What the “bleep” is Paleo?

By pran6588 on October 31, 2011 / Blog, Paleo / 4 Comments

Tags: Diet, eating, food, Mark's Daily Apple, Paleo, Robb Wolf

Image: liftingrevolution.com

Since I did my post on 5 Random Things, I have had people ask me what the <bleep> is Paleo? The short answer is that Paleo is short for Paleolithic and refers to a lifestyle and eating plan similar to that of our pre-agricultural ancestors. No, this isn’t an historical re-enactment, this is a way of living that gets back to eating good, whole foods that are gluten, grain and legume free with little or no dairy. Here is how Robb Wolf, one of the leading Paleo proponents explains it:

In simple terms the paleo diet is built from modern foods that (to the best of our ability) emulate the foods available to our pre-agricultural ancestors: Meat, fish, fowl, vegetables, fruits, roots, tubers and nuts. On the flip-side we see an omission of grains, legumes and dairy. As this is directed to folks new to the paleo diet idea we need to address the “What Abouts.” This is the seemingly endless list of ingredients that folks ask: “What about artificial sweeteners, agave nectar, red wine…” In simple terms, if it’s not meat, fish, fowl, vegetables, fruits, roots tubers or nuts…it’s a “no-go.” At least initially. I like to see people go after paleo strictly in the beginning so we get the best possible results, then folks can tinker from there. I’ve detailed all of this information in my FAQ shopping and food guide, and quick start guides. These are all available for free (you do not need to buy the book to get any of the information) and it details all of the special considerations of autoimmunity, fat loss, athletic performance and muscle gain.

If you have any interest in how the Paleo lifestyle can benefit you, Robb’s book and website will keep you occupied for hours. He is the witty, tough love teacher of all things Paleo (a former research biochemist with an attitude, who wants to show you that science can be cool!)

http://robbwolf.com/2011/09/29/what-is-the-paleo-diet/

You may be asking yourself, “Why would I want to give up my healthy, whole grains along with my bagels, Krispy Kremes, corn chips and pizza?” Because whole grains are proven gut irritants. Yes, folks, wheat germ agglutinin damages our intestinal lining and lectins (proteins in grains) are then transported intact through the intestinal lining. The large, intact protein molecules in our system then cause our immune system to mount an attack against what it perceives as foreign invaders, and we get an inflammatory response. The inflammatory response can then lead to celiac disease, diabetes, rheumatoid arthritis, hypothyroidism and lots of other nasty diseases. The good news is that even if you already have one or more of these diseases, following a gluten, grain and legume free eating plan can significantly reduce the often painful symptoms of the disease and help to heal your gut. I went gluten free 2 years ago and had improvement in most of my symptoms related to Hashimoto’s Thyroiditis; but, 6 months I went Paleo and my health skyrocketed to another level. Trust me, this works.

Along with the eating plan, a Paleo lifestyle involves smart exercise (lift heavy things, move every day), good, quality sleep (8 hours in a totally dark room), and utilizing techniques to decrease stress. I love looking at different websites for ideas on exercise and lifestyle choices, so here are a few I look at daily:

http://www.marksdailyapple.com/welcome-to-marks-daily-apple/

http://www.globalbodyweighttraining.com/

And, before you say you can’t possibly do this because you have kids, a job, a home to take care of, laundry to do………..check out Sarah Fragoso who does all of the above.

http://everydaypaleo.com/about/

Do some reading, check out the website links, let’s talk more about this……..

Be well!

Five Random Thoughts

By pran6588 on October 28, 2011 / Blog / 1 Comment

Tags: eating, exercise, food, sleep, spa

1) You need to eat properly. You can do all the exercise you want, and if you are putting junk in your body, you will get a junk result. Not a judgment, just a fact.

Image: castlegrok.com

2) You need to move. Just move: go for a walk, stretch on the floor, go to a yoga class, do a DVD, ride a bike. We were not built to sit at a desk all day, drive home in a seated position, sit at the table (and eat junk), and then sit in front of the TV. Do something to move every joint in your body. Every day.

Image: Mike Fitch, Global Bodyweight Training

3) You need to sleep. Go to bed in a dark, silent room and get 8 hours of sleep. Trust me, you do need it.

Image: 9secrets.com

4) You need to treat yourself well. Don’t put yourself last on the list. No one likes a martyr and you really aren’t fun to be around when you are bitter. Your friends confirmed this for me.

