Farnsworth Orthopedic Physical Therapy

Orthopedic Physical Therapy

back pain

Battle of the Bulge

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Understanding Disc Bulges

Disc bulges can be caused by immediate trauma or injury (sports injury, auto accidents, etc.), as well as long-term trauma such as improper posture.  Discs are located between each of the vertebral bodies of the spine. The discs are the shock absorbers of the body. They also help to give the spine more movement and flexibility as we twist and bend.

The discs are shaped like a hockey puck and are made up of cartilage, which is tough and leather like. Each of the discs is constructed like an onion, layered in rings. At the center of each disc is a watery, gelatin-like center called the nucleus. The discs have a high content of water and this is what makes them flexible. As we age, the discs lose some of their water content and become less flexible. This makes the layers of the “onion skin” more brittle and weaker.

What Is Causing the Bulge?

As we do activities that place us in a bent or “flexed” position (sitting, driving, reading, or watching TV), the low back can lose its natural curve, and pressure from the nucleus can be exerted on the back side of the discs. Over time, one layer at a time of the “onion skin” splits or cracks and the gelatinous center moves closer to the outside. Eventually this nucleus begins to distort the shape of the disc, causing the disc to bulge. This can happen to the direct back side but most often is slightly to one side or the other. (In rare cases, the bulge can be on the front side.)

The pain is caused because the back side of the disc has many nerves. Another factor is that the spinal cord is directly behind the disc and, as the bulge increases, it begins to irritate the nerves that are attached to the spinal cord. In the low back, these nerves travel down the leg. This can cause feelings of pain as far down as the foot and toes, as well as numbness or tingling in the leg and foot. This is called sciatica.

Fixing the Problem

One way to help with this problem is by beginning flexion or extension exercises.  If this is done often, the layers of the annulus can begin to heal and can form scar tissue. As the disc heals, the bulges reduce in size and take the pressure off the nerves, decreasing or eliminating the sciatica.

“Traction” may also help relieve the sciatica. Consult your doctor or health professional to see if this is an option for you.

Another item that can keep the low back in its proper curve is a lumbar roll. The lumbar roll is placed behind the low back while you sit, and helps keep the back in its proper curve.

In some cases, surgery may be necessary if the exercise, traction, and lumbar roll do not resolve the condition. Your doctor or therapist will show you the exercises best suited to your situation.

Post Written By: Travis Rohner, PT

Back to Back Basics

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As I continue in my career as a physical therapist, one of the most common problems I treat is lower back pain. This can affect anybody, from the young to the old. There are various reasons that one can have low back pain, but most of the time there are common issues that those who are in pain share. A little information can help in order to reduce your pain.

First off, let’s review a little about your spine. Your spine is flexible and can move in different directions based on the positioning of the facet joints, the movable areas of the spine, and where those individual segments connect the bone above and below it. There are also muscles which attach directly to the bones of the spine, and those adjacent to it which can cause problems. It’s often abnormalities in these muscles that can be the cause of your back pain. Certain muscles can be weak or tight which can limit mobility. This causes pressure where there shouldn’t be, and that causes pain.

 Muscles which can cause trouble:

  • Hamstrings: The hamstrings are a group of muscles on the back of your upper leg. If these are tight, they affect how your hip bones move. If they are really stiff they can rotate your pelvis backward, which pulls at your spine. A great way to stretch these is to sit in a chair with your leg extended in front of you, your heel on the ground, and lean forward keeping your back straight. Most people want to reach down the leg but I suggest keeping your hands at the top of your leg and supporting your straight back. Hold this for 30-45 seconds. Perform this move about 3 times, and do a set a few times per day.

  • Piriformis- Next, the piriformis is a muscle that is beneath your glute muscle group. Most people know where their gluteus maximus is. Well, this muscle is right beneath it. It runs from your sacrum, which is what you sit on, to behind the big bump on the outside of your upper leg called the Greater Trochanter.  An easy way to stretch this is to sit and cross the affected leg over to where your ankle is resting on your opposite knee. Your lower leg should be as flat as possible. Gently lean forward until you feel a gentle stretch in the back of your buttock. Hold this for 30-45 seconds. Do this three times in a row, a few times per day.

