MedX: The Importance of a Strong Back

One of the primary myths surrounding back pain is that exercise, especially weight training, should be avoided because of back pain.

The importance of exercise and a strong back is often underestimated in the case of both acute and chronic LBP. Studies have found the recovery from acute back pain occurs more quickly with the right type and progression of exercise. Even chronic back pain shouldn’t keep you from the activities you enjoy, including exercise.

Your back needs movement to be healthy like any of the other joints in the body. Exercise helps maintain your range of motion and prevents your muscles from weakening, in turn allowing you to heal more quickly. Underworking your back can be equally as detrimental as overworking your back.

The deep muscles that stabilize the spine are small and often inhibited by the body’s response to pain. This guarding response can result in weakness during reduced activity levels associated with prolonged periods of pain. In turn, allowing these deep stabilizers to be overridden by the larger muscles of the hips and back. This can result in abnormal muscle firing and pain as you begin to resume daily activities. Unless these larger muscles are prevented from being used during back strengthening exercises, it is difficult to directly target the correct muscles groups required to have a strong spine and full return to normal function without pain.

The lumbar MedX machine has proven to be extremely effective in the treatment of back pain. The patented restraint system provides an effective way to isolate the deep spinal muscles by preventing movement in the pelvis and firing of the hip and leg muscles. This isolation allows the spine to move smoothly and restore normal firing of the deep spinal stabilizers through a pain free range of motion.

Another benefit of the MedX is the ability to test an individual’s low back strength effectively with comparison to normal values taking into account the patient’s age, weight, and gender. This allows us to determine how strong your back should be if it was healthy.

Following this baseline test, a training program with individualized progression of resistance levels is performed, in addition to core stability exercises, in order to normalize the overall physiologic strength of the lumbar spine, decrease pain, and reduce susceptibility to future back injuries

Back pain is common, but a strong spine can allow you to continue doing the things you love.

How Urinary Incontinence Helped Me Find My Calling

As a pelvic health physical therapist assistant, I am often asked by our patients why I chose to specialize in pelvic floor physical therapy or if I personally have ever experienced any type of pelvic floor dysfunction. I suppose my mother was a great influence on this decision. See, I grew up with a mother who many would deem as an “over-sharer.” Due to her lack of inhibition blended with her passion as a labor and delivery nurse, I learned, from an early age, the details about the female body, childbirth and her issues with incontinence. As a mother of three, she often experienced urinary leakage while laughing, jumping on a trampoline, or horseback riding. Just not making it to the bathroom in time, was also a common occurrence in her life. What she had endured for so many years was mixed urinary incontinence conjoined with bladder prolapse. All those embarrassing teenage years did serve a purpose, they ultimately led me to find my calling as a pelvic health professional.

In my mid-twenties, I began to struggle with my own pelvic floor dysfunction. Like many women, I was confused and a bit embarrassed. Unlike my mother, I had not had children and I was physically fit. The only time that I experienced urinary leakage was when I was dead-lifting and squatting heavy weights, as I was a power lifter. Occasionally, there would be instances when I would completely soak myself.  Black or dark colored workout leggings became as necessary as a spotter, chalk and my belt during my workout routines. So, what did I do besides modify my workout attire? I turned to Google, of course. I discovered that I was not the only female struggling with this problem. In fact, many athletes struggle with urinary incontinence due to improper breathing techniques, straining, constant demand from high impact activities, or weak/tight pelvic floor muscles. According to the internet, the answer to my problem was as simple as performing Kegel exercises. However, not all that you read on the internet is true. I wish it had been that simple or at the very least, not so misleading. Not only can this be the wrong advice if your pelvic floor muscles are too tight, but that also most women do not perform Kegels the proper way. 

At that time, like many women, I had no idea that pelvic floor physical therapy existed. Therefore, my issue continued for years and actually worsened when I began participating in CrossFit. I have come across many CrossFit athletes who equate accidentally urinating while exercising. While indeed, they may have had great workout, and perhaps even hit a new PR, their urinary incontinence is a symptom of pelvic floor dysfunction. It is absolutely nothing to be ashamed about, however, it is also not something that should not be encouraged. Using specific training techniques, pelvic floor physical therapy not only can help with urinary leakage when lifting, running, or performing double unders, but it can also positively impact an athlete’s performance by addressing muscular imbalances and by practicing proper breathing technique. 

