Thrive Physical Therapy in Richmond

Physical Therapy and Fast Pain Relief

Exciting New Thrive Yogalates Class!

Monday July 17th 6:30 am @ Thrive PT

More Mobility, Strength, Tone, and Reduced Pain!

Very exciting new class taught by multi-talented Sophia Wilson! Ever wonder what is the best exercise class for you? Should you choose Yoga, Pilates, Strength training, general exercise? We get asked this all the time! The short answer is that it depends on your particular issues. The choice should be made based on what you need most. Trouble is very rarely does someone need just mobility, core, or strength! Most people need a combination of activities and not just one form of exercise. Also if you make a good choice on the type of class where do you start regarding level of difficulty and with whom?

We have a solution! Join us for our new class Thrive Yogalates. The class will be a combination of activities blending principles of Yoga, Pilates, Sound Movement, etc.directed at improving your health. Hope to see you at class!

Price is $18 per class or package discounts are available.

Space is limited to 15 people so please call ASAP to reserve your spot! Please bring your yoga mat, towel, and water.

6 Tips to Eliminate Back Pain with Standing and Walking

Studies show that Americans suffer from back pain in significant numbers. It is a major contributor to absenteeism in the workplace; sixty to eighty percent of workers take time off because of it. Also, it is not exclusive to any one age group. The highest incidence of back pain occurs in those between the ages of 35 and 55, a worker’s prime years. Also, it is the leading cause of disability in people under 45. Clearly, back pain is pervasive.

Why is back pain so difficult to diagnose and treat? According to a classic study by Nachemson (1985), only 20% of those experiencing back pain can be given a specific patho-anatomical diagnosis, or, more simply put, only 20% can pinpoint a specific tissue such as disc herniation or muscle strain, to account for their back pain. For this reason, evaluation of back pain should include an analysis of how the individual’s body functions, not just an anatomical cause. For example, back pain is rarely the result of a single event or trauma, but rather repeated, inefficient movement and repetitive stress during daily activities.

At Thrive Physical Therapy, we examine how the body functions from a specific and global perspective, not only to determine what is painful, but also to identify–and correct–the underlying causes of the patient’s discomfort. Many factors contribute to back pain such as mobility, strength or weakness, body alignment/posture habits, efficiency of movement, work and daily activities. By using a global perspective, we identify the factors that adversely affect the body’s ability to heal and / or increase sensitivity of the nervous system. For example, lack of sleep and physical and emotional stress increase inflammation, which adversely affects tissue health, contributing to pain sensations. We have identified multiple factors in our patients that contribute to back pain with upright activities and standing. The key is to identify your specific issues and to address them effectively. The following guidelines will help:

