Archive for September, 2010

Increased Knowledge About Back Pain Helps With Relief

September 30, 2010

It has long been recognized that patients’ attitudes and beliefs about their back pain can play a big part in how well their pain is managed. Now new research confirms a patient’s level of knowledge about the condition is also critical, as well as their willingness and ability to use that knowledge.

For back pain help and information about back pain related topics visit our website at:


What To Look For When Consulting A Spine Surgeon For Back Pain Help

September 29, 2010

By: Peter F. Ullrich, Jr, MD

“As a general rule, patients will be advised to start with 6 to 12 weeks of non-surgical treatment, such as physical therapy, epidural injections or medications. There is a wide range of non-surgical treatments available, and some treatments may work better for some patients than others.”

This is a quote from an orthopedic spine surgeon’s website. It is very revealing in that it shows that this surgeon is very conservative when it comes to considering surgery for his patients.

I practice physical therapy in Boise, ID which has one of the highest per captia rates of lumbar spine surgery in the nation. There are a lot of very qualified surgeons in Boise but I will only recommend conservative surgeons to my patients who require a surgical consult. I have seen too many spine surgeries that may not have even been necessary, go bad to the point where the patient wishes he/she never had surgery in the first place.

It is imperative to exhaust all non-surgical options before considering any sort of low back surgery.

For more information about back pain help for lumbar herniated discs and other considerations with regard to low back surgery see the full blog post at:



Back Pain Help – Overcoming Back Pain With Walking or Running

September 28, 2010

This is an excellent video that shows how the lumbar spine moves while we walk. When we run it is a similar motion but to a greater extreme. The unique thing about this video is that it shows the rotation of the spine. This twisting motion of the low back is primarily controlled by our abdominal muscles:

External Obliques

Internal Obliques

In this video it is easy to see how repetitive this twisting motion is. When we are young we learn how to walk with adequate control of our spine and legs and this twisting motion becomes our natural stride. However injuries and other factors can disrupt this finely tuned mechanism of control. When abdominal control is lost or altered, walking and running can cause back pain.

Fortunately, it is possible to regain the proper abdominal control needed to walk and run pain free. Physical Therapists have been helping walkers and runners regain their pain free stride for decades by teaching them specific exercises designed to retrain the low back and abdominal muscles.

For more back pain help and additional information about low back and abdominal exercises for walkers and runners visit our website at:





When To Use Pain Killers For Back Pain

September 24, 2010

Herniated Disc and Low Back Surgery

September 22, 2010

This is a excellent video that shows how a nerve in the lumbar spine can be pinched by a bulging disc. It also shows a type of low back surgery called a laminectomy / discectomy. This type of surgery may be required if a disc bulge is too large to be addressed with conservative measures.

Having lumbar spine surgery is only recommended in cases where the patient’s persistent radiating leg pain does not resolve with conservative measures or he/she has bowel or bladder dysfunction related to nerve compression in the spine.

The conservative measures that should be tried before surgery are:

– Physical Therapy including low back traction or spinal decompression (if appropriate)

– Oral Anti-inflammatories (non-steriods and steriods)

– A floroscopically guided steroid injection (if appropriate)

For back pain help and more information about physical therapy for low back pain visit our website:


Low Back Pain Muscle Studies

September 22, 2010

The role of the lumbar multifidus in chronic low back pain: a review.

Freeman MD, Woodham MA, Woodham AW.

Department of Public Health and Preventive Medicine, Oregon Health and Science University School of Medicine, Portland, OR 97205, USA.


Low back pain (LBP), a highly prevalent problem in society, is often a recurrent condition. Recent advances in the understanding of the biomechanics of LBP have highlighted the importance of muscular stabilization of the “neutral zone” range of motion in the low back. The lumbar multifidus muscles (LMM) are important stabilizers of this neutral zone, and dysfunction in these muscles is strongly associated with LBP. The dysfunction is a result of pain inhibition from the spine, and it tends to continue even after the pain has resolved, likely contributing to the high recurrence rate of LBP. Persisting LMM dysfunction is identified by atrophic replacement of multifidus muscle with fat, a condition that is best seen on magnetic resonance imaging. Muscle training directed at teaching patients to activate their LMM is an important feature of any clinical approach to the LBP patient with demonstrated LMM dysfunction or atrophy.

