Is your hip causing your back tightness?

In a previous blog, I talked about how western medicine tends to treat the symptoms of back pain and not the actual cause. How doctors tend to focus on pain medicines and X-ray/MRI results to guide their treatment of your symptoms without actually putting their hands on you and trying to FEEL what the real problem is.

When I first graduated from PT school, I used to actually “care” that I could read and interpret X-rays and MRIs. But then my boss/mentor taught me to never look at an MRI/X-ray before actually putting my hands on somebody because “you don’t want to be looking for something that might not be there” aka you don’t want to influence what your hands are feeling. Then after treatment if you can’t make sense of your findings, compare with the X-ray/MRI.

Why would he tell me to NOT use this great knowledge I spent a ton of money (that I didn’t have!) attaining in grad school?!?! Why wouldn’t I use the “special test” (X-ray/MRI) results to guide my treatment?

Here’s why-Over the past 5+ years there have been multiple high quality studies looking at MRI results of the lumbar spine in asymptomatic people aged 50+. Asymptomatic meaning they have NO symptoms. And the results….drum roll please….Over 60% of people aged 50+ have some type of degeneration, herniation, bulging, etc in there lumbar spine!!! Now remember, these studies were done on people who DIDN’T HAVE ANY SYMPTOMS!

That is why I really don’t care what you X-ray/MRI says until AFTER I put my hands on you. IF I can’t figure out what the true underlying problem is, THEN I will consult the “special tests”.

The reason your back tightness won’t go away…

One of the most common things I hear on the 1st phone call with new clients is “My back has been bothering me for X amount of time…my MRI/ X-rays say that I have degeneration, herniation, bulging, etc…” Many of those people have tried core strengthening, back stretches, pain meds, and even injections with no lasting relief. WHY?!?!

Because the focus has been on your SYMPTOMS, not the underlying PROBLEM! Chances are that up until this point, nobody qualified has actually put their hands on you to figure out what is CAUSING your symptoms. You’ve waited at the doctor’s office for hours for him to come in for 2 minutes, just enough time to half way listen to your story and then write you a Rx for pain meds and order an X-ray. Nothing “definitive” has come back on X-ray so now here’s another Rx for more pain meds and now an MRI. The MRI shows (above) so either get scheduled for surgery OR just take it easy and keep up with the pain meds…

99% of the clients I’ve worked with suffering from back pain have had some type of pelvis/hip issue. A very simple thing to try right now is when sitting nice and tall on a firm surface, cross your right leg over the left as a man would sit cross legged (right ankle on left thigh area). Now press gently on your right knee down towards the floor until you feel a stretch in the right hip/glute area. Take note on how that feels and then do the exact opposite with the left leg and see if there is any discrepancy between the sides.

IF you found one hip is tighter than the other, guess what??? That is now your new homework! Just do that simple stretch whenever sitting for as long as you can comfortably- shoot for AT LEAST 3 minutes. DO NOT continue if paresthesia (numbness/tingling) begins. Just relax the foot back on the ground, take a break, then repeat this process until the discrepancy dissipates.

Osgood-Schlatter Disease

Osgood-Schlatter disease (OS) is an overuse injury causing pain to the inferior knee area and often noted with a visible growth just below the kneecap on the proximal tibia. The development of OS is most often a consequence of excessive stress to the area where the patellar ligament attaches on the tibia during periods of rapid skeletal growth. As this condition progresses, the body responds by increasing bone growth to the area being ‘pulled on’ (where the patella ligament attaches to the tibia). This increased bone growth is the bump that is usually felt over the painful area on the front of the shinbone. OS most commonly affects adolescents because they typically experience the greatest rate of skeletal growth.

OS disease is usually the cumulative effect of repeated stress or trauma on the patella ligament attachment on the tibia. Repeated stress or trauma can be secondary to increased participation in running, jumping, and cutting activities. OS disease can be effectively treated by a quality manual physical therapist using manual therapy and sport specific functional movement exercises. Call Berman Physical Therapy and schedule your appointment today!

5 Ways to Prepare Your Body for Pregnancy

This blog goes along with the concept that “prehab” is always easier, less painful, and cheaper than “rehab”. Ensure that your body is ready to carry a baby by addressing pains or problems associated with posture and/or weakness BEFORE you start gaining “baby weight”. For example: extra abdominal weight changes the position of your center of mass (COM) and causes it to shift forward which in turn can cause a compensatory hyperextension in your low back and eventually low back pain. Here are some physical therapist tips for helping to prepare your body for pregnancy for better odds of avoiding musculoskeletal pain/dysfunction during and/or after it.

