*RESEARCH: Study Finds Routine X-rays for Low Back Pain May Not Be Needed

Most people who have experienced low back pain want to get better as fast as possible.  Who wouldn't? Do X-rays and MRI or CTscans help speed up the process and get you back on your feet faster?  

 

A study published in the Annals of Internal Medicine found that these tests rarely improve outcomes. The authors suggest that they do not help and they add cost and potential for harm (exposure to radiation). They state that testing may even lead to unnecessary procedures or surgeries as the tests often pick up non-symptomatic findings.  They recommend that imaging be performed only when there are added risk factors.  These factors may include a history of cancer or osteoporosis.  

 

So although back pain makes you want an answer NOW, X-rays or other tests may not give you the answers you need to get better, and may lighten your pocketbook in the process.  The good news is that most back pain gets better on it's own or with conservative treatment (such as Physical Therapy).  Talk with your Doctor to see if imaging is needed.

 



*SIMPLE STEP EXERCISE: Laying Around with Feet Up for Low Back Pain

Did I get your attention with the name of this "exercise"?  I can just hear you thinking " forget the sweaty-ab crunchy- run till you drop stuff.  I want to do that laying around exercise."  This won't whittle your waist or make you drop pounds but it is good for pain.

This is one of my favorite starter exercises for low back pain.  It is tolerated by almost everyone and can result in a lot of pain relief.  I could have called it something more technical sounding but this gets the point across.  Patients also have a harder time coming up with excuses for not doing their exercise (it is a little hard to say you don't have time to lay around).  

 

It is a little more than just lying down like a couch potato.  The secret is in the positioning.  Basically, you lie on your back with your feet up on a chair or something else (see other options below) that keeps your hips and knees each at 90 degree angles.  Picture the position you would be sitting in a chair but lying on your back.  

 

There are several benefits of this position.   It helps take the pressure off the lower spine which is a common area of compression.  Gravity takes a toll on the spine and most daily activities involve sitting, standing or picking things up which increase the wear and tear on the back.  Laying down in this position allows for the spine to elongate and improve the spaces between the bones. It also gives the discs a chance to "plump" back up. Even though the position is the same as a sitting position, the spine is not bearing weight in an up and down manner, allowing it to stretch out.  

 

If the support is good, this position also allows all the muscles to relax.  The muscles usually tighten up when there is pain which leads to more pain.  In this position, you can let go from trying to support your spine and body. This gives the muscles a chance to "reset" and relax.  

 

This exercise also allows for a good posture position to be achieved in a safe manner.  When trying to teach correct posture in sitting or standing, there are a lot of moving parts to consider.  When lying on the back, it easier to get the correct position.  The spine is supported on the surface and the legs are supported on the chair.  Everything lines up better in this manner.  

 

Often, when people in pain can't tolerate any other position, they can tolerate this one.  The only tricky part can be getting up and down.  If you don't have pain, it is still a good idea to follow these steps.

 

1.  This exercise can be done on the floor, but I often recommend people do this on the bed to avoid getting up and down from the floor.  

2.  Try to keep back straight when getting up and down, don't twist your spine.  Sit, lower yourself down onto your side with your elbow, then turn as one unit (keep spine-hips-knees together "like a log"), and put your legs onto the chair (or other object- see below).    Have someone help you with your legs if needed.  

3.  Make sure your calves are completely supported by the chair.  

4. Now the best part:  Lie there and rest comfortably and let all your muscles relax.

5.  This exercise is best done for at least 5-10 minutes, but feel free to hang out for a while.

6. When done, bring your knees towards your chest and "roll like a log" in the reverse order of the way you went down.  Sit for a minute or two, then stand up.  

 

 

Some things to consider:

 

1. There should be NO pain doing this exercise.  If there is pain and you can't readjust to relieve it,  see your physical therapist-there may be something else going on that needs checked out.

2.  The floor is a good surface to do this on but only if you can easily get up and down.  Do it in the bed if you can't.  

3.  The back doesn't have to be completely flat but shouldn't be curved up too much.  

4. Relax and breathe slowly and let your belly rise up and down instead of your chest.  

5. Have someone help you get in to position if needed.

6.  This is a good before bed exercise.  It relaxes your body and helps you sleep better.  

7.  Besides before bed, it can be done any time of day.  I have had people lay down on the floor in the office in the middle of the day.  Whatever works for you.

8.  This exercise is intended to give some pain relief so that walking and other activities can be easier to do.  I am NOT suggesting that this is your ONLY exercise for low back pain.  Many studies have shown that complete bed rest is not good for recovering from acute back pain.  Use this exercise to decrease the pain so you can start walking or doing other active pursuits to recover faster.

  

 

Other options for leg support in place of the chair:

 

 

Couch

 

Shower chair: This is what I use in the clinic- it is easy to clean, lightweight, and mine has handles to make it easy to lift. They also typically have adjustable height legs (handy if you have to switch between tall and short people). You can typically find them at places like Wal Mart or a drug store.  

 

Exercise Ball:  This isn't the best option for relaxing in this position as it rolls and moves. This can be used in bed if you have a way of keeping it stable. It can be good as an option if you do want to work on mobility in this position, such as gentle rocking of the knees side to side or back and forth.  Check with your therapist to see if you are up to these movements.

