opportunity to dissect what was going on. Some of my patients go through spinal injections and they will often ask me if it is painful. Now I was about to find out. I’m sure the experience is different for all people, but my procedural pain was considerable, though quite brief. Dr. Slocum injected around C6 on the left and for about 5 to 6 seconds I felt all of the pain that I had experienced over the last week and a half condensed into my neck, shoulder blade, and arm. Within a few minutes there was some relief. Dr. Slocum explained that the injection could take 1 to 2 weeks for the full positive effect, but I would experience an initial decrease in pain within the first day, which might not last.
The next morning I woke up and felt 90% better. I could move my neck, lie down comfortably on my back, and work on patients without concentrating on my own pain. Slowly, by the next day this reduction in pain slid backwards to about 50% better. I had a problem. Two days later, I was to be on a flight to Chicago for a much anticipated PT continuing education course. Bryce prescribed me another round of oral steroids and more hydrocodone for pain relief. I made it to Chicago, wearing a soft cervical collar on the airplane to support my neck.
I arrived at my continuing education course tired, now only 40% better, and unable to sit during the presentation. I was truly blessed to be traveling with Jason Lunden, one of our sports specialist PTs from Excel PT, and sitting next to another experienced PT named Effie. During the first break she looked at me and asked if I was OK. She got the full story. Effie said “I can help you.” I immediately explained how serious this problem was and that I probably was not appropriate for hands-on PT treatment. She assured me that her specialty was in spine. Sounds familiar. Effie performed left sided cervical and upper thoracic joint mobilizations, soft tissue techniques to the shoulder blade and shoulder muscles, and traction to the neck. These techniques were more aggressive than I would have chosen for my patients, but I was willing to try anything and I trusted her. After 10 minutes of treatment, my pain was reduced greatly and I practically fell asleep on the table.
Effie treated my neck again on the following 2 days of class and, by the time I returned home to Bozeman, the symptoms were improved to 75% of normal. I continued under the care of Megan Peach, at Excel PT, and I reached 95% improvement over the next month with physical therapy treatments 2x/weeks. The remaining 5% of symptom reduction and full strength in the left arm took 2 to 3 more months of performing my exercises independently.
"I am training for a triathlon which involves lots and lots of hours on a time trial bike. I went to Jason to get my bike fit dialed in. He not only helped me get more aero but helped make it more comfortable. Secondly, he helped me with alignment with me feet and knees. The muscular pain I was having last year from doing the long rides in my back and glutes has not re-appeared this year. Thanks Jason. I am feeling faster and fitter because of the Professional Bike Fitting." -Bozeman Patient
Your Chronic Low Back Pain Could Be Instability of the Spine Lurking in the Shadows
How often do we find ourselves stuck in postures such as this? Poor positioning, most often producing a forward head, causes undue stress on the neck and upper back muscles and joints. Over time, the soft tissues cannot bear the burden without developing tightness and inflammation. Such complaints lead to pain and a visit to the physical therapist, massage therapist, or doctor in search of relief.