This a the summary of scientific paper that reviews all of the studies that have been done on the low back muscles in relationship to low back pain. The studies that it reviews have concluded that the low back muscles become weak and dysfunctional in people with recurrent low back pain and that this dysfunction leads to increasing bouts of pain in the future. The primary dysfunction that is referred to in the above summary is loss of “muscular stabilization of the neutral zone”   This means the deep muscles of the back that control the movements of the individual vertebrae lose the ability to effectively control those movements. This loss of control results in irritation of soft tissues and nerves in the low back which in turn causes persistent back pain.

Physical therapists teach their patients therapeutic exercises that are designed to rehabilitate these muscles and prevent future recurrence of low back pain. For back pain help and more information about low back strengthening exercises. visit our website at:




Avanced Low Back Exercise – Supermans

September 16, 2010

This is a great instructional video (2 min 45 sec) about how to perform the Superman low back exercise as well as a variation that I refer to as the Prone Cobra exercise (arms at side).

Supermans and Prone Cobras are rather advanced lower back exercises but I have many of my patients do them during the later stages of their rehab.

For more Back Pain Help and instruction in safe lower back stretches and exercises visit my website:

Chronic Pain – Back Pain Can Mask Galbladder, Bladder Problems

September 14, 2010

Sometimes back pain is not strictly related to spinal structures. Sometimes back pain comes from other places, specifically internal organs. In a process called referred pain, internal organs can send pain signals to other parts of the body. For example, when someone is experiencing a heart attack, the left arm may ache. Nothing is wrong with the arm, but this limb hurts because the heart is referring pain to it. The neck, mid-back and low back are also potential targets for referred pain. Here are two examples when “back pain” has nothing to do with spinal problems.


Gallbladder: The gallbladder is a small organ tucked up near the liver that helps with digestion. Within this internal organ problems can arise like a blockage from a stone, an infection, or just an inflamed gallbladder attack. Sometimes the symptoms clearly point to a problem with the gallbladder. These classic symptoms include right upper quadrant abdominal pain just underneath the right chest wall, nausea, gas, and pain with a deep breath. Many times these classic symptoms occur at night or just after a meal. At first, one may think that the problem is just indigestion until the symptoms progress. However, sometimes the symptoms are a little more elusive and give a murky picture of vague discomfort and pain.


Referred gallbladder pain can be especially tricky because it is felt in the mid-back, right shoulder, and between the shoulder blades. Because these symptoms are especially common in women, all women with pain in these areas should have the gallbladder evaluated and should also consider some dietary restrictions to prevent gallbladder attacks. Oftentimes, referred pain from a sick gallbladder will rear its ugly head as a serious problem requiring surgery. This scenario can be prevented if the patient and doctor have earlier suspicions of a potential gallbladder disease.


Bladder: The bladder is the all important organ in the pelvis that collects and hopefully empties urine at the right time. Many problems can arise here like infections, cancer, interstitial cystitis, and, arguably the worst problem, a “fallen bladder” (a.k.a. Prolapsed Bladder, Cystocele). Yikes! That’s right; the bladder can literally fall out. Varying degrees of a prolapsed bladder exist starting with Grade 1, where just a little portion of the bladder pokes into the vagina, all the way to Grade 4, where the entire bladder is fallen out into and through the vagina. Now that condition can be as painful as it sounds and looks. Pain from the prolapsed bladder can be felt in the low back, sacrum, and pelvic region.


If a woman has low back pain with the “usual” urinary incontinence, a mild prolapsed bladder can be mistaken as just “low back pain.” As the bladder falls further and the pain gets worse, the prolapsed bladder becomes more obvious. After a little “nip, tuck, and sling,” the bladder can be put back into place and the back pain magically disappears. Other female organs can prolapse and cause back pain besides just the bladder. So, women with back pain might want to consider having a full pelvic exam especially if urinary incontinence is present. Back pain may not be all that it seems.

This is a good article about some abdominal/pelvic problems that can be misdiagnosed as mechanical back pain. It’s not common but it’s something that women and their therapists or doctors should be aware of.