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Print8 Tips for Back-Care When Flying
1. Lift Your Cabin Luggage in stages. Move slowly when lifting your luggage and break the action into smaller steps. When lifting a bag into an overhead compartment – first lift it to the arm of the seat, then to the top of the seatback, and then into the compartment.
2. Never twist while lifting. This is a common cause of injury to the low back. Turn with your feet so that your whole body moves around instead of just twisting your back.
3. Avoid lifting if possible. Ask for help. If you explain you have back condition, you will be surprised how helpful the airline staff will be. If your bags are small and light, it will be less of a burden to ask someone to do this for you.
4. Pick an aisle seat. Ask for an aisle seat as it is easier to get into and out of an aisle seat, and allows you to get up and move around, throughout the flight with greater ease. Quite a number of airlines now allow you to select your seat when you are making a booking online.
5. Stretch key muscles. Sitting for extended periods can cause stiffness and tension in the hamstrings (the muscles in the back of the thighs) and hip flexor muscles, which in turn puts added stress on the low back. Ask your doctor or physiotherapist to advise you on a few safe stretches you can do whilst traveling.
6. Good posture in sitting. Place a small rolled-up airline pillow, blanket, towel or lumbar pillow between your back and the seat to support the natural inward curve of your lower back. You may also use commercial low back supports if you prefer.
7. Firmly plant your feet. Bottom-up leverage from your feet is also required to support your low back. While seated, your knees should be bent at right angles. If your seat is too high, place your feet on the footrest to keep your knees at a right angle to avoid stressing the low back.
8. Get up and move. Sitting in one position for extended periods of time stiffens the back muscles, which can put stress on the spine. Get up, stretch and move around every 30 minutes if possible. Movement stimulates blood flow, which facilitates the transfer of important nutrients and oxygen to your back, and thus reducing stiff muscles and muscle aches.
Hope these tips help you have a safe journey back!
Arm pain or neck pain…Where is the source?
Have you ever experienced pain in the arm, but the movements of the shoulder and elbow do not seem to aggravate the pain? Or found pain on the side of your thigh or knee, but there is nothing wrong with your knee? Are you imagining the pain? Where is the pain coming from?
These pains are real. Pain in the arm can be referred from the neck and similarly the source of pain in the leg can be from the lower back.
Types of referred pain from the spine
- The most common is a deep dull ache in certain parts of the affected limb. See image below. These areas of pain correspond to where the nerves in the spine supply sensation to. There are 7 vertebrae in the neck. Depending on the level, nerves exit from the vertebra and travel to specific areas of the scalp, shoulder, arm, forearm and hand. Similarly nerves exiting between the 5 vertebra of the lower back travel to the bottom, thighs, legs and feet. These nerves supply sensation to these particular areas and are called dermatomes. So if the exiting nerves are mildly irritated, it can refer pain to its specific dermatome. Therefore, if the structures surrounding the nerves are inflamed, immobile, strained or somehow affect the exiting nerves, pain can develop in the extremities.
- The second type of referred pain is sharper, more acute and often described as pulling, stabbing and severe pain. However, the site of pain remains the same. In these cases, the nerves exiting the vertebra are not only irritated but usually impinged or compressed. The cause of the impingement is usually severe degeneration in the vertebrae, disc prolapse and swelling which reduces the canal space, for which the nerves to exit. These types of pain can be accompanied by loss of strength of muscles in the arm and leg as well as decrease sensation as the compression affects the conduction within the nerve fibres. The impinged nerve essentially is less able to send its usual amount stimuli to the muscles it excites.
Treatment of referred pain
The treatment for referred pain is simple. Find the cause of the irritation or compression and remove or reduce the cause as much as possible within the realm of physiotherapy.
- Type 1 Dull achy pain is usually due to poor posture, excessive mechanical loading on the spine, i.e. tight muscles, stiff and or mal-positioned facet joints.Once the mechanical fault is corrected, the structures offloaded, through manual therapy, the symptoms tend to promptly reduce.
