In conjunction with the American Physical Therapy Association, Cedar Hill Physical Therapy has also created a brochure filled with exercises to prevent pain while traveling. The exercises are simple, seated exercises to keep the blood flowing, the joints mobile, and the muscles relaxed. They are also helpful for prevention of deep vein thromboses (blood clots) that can develop due to poor circulation in the legs and feet. For more information download our  In Flight Fitness Guide (24).

Neither the brochure nor the article is intended as a substitute for professional health care. If you have an existing back problem or are at risk for developing deep vein thrombosis, appropriate guidance should be given to you by your physical therapist before any extensive travel. Working as a team, you and your therapist can design a plan to promote movement, prevent pain and make your travel much more comfortable and enjoyable.

Through the McKenzie approach, you gain an experiential education and learn to self-treat your back and/or neck pain.

Remember, not all therapists are created equal. It is important to seek out a well-trained McKenzie practitioner.

For more information on the McKenzie Method and how it works, check out this link to Paul’s article, The McKenzie Method Works (49) which can also be found in the June/July edition of The Guilford County Women’s Journal.

Everyone that I have the opportunity to work with is unique. I constantly find myself trying new techniques in order to bring about the desired results. In this blog I’m going to talk about those techniques which I use to improve follow through with the exercise prescription which is tailored to help the individual to reach his or her goals.

Most people that I see experience pain with movement. One of the surest ways I have found to get a person to perform their exercises is if they can see an immediate improvement as a result of doing them. For example, I recently had the opportunity to help a lady who was experiencing back pain when she climbed stairs. After evaluating her, I took her to the stairs leading into my clinic. I had her to climb them and asked her to make a mental note of how it felt. It was indeed painful for her.

Based on her description of her problem and the results of my physical examination I tested her on exercise that I thought would help to decrease the pain that she was experiencing. After taking her through this exercise we noticed that some of the stiffness she initially presented with had improved. I then asked her to climb the stairs again. I smiled when I saw the curious expression on her face. She was able to climb the stairs with much less pain than she had immediately before performing that exercise.

We had initially planned for her to attend several visits of physical therapy. When she came in for her second follow-up visit she told me that she was ready to graduate, and indeed she was. As it turns out, any time she had a hint of back trouble she did her exercises and her back troubles subsided. I believe that the manner in which I taught her this exercise was instrumental in her understanding that the exercise would decrease her pain and since it was her goal to experience less pain she was committed to its regular performance. Now, it is entirely possible that the first exercise I showed her would not have yielded such a positive result. If that were the case, we would have tried other exercises and treatments until we found what would help her or until we exhausted these efforts.

About half of the people that we see have such a rapid response. Indeed, it is the other half who present with a greater challenge. While the results may not be as rapid, the principle of linking the exercises to a person’s goal remains a key element. When the results are not as rapid, I know that the patient must have confidence in the prescribed treatment in order to take an active role. In order to gain that trust I educate them in regards to how the exercises will be of benefit.

For example, let’s look at a person who experiences pain with picking things up from the floor. Oftentimes for this to be accomplished with a minimum of discomfort it is necessary to lift with the knees. However, in the case of someone who does not have the requisite strength in their legs to perform this task they will not be able to immediately derive a benefit. In that case I would prescribe an exercise program to improve the strength in their legs such that they could be used to lift things from the floor with proper body mechanics.

In many ways, this represents to me the most enjoyable part of my work.

Among these was a talk I think of as the “Plant the Seed” talk. When I was in elementary school, I was a good student, albeit not the most motivated of kids. We talked about a fellow student, a bright young man who excelled in his studies. Mom told me that if I applied myself, I could do just as well. She described my potential as a gift, a seed that needed to be planted and nurtured in order that it would grow.

When I was in kindergarten, mom came in one day to teach knitting. Several girls in the class were to take her class. One boy was to do so, as well. Before she taught, I asked my mom why a boy was to be part of her group, in a manner that I am sure reflected my feeling that it just wasn’t right. She told me that if a boy wanted to take her class then he could, and that was OK. And that was that. It wasn’t until later in life that I realized how that was a lesson in civil rights. I reflect on it often.

My mother, Raye, was the eldest of 4. Her siblings are my Aunt Charlotte, Aunt Esther and my Uncle Larry. Uncle Larry was the youngest. My grandfather always wanted a boy. After Uncle Larry was born, the story goes that grandpa got home from the hospital and ran up the stairs of the apartment building they grew up in shouting, “He’s arrived! He’s arrived”. It is said that you would have thought the Messiah had come.

As I grew to Bar Mitzvah age, a Jewish celebration of the transition from childhood to adulthood at the time of one’s 13th birthday, I learned more about my mom’s life. She grew up in Orthodox Judaism, with its strongly defined gender roles. These roles had boys to celebrate their Bar Mitzvah and read from the Torah, but did not permit girls to have a Bat Mitzvah. Mom wished for such an opportunity. As an adult, Mom went on to celebrate her Bat Mitzvah in a Reform synagogue.

