The Jackson Clinics

Exercise is often prescribed as the preferred treatment for lower back pain, and walking seems like a healthy, low-impact option. Yet patients often return to their physicians complaining that their walking program has not helped—or has even made things worse.

The problem is usually not the walking itself, but the absence of other stretching and strengthening activities. This is where physical therapy comes in. We can design a program that not only relieves the constant discomfort of chronic low back pain but may also prevent it from returning.

Low back pain is often caused by poor posture, and people who stand with poor posture usually walk with poor posture as well. Therefore, starting a walking program without first addressing the issues that caused your pain in the first place is not always going to help matters. We will focus on core exercises that help strengthen the muscles around the trunk and thus help stabilize the spine. We will recommend stretching routines for the hips, legs and trunk when appropriate.

Dynamic stabilization exercises are also key for those with certain lower back problems. These build up spinal muscles necessary for good range of motion when twisting, bending and so forth. Some discomfort is normal at first, but do not get discouraged. We have been trained to distinguish “good” pain from “bad” pain and can relieve both your fears and the  pain itself. Physical therapy often includes deep tissue techniques, traction and/or ice/heat therapy, followed by exercises to facilitate enhanced function.

Since lower back pain is often relatively easy to resolve through physical therapy, most patients complete their exercise program in a matter of months. Afterward, it is important to adhere to an at-home maintenance program. If you stop doing your exercises, you can lose flexibility and strength and end up back where you started. Keep on walking, stretching  and ensuring that your core muscles stay strong, and you often will be able to avoid low back pain for years to come!

Pain across the shoulder blades or weakness in the upper arms could be symptoms of C5 radiculopathy, a condition caused by the malfunction of a nerve in the neck that affects the shoulders and arms. Symptoms include pain of the shoulders and upper arms, and weakness in those areas, especially when you attempt movement. The pain may worsen over the course of  a day and is sometimes described as sharp.

The C5 nerve can malfunction when inflamed, or when it is compressed or “pinched.” Both conditions result from a variety of causes, such as the sudden trauma of an athletic injury or from heavy lifting and other stressful or repetitive activities. Often, degeneration of the spine due to aging or disease is a factor. All of these may result in a narrowing of the space around spinal nerves or a deterioration of the discs that provide cushioning of spinal bones, leading to pressure and pinching of the nerves.

With a physical examination, an x-ray or an MRI (magnetic resonance image), we can determine whether C5 radiculopathy is causing your shoulder pain and design a treatment plan to ease pain and restore function. Treatment usually involves

• physical therapy
• rest
• pain medication
• anti-inflammatory drugs
• prescribed muscle relaxants
• controlled sleeping positions

Wearing a neck collar to rest neck muscles or using at-home traction to relieve compressed areas may be recommended. We may also prescribe massage, gentle manipulation and an exercise program to stretch and strengthen neck muscles.

To assist in your recovery and help maintain long-term spinal health, we will work with you to establish healthy daily habits, such as improving your posture. Most patients will see a noticeable improvement in their symptoms after a few weeks and usually go on to be symptom free after six to 12 weeks of treatment.

Recently, experts have been paying more attention to how physical therapy can help those with Parkinson’s disease. This  degenerative neurological disease is usually treated with medication, but new studies suggest that certain types of therapeutic exercise can make significant improvements in the daily lives of those living with Parkinson’s disease. A 2012  study published in BMJ (formerly British Medical Journal) showed that, in the Parkinson’s population, gait (or walking)  speed, balance and level of disability were all positively affected by physical therapy.

What can Parkinson’s patients expect from physical therapy? Skilled therapists will design a program tailored to address the specific problems common in those with this disease. Since Parkinson’s disease can wreak havoc on balance and fluidity of movement, the focus will be on exercises that address these issues. There is some quality evidence that “random practice exercise,” in which you are required to change speed, direction or activity at random intervals, can be especially beneficial to those with Parkinson’s disease. Aerobic exercise that encourages good biomechanics is also recommended.

Since Parkinson’s disease suffers often experience balance problems, muscle weakness, and pain and stiffness in their joints, we will focus on increasing movement through “compensatory treatments” to help you compensate for the physical impact of Parkinson’s disease. Static, repetitive exercise, like walking on a treadmill or stationary biking, are not appropriate for patients with Parkinson’s disease, and weight training can be dangerous due to the high risk of tremors or sudden muscle weakness. We may design an unorthodox program that utilizes dance, ping-pong and skipping along to music. Even Nintendo Wii games, such as tennis, bowling and boxing, improve coordination, reflexes, balance and other movement-related skills as part of an overall therapeutic plan.

Beyond the obvious mind-body connection, activities that require concentration or learning new skills are imperative for those living with neurological conditions, so we may find ways to incorporate cognitive training into your therapy, as well. As an added advantage, physical activity reduces depression, a common side effect of degenerative diseases.

If you or someone you know has Parkinson’s disease, make an appointment with us to begin addressing this condition. While physical therapy cannot cure Parkinson’s disease, it can help those afflicted with this condition live happier, healthier and more independent lives.