  1. Strengthen your pelvic floor muscles. This is done by performing pelvic floor contractions (Kegels), or gently squeezing your pelvic sphincter muscles (not the buttocks or thighs). Strengthening/tightening these muscles will help prevent leakage when a woman sneezes, coughs, etc, and can also reduce pelvic pain during pregnancy.
  1. Prepare for “baby belly” by focusing on your core. Core strengthening can help prevent diastasis recti-abdominal muscle separation. As your belly grows, the abdominal muscles that run vertically along either side of the belly button can be forced apart, like a zipper opening. Too much separation can cause core weakness, resulting in low back pain, pelvic pain, or other injuries due to compensatory strategies from the increased core weakness.

It is important to perform proper and safe core strengthening exercises as some exercises such as a traditional sit ups can actually increase the likelihood of developing diastasis recti, incontinence, and back pain during and after pregnancy. Because of this, it is important to consult with your physical therapist on the right exercise strategy for your core strengthening.

  1. Take a breath! Breathing technique is something that most of us usually take for granted however there is a lot of strategy and components to breathing efficiently. Learning proper breathing techniques from your physical therapist will help prepare your body for a healthy pregnancy. Learning to properly exhale while performing the concentric part of any exercise or task can do this. With proper technique, your core and pelvic floor muscles will contract automatically, and this will lead to optimal stability and injury protection.
  1. Begin a regular fitness routine. Exercise will help boost your muscle and cardiovascular strength, which will help you carry that extra baby weight! Once you become pregnant, consider maintaining increased physical activity by engaging in relatively low-impact activities, such as swimming, walking on even surfaces, biking or using an elliptical machine. Runners should be aware that loosening of their ligaments (due to release of the hormone of relaxin) may make them more susceptible to sacroiliac, knee, and ankle injuries.
  1. Practice good posture. Poor posture can have a major effect on every part of your body, particularly with regard to pain during pregnancy. A physical therapist can evaluate your posture and suggest postural strengthening exercises and ergonomic corrections for prolonged sitting at work and during commutes. Establishing health posture habits will better prepare your body for the extra weight gain of pregnancy and lessen your chances low back and/or pelvic pain.

Call Berman Physical Therapy today for more information!

Postural Prehab vs Rehab

It is difficult in today’s world of desk jobs and prolonged commutes to maintain proper posture, however posture is frequently the underlying culprit that leads to neck, shoulder, and back pain. The reason proper posture is so difficult to maintain is because you must constantly fight gravity to avoid falling into positions of comfort. These comfort positions usually consist of slouching in our chairs at work or in the car which causes a chain reaction beginning at the pelvis and works it way up to the neck and head. After staying in this position for hours at a time (usually all day at work), anterior hip and chest structures become tight (hypomobile) with posterior back/scapular muscles becoming over stretched and weak. The exact opposite is usually true regarding the neck; anterior muscles become over stretched and weak with posterior structures becoming hypomobile. Once this new “learned posture” begins, neck, shoulder, and or back pain is usually not far behind.

There are 3 main components to improving posture: joint flexibility, proprioceptive awareness, and postural muscle strength. It is very difficult to attain improved or proper posture without all 3 of these components. Because of this, it is important to identify the cause of person’s breakdown into poor posture in the 1st place, in order to devise a customized plan for each individual. Many times ergonomics must be altered at work to promote improved posture, in addition to car seat positioning, and even standing posture.

Remember: prehab is usually always easier (and less painful) than rehab. Addressing posture proactivity will likely get better results with less effort than waiting for something to hurt and then taking action. Call Berman Physical Therapy to schedule your postural assessment and to devise a customized exercise plan today!

Low back pain and pregnancy

It is very common to experience pain during pregnancy and all too often it is just brushed off as “This is normal. I’m pregnant and I’m going to hurt.” There are many reasons as to why low back pain occurs during pregnancy however in many cases the main culprit is an increase in the release of the hormone Relaxin. This hormone can increase up to 10 times the normal concentration in the body. It helps to prepare the body for delivery by increasing joint laxity. Increased joint laxity or hypermobility without increased stability (muscle motor control) often leads to pain. Implementing the right stretching and strengthening program can significantly reduce musculoskeletal pains associated with pregnancy.

I addition, it is very important to have proper safe and effective soft tissue mobilization of scar tissue that forms after a caesarean section. Scar tissue can bind down on visceral organs causing hypomobility of surrounding structures. Often complications with bowel, bladder (incontinence), digestive, and even low back and pelvic pain can occur years after a C section. Call Berman Physical Therapy today for more information on pain and pregnancy!

Sacroiliac Joint Dysfunction or “SI pain”

Sacroiliac joint dysfunction (SIJD) is a low back/pelvic condition that occurs when there is hypomobility or hypermobility at the SI joint(s) in the pelvis.   This condition can affect both males and females, however it is more prevalent in females due to hormonal changes during menstrual cycles that causes joint laxity. SIJD can also occur from trauma and/or injury, such as from a fall and landing on one side of the pelvis or from over training for athletic participation. Muscle imbalances and hip hypermobility (dysplasia) can also lead to SIJD.

Symptoms may feel like sharp or dull, usually localized to one side of the low back and/or pelvis. Symptoms may also radiate down one leg to or past the knee. Symptoms are usually worse with getting in/out of a car, standing up from a seated position, rolling over in bed, and/or prolonged standing/walking.