- Type 2 Pain which is more acute, it is more difficult to treat. As the source of pain is from the compression /impingement of the nerve, the cause of the impingement is usually structural. This means that the existing degeneration of the spine and the significant disc protrusion are the main reasons for the impingement. Therefore unless that is addressed, often the pain is not completely resolved.
The role of physiotherapy in this intance is to reduce the non structural causes such as excessive vertical loading, the narrowing of the canal and pain reduction. These non structural causes could be the result of swelling, poor posture, muscle spasm. Traction and specific exercises are therefore taught to open the canal space and reduce disc protrusion and impingement.
Pilates and Physiotherapy
What is Pilates?
Pilates is a unique body conditioning exercise designed to rebalance the body, bringing it, into its correct neutral alignment whilst targeting the deep postural muscles (Transverse abdominals and muscles of the pelvic diaphragm). In essence pilates challenges the core muscles and builds strength from the inside out, helping a person to reshape their body, adding to a leaner and more toned figure. It boasts of a perfect balance between strength and flexibility, whilst relieving unwanted stress and tension. The phenomena of pilates is a popular and growing trend in western countries amongst athletes and celebrities, as well as in the treatment of peripheral and spinal musculoskeletal dysfunction. Today pilates is evolving and is taught worldwide in gyms and hospital, benefiting millions of people. The aim of this article is a brief introduction to pilates and its clinical benefits in physiotherapy.
Background
Pilates was first discovered in Germany in the early 20th century by a keen diver, gymnast and boxer by the name of Joseph Pilates. Joseph Pilates had spent the majority of his childhood fighting rickets, asthma and rheumatic fever and this fuelled his desire to become physically immune to these ailments. Through studying a variety of different disciplines (yoga, Zen) he brought about this new notion of exercise. During the war he practised his theory of exercise, and became involved in the rehabilitation of war victims. Once the war ended, Joseph Pilates relocated to New York and soon went on to open the first pilates studio attracting elite actors, dancers and athletes.
Clinical Pilates vs Pilates
Clinical pilates is used to treat people with musculoskeletal injuries and is conducted by a physiotherapist certified with Clinical pilates certification. If a person experiences an injury or repetitive injuries, they may have joint stiffness, muscle spasms, poor posture or abnormal movement patterns as a cause or a result of the injury. It is therefore important to first treat the above complaints before commencing pilates.
In addition certain pilates exercises may aggravate the symptoms. An example is someone who may experience a back strain, due to too much extension in the lower back. Such individuals may have an exaggerated lordotic postures and therefore extension pilates exercises may not be advisable. This is something that would not be picked up if a person was to attend a routine pilates class, which does a combination of both flexion and extension exercises.
Not only is it important to select the right type of pilates exercise, it is also necessary to ensure that the correct and appropriate level is prescribed. Routine pilates may be too challenging for a person with back pain. This will cause the individual to compensate and utilise stronger global muscles as opposed to the core muscles, therefore negating the benefits of the pilates exercise. As a secondary result, a person may start to experience muscle spasm in the global muscles due to the increased exertion. The physiotherapist having tested your muscle strength and range of movement, will be able to ensure that the exercises are appropriate and although challenging not detrimental to recovery.
The added benefit of clinical pilates to routine pilates is not only is it more individualised to the person and their problem, it can also be more functional. If the person for example is keen to return to an activity or a sport (swimmer, footballer, dancer) the standard exercises can be modified by the physiotherapist to strengthen the core muscles whilst carrying out the aggravating movement. This could mean that the core muscles of a footballer is challenged as he kicks, dribbles a football and not just in static postures.
Peripheral injuries
When dealing with peripheral joint/ muscular injuries e.g. ankle instabilities the ankle is the main focus of the treatment. This makes sense and is always a good place to start to strengthen and rehabilitate local structures. However the research is beginning to move towards looking at the whole picture. Improving an individual dynamic control of their movements, will mean that person is less likely to sustain injuries. There is a growing trend to rehabilitate athletes whilst incorporating Pilates based exercises to teach a person to move more efficiently. Pilates can be used to treat hip, shoulder, knee and ankle injuries.