At East Tennessee Spine and Sport, our pelvic health team is excited to be part of your journey. Whether you are an athlete, a mom, mom to be, or if you just want to be able to perform daily activities without limitations, you are in the right place. This isn’t just part of being a woman or something you must live with. Your treatment plan will be individualized based on your needs/goals and our team will be there to direct, educate and encourage you along the way. Now, it is time to ditch those dark colored leggings and start living life with confidence.

I thought all Physical Therapy exercises were the same?

As professionals in Physical Therapy, our knowledge and expertise lie in the way people move and the way the human body works. We are able to assess, examine, and tailor specific treatments for each individual patient. Our goal is to help you and your body facilitate opportunities for you to heal, become more proficient with the way you move, adapt to your specific environments/goals, and ultimately return you to a level of functioning.

 

A large part of that consists of specific corrective exercises we prescribe. Corrective exercises are given specifically to you based on your individual assessment and will progress and change as you progress through your time with us. These corrective exercises are used to address the imbalances, movement compensations, and other issues found with the way you might be moving that are limiting your ability to perform certain things in your life – that you would otherwise be able to perform.

 

In the same way your Medical Doctor will prescribe a medication according to specific dosages, we think of these corrective exercises and corrective movements the same. The number of sets, the number of repetitions, and the frequency given to you by your Physical Therapist is important. The first thing you often hear when receiving a prescription is to “take it as it prescribed.” This is how corrective exercise prescriptions from your Physical Therapist are viewed as well. We design a specific exercise program for you to be followed “as prescribed.”

 

We understand that life can be busy, even when you might not be performing at the level you would like to be performing. Like anything, habits take some time to be formed. We have a few suggestions for you to help you establish a good routine with your corrective movement prescriptions at home:

  1. Talk to your Physical Therapist and ask them questions, making sure you understand what they are prescribing
  2. Perform them at the same time each day – this will help establish a routine schedule
  3. Couple the exercises with another already formed habit – for example, if you take a blood pressure medication at the same time each day, follow that up with your corrective exercises OR perform them during a commercial break.
  4. If you are feeling like the exercises are time consuming talk to us about it! This should never be the case.

 

Whatever you do, avoid not performing corrective exercises. They are the movement medicine given to help get you better and back to the things you love doing! As always, if you have any questions or would like to talk to one of our professionals call one our six clinics located throughout the great Knoxville area!

What to Expect During Your Initial Visit

Whether you have been to physical therapy before or not, we want you to know what you can expect when you visit one of our East Tennessee Spine and Sport Physical Therapy clinics around Knoxville!

 

Lots of questions can swirl in our minds about how long it will take, what the visit will consist of, and other thoughts/worries can come up as well. We are here to help provide clarity regarding your first visit to decrease the uncertainty.  

 

Here’s what you can expect at your initial visit with us:

  • To fill out paperwork for our front office, however you can also find these forms on our website and bring with you on your first visit to save time

 

  • Once you finish the paperwork you physical therapist will walk you back to the evaluation room, where they will sit down with you and discuss the nature of what has brought you into the clinic. Whether you are here as a result of new or ongoing pain, a workplace injury, post-surgical rehabilitation, sports injury, etc. we will thoroughly review your history to determine how to best help you. Don’t worry, this is not the only time you’ll have to explain what is going on, but it is the time for you to explain things as best as you can!

 

  • The physical therapist will then begin a thorough movement assessment – we want to see how you move. We want to see how your pain/body responds to certain movements. Your physical therapist will also use their hands as a tool to aid in their examination and assessment. There are many specialized tests and methods used to help us evaluate that include hands-on examination and treatment.

 

  • Once your physical therapist has completed the assessment and examination portion of your initial visit, they will explain what they’ve found and how they want to help you progress – through various treatments – and they will help develop goals for you and your specific needs. Followed by corrective manual therapy and corrective exercises to address the specific needs and limitations the physical therapist found during the evaluation.  

