What is an expert?

I have been reading various magazines and watching news shows that feature supposed experts on back pain or strengthening abdominals. Each time a new expert appears with a cute work out outfit and a new exercise routine, I wonder where they came from. What are the credentials of that expert and how long have they been giving advice?

It is true that a pretty face may be more fun to look at on the Today show or on Oprah but when you see that pretty face inflicting pain and potential damage to that person’s back or shoulder, you know that the pretty face can more damaging than doing nothing at all.

An expert on the body should be someone who has an advanced degree and many years of experience working with patients. A novice should not be giving advice about back pain in a magazine or on the screen if they don’t have the training to do so. Are they a physical therapist? Have they had special training on back pain or shoulder pain? How many years of experience have they had? A good body and a pretty face are great if they come with the above qualifications as well.

An expert on television needs to have the credentials to support what is being told to the public. The show that chooses poorly may be responsible for causing pain or injury to its readers. Readers need to be ware and ask for credentials before following bad advice. An expert may or may not be the most beautiful but the information given must be well documented and evidenced based.

Should treatment of all types of pain be the same?

As the chronic pain physical therapy specialist at our hospital, I was asked to speak with the newly admitted chronic pain patient on our rehabilitation floor. The program is designed to help get a patient moving as much as possible and to help the patient wean off of drugs if that is a goal they have chosen. Those treating this patient were looking at her through a standard physical therapy lens.

A full evaluation was done yesterday and the patient was sufficiently flared up to make it difficult to touch her. I performed some relaxation and gentle manual therapy techniques and the muscle spasms started to decrease. I told her that the “no pain no gain” philosophy was not mine and we would go slowly. That helped her to relax some more.

We had a great first session and trust was the result. There is a big difference between chronic and acute pain. With acute pain patients, you can address the problem directly and then fix it. With chronic issues, trust is even more important. Gentleness in treatment is also crucial. If you scare someone away at first, you may not get another chance to gain their trust again.

Treatment of all types of pain should not be the same. You can’t fix chronic pain with a quick manual therapy treatment or a few modalities. It takes slow, small steps and lots of patience.

Can using a cane or walker be addictive?

I was visiting in Florida this past week and I noticed a woman hobbling on obviously uneven hips while holding onto the furniture. It not unlike a child that cruises when learning to walk. I asked the woman if she was experiencing back pain and she answered that she was. I asked her why she wasn’t using a cane and she said that she was told that she would get too used to it and would not be able to walk without it. She said that she could become addicted to the cane.

This particular woman had undergone a total hip replacement recently and the legs were of different lengths. She was obviously causing back pain due to the uneven height of her hips. In addition, she was unsafe in her walking which was evidenced by her need to hold onto the furniture to walk safely. Walkers and canes are not addictive. There is no chemical that will cause withdrawal if you stop using them.

When someone who needs an assistive device stops using it because of vanity or worry about addiction, they become more dependent on others, can potentially cause back pain and even more seriously can potentially cause a fall due to lack of safety while walking. There is no good reason not to use an assistive device if one is needed.

Using a cane or walker is not addictive but it is the safe alternative for the individual that wants to be independent. A broken hip or even a head injury from a fall can be far more damaging than a bruised ego from using an assistive device.

Is it hazardous to your health to run in winter weather?

I was walking the dog the other day in a long down hooded coat, winter treaded boots and a scarf covering my face and neck when I noticed a man in what looked like spandex running along side of the road. He was wearing running shoes and was not being pursued by anyone as far as I could see. In his defense, he was wearing a hat and gloves but only a small sports type jacket. It should be mentioned that it was only 11 degrees at the time with patches of ice on the ground. Thankfully, he was the only one I saw that day. My husband remarked that the guy was nuts and I agreed. I thought I might be seeing him as a physical therapy patient some time soon if he didn’t wise up.

In the dead of winter, is it healthy to keep running?
Well yes it is, but inside would be so much better for you than outside when the temperature is below freezing. In addition, ice on the ground makes it so much more likely that an injury will happen as well. We all need to keep up our exercise routines in winter, but when the temperature plunges there are hazards to our muscles and joints as well as to our bodies in general. Hypothermia and frostbite are real threats to our safety. Individual bones and soft tissue like tendons, ligaments and muscles are much more vulnerable to injury in frigid temperatures. Falls are more frequent as well.

