Sooner Is Always Better
Recent Research On Early Physical Therapy Intervention For Lower Back Pain
Physical Therapists play a key role in the management of lower back pain. The lower back pain patient often must travel a long and irregular road on the way to a physical therapist for care. Patients often have multiple doctor visits, imaging tests, various medications, epidural injections, and worst of all– rest. So when is the best time for a lower back pain patient to see the physial therapist? A recent research study has answered that question.
Scheduled to be published in the journal Spine, this study* of over 32,000 patients has concluded “Early physical therapy following a new primary care consultation was associated with a reduced risk of subsequent health care compared with delayed physical therapy”. Early physical therapy was defined as less than fourteen days. Early physical therapy lowered costs, reduced the number of visits to the physician and decreased the use of injections, diagnostic imaging tests, and surgery.
Industry and business has figured this out. Computer chip maker Intel has a program that gets their injured employees with back pain to the physical therapist in 48 hours. Since utilizing this program, the cost of care has dropped by 30%. The number of lost workdays has fallen from 52 to 21 days and patient satisfaction with the program is better. Since 2006, Starbucks has been using a program that gets their employees with back pain to the physical therapist in twenty-four hours. They have achieved lower costs, earlier return to work, and greater satisfaction from the patients.
In 2009, I spent three days with WorkSmart Solutions in two different industrial plants in Rockton, Illinois. The physical therapist from WorkSmart visited the plant three days a week and consulted with the employees on any problems with pain. They provided treatment as needed and assisted with work site ergonomics and activity modification. The Human Resource departments in both plants remarked on the reduction in administrative hassle and the lowering of work compensation claims for lower back and neck pain. The employees raved about the care for from the physical therapist and the ease of access to ongoing help.
The earlier we can intervene with physical therapy treatment the more likely we are to prevent the deconditioning that occurs with rest, the development of hypersensitive pathways, and fear of activity. Lower back pain is a mechanical injury that requires the management of all mechanical forces in the patient’s life. Education on proper posture, body mechanics, and fitness activities as well as modification of the work site are all part of comprehensive physical therapy intervention.
*Spine, Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary car referral of patients with low back pain to physical therapy: Impact on future health care utilization and costs.
Michael S. O’Hara, P.T., O.C.S., C.S.C.S.
Multi Directional Power Training
We have recently added a new training tool to our physical therapy clinics. The Surge 180 is a simple and incredibly effective training device for rehab patients. The patient stands on the platform, grasps the handle, and works against resistance provided by three pistons. The physical therapist can use the Surge 180 to improve many different areas of performance.
Safe and Effective Power Training
Most physical therapy patients are severely underpowered. Not only do they need to get stronger, they must also get better at creating force quickly. The patient can accelerate against the handle of the Surge 180, and because the overall mass is so small, there is no damaging inertia to overcome. The mass of a weight stack, barbell, or dumbbell creates so much inertia that when you attempt to move the load quickly it creates damaging joint stress.
In life and athletics, our bodies move in all directions. The Surge 180 handle moves forward–backward, right–left, diagonally, and into rotational movement patterns. The handle excursion is big enough to accommodate patients of all heights.
It Demands You Stand
Rehabilitation is all about getting better at functioning in standing positions. Patients need to learn how to efficiently transfer forces from the ground up through their body. On the Surge 180 platform, the patient can be positioned in-line, split, straddle, or single leg stance. Connecting the shoulder to the opposite side hip, through an active core is the essence of rehabilitation training.
The coordinated performance of the team of muscles that control the hips, pelvis, and spine is more important than simple strength. Standing, walking, climbing stairs, and carrying all require the synchronous transfer of forces from right to left and back again. The resistance provided by the Surge 180 creates the neural feedback to fire those reciprocal motor patterns.
Michael S. O’Hara, P.T., OCS, CSCS
Suspended Push Up Animation
Atomic Push Ups Are A Fitness Blast
Your muscles work as a team to carry you through the day. They never function alone, so training them with isolation exercise will produce less than optimal results. The muscles over the front of the body are linked together through interwoven layers of fascia to form what Thomas Myers, in his book Anatomy Trains calls the “superficial front line”. The shoulder girdle is slung onto the body in a basket weave pattern of muscles. One of the best exercise activities to activate this team of muscles is the Atomic Push Up.