Image: Thepartydress.net

5) You need to take care of those nagging injuries before they start screaming for your attention. Get evaluated by a physical therapist who will look at you as a whole, then work with said physical therapist to address your issues. If you are given home exercises to do, well………….do them. We’re really not mean; we just know that if we don’t hold you accountable and don’t encourage you to push your limits, you might as well be having coffee with your friends.

Image: Cafepress.com

Why I decided to go back into private practice (AKA Why I would leave a good paying job with full benefits)

By pran6588 on October 24, 2011 / Blog / 6 Comments

Tags: dry needling, insurance, patient therapist relationship, private physical therapy practice, restrictions

Since I have been asked this question multiple times lately, I figured I would answer it in my first blog post as an unempl….I mean self-employed physical therapist. Many of you know that I was in private practice from 2003-2006 in Alexandria, VA. After three years of successful private practice, the (un)perfect storm of events conspired to make it clear that I needed to make some changes. In 2006 I went to work for two of the most gifted PT’s I know at Hand -N- Hand Therapy in Arlington, VA. I learned so much from these ladies; but, in 2007 I needed health insurance and some of the benefits of a big company. I went to work for a large physical therapy company. During my time at said large orthopedic physical therapy practice, I was able to update my skills with post-op orthopedic patients and also take some amazing continuing education (insert shameless plug for Myopain Seminars). After 100 hours of classroom education and training (and a million more hours of driving and studying, not to mention getting stuck by my partner with hundreds of needles….but I digress), I successfully passed the written and practical exams to become a Certified Myofascial Trigger Point Therapist (i.e. I can now utilize dry needling in my practice). After 6 months of incorporating dry needling as a modality, I began to think outside the box again, and realized there was so much more I could do to help my patients………..but not in that setting.

The large physical therapy practice I worked for was IMO the best around, so by no means is this about them. This is about the state of physical therapy (and healthcare) in general. As providers, we want to have a steady paycheck and full benefits to support our families; but, this comes at a cost. The cost is our freedom, our creativity and our own physical and mental well-being. It is nearly impossible to stay passionate about your life’s work when you treat 15 patients a day, 5 days a week, 50 weeks a year. Believe me, I tried. The sheer number of people you come into contact with a day begins to wear down your compassion and patience. It also becomes almost impossible to treat creatively or to treat each person as an individual with only 30 minutes for initial evaluations (sometimes an hour for neck or back patients) and 20-30 minutes for treatment in subsequent visits. Again, believe me, I tried.

There is also a great cost to our patients in this type of setting. They usually get appointments with whatever PT is available during their specified times, which leads to lack of continuity of care, as well as lack of therapeutic relationship. The therapist may not have time in 30 minutes to do the treatment is truly best for the patient, so things are left out. The therapist may need to follow a protocol depending on the injury or surgery, which sets certain milestones for recovery, not based on the individual patient, but on the “average” patient. And, last but not least, the patient’s care is mostly dictated by the constraints of their insurance company. I treated many patients who had “20 PT visits a year” or “20 visits per condition per lifetime” or the worst “5 visits of PT.” Insurance companies also dictate what modalities they will cover, how much time you can spend with the patient, and their case managers make a determination of the “medical necessity of continued care.” Super, I went through 10 years of schooling to be told what is medically necessary by someone who doesn’t even know my patient. Awesome.

So, all of that to say that I am returning to private practice because I want to call the shots again. I want to evaluate and treat patients based on what my knowledge and clinical experience tells me they need. I want to take the time to sit and really listen to my patient’s medical history, their perception of their current condition and their goals for recovery. I want to see a reasonable number of patients a day, and still have time for myself, my family, my writing and teaching, and my rock climbing and crazy, fun workouts. I want to feel passionate about what I do, so that some of that enthusiasm may rub off on my patients and inspire them to live a healthy life, too. I hope to sit down with you soon to talk about what inspires you to do what you love. There is always risk in life. I have decided to leap right into the uncertainty.

~ Tell me, what is it you plan to do with your one wild and precious life? Mary Oliver

Stable to the Core

By pran6588 on October 21, 2011 / Articles, Blog, Core / Leave a comment

Tags: c section, Core, core stabilization, exercise, physical therapy, Pilates, PT

Donna was overjoyed when she gave birth to her “miracle baby”—Kelly Grace—last year.

