What do you think of when you hear physical therapy? Most individuals may have experienced or know of someone who experienced physical therapy with a pastinjuryor surgery. This is the bread and butter of what we do as physical therapiststhroughrehabilitating individuals back to what they love to do; however, most people do not know the benefits of seeing a physical therapist for “prehabilitation” or “wellness checkups” prior to a possible or potential injury from occurring.
Just as one goes to the dentist for a biannual checkup for prevention of possible future dental issues, physical therapy has and can be an option for the public in addressing possible musculoskeletal impairments, muscle strength deficits, and range of motion deficits in the body. As most of us all know, exercise has been suggested to aid in multiple health benefits such as preventing chronic disease, boosting mental health, increasing overall longevity, reducingrisk of cardiovascular disease, and improving bone health – just to name a few. As orthopedic physical therapists, we are trained and knowledgeable in rehabilitation and appropriate exercise prescription following injury and/or surgery, but we are also trained in injury prevention by providing patients and clientsresources for reducing their chance of an injury.
As spring is approaching and we are gearing up for the beautiful Montana summer, physical therapy may be of benefit to you or someone you know to increase your chances of a healthy, active, and injury-freeyear. It is typically easier to address these possible impairments before an injury may emerge versus after an injury has occurred. Most everyone, including you, may benefit from a “biannual checkup” with physical therapy!
Matt Schumacher, DPT, MTC, CAFS, CSCS received his Doctorate in Physical Therapy from the University of Mary in Bismarck, ND where he was recognized as a nominee for Outstanding Student Award in his physical therapy class demonstrating excellence in academics, volunteering, and servant leadership. Following graduation, he received training from Gray Institute with a Certification in Applied Functional Science (CAFS). Matt also completed a rigorous year-long program with Evidence in Motion (EIM) achieving his Manual Therapy Certification (MTC) gaining advanced training in mobilization and manipulation techniques for common diagnoses of the spine and extremities. Matt specializes in assisting individuals following post-operative rehabilitation, sports medicine rehabilitation, and orthopedic injuries/ailments of the spine and extremities utilizing advanced knowledge and skill with manual therapy and appropriate exercise prescription.
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.
How a physical therapist uses specialized techniques to help alleviate low back pain.
Learn proven exercises to help low back pain symptoms.
Q&A with Jackie after the talk. Please bring your questions.
Back pain is the most common complaint U.S. healthcare professionals receive daily. Come hear Jackie Oliver, DPT of Excel Physical Therapy discuss back pain and how you can find the pain relief you seek.
Jackie Oliver, DPT completed her Doctorate in Physical Therapy at the University of Utah in Salt Lake City, Utah, one of the top Physical Therapy schools in the nation. Jackie is a certified dry needling provider with advanced training from Evidence in Motion and KinetaCore.Jackie has an intense passion for helping and educating others as well as preventative medicine. Because of her college sports background, Jackie loves working with athletes and has experience with biomechanical training and injury prevention in sports. She is also trained as a Diabetes Lifestyle Coach and has worked for the University of Utah and CDC helping individuals decrease their risk of developing diabetes.Prior to completing her Doctorate in Physical Therapy, Jackie played basketball for Carroll College in Helena, Montana, while also obtaining a Bachelor of Arts degree in Health Science. Jackie was Academic All-American her last two years at Carroll.
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.
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: 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.
My Personal Bout with Acute Neck Pain: Lessons Learned ~ Part 3 of 3
Lessons Learned
I believe that there was a silver lining or a purpose to why I experienced this cervical radiculopathy. As health care practitioners, we sometimes lose perspective on the severity of what our patients are dealing with. The terrible pain, decrease in function, and loss of sleep will be hard to forget. I gained valuable familiarity with the use of a Saunders Cervical Traction Unit and other treatments that are best for an acute and sub-acute radiculopathy. I also became more personally familiar with the use of different medications to treat this condition.
Perhaps the most valuable lesson learned was an appreciation for how important good physical therapy and excellent physician specialty care are. I would not be where I am today without the tremendous care from Megan and Effie (my physical therapists), Dr. Slocum, and the doctors at Bridger Orthopedics and Sports Medicine. Hands on manual therapy, exercises, diagnostic imaging, and epidural steroid injection were all very helpful to me.
This ordeal has helped me to be a better physical therapist when treating the neck. I value the experience over any class or formal education in my past.
Now we love a good pair of heels too, but we saw this information and wanted to pass it on. Perhaps worn more in moderation…. “Ever wondered the effects of high heels on your feet and body? Often painstakingly selected to complete outfits, high heels put stress not just on feet, but on ankles, knees and backs, contributing to the approximately $3.5 billion spent annually in the United States for women’s foot surgeries, which cause them to lose 15 million work days yearly.”
SOURCE: American Academy of Orthopaedic Surgeons, American Apparel & Footwear Association, American Orthopaedic Foot & Ankle Society, Mayo Clinic, Society of Chiropodists and Podiatrists, “Women’s Shoes and Knee Osteoarthritis,” by D. Casey Kerrigan, Jenn.
"I was struggling with wrist pain for over a year, and I thought I had to do surgery and injections to make it better. Jason was a life-saver. I am doing my exercises, and my work at the computer doesn't bother me any more! I feel ready to resume my yoga practices as well. I am very happy Excel physical therapy was recommended to me, and I recommend it to you!" --Bozeman Patient
Physical Therapy as a Means for Prevention 
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.