Stretching not Screeching

Lastly, and the most important thing  about stretches is: they should not hurt! If they hurt, you’re going too far. This is so important because a stretch that hurts is typically a muscle contraction, which is a shortening of the muscle. This is the exact opposite of what we are trying to achieve, so don’t do it! Remember these two factors are just the tip of the iceberg of what can be causing your pain. If you want to get more details, please consult with a professional so you can get properly diagnosed in order to return to all of your daily activities. Happy stretching!

Post written by Rod Walker, PT

The Right Side of the Bed

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Getting out of bed in the morning can be a figurative pain for many reasons. For one, who couldn’t use more sleep? I find myself wishing I could sleep just a little longer most days, especially in the winter time when it’s dark in the morning. Getting out of bed can also be a literal pain for some people. It’s important that we learn proper body mechanics when getting out of bed to ensure that our day starts in the best way possible. Though I can’t give you permission to keep hitting the snooze button, I can give you some tips for getting yourself up and at ’em, so you can start your day on the right foot.

I’m forever grateful that my alarm clock doesn’t come in the form of birds and mice.

Injury, degenerative changes, and improper body mechanics are some of the most common sources of back pain. If you currently have back pain, there are several ways of getting in and out of bed to decrease the discomfort while you heal. First, to move from lying on your back, bend your knees upward and roll onto your side. Next, slide your legs off the edge of your bed with your knees bent. Finally, push yourself up with your arms, using your legs as a counter weight and sit up.

 

To move from sitting to lying down, reverse the procedure. Begin sitting on the bed, then lower yourself down onto your side, using your arms to help guide you. Once you are lying on your side, you may slide your legs up onto your bed. Make sure to keep your knees bent to roll onto your back. Body mechanics while getting in and out of bed is only part of the battle when it comes to pain. Proper sleep positions are also very important. You can read more about those here.

Now you’re well on your way to getting out of bed faster than Grandpa Joe when he found out Charlie won a Golden Ticket. Just kidding, no one could possibly get out of bed faster than that fraud.

Post Written by: Clint Bunker, PT

Sleep Tight

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There’s an Irish proverb that says “A good laugh and a long sleep are the best cures for anything”. Did you know that 35% of adults report less than 7 hours of sleep per night? In order to obtain maximum mental function, the average adult requires 7-9 hours of sleep per night. So the question becomes, are you getting enough sleep?

There are a few contributing factors that may effect the amount of sleep you get each night. Stress is one of the most common and one that can be the most difficult to control. Making sure you are eating a proper diet, drinking enough water, and exercising regularly can help manage stress. With all we have going on in our daily lives, it is easy to forget to care for ourselves.  Because of this, stress levels can rise, which leads to other medical issues.

Pooh is stressed about Heffalumps and Woozles, which doesn’t make for a decent night’s sleep.

Aside from controlling stress, you can prepare your bed for a good sleeping posture. Ideally, the best sleeping posture is on your back. First, try using a pillow or a bolster to elevate your feet from the knees down. This takes the pressure off the joints of the low back, as it allows for proper curvature of the spine. However, there are some medical diagnoses that don’t allow for sleeping on the back. If you are unable to sleep on your back, try sleeping on your side with a pillow between your knees. Again, this allows for proper curvature of the spine as well as placement of the hips in this position. The worst posture for sleeping is on your stomach, as it can often lead to shoulder or neck issues and should be avoided if possible.

There are times when we wake up feeling like our body has been wedged in the entrance to Rabbit’s House.

The other factor for sleeping posture is the type and position of the pillow used. Some people have a preference of using a feather pillow. Though they are soft and fluffy, they’re often not supportive enough for the curvature of the spine. On the contrary, using a memory foam pillow may have too much support for the spine. Therefore, each person may benefit from a different type of pillow. A physical therapist can help you figure out which pillow is best for your needs. Whether firm or soft, the pillow should be placed at the base of the neck for the best support.