In order to cut down on the chance of injury to any muscle or joint, keep the running inside when the weather is iffy. Ice, snow and below freezing temperatures are not the time to be stubborn. A seemingly small injury like a tendon tear or a hairline fracture can keep you from doing your sport for a lot longer than a few cold days. So run in cold weather, but do it inside when the temperatures are below 32 degrees or the ground is slick.

Are sex and low back pain incompatible?

Once my evaluation is completed, it usually comes out. I have not had relations with my husband or wife since my back pain started and things are strained between us. Will I make my pain worse if I do it anyway? I am scared that my relationship will continue to suffer if I don’t do something.

This is an important issue between couples and low back pain is not incompatible with sexual relations. To the contrary, the chemicals released during sex may help to decrease your pain. Positioning to decrease your discomfort is the most important thing for the individual with pain. Use pillows to balance the body to comfort and make sure that you speak up if any pain gets worse during any activity.

Talking with your partner about your fears can make them a partner in creatively avoiding positions that will increase your pain. Hiding your fears and avoiding the issue will indeed put more strain on your relationship.

Therefore sex and low back pain are not incompatible but avoiding the subject may be a problem for your relationship.

Can flat feet cause back pain?

I was walking after work this afternoon and ran into a neighbor. He was complaining of back pain, hip pain, and sciatica. As a second thought, he mentioned that he had flat feet and after years of doing without them, finally had orthotics custom ordered. He wanted to know about what to do about the hip pain.
I told him that if one has flat feet, that can affect the rest of the body if uncorrected. If one foot is flatter than the other, the body can be affected resulting in all sorts of back, neck and sometimes even shoulder pain asymmetrically.
If you place a stack of books on a table and the table legs are uneven, it will tip. The body will as well. Anyone with any sort of foot problem should address it sooner with proper foot wear and orthotics or they may find it spreading to the rest of the body. Back pain can be a complication of flat feet. Orthotics can make a big difference in avoiding long term problems.

Can lack of sleep cause pain?

One of the questions I ask patients on a regular basis concerns their sleep patterns.  Many of the patients with the most neck or back pain sleep the least.  Is that because they are in too much pain to sleep?  Sometimes, but often they are just too busy to sleep much or they feel that they just don’t need it. 

Research lately has linked the lack of sleep to diabetes, weight gain and higher stress levels.  It can also be related to increased pain.  If you don’t get that good night’s sleep that allows your body to recover from the day’s stressors, you will be more likely to be overweight, full of stress, more apt to catch all sorts of diseases and even more likely to have pain or more pain than if you were sleeping. 

What is an appropriate amount of sleep?  If you are not getting that 7 – 8 hours of deep uninterrupted sleep, you may be causing your pain to increase.  That includes back and neck pain or any other chronic pain condition. 

What should you do to promote good sleep?   Start with getting rid of all visible light sources and that includes electronics.  If the pineal gland in your skin sees the light, you will not be able to get into that deep restful sleep.  Another tip is to not use your bed as your office.   Also, limit the caffeine in your life. 

Good sleep is essential for good health.  It can mean the difference between no pain and lots of pain.  It is a choice that every individual needs to make for himself.  I ask all of my patients to address the issue, to try some of those tips and to report back to me.  If you don’t sleep, your body cannot heal.  If it doesn’t heal, then your pain has to be worse.  So can lack of sleep cause pain?  Absolutely and that is something we can all attempt to do better.

Is a lawyer a good referral source for a physical therapist?

One of my pet peeves is the legal loop that accompanies accident cases.  When you have an accident and you ask your lawyer for a referral for a physical therapist, should you follow his or her advice? 

First of all, if you are hurt as a result of a car accident, you should see a physician as soon as possible to rule out any serious trauma, fractures or even torn muscles.  He or she can refer you to a physical therapist or you can ask a friend to refer you to someone they trust for treatment. 

What happens when you call a personal injury lawyer for a referral?  Unfortunately, most lawyers will refer you to the professionals that will help you win a legal case.  That is not the same thing, unfortunately as a professional that will give you the best treatment.  If you mistakingly end up in that legal loop, you may make money in the end but in many cases you lose.  Even if you  lose the case, the medical professionals win, because they get paid for what they have billed.   Often,  I have seen the PIP or personal injury protection used up and patients without appropriate treatment go for months or more with problems that could have been successfully treated immediately.  Many times I have seen patients who have no insurance come in to our clinic only to find out that their PIP was exhausted by these so called professionals that padded bills with minimal treatment masked as physical therapy and no where to turn. 