The guys and gals at TRX named this exercise because of the metabolic response it produces. Although the TRX company popularized the Atomic Push Up, you can use any type of suspension trainer that has foot straps. This exercise helps build a better connection between your shoulders and hips. It will strengthen the push pattern and activate the frequently neglected hip flexors. Unlike a bench press type drill, the Atomic Push Up requires core control and the active participation of your legs. Atomic Push Ups require a great deal of neural control as you must coordinate muscles from the hands to the feet to properly perform this drill. The Atomic Push Up is not a bodybuilding type exercise that will “sculpt your outer pectorals” but it will help you move better.
Atomic Push Up Performance
Attach the suspension trainer overhead with the foot straps eight inches off the floor. Sit on the floor and place the feet in the straps. Roll over and assume a push up position with the feet suspended off the floor in the straps. The top of the suspension trainer should be directly over your feet. Descend toward the floor, and as you push back up, pull the knees up toward your chest. Use a steady cadence of lower down–push up–knees in–knees out. Beginners should aim for sets of five repetitions. Stop before the performance of the drill deteriorates. Common faults are sagging in the middle, lack of depth during the push up, and poor head position. For men, twenty repetitions of Atomic Push Ups is a worthy fitness goal. For women, eight is great.
You generally do not see Atomic Push Ups performed in commercial gyms because suspension trainers are rare and this exercise is difficult. Beginners may wish to place a mat under the torso and head in case of a sudden face plant. You can use a pair of parallellettes if you find weight bearing on your hands is difficult. Moving the body forward so the suspension strap is pulling you backward makes the exercise more challenging.
Michael S. O’Hara, P.T., O.C.S., C.S.C.S.
Our shoulders and spine must endure prolonged computer input, extended commuter drives, sustained television staring, and way too much general slumping. The important postural muscles that keep us tall become weak and the muscles in the front of the shoulders get tight. The spinal muscles that hold our 24 vertebrae upright and stable functionally fall asleep and forget how to work together as a team. Prolonged sitting creates all sorts of neuromuscular problems that can be managed with restorative exercise. One of the best exercises you can perform to mitigate the damaging effects of prolonged sitting is the suspension row.
Better Than Seated or Bent Over Rows
Suspension rowing requires your spine to stay in a neutral position from the head to the pelvis. Most of the bent over rowing I witness in the gym involves the same slumped sitting posture you see in every office in America. Rows performed with a flexed thoracic spine are far from optimal and often help reinforce postural deficits. Properly performed suspension rows improve communication between the spinal stabilizers and strengthen the muscles that retract the shoulder blades.
Mastery Of Your Bodyweight
Being able to maneuver your body using the arms makes you functionally fit. During suspension rows, the resistance is not a plate or weight stack, but rather the weight of your body. You alter the resistance by moving the feet and changing the angle of the body in relation to the floor.
Friendly Force Curve
Suspension rows produce an accommodating resistance that is easier when you are at the weakest part of the rowing motion. The force necessary to perform a suspension row decreases as you move from the arms fully extended to the arms pulled in close to the body. This makes it a good exercise for people with weaker than average shoulder muscles.
Many people have no idea of how to correct the posture of their head and neck. Prolonged sitting, driving, and computer work have damaged their positional awareness or proprioception. The movement of the head and neck during suspension rows produces a neurological training of the cervical proprioceptors that can help fix this problem.
Improve the strength and endurance of the team of muscles that keep your posture tall and shoulders strong with suspension trainer rows. At FFAC, several TRX suspension trainers are located throughout the gym. For home use, attach the suspension trainer to the top of a doorway. Adjust the suspension trainer length so the handles are at your waist level or lower. Stand facing the TRX and grip the handles firmly. The position of your feet will determine the amount of resistance. Move the feet forward and the exercise is more challenging. Keep the entire torso straight, one long line from ear to ankle. Brace the abdominal muscles and gluteals and lean back. From the arms extended position, pull the handles into your side. As you perform the rowing motion, focus on moving the shoulder blades down and back. Return to the starting position and repeat. Perform two or three sets of six to ten repetitions. As you get stronger, progress to a full inverted row with the legs on a bench.
