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How Do They Know What Is Wrong Without An MRI?

This is a fairly common question in physical therapy.  Patients with lower back, leg, neck, and arm pain know the test they need is an MRI.  They have friends and relatives that tell them they should have an MRI.  They are concerned that something is being overlooked and that the pictures from the MRI will make treatment more beneficial.  I have some research information on the limitations of a spinal MRI.

In 1994, the *New England Journal of Medicine published a study on physician evaluation of lumbar spine MRIs.  The MRIs of 98 asymptomatic individuals –-no pain, feelin’ good people, were found to have disc abnormalities (82% of the MRIs).
-52% had a bulged disc at one level
-27% had a disc protrusion
-1% had a disc extrusion
-38% had an abnormality at more than one disc

Since that publication, several other studies have backed up these results.  Bulged, protruding, and extruded lumbar discs are a fairly common finding on a lumbar MRI.  Changes in our lumbar discs are probably no different than the wrinkles on your face or the gray in your hair.  Changes in a disc’s shape is not a indicator of pain problems

Another **MRI study of athletes revealed spondylolysis (vertebral fractures) are fairly common, yet less than 50% of the athletes with these fractures ever report any episode of lower back pain.  It appears that lumbar spine fractures do not always produce pain.

In my years in the physical therapy clinic, I have received the MRI reports of many neck and lower back pain patient’s spines that show disc protrusions and foraminal stenosis on one side of the spine but the patient has all of his or her symptoms on the opposite side.  I have treated patients with severe lower back pain and completely normal spinal MRIs.

MRI research has demonstrated that “abnormalities” in our spines are fairly common and difficult to accurately link to any specific pain problem.  We do know that once a patient has an MRI, they are far more likely to progress to ***surgery.  Please read, The Myth of Accuracy in Diagnosis, by Dr. Ron Fudala.  In physical therapy, the resolution of a spinal pain problem starts with a history and thorough physical evaluation.  Imaging tests are a small part of the “big picture” and often provide nothing but confusion.

*Jensen MC et al. Magnetic resonance imaging of the lumbar spine in people with and without back pain, New Engl J Med. Jul 14

**Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete.  Am J Sports Med, 2000 Jan – Feb.
***Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine 2003;28:616 –20.

Read more here: http://spineline.net/spine-pain-the-myth-of-accuracy-in-diagnosis/

Michael S. O’Hara, PT, OCS, CSCS

Think About This

The Latest Science on the Prevention of Alzheimer’s

Over the last 30 years, more than two hundred experimental drugs have failed to produce any success in the fight against Alzheimer’s.  It does not appear we are going to have a pharmaceutical for the treatment of Alzheimer’s any time in the near future.  A recent *article in the April issue of Scientific American discusses a treatment option that does appear to work.  This is currently our only hope in the fight against this terrible disease.  The good news is the treatment that prevents cognitive decline helps with so many other problems.

The study’s researchers demonstrated that an interventional program of exercise, proper nutrition, and cognitive training produced significant improvements in brain function.  The **Finnish Intervention Study to Prevent Cognitive Impairment and Disability (FINGER study) enrolled 1260 men and women between ages 60 and 77.  Over the course of two years, participants demonstrated improved cognitive test scores in processing speed (up 150%), executive function (up 83%), and complex memory (up 40%).

The exercise program in this study was not complex or time consuming.  The routines were developed by physical therapists and performed four or five days a week.  The exercise sessions involved strength training, balance skills, and aerobic activities.  As the participants became fitter, their training regimens were progressed–more challenging activities, more resistance, and/or more volume.  The time spent in training was four to five hours a week.

If your goal is to maintain or improve cognitive capacity and remain independent, then the prescription is a consistent routine of exercise.  Take the time to read the article, lace up your sneakers, and make a progressive program of fitness a lifelong habit.

* A Rare Success Against Alzheimer’s, Scientific American, April 2017

** The FINGER study, Alzheimer Prevention. Download the article here: http://r.search.yahoo.com/_ylt=A0LEViMTIfZYurkAQNsnnIlQ;_ylu=X3oDMTBybGY3bmpvBGNvbG8DYmYxBHBvcwMyBHZ0aWQDBHNlYwNzcg–/RV=2/RE=1492554131/RO=10/RU=http%3a%2f%2fwww.alzheimersprevention.org%2fdownloadables%2fFINGER-study-report-by-ARPF.pdf/RK=0/RS=fHWCrTAi9LEEDrH5jWfmRvAI7LU-

Michael S. O’Hara, PT, OCS, CSCS

Aging Muscles and Exercise

Fast Reaction and Helpful Hormones

New technology has produced some surprising information on the cellular response of muscle to various types of exercise.  Super blood analyzers and computers have enabled scientists to monitor gene expression and hormonal release in muscle cells during and after sessions of exercise.  The information from this research is revolutionizing our understanding of optimal exercise prescription for health and longevity.  It appears that older individuals derive the most beneficial muscle cell response with fairly intense interval training sessions.  Please take the time to read Gretchen Reynolds article in the New York Times, The Best Exercise for Aging Muscles.