Years ago my daughter was in a car accident with her stepsister.  They had unfortunately hit a cab, having missed a stop sign and thankfully were only going about 15 miles per hour.  We arrived to see the cab driver who was a healthy looking man moving well and twisting his neck from side to side looking for someone.  That someone turned out to be his lawyer who arrived moments later and called an ambulance.  This cab driver climbed into the ambulance by himself and went on to claim thousands of dollars in injuries from this little fender bender.  As a physical therapist, I knew what was coming.  Years ago, these practices were more common, but they still exist today.  Most physical therapists know where these practices are. 

So in my opinion, few person injury lawyers are good referral sources for physical therapists, because their contacts are usually the ones that know how to pad a bill in order to win a case.  If you need a referral for a good physical therapist, ask a friend who has been to one, or ask a physical therapist who they would see for a particular problem.  Valuable time can be wasted going to the wrong person if you have a legitimate problem.

Which is more expensive for travel; a large suitcase or several small ones?

Today with all the add on costs for travel, many people are choosing to carry on all of their luggage onto the plane instead of checking it.  They have a suitcase wheeled from behind and a strap over the shoulder that is equally as cumbersome.  This way they can avoid the time and cost of checking bags.  By the time they have finished lugging all that into the plane, there are probably complaints of neck, back and often shoulder pain.  Is it worth it?  I don’t think so.  It can spoil a vacation.

Some people think it might be better to stuff everything into a huge suitcase with wheels and avoid the cost of checking two bags.  DId you ever try to lift one of those huge oversized bags?  I have plenty  of patients who have done so.  That is why they are my patients.  Torn rotator cuffs and bulging lumbar discs are often consequences of packing incorrectly or overpacking.

What is the best way to pack?  LIGHTLY!  Consider shipping the luggage ahead via UPS as another alternative.  If you must take many items, place them in several smaller bags and pay the extra money to check them. It is usually much less expensive than a shoulder or back surgery.  If you wouldn’t lift a 100 lb bag of potatoes, why would you lift a 100 lb suitcase? 

To answer the question, it is much less expensive to pack several smaller suitcases than to pay the physical  costs of packing a large one.

Are all physical therapists the same?

A patient that I have been seeing for several months called me last week and asked me to help to find him a physical therapist in Brooklyn.  He had just been offered a job there and wanted to have someone to call if he had a flare up of his symptoms that included back and neck pain as well as numbness and tingling in his toes.  Chronic pain conditions have a tendency to ebb and flow and his was not an exception.  Spinal stenosis can be a very debilitating diagnosis and as a responsible professional, I knew that he would need a particular type of physical therapist to get him back on track during the exacerbations. 

All physical therapists are not the same.  The training in schools today, whether the physical therapist has a masters or a doctorate is pretty much the same.  They receive the same general background in all areas of the profession, experience several clinical internships and go on to take state boards.  After that the similarity ends.  What courses one takes from that point on will determine what direction one takes in the field in addition to those he or she comes in contact with. 

When searching for a physical therapist, a patient will usually get the best results when choosing a professional that specializes in the diagnosis that is in question.  Today there are spine specialists, women’s health specialists, vestibular specialists, and even pediatric orthopedic specialists to name a few.  Experience and coursework determines these specialties.  You would not want to see a women’s health specialist if you had a neck problem and expect optimal results.

When the patient asked my advice, I gave him a list of possible treatments to look for when searching for a therapist.  I listed manual therapy techniques that I use like; muscle energy technique, strain counterstrain, primal reflex release, total motion release, and trigger point therapy to name a few.  I then looked up lists of manually trained physical therapists from various websites to give him a starting point and told him to ask each one he chose whether they were trained in those techniques. 

There is so much out there for physical therapists to learn that it is impossible to be the best at everything.  If I had a problem, I would want to choose a physical therapist that specialized in that problem and felt comfortable with all the available tools to fix the problem. 

All physical therapists are not the same.  We specialize just like other professionals.  FInding one that specializes in your particular problem can make all the difference.