Spinal Injuries
Pilates in conjunction with manual joint mobilisations and soft tissue release is an effective way to treat back pain.
Time and time again the research has shown that any form of back pain leads to a loss of function of the deep muscles (multifidus) of the spine at that level. Unfortunately these muscles do not have the capacity to turn back on again, once the initial episode of back pain has resolved, and therefore these muscles require specific training to reactivate and stabilise the spine. In the long term these muscles without exercise will continue to waste further and subsequent muscle spasm in the global and more superficial muscles is experienced. This predominately occurs as a mean to stabilise the back in the absence of the deep muscle activity. Such individuals will report recurrent flare ups of back pain in the year due to the ongoing weakness of the spine.
In addition to weakness, back injuries usually occur after an extended period of time, in a bad posture, excessively loading the joint.
Clinical pilates is a form of exercise that both facilitates the strengthening of these deep muscles whilst educating a person where a neutral spine lies. In time a person will feel that there back is stronger, as they become more aware of what sitting or standing in a good posture entails.
In the long term they will also have the endurance to sustain these better postures for longer periods, through conducting the exercises.
If a person is new to pilates one- to one sessions with a physiotherapist or very small classes is initially strongly recommended, this is to ensure a person can be taught the correct techniques and the 5 concepts of pilates accurately (breathing, neck, rib pelvis position and stabilizing). Pilates can be a little tricky and can easily be done incorrectly and therefore close supervision is required to prevent faulty patterns learnt.
The benefits of Pilates
• General fitness and body awareness greater strength and muscle tone
• Improved flexibility
• A flatter stomach
• Improved efficiency of the respiratory, lymphatic and circulatory systems
• Better posture and awareness
• Less incidence of back pain
• Increased joint mobility
• Lower stress level
Which clients would benefit from Pilates?
• Males and females
• Pregnant: Pre and post natal
• Athletes and dancers
• Amputee and stroke rehabilitation clients
• Elderly
• Children 12 years-old +
Clinical pilates therefore targets the musculoskeletal injury more specifically. The physiotherapist is able to identify your posture type, establish the mechanism of injury, understand what the peron is aiming to return to and work out which exercises would be of more benefit to the individual. Clinical pilates therefore looks at treating the cause as well as selecting the appropriate repertoire of exercises to strengthen the injured areas and even be done for injury prevention.
If your suffering from recurrent episodes of back pain or peripheral injuries – Clinical Pilates may be just what you need!
Treatment Options for Chronic Pain- What Does the Research say?
As discussed in the previous article, chronic pain can manifest through very complex thought processes, as result of a wide variety of factors stemming from physical, psychological and cultural influences.
For this reason, there is not one single fix for chronic pain, but its treatment is very much defendant on a combined approach.
This article will focus on the conservative management of chronic back pain whilst not negating the importance of appropriate pharmaceutical and other interventions.
So what does the research say?
- Exercise therapy -the first line treatment
The current evidence suggests exercise is more effective than “GP care” for the reduction of pain, disability and return to work . No one form of exercise (e.g. Aerobic, Mckenzie, conditioning exercise) appears to be superior to the other, although an supervised and individualised exercise programme is recommended over general exercise conducted individually. This is something that can be discussed and provided by a qualified physiotherapist following a thorough assessment of your back.
Studies comparing the effect of pilates based exercises and usual back care, has shown pilates to significantly reduce low back symptoms and disability over long term basis.
There is strong evidence showing that exercise therapy alone is not more effective than conventional physiotherapeutic techniques (e.g joint mobilisations) and therefore exercise therapy must be prescribed along side other treatment adjuncts.
- Cognitive behavioral therapy
This form of psychosocial therapy assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and “negative” emotions (Maladaptive behavior is behavior that is counter – productive or interferes with everyday living).This treatment focuses on changing an individual's thoughts (cognitive patterns) in order to change his or her behavior and emotional state, allowing them to partake in exercise and all activities of daily living.
- Manual therapy
Joint mobilizations should be considered as treatment in the short term management for chronic pain sufferers to increase function and decrease pain.
