Misinformation abounds about back problems. How many times have you heard that exercise can hurt your back? Or that if you consult a spine surgeon about pain, you’re sure to wind up in surgery?

​Back pain is a problem that is fairly common — as are the myths on the subject. If you have back pain, it’s important to get the facts.

We talked with Marzena Buzanowska, MD, Cleveland Clinic Center for Spine Health, to dispel these myths.

Myth: Exercise can hurt your back.

Fact: With professional guidance under a licensed physical therapist, exercise can help your back by strengthening the muscles that support your spine. A strong, well-conditioned back can withstand more stress and stabilize the spine better. In some instances, a spine-certified physical therapist can find a few simple exercises that will help relieve the pressure from a bulged disc to help with healing, Dr. Buzanowska says.

Myth: Herniated discs need to be surgically repaired.

Fact: The intervertebral discs, located between the vertebral bodies of your spine, act to cushion the spine against stress. These discs may rupture, or herniate, if the outer layer of the disc weakens. The jelly-like center of the disc leaks, irritating the nearby nerves and causing back and leg pain. More than 90 percent of herniated discs get better on their own with short rest or with treatment, such as physical therapy, anti-inflammatory medications or spine injections, Dr. Buzanowska says.

Myth: If you go to a spine surgeon, it’s certain you’ll end up having surgery.

Fact: Not necessarily so. Many spine surgeons often find themselves trying to talk patients out of back surgery, Dr. Buzanowska says. While there are a few spine conditions that require surgery, the vast majority of back problems are resolved without surgery. Surgery may be appropriate for select people who have exhausted conservative options. It all depends on your unique medical condition.

Myth: If you have bulging discs, you have a major medical problem.

Fact: Bulging discs are a normal part of aging, Dr. Buzanowska says. Our discs are like car tires that gradually lose air and wear down. This is why we may become shorter as we age. However, unlike car tires, an aged disc does not have to be replaced. Also, this problem causes pain in only a fraction of patients.

Myth: Magnetic resource imaging (MRI) scans always show the source of back pain.

Fact: MRI uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body. These scans can demonstrate annular tears, herniated discs and nerve compression. MRI scans do not show weak muscles or many other disorders that contribute to back pain. As mentioned earlier, MRI also will show the normal, age-related wear and tear that may be misleading as to the source of back pain sometimes. This is why a thorough physical exam is the most important source of information about the causes of your back pain, Dr. Buzanowska says.

Myth: The best thing for a sore back is bed rest.

Fact: It seems counterintuitive, but the best thing for your back is gentle exercise, Dr. Buzanowska says. Walking, for example, gets you out of a sitting posture and into a more neutral, upright alignment. Gentle, easy stretching may help as well.  Licensed physical therapists can best supervise this endeavor and can tailor a personalized strengthening and stretching routine for patients.

Myth: Spinal fusion surgery, which permanently joins two or more bones in the spine, always requires additional surgery.

Fact: We’ve all heard of someone who has had a failed back surgery, Dr. Buzanowska says. Yet, the reality is that when skilled surgeons perform spinal fusion surgery for the right medical reasons, the procedure rarely needs to be repeated.

Myth: Pinched nerves cause severe back pain.

Fact: That can be true, but only sometimes. Usually, an irritated or compressed nerve in your spine causes pain in your leg and foot, Dr. Buzanowska says.

This article was written by the Brain and Spine Team at the Cleveland Clinic.

I love coffee and feel like the day isn't right without having a cup....or four. 

I am constantly coming across articles that contradict each other on whether or not coffee is good for you.  So, thankfully the folks at authoritynutrition.com (who do great work and recommend you follow them) wrote a post ending the confusion and backing it with science.

Here's their findings:

• Coffee contains a small amount of some vitamins and minerals, which add up if you drink many cups per day. It is also high in antioxidants.
• The main active compound in coffee is the stimulant caffeine. It can cause a short-term boost in energy levels, brain function, metabolic rate and exercise performance.
• Studies show that coffee drinkers have a much lower risk of dementia, Alzheimer’s disease and Parkinson’s disease in old age, significantly lower risk of developing type 2 diabetes, significantly lower risk of cirrhosis and liver cancer, lower risk of becoming depressed and are significantly less likely to commit suicide....essentially live longer.
• Caffeine can have various negative effects, such as causing anxiety and disrupting sleep, but this depends greatly on the individual.  It is also an addictive substance. It can lead to tolerance and well documented withdrawal symptoms like headache, tiredness and irritability.
• Decaffeinated coffee is made by extracting caffeine from the coffee beans using solvents. Decaf does not have all of the same health benefits as regular coffee.
• It is important not to put sugar or a chemical-laden creamer in your coffee. Brewing with a paper filter can get rid of a cholesterol-raising compound called Cafestol.