But shortly after her C-section, the 46-yearold software consultant from West Springfield began to experience pain in her right hip, which grew steadily worse over the next 12 months. Her family doctor referred her to Mark McMahon, MD, at Commonwealth Orthopaedics, who performed arthroscopic hip surgery in May.

Although the procedure relieved Donna’s pain, Dr. McMahon recommended post-operative physical therapy to strengthen her muscles and prevent the problem from recurring. For six weeks, she worked with Ann Wendel, PT, ATC, a physical therapist specially trained in core stabilization and Pilates at Commonwealth’s Springfield office.

“Core stabilization involves exercises for the deep abdominal muscles, trunk extensor muscles and deep muscles of the back that control rotational movement of the spine,” Wendel explains. “Donna’s pregnancy and C-section had weakened those muscles and made her especially vulnerable to low back and pelvic injuries.

Donna has regained flexibility and stamina as a result of core stabilization and Pilates at Commonwealth. We focused on a combination of flexibility, balance and hip strengthening exercises tohelp her return to her normal activities and quality of life.” Donna saw Wendel twice a week and practiced daily exercises at home. Her routine included basic moves such as walking sideways, pivoting and turning, and gradually putting more weight on her hip to strengthen it. “Chasing around after my daughter involves every kind of movement imaginable—walking, running, lifting her out of the tub. I never realized how much my core is involved in these simple moves and what a difference good abdominal strength would make in my daily life,” she says.

It also was beneficial to perform the exercises under the guidance of a physical therapist with extensive training in core stabilization and Pilates methods. Ann would observe Donna’s technique and make subtle changes to be sure she was performing each movement properly for maximum benefit.

This one-on-one supervision taught Donna the correct way to safely activate the deep muscles of her abdomen and spine to strengthen and stabilize her core. Small tweaks here and there made a big impact when she practiced the routine at home. Donna was equally impressed with the personal attention and care she received from everyone at Commonwealth Orthopaedics. “They took into consideration that I’m a busy, working mother and tailored the exercises to fit my schedule and give me the results I needed,” she says. Joseph Pilates first developed his core stabilization techniques in the 1920s to train and rehabilitate ballet dancers. Over the years, the method has gained popularity and Pilates is now part of the fitness mainstream both as a popular workout regime and rehabilitation program. The exercises retrain the deep muscles that stabilize the abdomen and spine, as well as the superficial muscle known as the rectus abdominus. Anyone can benefit from this type of conditioning, including those with hip or back pain, or whose muscles are weakened due to spine or abdominal injury or surgery. Athletes are also good candidates.“Proper core stabilization promotes balance and strength and helps prevent athletic injury,” says Frank Pettrone, MD, a Commonwealth Orthopaedics surgeon who works with local sports teams to advocate these prevention techniques. “It’s especially important in activities where you pivot or push off and are particularly prone to abdominal injuries. People don’t realize it all stems from the trunk. Core stabilization strengthens these muscles.”

For athletes who have suffered injuries, Dr. Pettrone often recommends core stretching and strengthening exercises to repair the body and return to the playing field. A typical routine begins with easy stretching, moves into a more intense stretching phase, adds resistance exercises and aggressive strengthening, and culminates with sports-specific training. After her therapy from Commonwealth, Donna not only has the flexibility and stamina to chase after her active and growing toddler, she’s also resumed one of her favorite activities—a monthly golf game with her husband. “Golf requires a strong core and I was able to get back on the course in July, just two months after my surgery, thanks to the professional and helpful folks at Commonwealth Orthopaedics,” she says. Commonwealth Orthopaedics | www.c-o-r.com 23

Mark R. McMahon, MD graduated with a BA from the University of Oregon and went on to earn his medical degree from Oregon Health Sciences University. Following a general surgery residency at the University of Oregon, he completed a year of orthopaedic research at Rancho Los Amigos Medical Center and then finished his orthopaedic training at the University of Southern California. Frank A. Pettrone, MD, earnied a BA from Brown University and a medical degree from Georgetown University. Dr. Pettrone completed both his internship and residency program at Georgetown University Medical Center. Then, before joining Commonwealth Orthopaedics, he served a tour in the United States Navy as an orthopaedic surgeon.