When mom wanted to go to college, my grandmother told her that girls don’t need to do that, and did not permit her to do so. She vowed then that if any child of hers wanted to go to college, she would do everything necessary to make sure that happened.

Thanks, Mom for instilling in me the value of hard work; how important it is to use our talents; the ideals of fairness and equality; and how I should never take opportunities for granted. And regarding the “Plant the Seed” talk… I like to think that by being the first in my immediate family to graduate from college and using my education in my profession I have lived up to that lesson.

As Mother’s Day approaches, I think about how deserved a day that is. Thank you Mom for being my first and best teacher. Even though my mother is no longer living, I see that same determination, intelligence and caring in the many women I work with as a physical therapist. Along with mental and emotional stressors, motherhood brings about many physical challenges as well. Pregnancy. Bearing a child. All the bending, lifting and carrying involved in caring for a baby and a family. I feel honored to be able to help moms enjoy their lives and be there for all the people for whom they care.

Download: Posture Tips for Parents

During her course of therapy she corrected the deficits she had demonstrated at her initial evaluation. With that, I encouraged her to resume activity as tolerated. Towards the end of her treatment she reported resuming horseback riding. So much so that the activity was limited more by the horse’s fatigue than her own! With that, I recommended to her physician a full return to horseback riding as tolerated, including participation in an upcoming horse show.

At the horse show, I spoke with one of her parents. At her physician’s visit concern was expressed regarding her return to horseback riding. As any PT would like to hear, the doctor said that since I said she was OK to ride, then he was in agreement.

I understand that a parent will be concerned regarding the possibility of reinjury. However, in this case I was far more concerned regarding the negative effects of keeping this young lady off the horse for too long a period of time. Being restrained from a normal activity, particularly one someone enjoys, is, well, bad. Not only does one suffer the physical effects of being inactive, but there are psychological effects as well. The loss of the joy the activity brings. The change in a person’s self image from being a capable performer to someone who is disabled. It can lead to (or aggravate underlying) depression.

When someone is injured or sick, they may take on a “sick role”. They learn new limitations, and their relationships with those around them change. Instead of contributing as much, they require more. The extent of the sick role can be influenced by those around. Someone who encourages an injured person to do less than what they are safely capable of doing can increase the “sick role” behaviors. Someone who encourages an injured person to do what they can may facilitate their recovery.

Of course, it is important to consider the “tools” an injured person has to work with. Generally speaking, a physical therapist will determine where someone is weak and help them to become strong; they will find where they are stiff and help them to become flexible, and they will find where they lack control of their body and empower them to take control in a positive way. When these deficits are corrected, it is time to move on. That is the time when not to hold back.

As it turns out, her horse fell not once but twice when they were jumping at the show that weekend. Each time, her immediate response was to bounce up and check that her horse was OK. Everyone turned out just fine, including her parents.

Inflammation is often accompanied by pain, swelling, redness, and often times loss of movement or function. Inflammation plays a huge roll in many common diseases such as arthritis, heart disease, strokes, cancer, and dementia.

Treatments for inflammation include rest, light exercise, maintaining a healthy weight, and stretching. There are medications, including steroids and non-steroidal, designed to reduce inflammation and control pain. We’ve heard of the adverse side effects of steroids. Unfortunately, even the non-steroidal medications have side effects including stomach irritation, ulcers, and with prolonged use, possibly kidney problems.

What if you could control inflammation by changing what you eat? The foods you eat really do have an effect on how you feel. Adding foods that reduce inflammation and cutting back on foods that increase it can improve how you feel, help decrease your risk for chronic diseases, and help you move better with less pain.

Check out our article on The Mediterranean Diet- a diet rich in anti-inflammatory foods.

Register for a Feel Better, Move Better Cooking Class

“Following an anti-inflammatory diet can help counteract the chronic inflammation that is a root cause of many serious diseases, including those that become more frequent as people age. It is a way of selecting and preparing foods based on science that can help people achieve and maintain optimum health over their lifetime.”
- Andrew Weil, M.D.

The recipes that follow qualify as anti-inflammatory due to their ingredients and or method of preparation.  Check back each month for new dishes.  Enjoy!

Black Bean & Corn Salad

1 15 oz can black beans, drained and rinsed
1 15 oz. can whole kernel corn, drained
2 limes, juiced, and as much fruit as possible
1/3 cup minced red onion
1/3 cup minced fresh cilantro
3 tablespoons white vinegar
2 teaspoons sugar
2 teaspoons ground cumin
2 teaspoons chili powder

Mix dry ingredients, then add liquids. Stir together, then chill for 1 hour.

Watermelon Iced-Tea-ni

This drink has high levels of betacarotene and lycopene!

Make 4 to 6 cups boiling water and add a few herbal tea bags (peppermint, chamomile, lemon verbina, etc.)