 

  • Your physical therapist will finish your evaluation by creating your plan of care including working with you the number of visits, doses to perform your home corrective exercises, and length of time they think it will take from start to finish.  

 

Most importantly, know that your physical therapist wants to walk with you from your first visit with us, to your final visit! You can expect that we will listen, partner with you, and work towards enabling you and your body to return to an optimal level of functioning!

 

If you have any questions give us a call at any one of our clinics. We look forward to hearing from you and journeying with you! 

The Most Common Pelvic Floor Disorders

Pelvic health physical therapists treat multiple disorders including urinary and fecal leakage, pelvic pain, urinary urgency and frequency, pelvic organ prolapse, diastasis recti, low back, hip and abdominal pain, pregnancy related pain and postpartum care, just to name a few.  While our society has led us to believe that many of the mentioned problems are normal, know that there is conservative treatment available by visiting a pelvic floor physical therapist.  

 

As a pelvic floor physical therapist I commonly have to ask deeper questions beyond our initial intake questionnaire that asks, “Do you ever leak urine when you laugh, cough, sneeze, exercise or jump?” as many circle “no.”  After further questioning, however, a common reply is, “Well, yea, but I’ve had two children and my mom and grandma told me that’s simply a normal part of being a female” or, “I do, but only while running or jumping and a lot of my friends do too.”  While this is a very common problem, there is conservative treatment for it…pelvic floor physical therapy! In fact, 25% of women have urinary incontinence and up to 50% of those have urinary leakage who exercise regularly. While most assume urinary leakage equates a weakness based problem, that is not always true and in some cases strengthening the pelvic floor can actually make urinary leakage worse!  There are a variety of factors that may lead to urinary incontinence some of which include a weakened pelvic floor, overactive pelvic floor muscles that have a difficult time relaxing, damaged pelvic floor muscles resulting from surgical procedures or labor and delivery. Urinary leakage can also be caused by overactive and strong pelvic floor muscles in which the patient may be using mechanisms such as breath holding while lifting a heavy object, for example, as the increased pressure finds the weakest link within the system, commonly being the pelvic floor muscles.  This is why having an evaluation by a pelvic floor physical therapist is so important to determine the contributing factors that are causing the leakage. These muscles need to be both strong in order to contract fully but also mobile to be able to relax fully to function appropriately. It is our job as pelvic floor physical therapists to train the pelvic floor muscles accordingly. 

 

Another common disorder we treat is pelvic pain.  Again, this is another common problem that many don’t feel comfortable talking about. 14.3% of women experience pelvic pain and often take years to tell their medical provider. There are many conditions that can lead to pelvic pain including cesarean sections, episiotomies, or complicated deliveries including the need of forceps, for example. Other diagnoses that commonly lead to pelvic pain include those such as interstitial cystitis (also known as painful bladder syndrome), endometriosis, past history of trauma/abuse, or chronic pelvic pain that has been occurring for 6 months or more without explainable cause.  Pelvic pain can present differently such as sharp, stabbing pain or a deep, dull aching pain. Pelvic pain is not just limited to the pelvic area, however, as most also have discomfort in the surrounding area including the lower abdomen, hips and low back. Being orthopedically trained, we treat with an outward to inward approach meaning that we look at how the low back, the hips, core and the patient’s breathing mechanics are working first before examining the pelvic floor. Yes, even how you breathe plays a role in the function of the pelvic floor! With pelvic pain, it is common that the pelvic floor muscles spasm and are especially tight with a difficult time being able to relax.  The pelvic floor muscles have to be able to relax in order to empty the bladder and bowels, so constipation and incomplete emptying of the bladder, or needing to strain in order to empty the bladder are commonly seen with pelvic pain. At Spine and Sport, we realize that pelvic pain can be a very sensitive topic to share. With your therapist being a female and having a private treatment room, it is our goal to make your comfort our priority. If you have any questions or concerns prior to your first visit, do not hesitate to call the office and your therapist will answer any questions you may have.