Ann Airey Wendel, PT, ATC, earned a B.S. in P.E. Studies with a concentration in Athletic Training from the University of Delaware, and a Masters in Physical Therapy from the University of Maryland, Baltimore. She is a Certified Athletic Trainer (ATC) licensed in Virginia, and a Licensed Physical Therapist.

This article was originally posted in Commonwealth Othopaedics company magazine.

Adapting Thai Yoga Therapy for the Neurologically Involved Client

By pran6588 on October 15, 2011 / Articles, Blog, Thai Yoga Therapy, Uncategorized / Leave a comment

Tags: client, Neurological, Thai, Therapy, Yoga

Neurologically involved clients (and their families) have been through an incredible trial physically, emotionally, mentally, and spiritually. Thai Yoga Therapy can be a medium for teaching clients to feel pleasure in their body again, and to show clients that they can still move their body in meaningful ways. When clients are taken passively through the stretches, they are able to relax and let go of the frustration caused by their body no longer moving like it used to.

The gentle, rhythmic motions reduce tone and muscle tension, allowing clients to enjoy the
therapeutic movement provided by this form of massage. Most clients find the sessions to be an oasis of calm in their tumultuous lives. Thai Yoga Therapy is often referred to as a “meditation of compassion,” 1 and when done in the spirit of metta it is a beautiful dance between giver and receiver.
Case Study

In order to best illustrate the use of Thai Yoga Therapy as an adjunct treatment for neurological clients a case study is presented.

Patient History

The patient is a 72-year-old male with a history of cervical spinal stenosis (narrowing of the spinal canal causing compression on the spinal cord and spinal nerves). The patient underwent acervical fusion in January 2003 with good initial results. After discharge from the hospital, however, the patient lost consciousness while getting up one night and fell to the floor. As a result of the fall the bony fusion became unstable. Additionally, the patient tore his left rotator cuff muscles (which had been surgically repaired two times previously), and he sustained a mild head injury.

Once medically stable the patient underwent a second surgery to have metal rods implanted
along his vertebrae to stabilize the joints. After the second surgery the patient underwent
intensive inpatient and outpatient rehabilitation to regain ROM, strength, balance, and functional mobility.

His recovery was complicated by many medical issues, including respiratory difficulties
requiring supplemental oxygen, difficulty with bladder control requiring a catheter and
eventually surgery, feeding problems that necessitated placement of an N-G Tube, increased tone and spasticity that impeded functional mobility, stiffness of the left shoulder due to the injury to the rotator cuff, loss of fine motor control in both hands, digestive difficulties, and loss of appetite. Additionally, the client experienced nearly constant pain, which prevented him from sleeping.

When I met the patient, he required assistance to stand up from a wheelchair, and he walked with a rolling walker. He required assistance to roll from one side to the other and to move side to side in bed. When seated, he could not reach outside his base of support without losing his balance, and he had fallen to the floor several times at home. The combination of tone, weakness, and joint stiffness caused him to walk with a rigid, shuffling gait. Because of pain in the left shoulder, stiffness in his joints, and muscle weakness, the patient had great difficulty transitioning from standing to tall kneeling or quadruped position. These factors initially made it difficult for the patient to get to the floor mat for sessions.

Treatment Modifications

1
Raye, op cit.I initially treated the patient in an outpatient rehabilitation setting in the hospital, where we were able to use a raised mat table to avoid the floor transfer. The client simply walked to the mat using his walker, sat down, and then came to supine. This technique is helpful for most neurological clients who have loss of balance and decreased functional mobility. It is also useful in working with clients with spinal cord injuries who may be unable to transfer to the floor—they can transfer directly from their wheelchair to the mat table. This is the safest and most comfortable way to adapt the Thai Yoga Therapy session for those clients who have difficulty getting to the floor.

In settings where a mat table is not available the therapist must adapt the floor transfer. Once this patient was discharged from therapy at the hospital I worked with him in his home. We were able to adapt the process of getting to the floor by having the patient first come from standing to tall kneel in front of a coffee table. Once he was steady in tall kneel I was able to help him transition to his elbows and knees; from there I assisted the patient into prone position, and then slowly to supine.