  1. Critically evaluate and improve your standing alignment/posture: Think of your body segments like blocks. The head, rib cage, pelvis, and feet should be aligned vertically as if stacked directly on top of each other. See pictures for ideal and dysfunctional postures. An easy way we have found to accomplish this is to first center your weight over your feet and then make sure your sternum pubic bone are aligned vertically (hand placed on the upper chest should be aligned with hand placed just below the belt line when viewed from above while looking down or from the side when looking in the mirror). Please note if you lack hip flexor or thoracic mobility achieving an upright vertical alignment is more difficult.  Here is a link https://www.youtube.com/watch?v=yVrJfzcSrT4 regarding correction of standing alignment. 
  2. Ensure that you have sufficiently hip flexor mobility: if you lack hip flexor mobility, which is common in the modern population as a result of how often we sit, then maintaining a well aligned upright vertical posture is more difficult. One way to determine if your hip flexors are tight is to lie on your back, bring one knee to your chest firmly, and then let the opposite leg relax towards the floor. If your thigh has difficulty resting on the floor this can indicate the need for increased hip flexor mobility. Here is a link to one of our favorite methods of addressing this deficit. Supine Hip Flexor Stretch..
  3. Ensure that you have sufficient thoracic mobility/alignment: if you lack thoracic mobility and have an increased thoracic curve then the lumbar spine will typically make up for this deficit by extending excessively in standing (particularly if there is insufficient core/abdominal control to prevent this compensation). See picture. To ascertain this look at yourself in the mirror do you have an increased forward curve in your thoracic spine or excessive curve in your lumbar spine? If this is the case thoracic mobility may be a contributing factor. A simple way to correct this is to lie on your back with your knees bent, head supported on a small pillow, and your palms facing up as if lying in sand. Relax and breathe for five minutes while imagining yourself sinking further into the sand. This exercise relaxes muscles tension and helps increase thoracic mobility with breathing. 
  4. Ensure that you have sufficient core/trunk stability – control: this is a bit more difficult to determine without professional advice as there are many factors that will contribute to core function as well as how to train it effectively. At Thrive we have methods of determining an individual’s needs however, a simple push-up can be of assistance. Assume a prone face down position on the floor, place your hands just outside the shoulder with at the level of your collarbones with your lumbar spine reasonably flat with your chin down facing the floor (make sure neck is not extended and noses faces the floor). Then, while maintaining proper body alignment perform a push-up without bracing or thought of how to stabilize your trunk. If your core stability is reasonably efficient, you should be able to maintain a straight body without sagging from the pelvis/lumbar spine (without having to brace your abdominals actively). If you’re able to do this easily then your core is likely reflexically stable and responsive. If you sag or have to perform a large abdominal brace to accomplish the preceding movement then this is an area that could likely use additional work.  If upper body strength is a limiting factor then it is permissible to perform the preceding with the knees on the ground.  Here is a link to a beginning level trunk stabilization exercise that can be helpful in improving core function  Beginning Level Quadruped Stabilization..
  5. Ensure that you have good hip and glute strength: the hips are essentially the motor that you should be using to walk with in addition to your core/trunk musculature (we actually generate our walk from the trunk but that is a topic for another blog). The core and hips work together functionally, and are mutually dependent on each other. If you have a weak core, you will likely have weak/suboptimal hips and vice versa. With weak hips (and core) a common substitution pattern we see in our patients, is to use excessive lumbar back muscle activity in standing and ambulation, which can contribute to back pain. A good test for this is sit to stand or standing squat as seen in the links below.  To perform this test, sit at the edge of the chair, cross your arms across your chest, hinge from the hips placing your nose over the toes and practice standing up and sitting down by pushing down through your heels. Essentially you are performing standing squat with the use of your hips. If you are able to accomplish this 30 times with good technique, while feeling the effort in your rear end (not your quads) and good balance, then your hip stability is at least somewhat functional. Here is a link to a sit to stand maneuver as well as a bridge both of which are good ways to evaluate and train for hip strength. Sit to stand. Functional Squat., Supine Bridge
  6. Ensure that you have good single leg balance: in order to stand and walk without pain one must have the preceding variables but also balance, which is a good measure of how efficiently the body is working. Here is a way to evaluate it. With your weight centered over your feet attempt to stand on one foot and remain still without shifting of your body or hip. You should be able to accomplish this for at least 15 seconds without extraneous body movements, dropping/rotation of the pelvis. If this is difficult work to retrain it and improve by practicing standing on one leg while maintaining vertical body alignment and a stable pelvis.

If you are experiencing pain, injury, or weakness why suffer any longer? Take action to address it now!  Give us a call at 804 320-2220 and sign up for our complementary consultation while they are still available!  Or check out our blob or attend our monthly Thrive Movement Lab (call to RSVP second Tuesday of each month) to find out more helpful information to get you back to thriving!

By C. Clarke Tanner and your Team at Thrive Physical Therapy Inc.

MRI Back Scans Do Not Predict if You Need Surgery

This is an article written By Richard C. Senelick, M.D. in regards to MRI Scan and their indications for surgery that is well worth reading

Deep aching back pain that you feel all the way down into your leg. You wake up with it, or it shows up with a simple sneeze or when you bend over to tie your shoes. This problem, called sciatica, affects 13 to 40 percent of all people during their lifetime and costs our economy approximately $50 billion each year. Only headaches are a more common neurologic ailment.

In most cases, the leg pain and most severe symptoms resolve in eight weeks, but we are not a patient society. Many of the people who have sciatica symptoms go on to have back surgery that may or may not solve the problem. Despite changes in technology and fancy titanium screws, plates and cages, the overall results of surgery have not significantly improved over the last few decades. This over-prescription of surgery is a huge problem.
MRI Scans of the Back

The introduction of MRI scans in the 1980s resulted in elegant pictures of the lumbar spine and graphic demonstrations of the deterioration that happens to our spines as we age. It is one thing to look in the mirror each morning and see the wrinkles that slowly form at edges of your eyes and mouth. It is another thing to have your doctor suddenly show you a picture of your spine with its bony growths, deteriorated disks and endangered nerve roots.