Place the brewing tea in a window or somewhere it can cool for a while, then place it in the refrigerator to chill for at least an hour.

While the tea is steeping and chilling, cut 2 cups of watermelon cubes, about 2 inches square. Place these cubes on a plate or in a bowl, then freeze.

Serve the chilled iced tea with chunks of watermelon “ice cubes” and enjoy!

Zesty Strawberry-Citrus Salad with Mixed Greens

Banana-Walnut Oatmeal

This is one of my favorite ways to start my day.  It’s not your typical oatmeal.  The spices give a boost of flavor along with great anti-inflammatory properties.  The banana contributes potassium and sweetness.  The walnuts add omega-3 fatty acids along with a crunch.

Ingredients

1 cup unsweetened almond milk
1 cup water
Pinch of salt
1 cup gluten free rolled oats
1 very ripe banana, cut into chunks
1/4 tsp each of ginger, cinnamon, and cardamom.
1 tsp vanilla
1 tablespoon pure organic maple syrup or raw honey
1 tablespoon chopped walnuts

Instructions

Combine almond milk, water and salt in a medium saucepan; heat until almost boiling. Add oats, banana, vanilla and spices. Cook, stirring, until creamy, 10 to 20 minutes. Remove from heat, add maple syrup or honey. Divide between 2 bowls, sprinkle with walnuts and serve.
2 servings, about 1 cup each

Pear & Red Onion Gratin

Surgery and a cart full of drugs aren’t the only solutions for back pain.

Low back pain is the second most common reason that people see a physician.  (Colds and the flu are number one.)  In some cases back pain will resolve with time.  Unfortunately once someone has had an episode of low back pain, it tends to recur and can often become an ongoing problem.  In 2006, more than ten percent of North Carolinians reported chronic low back pain.

From 1997 through 2005, health care costs for low back and neck pain increased dramatically.  This would be okay if the increase in spending were met with an improvement in the condition, but such an improvement did not occur.

One reason for the rise in costs is due to the increased use of imaging studies which are far from perfect.  MRIs on people without low back pain often show abnormalities.  The New England Journal of Medicine reports the abnormalities found in people WITH low back pain may often be coincidental.

The early use of imaging studies to diagnose conditions may often mislead people into believing their problem is worse than it actually is.  In turn, this belief may lead them to seek more invasive and expensive treatments when other less invasive, more economical treatments would suffice.  A positive correlation between those areas where physicians order the most spine images and where the most spine surgeries are performed supports this concern.

Physical Therapy- an economical, non-invasive option

If we are looking to avoid expensive invasive procedures, what can we do for people with back pain?  Multiple studies have shown that well-trained physical therapists can effectively manage patients for musculoskeletal conditions and correctly identify those who need to be referred to an orthopedic surgeon.  In fact, these studies show that physical therapy is a cost effective treatment that WORKS.  Unfortunately, a recent study has shown that exercise and physical therapy, the most effective treatments, were underutilized, while narcotics and other medications were over utilized.

The overwhelming majority of low back pain cases are uncomplicated.  Even those who have suffered from recurring episodes of back pain or have had surgery in the past are well served by seeing a physical therapist, and physical therapy should be in the front lines of treatment.

All physical therapy is not created equal

A recent article in The New York Times highlighted an area of concern in the physical therapy profession.  Many therapists provide passive treatments- such as heat, ice and electrical stimulation- that only bring about temporary relief of symptoms.

Take time to learn about the physical therapists in your area.  What advanced training do they have?  Do they help to empower patients to take an active role in their rehabilitation?  Do they focus on you and your needs or are they spread thin running between multiple patients?  Do you see the same therapist for each visit?

A good therapist uses a combination of education, exercise prescription and manual therapy.  This speeds recovery and ultimately helps people to know how to be more active with less pain.  Your physical therapist should be able to explain various treatment options along with their benefits and risks, and the evidence for what will work.  If your physical therapist cannot do this, you might want to rethink your choice of therapist.

When someone has low back pain, their stomach and back muscles do not work properly to support the spine.  Exercise is the best prescription for teaching muscles to work properly.  A helpful strategy is to watch these muscles as they contract and relax so that proper exercise performance is achieved.  The use of an ultrasound imager (similar to ones used to monitor the fetus during pregnancy) allows patients to see these deep abdominal and back muscles while they exercise.

Patients often come to physical therapy thinking they know how to use their muscles to support their spine.  Viewing what is happening with the ultrasound imager is often an eye-opening experience…people often come back and ask to be rechecked with the imager to see if they are doing their exercises right.  By that time, they usually are.

For back pain, see your PT first

In most instances, lower back pain can be successfully treated with physical therapy, without the need for costly invasive procedures.  In north Carolina, people have direct access to physical therapists, meaning that this beneficial treatment does not require a physician’s referral.  That gives one more reason to seek the professional treatment that you might need.