In my opinion, a bed is soft and yielding, so it is not an ideal surface for energy line work. It is, however, a safe option for those clients who are unable to get down on the floor safely. One session, after this patient underwent surgery, I treated him bedside with a modified session to decrease pain and to work specific acupressure points and energy lines for the bladder, kidneys, and prostate. The patient experienced almost immediate reduction of pain and anxiety from this session.

When working on the floor we made adaptations to accommodate the stiffness of the patient’s joints. The patient’s neck ROM was limited because of the cervical fusion. For comfort we used a pillow under his head to keep the spine in alignment. Once the patient was comfortable he was able to relax, and we started each session with gentle rocking motions of the trunk and extremities to reduce tone. This was followed by working the foot sen and marma points and kneading the feet with oil. Over the course of treatment the muscles in the patient’s feet relaxed, allowing the toes to extend and the arches to spread; as a result, the patient’s standing balance improved once more of the foot was in contact with the ground. Once the feet were relaxed the inner and outer leg lines were worked to stimulate the balanced flow of energy to the spine and organs. The compression from palming along the lines also kneaded the tight muscles. Stretching postures for the lower extremities, hips, and low back were
performed gently and slowly. Over time, the patient gained range of motion in the legs and spine, which increased functional mobility and decreased his back pain.
In Thai Yoga Therapy, the back of the body is worked with the client prone. Since the patient was unable to remain prone for any length of time because of the cervical spine fusion and pain/stiffness in the left shoulder, I worked the back sen and back muscles with the client in sidelying position with a pillow supporting his head. I also stretched the chest muscles and mobilized the scapula with the patient in side-lying position. Another alternative for clients with limited neck ROM is to use a “prone pillow,” which is a firm, spongy pillow with a cutout for the face, similar to a face rest on a massage table.

After the work done in prone (side-lying in this case) the middle arm line was worked with the client supine, followed by hand massage and wrist/finger stretches. Since this patient had a history of pneumonia and emphysema we worked on diaphragmatic breathing and abdominal massage in supine to free up the diaphragm. Abdominal reflex points for the organs were also worked during this section of the massage to stimulate digestion and peristalsis. The sessions were concluded with massage to the upper back and neck muscles in supine position, followed by facial massage with essential oils. The client was visibly more relaxed, and his breathing was deeper and easier by the end of each session.

Results

This patient has attended a total of 13 sessions since November 2003. His overall level of health, vitality, and functional mobility has improved tremendously. The patient now transitions from standing to supine on the floor with only standby assistance. He turns from side to side and scoots up and down independently. He has regained a significant amount of active movement in his lower extremities and has regained some degree of fine motor control in both hands. He can balance in tall kneel and quadruped positions, withstanding minimal challenges to balance, and can reach six inches outside his base of support in sitting. He walks independently with a quad cane (four-pronged cane) and is able to get into and out of a car with standby guarding for safety.

He can rise to standing position from a low surface independently and his posture is more
upright. He can stand independently without his cane, maintaining his balance against minimal challenges (light nudges/pushes). He has regained some of the weight he lost over the course of events, and his skin tone and skin quality have improved. He enjoys the increased independence and mobility he has gained, which allow him to attend family events and resume a modified work schedule.

Conclusion

Thai Yoga Therapy is a powerful healing art suitable for the treatment of clients of all ages and ability levels. The skilled therapist, working with the client’s physician, can adapt sessions to meet each client’s needs. The results stated in this case study illustrate the complimentary effects of Eastern and Western healing. I encourage Western-trained physicians and therapists to go beyond treating the physical body to treat the patient as a whole. The most wonderful aspect of Thai Yoga Therapy is that it is healing for body, mind, and spirit for both the practitioner and the client, providing a space for healing in the midst of our chaotic lives.

This article was originally posted on the Thai Institute website.

Resources

O’ Sullivan, S., and T. Schmitz. Physical Rehabilitation: Assessment and Treatment. 3d ed.
Philadelphia: F. A. Davis Company, 1994, pp. 491-508.
Umphred, D. Neurological Rehabilitation. 3d ed. Baltimore: Mosby-Year Book, 1995, pp. 375-
420.
Adams, R., and M. Victor. Principles of Neurology. 5th ed. New York: McGraw-Hill, 1993, pp.
749-775.
Taber’s Cyclopedic Medical Dictionary. 17th ed. Philadelphia: F. A. Davis Company, 1993.