 

Rubber Tote/ Container/ Laundry Basket (turned upside down):  The type you would store things in the attic or garage.  Make sure it is the right size for you.

 

Storage Ottoman:  This is one of my favorite recommendations for at home use.  It is a multi-purpose piece that you can use on the bed or on the floor AND you can sit on it or prop your feet on it while sitting in a chair.  It also stores items inside and typically has handle openings on the side for ease of lifting.  

 

Five Gallon Bucket (turned upside down):  Not as ideal as the other options as it is narrow and harder to keep your legs on, but it can work in a pinch.  

 

 

Now, go lie about in the Laying Around With Your Feet Up position.  If anyone calls you lazy,  you can tell them "No, I'm exercising".

 

 

TIME SENSITIVE BONUS INFO:

 

As of the writing of this post, Target has the storage ottomans on sale in their weekly catalog for $16 (Feb 27 to March 5 2011). This is the lowest price I have seen them.  They are only 15 inches high so they may not suit everyone.  A quick search on their site shows more variety in sizes and styles (some even have trays) in the range of $35 to $80.  I have also seen them at Wal Mart and other stores that carry furniture.

 



*Product: Commandos - Underwear Alternative for Pelvic Pain

Have you ever gone commando?  No we're not talking military references here.  We're talking without underwear- sans panties- hasta la vista lingerie-you get the idea.

While there are some people who may choose to do so to avoid panty lines, there are people with pelvic pain who may benefit from a panty-less option due to pain.

 

Often people with pelvic pain (including vulvodynia, vestibulitis, interstitial cystitis, and people who have had multiple pelvic/abdominal surgeries) or fibromyalgia may not be able to tolerate even the compression in the waist and leg bands of underwear.  They also may be sensitive to chemicals and manmade fabrics -anything other than natural cotton.  This makes even something as simple as wearing underwear very painful.  

 

Enter the Commandos solution.  They are a cotton patch that you simply stick to the seam of your pants.  You can wear them without chemicals or compression.  Simple but effective.  You also get the benefit of avoiding the dreaded "panty lines" without the dreaded "thong" (a complete no-no for the pelvic pain population).  

 

Check out the testimonials on their web site from other women with pelvic pain.  You can currently purchase 8 patches for $16.00.  

 

Give them a try and let me know how it goes. Best of all, no one else has to know you "go commando". 



*Surprised at What PT Can Do?

The past several posts were an overview of some of the conditions and physical therapy treatments that will appear routinely in this blog.

 

So, were you surprised at some of the problems that physical therapy can help?  You are probably familiar with PT for back and neck pain and other joint and muscle injuries. Did the parts about pelvic pain, incontinence, pregnancy, fibromyalgia, and TMJ- Jaw pain make you think "I didn't know PT did that!"  Well, that's what some of us do.  We all work on muscles, joints, bones and improving function.  PT's who specialize in pelvic floor rehab or women's health work on muscles, joints, bone and improving function in the pelvic area.  

 

Hopefully I have stimulated your interest.  Keep checking back for more articles on a variety of these topics in the future. In addition to information on conditions related to pain and women's health, there will also be posts on product reviews, useful ideas to help make life easier, tips and tricks, and things I throw in just for fun.  

 

Feel free to add your comments and let me know what topics you want to read.  

 

Be sure to check out the next post for a useful and fun product review. 



*Osteoporosis and PT

OSTEOPOROSIS

Osteoporosis or osteopenia is a thinning of bone caused by your body not building enough bone or breaking too much down. When this happens your bones break more easily. This condition affects more than 25 million Americans of both sexes and includes men and children. Women, however are hit the hardest with one-third of all women over 50 suffering a broken bone because of bone thinning.  The most common fracture areas are the spine, hip, and wrist.  Fractures are difficult for anyone but are especially devastating for the elderly who are more at risk of falling and ending up needing nursing home care. 

Physical Therapy can help by establishing an exercise program to stimulate your body to build bone safely.  A PT can also help with modifications to movements and improvements to balance to make fractures less likely. 

Conservative Physical Therapy Management of osteoporosis may include: 

• Modalities: such as heat and ice
• Manual Therapy:  “hands on” treatment to improve pain and restore function and movement. 
• Mobilization and Manipulation:  movement of a joint to improve pain and restore functional movement.
• Therapeutic Exercise:  specific exercise to improve pain and restore functional movement.  It is important with osteoporosis to avoid certain positions and progress slowly.
• Functional Movement Training:  exercises to improve posture and movement.
• Biofeedback:  a way of using a computer or other device to “see” and improve body functions such as muscle activity or indicators of stress.   
• Electrical Stimulation or TENS:  used to help improve pain, inflammation, muscle spasm, muscle function, and circulation.

Physical Therapists are specialists in restoring movement and function related to muscle, bone, or joint dysfunction.  They often work to improve pain and disability.  To learn more about PT or find one in your area, check out a consumer oriented site on PT here   or the main site of the American Physical Therapy Association (APTA) here.

Here is a slideshow on diet and exercise for osteoporosis.

*Links are given to provide a general overview of a topic and not intended to suggest complete or authoritative information on a particular subject.  The information provided is always subject to change.*