When throbbing back and leg pain attack your brain’s pain centers, it is easy to say, “I will do anything to get rid of this pain. Where is the surgeon?” But, a recent study in the New England Journal of Medicine looks at whether an MRI scan can predict whether you need surgery or whether you are better off taking your time and following an extended course of conservative treatment. Having an MRI of your lumbar spine performed may be quick and painless, but it can lead to unneeded surgeries, complications, poor outcomes and chronic pain. The 15-20 percent of people who have recurrent episodes of sciatica will have even more MRI scans and repeatedly face the decision of whether to have surgery.

Researchers at multiple centers recruited 283 patients with persistent symptoms of sciatica (symptoms that had lasted 6-12 weeks) and randomized them in a study comparing early surgery versus prolonged conservative therapy. All of the patients had a herniated disk on their MRI scans, and scans were performed at the beginning of the study and one year later. The question was whether there is an association between what we see on the MRI scan and the eventual clinical outcome. Did the pain go away, and was the patient happy with the outcome?
Herniated Disks Can Disappear!

At one year, 84 percent of all the patients had a favorable outcome whether they had surgery or conservative treatment. Previous studies had reported that those who have surgery may get better faster, but at one year there is no difference. The disk pressing on the nerve root is thought to cause the pain down the leg, and it disappeared on the MRI scan in 82 percent of people having surgery. But, it also disappeared in 60 percent of those who had conservative therapy.

This shows that herniated disks get smaller and disappear even without surgery! The study also looked at those patients who still had a disk herniation on their MRI scan at one year, and once again there was no significant difference. Eighty-five percent of those with a disk herniation on their MRI scan at one year still had a favorable outcome, as compared to 83 percent with no disk herniation.

Of course, it is not so simple as to just assume that something is pressing on the nerve and causing the pain. How many times have you heard someone say that they had a “slipped disk” that their chiropractor put back in place? It sounds good, but it doesn’t work that way. It may be inflammation, a chemical reaction or some other process that causes the pain. The truth is that the source of a person’s low back and leg pain is frequently illusive.
The bottom line: When trying to decide who should have surgery, a herniated disk or nerve root compression on a MRI scan does not predict a better outcome. This study even looked at those situations where a piece of disk has broken off (an extrusion) and there was no difference. It is difficult to correlate a patient’s symptoms with the findings on their MRI scan.

5 Guidelines to Follow

If a MRI scan does not distinguish between a favorable and unfavorable outcome, how should a doctor and patient make the decision on whether to have surgery? Here are the five guidelines that have served me well over the years.
1. You have persistent pain that you can no longer tolerate, and it is unresponsive to medications, physical therapy and a prolonged period of conservative therapy. Give it time.

2. The planned surgery correlates with the anatomic location of your symptoms. For example, your back hurts, so you think that means you should have surgery on your back. Far too many times I have seen patients have surgery on an area that is unrelated to the location of their complaints. Surgery that is performed for low back pain without leg pain is fraught with difficulties.

3. If you have “progressive” weakness, this may suggest that the there is increasing pressure on the nerves that needs more immediate attention. Weakness, in and of itself, is not an absolute indication for surgery.
4. Many people have numbness, tingling or some loss of sensation in their leg. This does not automatically require surgery and frequently does not resolve with surgery. The key here is whether you have a progressive loss of sensation or a sudden change that needs immediate attention.

5. The rapid onset of bladder or bowel symptoms may be a neurological emergency that needs immediate surgery. If you have chronic back or leg symptoms and then develop problems urinating, this needs immediate attention.
The next time your are lying on your back, encased in a MRI machine making clanging and banging sounds from another world, keep in mind that the amazing pictures your doctor will show you of your back are only part of the story. Remember that there is no such thing as “good as new.”
For more by Richard C. Senelick, M.D., click here.

If you are experiencing pain, take action to eliminate it! We can help. Let us help you get back to the activities you enjoy. Call 804 320-2220 and setup an appointment today.

THRIVE PT is a specialized manually based orthopedic, spine, and sports physical therapy practice that provides individualized care to its patients. All of our therapists have specialty training, advanced certifications in orthopedic manual therapy, and extensive post graduate course work, and are highly qualified to help you reach your therapy goals. Our methods include hands-on corrective treatment, movement training, dry needling, and therapeutic exercise provided exclusively by your therapist. Our objective is to teach you how to move efficiently and painlessly and to educate you on how to stay healthy. We can help you achieve your goals to lead a healthy, active life--in a word, THRIVE!

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