Low Back Pain Treatment and Stretches

By pran6588 on October 13, 2011 / Articles, Back Pain, Blog, Core / 1 Comment

Tags: back pain, low back pain, physical therapy, stretches, Trigger Pont Dry Needling

You know the drill. You are in your office, working away. You drop your pen on the floor, reach over to pick it up, and BAM! Serious low back pain. It’s not like you were squatting your bodyweight or scaling a mountain; but, there you are, in a world of pain and wishing you had just left that pen on the floor! How did you get to that point and what can you do to speed up your recovery and prevent reinjury? That is the focus of this post.

Low back pain (LBP) is a common problem affecting as much as 80% of the population at some point in their lives. People of all ages, and both males and females are susceptible to acute and chronic low back pain. Back pain is the second most common reason for visits to the doctor’s office (outnumbered only by upper respiratory infection). Most cases of back pain are mechanical or non-organic, meaning not caused by serious medical conditions such as fracture or cancer. Muscular causes of low back pain or low back myofascial pain syndrome are often overlooked because they are not accompanied by structural abnormalities (i.e. not seen on imaging studies).

What may be the cause?

Let’s look at factors that may predispose you to low back pain. Among the many factors are obesity, lack of physical fitness, hypermobile joints, occupation, age, psychological stress, and smoking. Smoking has been found to have an overall detrimental effect on the intervertebral discs, by causing vasoconstriction (reduced blood flow) and decreased rate of healing. Other conditions such as osteoarthritis and osteoporosis may increase likelihood of low back pain, as may anxiety and depression.

When to see a Doctor

Before beginning any program of self-care, it is important to rule out serious pathology in the back. Pain can be caused by metastatic cancer, herniated disks, lumbar facet joint syndrome, and referred pain from visceral organs. If back pain is accompanied by loss of sensation in the legs, weakness of the muscles of the legs, changes in bowel and/or bladder habits, or increased pain with coughing or sneezing then a visit to a physician for further evaluation is warranted.

Things you can do on your own

If X-rays and MRI have ruled out serious pathology in the back, it would make sense to look at muscular causes for the pain. A combination of self-care, physical therapy, medications, and activity modification may be helpful in returning to prior level of function.If diagnostic tests are negative, you may be dealing with non-specific low back pain (NSLBP), defined as back pain without an identifiable cause. Muscle and myofascial trigger points are often overlooked as the cause of pain. A trigger point is defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. Trigger points are responsible for stiffness and decreased range of motion in muscle, and can cause referred pain into other areas of the body.

Once muscle and myofascial trigger points form in muscle, they can alter body mechanics, cause muscle weakness, inappropriate co-contraction of muscles, disorganized sequence of muscle firing, and persistent functional change even after pain has resolved. It is important to begin treatment early, to prevent pain from becoming chronic in nature. Chronic LBP affects the function of muscles, decreasing stability and normal control of back movement. For early self-care of back pain, gentle stretching will help to relax tight muscles.
Let’s take a closer look at the muscles involved

We are going to look at six muscles in the low back, discussing their function and the ways they are most commonly injured. These muscles are:

Superficial and deep erector spinae muscles: The erector spinae muscles run vertically along the spine in the mid-thoracic and thoraco-lumbar area. They function as a group to stabilize the spine and are often injured with chronic spine flexion (stooped posture or repetitive bending from the waist), lifting, twisting, carrying heavy objects, or falling.
Quadratus lumborum: The quadratus lumborum is probably the muscle most commonly involved in LBP. It runs from the ilium (hip bone) to the 12^th rib and extends the spine as well as hikes the hip. MTrP’s often form from a combination of bending, lifting and twisting, prolonged standing, rear end motor vehicle accidents, and leaning forward to lower a load.
Psoas: The psoas runs from the lumbar vertebrae to the femur and flexes and externally rotates the hip. MTrP’s often form in the psoas from sitting for an extended time without a standing break, and can refer pain into the groin, hip and thigh.
Abdominals: The abdominals flex and rotate the trunk as well as stabilize the spine. MTrP’s can be caused by dysmenorrhea (painful periods in women), endometriosis, coughing and vomiting. MTrP’s in the abdominals can refer pain to the low back and cause impaired ability to stabilize the spine during functional tasks.
Serratus posterior inferior: The serratus posterior inferior (SPI) runs from the spine to ribs 9-12 and depresses the ribs during exhalation. MTrP’s in the SPI cause pain directly over the muscle.
Gluteals: The gluteal medius runs from the ilium to the femur and abducts the hip. It is the main hip stabilizer in single limb stance and is often injured with falls and with running on a canted surface such as the side of the road. Pain from MTrP’s in gluteus medius refer to the sacrum and the low back just above the iliac crest.