 

Pelvic floor physical therapists also commonly treat urinary urgency and frequency.  These problems tend to have multi-faceted contributions. While there is typically a musculoskeletal involvement such as increased tone or trigger points within the pelvic floor muscles, there are typically other causes as well.  One of which being dietary choices. There is a list of commonly known foods and fluids that contribute to bladder irritation. An abbreviated list includes coffee, tea, carbonation, citrus fruits, tomato based products and fruit juices.  Additionally, not consuming enough water concentrates the urine which irritates the bladder. When the bladder becomes irritated, common side effects are urinary urgency and frequency. Your pelvic floor physical therapist may give you a bladder diary to complete for a few days to examine any possible foods or fluids that are contributing to your symptoms.  Additionally, your physical therapist may have you work on something called behavioral retraining techniques if you report voiding more than 6-8 times or more than once every 2 hours within a 24 hour period. The bladder provides the brain with two signals. The first signal is sent to the brain when the bladder is about 25% full. This is a subconscious, warning signal to become alert of knowing where a nearby restroom is.  This signal does not mean it is time to empty, though! The second signal to the brain is when it is truly time to empty the bladder due to being full. When patients use the restroom, “just in case” or more frequently than needed, this habit starts to trick the brain into feeling full before it actually is. Your pelvic floor physical therapist will educate you on behavioral retraining methods in order to prolong the time before voiding, thus being able to delay urinary urgency until that second signal tells your brain that the bladder needs to be emptied.  

Pelvic organ prolapse is a condition that pelvic floor physical therapists commonly treat.  The pelvic floor muscles are shaped like a bowl and one of their primary functions is to lift and support our organs.  When the pelvic organs descend, this is pelvic organ prolapse. Pelvic organ prolapse is categorized by the specific organ and graded based on severity, or amount, of descent ranging from grade 1 (least amount of descent) to grade 4.  Some common symptoms of this condition include a pressure or bulging sensation within the pelvis, a feeling as though “something is falling out” of the vagina, difficulty with inserting tampons, aching low back discomfort, urinary leakage or difficulty emptying the bladder or bowels.  More often than not, patients report that their symptoms are aggravated by standing, walking or lifting heavy objects for prolonged time periods. While pelvic floor physical therapists are unable to change the grade of the prolapse that was given by the patient’s medical professional, there are many different interventions that can significantly reduce the severity of symptoms a patient may experience.  Sometimes physical therapy care can completely eliminate pelvic organ prolapse symptoms! Your physical therapy may provide manual therapy, prescribe specific therapeutic exercises, and educate on how to breathe properly while performing strenuous activities to prevent breath holding among many other interventions.  

 

This provides a very condensed list of the disorders a pelvic floor physical therapist treats.  Our patients commonly experience low back, hip or abdominal pain, core weakness or diastasis recti after pregnancy.  We treat pregnancy related pain and postpartum care including safe return to previous level of activity and proper body mechanics for the high demand that comes with being a new mother.  If you have any questions about conditions we may treat as pelvic floor physical therapists, please do not hesitate to call any of our locations to speak with the therapist in order to determine if you are an appropriate candidate for pelvic health physical therapy. 

 

To learn more about our pelvic health program, visit the Pelvic Health section on our website.

To request an appointment, click this link.

Coronavirus Update

With the growing concerns regarding the potential community spread of the Coronavirus (COVID-19), East Tennessee Spine and Sport is committed to maintaining a safe environment for our patients, visitors, and staff members. Currently, the CDC is not recommending any additional precautions within our healthcare setting beyond the normal practices performed to prevent the spread of respiratory viruses. Our clinics will remain open during normal clinic hours to treat our patients. As always, we will go above and beyond our usual practices to ensure the safety of everyone involved with our clinics.

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Headaches are a pain in the neck!

Most people have experienced some type of headache in their life, whether it has been a mild sensation of tension, pressure, or a full blown migraine that is life altering. Sometimes we are able to muster our way through our daily tasks. Other times, though, the severity can render us unable to do anything but find a dark and quiet room in an attempt to abait the pain. There can be an underlying cervical issue that can be directly related to our symptoms. Cervicogenic headaches (CGH) and migraines are not the same, but CGH can become a trigger for a migraine.