The research shows that joint mobilizations carried out in physiotherapy treatments is of equal effectiveness to analgesia, normal "GP care" and physiotherapy exercises in reducing symptoms.
- Massage
Massage is not considered as an effective treatment option for chronic pain sufferers, but may be useful to treat the symptoms of muscle tightness post exercise.
- Education
This is vital in in helping people understand that beliefs can alter and affect their recovery from pain. Pain should not been taken for granted, and a person should seek medical advice to decrease the amount of pain as soon as possible.
Education regarding pain, and understanding that pain is an unpleasant but subjective emotional experience, and therefore should not be used as a tool to measure the amount of tissue damage is vital.
Having less fear and anxiety will make a person more willing to return to functional activities and exercise allowing for recovery.
References:
O. Airaksinen, J. I. Brox, C. Cedraschi, J. Hildebrandt, J. Klaber-Moffett, F. Kovacs, A. F. Mannion, S. Reis, J. B. Staal and H. Ursin, et al (2006) European guidelines for the management of chronic nonspecific low back pain, European spine journal, vol 15: 193-300
Rydeard,R., Legar, A., Smith, D (2006) Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability : A randomized controlled trial, The Journal of orthopaedic and sports physical therapy, vol 36:474-484
Anti-Aging Exercise for your Lower Back – Good Nourishment is the Key
The discs in the spine age and degenerate just like all of the other structures in the body. However, today’s sedentary lifestyles often speeds up this process. We cannot apply anti-aging creams or lotions to our discs, but certain exercises can help to maximize the discs nourishment.
The Theory: Disc Nutrition
The discs are fluid filled gel like structures that act as shock absorbers in the spine. They are found between each segment of bone throughout the spine. The discs slowly lose some of this fluid through the daytime under the effects of gravity. The fluid is then drawn back into the disc when we sleep at night in an unloaded position. This movement of fluid is critical for disc health as discs nutrition is provided from this exchange, and the volume exchanged must remian balanced. Unfortunately, sedentary individuals may be encouraging a negative fluid balance. It has been shown that sitting or standing statically for as little as 1 to 2 hours significantly increases the outflow of fluid. This process leads to the first step in disc degeneration. The disc becomes ‘dehydrated’ and mechanically ineffective when it tries to distribute the body’s load. This initial change often presents as the mild ache you feel when sitting for long periods.
The Degeneration Cycle
Over time the disc reduces in height and becomes less compliant. Globally the spine loses flexibility and therefore cannot create enough pressure on the disc to effectively and sufficiently move the fluid in and out. The disc receives less nutrition and has difficulty removing waste products. The cycle continues and may cause a break down of the structure of the disc. This stage relates to when back pain becomes more chronic in nature, and additional disc damage and pain can occur from minor activities.
The good news
Traction exercise completed on a daily basis can halt and even reverse this process. The overall aim is to improve the fluid flow mechanism in the disc and ultimately increase disc height and health as it rehydrates.
Where to start?
Any exercise to ‘traction’ or ‘decompress’ the lumbar spine can help. An example is shown below using a yoga block (approx. 7cm height), placed below the belt line
- Spend 1 minute relaxing in this position
- Remove the block and rest for 30 seconds
- Repeat this process 3 times in 1 session
- 1 session should be completed around midday, and a further session prior to sleeping.
Other Important Factors
- The exercise should be carried out in the evening. This is when the disc has been maximally compressed from daytime activity. Traction allows the discs to take in fluid more efficiently during the night hours when the spine is unweighted.
- If you normally exercise immediately after working at the office all day, use the traction exercise as part of your warm up to ‘decompress’ the discs. This will reduce the stress on the disc during your exercise routine.
- Added benefits This position stretches the muscles and other soft tissues at the front of the spine and hips, which are often tight from many hours spent in working postures.
- The stretch can create better alignment of the upper body making you stand straighter, which is important for maximum recovery following a lower back injury.
Caution Assessment by a Physiotherapist is strongly recommended prior to starting the above exercise. If you already have lower back pain you may also require hands-on treatment from a therapist to physically mobilise a particularly stiff spinal segment for the above exercise to be more effective.