Dr. Martin Gibala, a professor at the kinesiology department at McMaster University in Hamilton, Ontario recently released an outstanding book, The One Minute Workout.  Dr. Gibala explains the science behind high intensity interval training (HIIT) and why it is safe and effective for older fitness participants.

Skeletal muscles produce beneficial biochemicals called myokines that stimulate a response in cells throughout the body.  Myokines are a fairly new scientific discovery and we have only recently begun to understand their remarkable effect on human physiology.  Myokines enhance blood vessel development, promote beneficial hormone levels, stimulate greater mitochondria production, and improve the metabolism of fat.  In the older individual, myokine levels are enhanced with strength training and high intensity interval training.

The best method of creating more of the beneficial myokine biochemistry is to consistently perform some progressive resistance training followed by a brief but intense interval training session.  This regimen of training is similar to that of track athletes involved in sprinting.  These athletes have high levels of muscle mass and very low body fat levels.

Michael S. O’Hara, PT, OCS, CSCS

Read the NY Times article here: https://www.nytimes.com/2017/03/23/well/move/the-best-exercise-for-aging-muscles.html

PDFTreadmills are found in virtually every gym.  Read the six treadmill facts you need to know.  Meet a Fenton Fitness member who learned how to manage her back pain, and read about the seven best TRX exercises.  Do you have limited time to exercise?  Be more efficient with HIIT.

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Are You Ready?

Spring At The Physical Therapy Clinic

The weather is warming up and soon we will leave the heated, insulated, safety of our home gyms and fitness centers.  The spring migration back to tennis, soccer, pickleball, golf, fitness running, ultimate Frisbee, and stadium steps will begin.  My physical therapy question is– Are you ready for these new challenges?  Has your fitness program prepared you to withstand the rigors of these spring endeavors?  This checklist should help you answer the question.

Have you been performing most of your fitness activities in standing?
Nearly every sport and most household chores are performed in a standing position.  During most of my visits to commercial gyms, the majority of the activity I witness is in the supine, seated, or heavily supported positions.  If your goal is to move better and remain free of injury, then 90% of your exercise should be performed in standing.

Do you practice moving in all directions?
Nearly every sport involves moving side to side, forward-backward, and in a rotational pattern.  Basketball, soccer, golf, and tennis all require you to accelerate and decelerate movement in all directions.  Most gym activities are predominantly sagittal plane– forward and backward.  You ride on the elliptical, spin the bike, and run on the treadmill for months, and your spring visit to the tennis court results in a twisted ankle because you are unfamiliar with side to side movement patterns.

Have you been working on better balance?
Balance is a skill that tends to deteriorate with age, injury, and a sedentary lifestyle.  Many commercial exercise machines take all balance demands away.  The elliptical, spin bike, recumbent bike, rower… all are heavily supported.  Proficiency with single leg stance balance prevents injuries and improves performance.  The older and more deconditioned you have become, the more your fitness program should include single leg stance balance training.

Do you perform any explosive exercises?
We get slower before we get weaker, and life is an up-tempo game.  We need to perform exercise that enhances quickness and improves control of deceleration forces.  What you do in the gym is reflected in how well you can move during activities of daily living.  If you continually exercise at slow tempos, you will get better at moving slowly.  If you train explosively, you get better at moving at faster speeds.  The capacity to decelerate a fall requires fast reactions.  Gracefully traveling up the stairs and getting out of the car are only improved with exercise that enhances power production and speed of movement.

Michael S. O’Hara, PT, OCS, CSCS

Advice From The Experts At Fenton Fitness

Tara Parker-Pope wrote a great article in the October 17, 2016 edition of The New York Times entitled “The 8 Health Habits Experts Say You Need in Your 20s.”  While I agree with some of these recommendations, we at Fenton Fitness and Fenton Physical Therapy have some suggestions of our own.

#10–Establish A Veggie And Protein Habit

One of the biggest deficits I see in many food logs is the lack of protein consumed.  We have been conditioned to snack on high carb/highly processed food, so eating more protein can be a difficult shift.  When I do see protein, it’s in the higher fat varieties of sausage, bacon, burgers, etc.  It would benefit younger individuals to start adding healthy doses of protein to their diets as soon as they are responsible for their own food preparation.  Shoot to have some form of lean protein as the base of your meal along with a couple of servings of vegetables. Once you have that base (taking up ½ to ⅔ of your plate), then you can add in whole grains, starchy carbs, fruits, dairy, healthy fats, etc.  Protein increases your metabolic rate more than any other nutrient, aids in recovery, helps build and maintain muscle mass, and much more.  We recommend 25-35% of total calories to come from protein, or 0.8-1gram/pound of body weight.  Most individuals should shoot for 4-8 servings of vegetables per day as well.