(Low Back Pain of Muscular Origin, Gerwin, R., Adapted from Mense and Gerwin, Muscle Pain, Springer, 2010).

THE STRETCH PROGRAM

Following are photos of stretches for each of the muscles we discussed. Hold each stretch for 20 seconds and perform 4 times on the involved side of the body.

Erector Spinae Stretches

Erector spinae pic 1 e1308245956732 Low Back Pain Treatment and Stretches

Erector Spinae starting position

Erector Spinae pic 2 e1308246016969 Low Back Pain Treatment and Stretches

Erector Spinae finishing position

Quadratus Lumburum Stretches

Quadratus Lumburum e1308248208532 Low Back Pain Treatment and Stretches

Quadratus Lumborum starting position

Quadratus Lumburum Pic 2 e1308249545990 Low Back Pain Treatment and Stretches

Quadratus Lumborum finishing position

Psoas Stretches

Psoas stretch 1 e1308249805375 Low Back Pain Treatment and Stretches

Psoas stretch starting position

Psoas stretch 2 e1308249881468 Low Back Pain Treatment and Stretches

Psoas stretch finishing position

Abdominal Stretches

Abdominal stretch start e1308250155488 Low Back Pain Treatment and Stretches

Abdominal stretch starting position

Abdominal stretch finish e1308250200372 Low Back Pain Treatment and Stretches

Abdominal stretch finishing position

Serratus Posterior Stretches

Serratus Posterior starting position e1308250393280 Low Back Pain Treatment and Stretches

Serratus Posterior stretch starting posiiton

Serratus Posterior finish e1308250471467 Low Back Pain Treatment and Stretches

Serratus Posterior stretch finishing position

Gluteals and Piriformis Stretches

Gluteals and Piriformis e1308250728860 Low Back Pain Treatment and Stretches

Gluteals and Piriformis starting position

Gluteals and Piriformis finish e1308250776288 Low Back Pain Treatment and Stretches

Gluteals and Piriformis finishing position

Hamstring Stretches

Hamstring stretch starting position

Hamstring stretch finishing position

If pain and dysfunction do not respond to self-care measures, it may be time to see a physical therapist. Licensed physical therapists will provide an in-depth evaluation to determine a specific treatment plan based on your injury. Physical therapists utilize manual therapy, joint mobilization, stretching and strengthening of specific muscles, and modalities such as electrical stimulation, cold laser, and increasingly, trigger point dry needling. Physical therapists with specialized post-graduate training utilize dry needling to cause a local twitch response in the MTrP. The twitch response causes mechanical and chemical changes in the muscle to allow the spasm/pain cycle to be broken. Once the MTrP is inactivated, the muscle can be stretched and strengthened under the guidance of your physical therapist.

As we have discussed, LBP is a very common and often prolonged problem affecting most people at some point in their lives. Proper body mechanics, nutrition, exercise, and avoidance of smoking can help keep your muscles and disks healthy. If back pain does not respond to self-care measures, a physical therapist can work with you to determine the cause of the problem and develop a treatment plan.

Article was originally posted on Global Body Weight Training.

Contact While Site is Under Contruction

By pran6588 on October 10, 2011 / Blog / Leave a comment

Tags: address, contact

Prana Physical Therapy, PLLC
at Core Wellness and Physical Therapy
2201 Mount Vernon Ave.
Alexandria, VA 22301

571-527-9192

Archive for October, 2011

What the “bleep” is Paleo?

Five Random Thoughts

Why I decided to go back into private practice (AKA Why I would leave a good paying job with full benefits)

Stable to the Core

Adapting Thai Yoga Therapy for the Neurologically Involved Client

Low Back Pain Treatment and Stretches

THE STRETCH PROGRAM

Erector Spinae Stretches

Quadratus Lumburum Stretches

Psoas Stretches

Abdominal Stretches

Serratus Posterior Stretches

Gluteals and Piriformis Stretches

Hamstring Stretches

Contact While Site is Under Contruction

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