How do I know if I have scoliosis?
What is scoliosis?
Scoliosis refers to a medical condition in which the spine curves sideways. On an X-ray film, the normal spine looks straight, but the scoliosis spine will look like a “C” or “S”.
I suspect that I have scoliosis, how do I tell?
Besides looking at X-rays, one can look at his or her posture in order to look for possible signs of scoliosis.
Signs that may indicate scoliosis are:
- Head not centered to the body Uneven shoulders (either one is in front of the other or one’s higher than the other)
- Uneven shoulder blades: one is more prominent or higher
- Uneven waist angle: the gap between arm to trunk is wider on one side
- One hip is more prominent than the other or the hips are not leveled
- The spine line is not straight
One can use the picture below for a quick self test of scoliosis:
You can also perform a Forward Bend test (also called “Adam’s test”) to detect for possible scoliosis.
- Standing with the feet together, then bend forward as far as you can with your palms together, fingers pointing at between your toes.
- Look at the back, one side of the back (either upper or lower back region) will be higher than the other side
Slipped disc – Do’s and don’ts
A slipped disc can be very painful and debilitating. However, in most cases, it should get better on its own, within six-eight weeks and there are certain things that you can do and avoid doing to aid and speed up your recovery.
What happens in a slipped disc?
Although people often mention about having a slipped disc, nothing in your spine has actually slipped out of place. Having a slipped disc means that one of the discs which sit between each of the bones in your spine has been damaged. When the disc is damaged, the soft gel-like inner pad of the disc squeezes out through a weak point in the torn outer layer, causing a bulge that often presses on nearby spinal nerves. This result in severe pain with symptoms that radiates down the leg/arm commonly referred to as sciatica. Slipped disc, also known as disc herniation, can occur in any disc in the spine but the two most common forms are lumbar disc and cervical disc herniation.
What can I do?
During the first 48 hours, a torn outer layer of the disc would result in the release of inflammatory chemical mediators which may directly cause severe pain, even in the absence of spinal nerve compression. This is the basis for the use of anti-inflammatory medication for pain associated with disc herniation. Thus, early treatment may include taking painkillers, anti-inflammatory medication and rest to give time for the body to reabsorb the herniated part of the disc. Before taking any medication, always see your doctor for a prescription.
Cold therapy should be applied immediately and after any activity that aggravates your symptoms as it helps to reduce pain and swelling. Use an ice pack or bag of frozen vegetables wrapped in a towel for no more than 10 minutes, every 2-3hrs. After 72hours or more Heat therapy, such as a wheat bag or warm soak can be used to promote muscle relaxation and pain relieve and may be used before performing stretching and strengthening exercises.
As the pain lessens, you will most likely to return to work and begin exercises to strengthen your back muscles and joints. Exercise is introduced to improve strength, flexibility and proper back mechanics as part of recovery. A physiotherapist will be able to give you an individually tailored exercise plan to help to strengthen any muscles that have become weak and also using techniques such as spinal manipulation to help improve the mobility of the spine. Physiotherapy would also help to correct one’s posture and use body mechanics to minimize stress and strain on any portion of your spine. This includes incorporating these exercises and posture principles into all your daily (e.g. sitting and lifting) and recreational activities.
What shall I avoid doing?
Don’t rest excessively and avoid activities. Studies have shown that it is important for one to remain active and keep up with your normal activities as much as possible.
However, it is paramount to discontinue with any activities that aggravate your symptoms such as bending over, heavy lifting and any quick twisting or jerking motions. Avoid standing or sitting (e.g. driving) for extended period of time as it would increase strain to your spine and aggravate disc pain. At home, keep away from overstuffed and low furniture, because it is difficult to stand back up after sitting in them. Don’t lie on stomach and prolonged bed rest especially during early stage post injury.
In the long run
Back pain from a slipped disc may return, whether or not you have had treatment and it is important to learn how to avoid damaging your back again.
The outcome for most people is that they will feel better within six-eight weeks; although for others it may take a while longer. With proper care through correct posture, core exercises and back ergonomics, it is possible for one to remain pain-free.