After your knee replacement, you might think your knee will work just fine. Unfortunately, many people do not realize that straightening the knee after surgery is not as simple as they originally thought. Along with loss of strength, reduced extension is one of the most common complaints following knee replacement. Full motion of the knee can take three to six months to regain after surgery.

A customized physical therapy program will address residual stiffness by combining stretching, exercise and a steady, safe return to your daily activities. For some people, the challenge to get the knee extended properly after surgery can result from poor pain control, making it hard to move the knee; stiffness before surgery, which makes it more likely there will be stiffness afterward; heavy scarring because some people form scar tissue more readily than others; a poorly positioned replacement implant; and surgical complications, such as an infection.

Treatment depends on the cause of your stiffness. We can design a rehabilitation program that focuses on proper knee extension. More invasive surgical approaches involve breaking up scar tissue. However, if you start physical therapy  early, it is unlikely this will be necessary.

Your personalized program will begin immediately after your surgery with simple movements such as knee extension and quadriceps exercises. Initial exercises will include

• isometric exercises to help improve circulation
• ankle pumps to strengthen calf muscles
• leg raises for strong leg and thigh muscles
• knee bending and straightening exercises to enhance range of motion

After surgery, you will begin physical therapy. This will provide you with the best chance of treating stiness in your knee. You will regain proper extension in your knee and enjoy all your favorite physical activities once again.

When you visited your doctor with pain in your big toe, it was diagnosed as hallux rigidus. Hallux rigidus is a form of degenerative arthritis (also called osteoarthritis) specific to the first metatarsophalangeal joint—the joint at the base of the big toe.

Similar to osteoarthritis, the root cause of the pain is a degeneration of the cartilage that cushions the bone ends within the joint. Additionally, bone spurs—unnecessary outgrowths of bone—can form in the joint, adding to stiffness and discomfort. The cause of hallux rigidus is not always known for certain, but a previous injury may lead to a predisposition to the condition.

Hallux rigidus can be particularly challenging and painful because so much weight is placed on the big-toe joint in every normal step we take. A natural reaction to alleviate such pain is to avoid putting undue pressure on the joint by modifying your gait. Such compensatory actions throw off your body mechanics, and you can develop other problems, such as low back pain. Thus, treating hallux rigidus quickly and effectively is quite important to your overall well-being. Strategies we might employ include

• ultrasound
• gait training
• ice and/or heat therapy
• mobilization to regain motion

It is also very important to modify your footwear. This may include wearing shoes with large toe boxes and stiff soles, adding orthotics and avoiding high heels. Nonsteroidal anti-inflammatory medications (if approved by your physician) and occasional corticosteroid injections may also help ease pain and swelling.

If these measures are not enough, surgery may be necessary to physically remove bone spurs and/or fuse or replace the joint. We can design a postsurgical rehabilitation plan to keep swelling to a minimum, help you learn to use crutches temporarily and, after fusion surgery, help you learn to walk without the benefit of a flexible big-toe joint.

Although hallux rigidus is not a household phrase, the condition is relatively common. Through exercises, we can make you feel more comfortable, help you to avoid other problems and walk more smoothly and without pain.

You lifted a bag of groceries from the floor. Now your physician says your back pain is the result of spinal compression fracture. What is that? Can it be treated? Will the pain go away?

Spinal compression fracture occurs when bones of the back cannot support the demand placed on them and collapse. Sometimes multiple or untreated fractures may lead to a hunchback deformity, loss of height, and even stomach or breathing problems from the compression of internal organs caused by the shrinking spine.

Sudden trauma, for instance, when lifting a heavy suitcase or turning a mattress, can cause spinal compression fracture. Osteoporosis, a gradual thinning of the bones, particularly in women older than 50, is another possible cause, weakening the spine until it can no longer withstand the demands of even routine daily activity.

Symptoms range widely from sudden, severe pain, usually in the mid-back, to a dull ache that worsens when standing, walking, bending or twisting. In some cases, there is no pain at all, and the fracture goes undetected until the back is examined or x-rayed for some other reason.

Most compression fractures respond well to conservative treatment. Treatment usually begins with a few days of rest from physical activity and medication to relieve the pain during healing. Wearing a back brace may be advised if you need the support.

We may recommend weight-bearing exercises such as walking to maintain bone density and range-of-motion exercises for your back, neck, shoulders and hips. Increasing your calcium intake to maintain bone strength can also be helpful. We will also teach you proper body mechanics to keep your back in safe positions when moving and to avoid extra strain near the fracture as you go about your work and daily activities.

With appropriate therapy, most compression fractures heal in about 8 to 10 weeks. As you recover, exercises will extend your range of motion and strengthen the abdominal muscles that support the spine, and the back muscles that resist the forward bending of the spine. After the recovery period, we can work with you to design a diet, exercise and lifestyle plan that can protect your spinal health and help avoid future fractures.