Caution: Make sure you use a solid suspension trainer product when performing this exercise. I have treated two patients with injuries that occurred when their homemade units malfunctioned and sent them flying to the floor. Do not skimp on safety with suspension training exercise. The emergency room visit and CT scan of your skull will be far more expensive. The TRX and Lifeline USA suspension trainers are the most well known units on the market.
Michael S. O’Hara, P.T., OCS, CSCS
Soft tissue mobilization with foam rolls has become popular in physical therapy, sports training, and fitness. Foam rolling helps decrease pain, improves mobility, and can enhance recovery from exercise. For an old gym rat like myself, it helps me bounce back from a tough training session, a long golf weekend, or too much computer time. More varieties of rollers have come on the market, and whenever we are faced with a lot of choices, it becomes more difficult to make a decision. In this short presentation, I have some suggestions on the proper roller for the job.
Rollers are available in three foot and one foot lengths. I find the longer versions easier to use, but I own a short pipe style roller that I take with me when I travel. Bigger guys generally do not do well with a short roller.
The best roller for you will depend on your tissue tolerance and how sensitive are you to the compressive forces of the roller. If you are new to foam rolling, a low density white Styrofoam roller is softer and will create less discomfort. As you develop better tolerance to rolling, you can progress to a firmer black foam roll. It has been my experience that the white rolls break down faster than the firmer black rolls, so be prepared to replace a white roll fairly often.
Hollow pipe style rollers are newer to the market and I have had good results with two products. The Grid Trigger Point roller is a cushioned hollow pipe with a grid pattern across the surface or the roller. Many smaller clients and patients report they like the short version of the Grid roller. Another hollow pipe version is the Rumble Roller. This product has a series of projections that extend from the roller surface. Self-soft tissue mobilization with a Rumble Roller is more uncomfortable than any other roller I have used. It is a more aggressive treatment but I have found it works well for individuals with thicker and denser muscles.
Not So Good
The hollow rollers that are covered with Styrofoam tend to break down fairly quickly. The rollers with fabric covers often create slippage problems with several types of clothing. The fabric interactions tend to make rolling less than efficient and are more difficult to control. The fabric covers tend to lose their fit after a few washings. The air inflated style rollers are a balance training device and are ineffective as a soft tissue mobilization tool.
Michael S. O’Hara, P.T., OCS, CSCS
PROPER TECHNIQUE–HIP HINGE
With their newest release, BODYPUMP is going back to basic, simple, weight training techniques and principles. New exercises are part of the lunge track, and greater focus on strengthening the gluteals and hamstrings are in the squat and deadlift tracks. BODYPUMP 85 will kick off in April at Fenton Fitness.
BODYPUMP TECHNIQUE: PROPER HIP HINGE
The hip hinge is a basic movement pattern we all should master. It keeps stress off the lumbar spine and improves strength in the hamstrings and gluteal muscles. The BODYPUMP row, deadlift, and clean all require a proper hip hinge. Many pump participants perform these lifts with way too much spinal motion. When you hip hinge the spine stays still and you tilt forward at the pelvis. The pelvis rolls around the femur to create flexion at the hip. The gluteal muscles and hamstrings create the motion that moves the bar, and the core stabilizers hold the spine stationary. The best view of your hip hinge performance is from the side. Practice the drill below to help improve your hip hinge.
Hip Hinge Stick Drill
You need a mirror and a pvc pipe, golf club, or yardstick. Stand sideways to the mirror and place the stick along the length of your spine. The stick should touch your gluteal muscles, thoracic spine, and head. A space between the stick and your body should be present at the lumbar spine and neck. Maintain those spaces as you push your bottom back and tilt forward. The knees should bend a little (20-30 degrees) and you should feel some tension in the back of the thighs. The motion happens at your hip and the lumbar and thoracic spine stays still. Use the mirror side view to assess your performance. The stick acts as feedback mechanism to help you keep the spine stable and initiate the movement at the hips. Progress to using your BODYPUMP barbell with a proper hip hinge motion.
Michael S. O’Hara, P.T., OCS, CSCS