So here's to coffee...and to me and you drinking it....a lot....everyday :)  

As my son approaches 2, I reflect back on his short time here on this Earth and also my time as a parent.  I can't help but think about my wife, and the challenges she faced getting back to an active lifestyle she was accustomed to.  It took over a year for her to 'get it all back.' 

Since then, I have seen many postpartum women that come in with various aches and pains and it always takes me back to seeing my wife with belly out to here (extend hand away from body).  Needless to say, having a baby takes a major toll on your body, both physically and mentally.

So while I may not have had a child myself, I worked in a women's health clinic in the past, treated many postpartum patients over the years, and now seeing it all first hand, here are my tips, with links, to getting it all back.

So, I googled 'postpartum core exercises' and here are some of the top findings, with my professional, and personal, feedback:

• Core Exercise Solutions by Sarah
  • some really great information, however I would re-number or prioitze her list a little differently...
    • 1. Diaphragmtic Breathing: always important.  Guy, girl, pregnant, not, young, old...you get the point...This point is VERY underrated
    • 2. Core: your kid totally stretched out your tummy, specifically your transverse abdominis (TA), and, with some crazy hormones and time, exercise can help put it all back.
    • 3. Glutes: isn't it always about the glutes?
• ​6 Exercise for Rebuiliding your Core after Pregnancy
  • not that big of a fan.  I found the exercises she chose were on the advanced side,  This article lacked a progression, plus the form in some of her pictures was no bueno.
• Restore Your Core: Progressive Exercises for Post-Pregnancy
  • a great article with great progression.  The only thing I felt lacking is a deeper talk about pelvic tilts, the basic building block of all core exercises

​Lay on your back.  Knees bent, feet flat.  press your low back flat on the ground without pressing through your feet....and keep breathing.

​Here is my (quick) playbook for getting stronger after having a baby:

1. start with pelvic tilts the first week or so.  Start with 10, 1 sec holds a couple times a day.  Build up hold times, rep counts, and sets as you feel stronger.
2. Once you can do 3 x 10 of 10 sec pelvic tilts, you can move on and layer more complex movement like bridges, clam shells, marching, heel slides (see the last link).  You can even begin doing these on hands and knees.  Pelvic tilt/holds then layer on kicking back, donkey kicks, etc.
3. At the same time above, you can begin mini squats, making sure at the top of your squat to lock knees, squeeze glutes, and tighten low abs (TA).  Deepen the squat, increase the reps and sets as you feel stronger.

I love to hear feedback! Hope this help some mamas out there!

​Dominick

On Sunday, August 19th, SRVPT took over suite 58 at the Oakland Coliseum to watch the A's take on the Houston Astros.  While it was an exciting game, the A's lost 9-4.

Lack of sleep has been associated with everything from chronic pain states, decreased concentration/problem solving, and longer recovery periods for injuries. Needless to say, quality and quantity of sleep is very important!

1) Limit the amount of screen time an hour before bed

• blue light from phones/tablets has been linked with difficulty sleeping and poor sleep quality
• Use Night Shift on your Apple device

2) Limit caffeine intake in the late afternoon or early evening

• I love coffee! However, if I have a cup after dinner I toss and turn for several hours at night
• if this sounds like you and you have a habit of drinking 2-3 cups/day, try decreasing by 1 cup and see what happens

3) Prepare your bed!

• check out this Physio Answers post I wrote a while back on different and supportive sleep positions
• many who toss and turn or have pain at night have found the positions very comfortable

4) Exercise regularly

• regular activity, especially in the afternoon has been associated with better sleep
• some experts say not to exercise at night, but some have said that it helps them sleep 
  • I have found exercising at night keeps me up....for me: the earlier the better!
• regardless, if you have difficulty sleeping or falling asleep at night, try something new with your exercise routine, either change the time, or start exercising more (possibly less)

5) Get a good evening routine going

• I learned the value of a evening routine upon having a kid that did not sleep very well as a baby
• the same holds true for adults, don't expect to be able to fall asleep easily after exercising heavily, then spending an hour on facebook with the lights on
• listen to relaxing music, and start your wind down 1 to 1.5 hours prior to the time that gets you your ideal number of hours of sleep

There are a number of "life hacks" that improve sleep quality, but these are some of my favorites. Sleep quality is something I go after on patients that are having difficulty keeping their improvements between visits or are unable to return to training.