 

Knowing how important sleep is to our everyday health, we must all take the proper steps to ensure we get the best sleep possible. Managing stress, sleeping position, and pillow choice/placement are all factors that could effect the number of hours we get each night. If you are having postural related issues or need help setting up an appropriate sleeping arrangement, feel free to contact our office for more information on how we can help you.

Post written by: Casey Badder, PT

That feeling when you find the best pillow and sleeping position for you.

Piriformis Syndrome

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The Piriformis muscle is located in the buttocks area, underneath the gluteus maximus. It’s one of the muscles that helps rotate the thigh bone outward, like you do when you cross your ankle over your knee. The muscle runs from the tail bone and attaches at the hip bone.The sciatic nerve is a major nerve that begins in the low-back area and travels down the back of the thigh and continues down, branching off in the lower leg and foot. The sciatic nerve usually runs directly through the Piriformis muscle, although it may lie above or under the Piriformis.

The cause of Piriformis Syndrome is not entirely clear and may be a result of several different things. It is often associated with sacroiliac (SI) problems. Trauma, such as falling on the buttocks may incite the symptoms. Extended sitting can be a factor, as in the case of professional drivers or office workers. Other problems, such as hip bursitis, back strains, or gluteal tendonitis may bring on the condition.

Symptoms include pain and tenderness in the buttocks area. The problem may be on one or both sides. Sitting is often uncomfortable. Walking, running, and climbing or descending stairs is often painful. In some cases radiating pain may shoot down the back of the thigh and into the lower leg because of irritation to the sciatic nerve.

There are many treatment options for Piriformis Syndrome. Moist heat can help relieve and control pain. Ultrasound may be beneficial since it is a method of deep heating. Certain therapeutic exercises may greatly help to recondition the muscle. There are several stretches for the muscle that can help relieve the tightness. Avoidance of irritating factors is crucial. Manual techniques such as soft tissue mobilization are often helpful. In severe cases, anti-inflammatory injections may be needed.

With proper treatment and follow through, this condition can be resolved. In some cases it will resolve quickly, while in others it may be a lengthy rehabilitation. For more information consult your physical therapist.

Post written by Travis Rohner, DPT

Get Your Body Moving… Correctly

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Using proper body mechanics can prevent back injury, help speed up recovery if you are already injured, and prevent further injury after your back has healed. Here are some suggestions that you may use with daily activities.

When getting out of a car, first open the door completely, then swing your legs out to the side and pivot on the buttocks so your entire body moves as a unit. Do not twist your low back. Place one hand on the seat and the other hand on the car frame. Scoot forward and place feet under the hips, lean forward, and push with one hand while pulling with the other hand, and use the leg muscles to come up to a standing position. To sit down, reverse the procedure.

When retrieving things from a low shelf, instead of bending over and twisting, it is better to kneel down or squat in front of the shelf, pick up the objects holding them close to the body, and then stand up using the strong leg muscles and keeping the back straight.

Activities such as brushing your teeth, ironing, washing dishes, or folding laundry require standing for extended periods of time. To avoid fatigue, try to break these duties up into smaller time periods. When standing, place one foot on a step or ledge. Do not bend at the waist; instead bend at the knees and keep back straight. To provide support, use one hand to brace yourself. Always try to do the activity at a comfortable height.

While doing activities like washing windows, painting, changing light bulbs, or hanging pictures, ALWAYS USE A STABLE STEP STOOL. This will help ensure that these activities are at a better level rather than being above your head. Another alternative is to use a long-handled tool to reach the overhead area.

When performing duties such as vacuuming, sweeping, shoveling, or raking, do the following: stay close to the work area; use the arm and leg muscles while keeping the back straight; avoid twisting movements; and use body weight to help with the job.

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Mesa, Gilbert, Chandler, Phoenix, Queen Creek, Apache Junction, Tempe, Globe, Gold Canyon

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730 N. Greenfield Rd.
Gilbert, AZ 85234
Phone: (480) 633-0666

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342 N Val Vista Dr. Suite 106
Mesa, AZ 85213
Phone: (480) 325-3310