Lower Back Lumbar Segmental Instability
Someone with a lower spine that frequently moves through a larger-than-normal range of movement is more susceptible to low back pain. This tendency of moving beyond its normal range is known as lumbar segmental instability.
The normal range of the movement is defined as the neutral zone. A person with lumbar instability tends to move beyond the normal range of movement into the extreme end ranges.
What keeps the spine stable?
In order to understand what causes lumbar segmental instability, we first need to understand what keeps it stable in the first place. The human body holds the spine stable or steady through the help of three basic structures – the passive, active and neural structures.
- Passive structures in the lumbar spine are the vertebrae, the discs, then joints and ligaments. These are structures that do not move.
- Active structures are the global and local muscles. These contract or relax depending on the direction of the force required.
- And finally the neural structures; nerves that control and direct the muscles. This control is also known as motor control.
A stable lumbar spine segment coordinates global and local muscles using the motor control system to supply compressive forces along the spinal passive structures for stability. This coordination helps maintain the spine's normal curvature at a segmental level as we move about.
Active Structures
The global muscles include:
- Rectus abdominis,
- External oblique
- The thoracic part of lumbar illiocostalis (an erectae spinae muscle). ·
These three muscle groups are large torque producing muscles that provide general trunk stability and allow movement to occur.
The local muscles attach directly to the lumbar vertebrae. They are:
- Lumbar multifidus,
- Psoas major,
- Quadratus lumborum,
- Lumbar parts of lumbar illiocostalis and longissimus (more erectae spinae muscles),
- Transverse abdominus,
- The diaphragm and
- Posterior fibres of internal oblique.
- Interspinalis/ Intertransversii
The two lowest spinal segments, L4 and L5 vertebrae, are the most susceptible to segmental instability. This could be due to pathological/ degenerative changes to the passive structures that sometimes show up on x-rays. Instability can also occur if there is a loss of motor control and muscle strength/stamina within the neutral zone.
What does it feel like?
A person with lumbar segmental instability typically has a patient-history something along these lines.
- Back pain may have started after a direct injury to the area, or it may have just developed gradually.
- The pain tends to be recurrent and has more debilitating effects as time goes on.
- That person will try to do as little as possible in an episode of pain. According to a survey (O’Sullivan 1997), people most commonly describe the pain sensation as · catching, · locking, · giving way or · feeling of instability.
Classically, the most painful postures are sitting or standing for long periods of time, or being in bent over postures.
The most painful movements are
- bending forwards,
- moving unexpectedly quickly,
- standing up straight after being bent over, lifting or sneezing.
So basically….
The lumbar spine moves in an uncontrolled manner, causing pain. Because the big muscles and little muscles don’t work together properly and the body is unable to control each segment as the body moves.
How do I get rid of it!?
A physiotherapist will need to perform an assessment to find out what type of segmental instability is present (and the type of control that is lacking due to which structure – passive, active or neural). Based on the findings, an intervention will be planned.
In cases where the passive structures have degenerated, it is often possible to train the active and neural structures to compensate for the lower level of stability provided by the passive structures.
With this sort of condition, the exercises that are required are more ‘brain’ exercises than ‘muscle’ exercises. A new way of moving has to be re-learnt, and it requires a lot of concentration.
Introduction to SpineCor Scoliosis Brace
This video introduces the SpineCor brace, a flexible dynamic brace for idiopathic scoliosis.
SpineCor®‘s unique dynamic action treatment approach offers improvement over traditional static braces. Research indicates that a significant dynamic action is required on the spine (vertebral growth plates) to alter the abnormal growth progressing the deformity in scoliosis patients.1
Traction Therapy – No Help in Long Term
Traction Therapy
Many people may have heard stories about their friends having treatment for their spinal pains in hospitals or physiotherapy clinics where they were strapped into a contraption and having their back or neck stretched. This device is called a traction machine. To some the description may sound intimidating or even medieval, but in fact, traction is a very gentle form of treatment and is extremely effective when applied appropriately in specific conditions.