This post is an oldie, but a goodie from Erson at TheManualTherapist.com  (I added a little).  He has tons of great content, primarily for physical therapists, but also provides great information for patients.

Osteoarthritis, aka degenerative joint (or disc) disease, aka OA, affects over 52.5 million people in the United States, approximately 50% of whom were 65 years or older, according to the CDC.  I tend to think that number is quite higher.

But you're in luck!  There is scientific evidence that shows you can decrease the pain in arthritic joints with exercise and activity.  The Journal of Orthopedic and Sports Physical Therapy (JOSPT) recently published an article discussing the benefit of activity for people with OA.  

They have 7 Key Recommendations:

1. Exercise and physical activity should be tailored to your needs and preferences.
2. Consider water exercises if it is too painful to exercise on land.
3. Supervised exercise therapy over a 6-week period is often helpful to get you started.
4. Some people may need 12 weeks of supervised therapy to begin.
5. After you complete supervised therapy, you may need periodic “booster sessions” to help with long-term management of your OA pain and overall health.
6. Home exercises should be performed to optimize your outcomes.
7. You should be sure you understand how to manage flare-ups in pain and how to modify your exercises when pain increases.

We see folks with arthritis everyday and have helped them restore motion and get back to the activities they love doing.  If you have any questions of how we can help, please let us know!

-Dominick; dominick@sanramonvalleypt.com

There are so many exercises for the shoulder, but here is one you can throw out...

The bilateral shoulder external rotation with dumbbells.  It's really targeting more of your biceps than anything else (yes there is some rotator cuff working here).  In fact, this motion is very similar to an orthopedic test (Yergason's Test) to look for a labral tear.  Just do the same movement with an elastic band or tube, which targets the rotator cuff, the whole purpose of this exercise.  Check out Mitch's video below:

There are many uses for the foam roll; from soft tissue release techniques, to stretching, and even taking up space in the corner of a room!

Dust off your foam roll, lay on it, any try this easy and effective neck stretch...especially after a long day.

First: lay on the foam roll with your head, neck, AND butt, all fitting on the foam roll.  The short rollers will not work for this exercise.

​Second: When turning your head to the right, first slide your head slightly off to the left side.  This keeps the integrity of your neck bio mechanics when going through the stretch.  Not doing this step would allow for your head to roll off to the right of the foam roll, making it a pointless exercise.

​Third: Rotate your head, pivoting off of the foam roll, angling your nose to the ground.  As you can tell, there is a straight line through the top of my head, down my spine, though the middle of my body.  

Hold this position 3-5 seconds and perform 5-10x each side.  This is a big stretch targeting  the upper half of the neck.

Hope you enjoy! Let me know if you have any questions.

​Dominick

Perform 10-15 reps for 3 sets.

Changing the strength of the band will make the exercise more or less challenging.

A substitute for the band would be to just hold a weight in one hand and transfer it the other hand, back and forth, while holding the single leg stance position.  Start with 10 lbs and work your way up to heavier weight.

I hope you have enjoyed this little series.  If you have any questions, feel free to ask.

​Dominick

The Single Leg Deadlift is the second of three exercises I commonly prescribe to work on hip and knee strength and stability.  It is a challenging exercise that requires good balance but can still be tailored to any fitness level.

Step 1: Single Leg Balance

Start by standing on the leg you are intending to strengthen.  That knee should be locked straight with that glut tight.  You can see from the side picture, I can draw a straight line from my shoulder through my hip to my ankle.  From the back, I can draw a straight line from my head through my hip to my ankle.  The opposite hip and knee are bent to a 90 degree angle. 

​If this is challenging, you can use a foam roll or counter to help with support.

Step 2: Swing

Next, swing the floating leg back, allowing the knee on the stance leg to bend slightly (no more than 20 degrees).  Hold this position for 1-3 seconds and return to the starting position, never letting your swing leg touch the ground.  It is crucial to keep your pelvis level with the ground.  I often use my arm as a guide to help me make sure this happens.  A mirror is also a great feedback system.  If the pelvis rotates, the glut is not doing the work, and you are not getting benefit from the exercise. 

Regression: use a foam roll or counter to help with balance
Progression: hold a weight on the opposite side of the stance leg; the arm should be loose and the weight does not need to touch the ground.

​10 reps, 3 sets.

Stay tuned for the last exercise: Single Leg Balance Press.

In the meantime, if you have any questions, feel free to ask.

​Dominick