Headaches and migraines can also be worsened by musculoskeletal tightness and stress. Chronic or frequent headaches generally have been associated with poor posture and prolonged loading of the cervical spine outside of a neutral position which creates musculoskeletal imbalance. Typically there are muscle groups that are stretched and weak and muscle groups that are tight and overworked. How many times have we been caught looking down at our phones, squinting and leaning in to see a computer screen from eye fatigue, or bending our head to hold the phone during that hour long conversation all the while probably slouched while sitting in a chair? I can hear the echo of my grandmother… “ Sit up straight, put your shoulders back.” She was right!

Treatment for cervicogenic headache should target the cause of the pain in the neck and varies depending upon what works best for the individual patient. Treatments include physical therapy and exercise, and may require medications or further intervention by a specialist.

Physical therapy is an avenue for those suffering from headache and migraine symptoms to undergo comprehensive assessment and treatment for possible underlying cervical involvement. You will also be prescribed an exercise program that is safe and effective in reducing severity, frequency and duration of symptoms. It includes an ongoing exercise regimen that seeks to restore joint mobility, alignment, and strength. These corrective exercises can be utilized as prevention and even as treatment for headaches. It gives you independence and an added tool in your tool box to manage your symptoms.

So maybe you should take the time to check in with yourself. Do you have frequent headaches? Does your upper back and shoulder muscles feel tight or are they easily fatigued? Do you have neck pain? Do you hear the echo of your grandmother in your ear about your posture? If you answered yes to these questions, then you should consider physical therapy as a way to evaluate and help address your headache issues.

Physical Therapy Can Help With What?

When people ask me what I do for a living, I generally say I’m a physical therapist, but sometimes I will divulge that I am a pelvic health physical therapist. This is usually met with lots of questions. Yes, I can treat neck pain, knee problems, general weakness, and all the usual things that you normally think a physical therapist can treat. However, I also have additional training that allows me to treat specific dysfunctions in the pelvic area like bowel and bladder incontinence, pelvic pain, and tailbone pain. These are often conditions that people think they need to just live with, but that is absolutely not true!!

I hear this statement all the time: “Sometimes I leak urine, but I’ve had kids so that’s normal right?”

No. Urinary incontinence is very common-ranging from 0.3-44% in the literature, but it is not normal even after having children. Urinary incontinence can occur in all ages and fitness levels. It can be the result of a strong urge from the bladder or it can be caused by cough, laugh, sneeze, or other movements that will increase the pressure in the abdominal area. Both types of leakage can be helped by a physical therapist with this additional training.

Everyone has a group of muscles that make up the bottom of their pelvis called the pelvic floor muscles. These muscles are key players in the ability to maintain bowel and bladder continence and just like any other muscle group, they can get weak over time. Most people have heard the term “Kegels” which is just another name for a pelvic floor muscle contraction.

Another statement I hear a lot is that “Well, I’ve tried Kegels in the past and they didn’t help!”

Only about 50% of people verbally cued to do a pelvic floor contraction are doing it correctly. So about half of the people who have tried to strengthen their pelvic floor on their own are not utilizing these muscles correctly. These muscles also have to have the correct dosage of exercise to be effective. If these muscles are overworked, urinary incontinence may get worse. If these muscles are underworked, the muscles never get stronger and these symptoms never improve. Maybe the muscles are strong enough, but the timing of the muscle contraction is not occurring when it is needed to prevent incontinence. Maybe these muscles are working too hard because another muscle in the hip or core is weak and the pelvic floor is trying to make up for that weakness.

Sometimes it is not as easy as doing Kegels at every red light to fix a problem like this. A physical therapist with training to assess this condition can help to figure out what is causing the muscles to work inefficiently. Spine and Sport is excited to be able to offer pelvic health services in our Oak Ridge by myself and West locations by Lauren MacGuire to help patients across the greater Knoxville area find solutions to their pelvic health problems.