-Jeff Tirrell, CSCS, Pn1

To read the article, click on the link below:

http://www.nytimes.com/interactive/2016/10/16/well/live/health-tips-for-your-20s.html?_r=0

 

 

Advice From The Experts At Fenton Fitness

Tara Parker-Pope wrote a great article in the October 17, 2016 edition of The New York Times entitled “The 8 Health Habits Experts Say You Need in Your 20s.”  While I agree with some of these recommendations, we at Fenton Fitness and Fenton Physical Therapy have some suggestions of our own.

#9–Build Muscle

Much like strength, muscle mass is often not prioritized until it is largely too late.  Though you can still build muscle at an older age, it is much more difficult.  Muscle mass is highly correlated with strength which is correlated with power.  All of these tend to decline substantially at around age 30.  If you take advantage of your hormonal environment and your recovery abilities in your 20’s, you can stockpile a good amount of muscle for the rest of your life so that you can keep doing everything you want as you age.  More muscle also means a better and healthier metabolism which means less accumulation of unwanted body fat and overall better health. The best way to build muscle mass is through resistance training with gradual increases to volume (weight x reps x sets) over time along with a moderate to high protein intake.

-Jeff Tirrell, CSCS, Pn1

To read the article, click on the link below:

http://www.nytimes.com/interactive/2016/10/16/well/live/health-tips-for-your-20s.html?_r=0

 

 

Advice From The Experts At Fenton Fitness

Tara Parker-Pope wrote a great article in the October 17, 2016 edition of The New York Times entitled “The 8 Health Habits Experts Say You Need in Your 20s.”  While I agree with some of these recommendations, we at Fenton Fitness and Fenton Physical Therapy have some suggestions of our own.

#8—Eliminate Liquid Calories

One of the easiest ways to improve nutrition is to eliminate liquid calories from the diet.  Liquid calories for young people can come in many forms including coffee drinks, alcohol, pop, smoothies, juice, energy drinks, etc.  Most of these items offer very little nutritional benefit, are highly correlated with increased body fat, and don’t cause the same amount of satiety (feeling of fullness) of their calorie matched food equivalents.  Over the last decade working with individuals on their nutrition, I have seen magical transformations simply by eliminating calories you can drink.  Rather than wait for the body fat to pile on and your insulin sensitivity to be shot, avoid this pitfall early in life.  Opt instead for more water, plain tea, or diet soda if you can’t resist something sweet and fizzy.

-Jeff Tirrell, CSCS, Pn1

To read the article, click on the link below:

http://www.nytimes.com/interactive/2016/10/16/well/live/health-tips-for-your-20s.html?_r=0

 

 

PDF

Hamstring injuries are on the rise.  In this month’s newsletter, Mike O’Hara, PT provides information on preventing hamstring injuries and includes videos of the recommended exercises.  Learn what it is to be “farm boy strong” and what you can do to become a “functional farmer”.

Download Here

Advice From The Experts At Fenton Fitness

Tara Parker-Pope wrote a great article in the October 17, 2016 edition of The New York Times entitled “The 8 Health Habits Experts Say You Need in Your 20s.”  While I agree with some of these recommendations, we at Fenton Fitness and Fenton Physical Therapy have some suggestions of our own.

#7—Go Easy On Caffeine And Sleep More.

Caffeine is one of the most widely used drugs in the United States.  We consume it in coffee, tea, pop, energy drinks, and sometimes even in pill form.  We often consume caffeine to help us feel more awake and alert or to elevate our performance.  Often times, this is done in an effort to undo the lethargic effects of inadequate sleep.  Unfortunately, many people are sensitive to caffeine.  These individuals can experience increased heart rate and/or blood pressure which puts extra strain on the cardiovascular system.  All the caffeine in the world will not make up for the poor hormonal profile which results from low levels of sleep and eventually leads to decreased muscle mass and increased fat mass.  In addition, the stimulating effects of caffeine wear off over time and your body requires more and more to create the same effect.  It is far better in your 20’s to establish a sleep and waking routine that allows you to consistently get 7-9 hours of sleep each night.  The well-formed habit will then be easier to maintain as you age and adopt a more complicated schedule with work, kids, a spouse, etc.

-Jeff Tirrell, CSCS, Pn1

To read the article, click on the link below:

http://www.nytimes.com/interactive/2016/10/16/well/live/health-tips-for-your-20s.html?_r=0

 

 

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