This condition is usually easily diagnosed and treated by a quality Manual Physical Therapist with the proper muscle energy technique (MET) to realign the pelvis or “get back in wack” and with specific strengthening and postural stabilization exercises. Contact Berman Physical Therapy, LLC today for more information for what could possibly be an “easy fix” to this common aggravating condition!

Lateral Epicondylitis or “Tennis Elbow”

Tennis elbow is a painful condition caused by overuse of the “extensor” muscles in your arm and forearm, specifically your wrist extensors, which causes inflammation to the extensor tendons where they attach at the lateral epicondyle on the outside of the elbow.

Prolonged use of the wrist and hand, such as repetitive gripping tasks, computer use or operating machinery, and obviously improper grip while playing tennis, can all lead to tennis elbow. Symptoms can occur in men or women, and most commonly affects people between the age of 30 and 50.

Symptoms may include:

-Pain that radiates into your forearm and wrist

-Difficulty doing common tasks, suck as turning a doorknob or holding a coffee cup

-Opening a jar, or gripping fine objects such as a fort or a key

-Stiffness in the elbow and/or weakness in the arm

The difficult part to treating Tennis Elbow is identifying the cause of the problem, not just treating the symptoms. There is a reason why the forearm extensors are becoming over worked and inflamed. More often than not, this is because there is a mechanical restriction in the neck, which is causing a slight weakness in a particular muscle in the arm, in turn causing the wrist extensors to work harder to compensate for that weakness. This is why 99.9% of the time, wearing a “tennis elbow brace” doesn’t completely work; it may make your symptoms feel better while wearing it but it does not “fix” the problem in the neck.

Here at Berman Physical Therapy we assess the whole system, not just the body part, to help identify the true underlying cause of your symptoms. The majority of our patients see dramatic improvements with their tennis elbow symptoms after just one visit! Call us today and schedule an appointment with a quality manual therapist and start seeing improvements today!



Greater Trochanteric/hip Bursitis

Greater trochanteric bursitis (GTB) is one of the most common causes of hip pain. This condition can affect both active and inactive individuals, but is most common in moderately active, middle-aged females or those who have recently increased their activity level. Symptoms can present as inability to lie on the involved side, walk, climb stairs, squat, or participated in recreational activities. To treat hip bursitis, physical therapists typically prescribe a combination of stretching and strengthening activities to decrease irritation in the hip and resolve the pain.

What is greater trochanteric bursitis? GTB is an irritation of the bursa, a fluid-filled sac that sits on top of the greater trochanter, a bony prominence on the outside of the hip bone (femur), the most outside aspect of the hip. The bursa acts as a cushion to decrease friction between the outside of the hip bone and muscles attaching to the bone. This leads to inflammation of the hip bursa. GTB occurs due to repetitive friction to the bursa due to a combination of muscular weakness and tightness that causes increased friction on the outside of the hip.

GTB may result from a combination of several different variables, including:

  • Iliotibial (IT) band tightness
  • Hip muscle tightness
  • Hip muscle weakness
  • Abnormal pelvic, hip, knee, or ankle structure
  • Abnormal pelvic, hip, knee, or ankle mechanics
  • Improper technique with repetitive activities
  • Change in an exercise routine or sport activity

Most commonly found, as the culprit to GTB is glute medius weakness and/or pelvic obliquity. When addressed early enough, this condition can be easily corrected with simple strengthening and stretching exercises in addition to neuromuscular re-education to retrain proper body mechanics. Call Berman Physical Therapy to schedule an evaluation with a quality manual therapist today!

Carpal Tunnel Syndrome (CTS)

CTS usually starts gradually, with complaints of burning, tingling, “pins and needles,” or numbness in the palm of the hand and fingers. Often the symptoms are more noticeable during the night, and individuals often report being wakened with symptoms. As the condition progresses, the symptoms are noticed during the daytime and are often worse with excessive computer use and/or gripping fine objects as when writing. Weakness of the hand and more constant numbness may occur if the pressure on the nerve continues. You may find that you drop objects unexpectedly or have a weakness in your grip.

CTS can have multiple contributing factors including overuse or repetitive tasks and poor posture (forward head rounded shoulders). Because of this, the cervical spine is usually involved in contributing to distal (arm/hand) symptoms. Conservative treatment should consists of quality Manual Therapy, postural strengthening of deep neck flexors of the anterior neck and mid scapular muscles, nerve glides, and proper stretching routines.

Conservative treatment should ALWAYS be attempted first! It is often that we see patients that have already undergone a nerve conduction study (EMG), injections, and even a carpal tunnel release (surgery), who STILL have their symptoms (usually because the cervical spine is the underling culprit). The majority of our patients who have CTS see dramatic results in a reduction of their symptoms after just one visit! Call Berman Physical Therapy today to begin on your road to recovery!