Spinal Stenosis, What???

Are you experiencing pain in your back with walking? Stiffness in your back in the morning that lasts for less than 30 minutes? Are you more comfortable leaning on a grocery/shopping cart? Are you getting symptoms like numbness, tingling or pain down either one of your legs?

OR

Have you seen your doctor for back pain and been told you have Spinal Stenosis?

All of this can sound foreign and scary especially if you haven’t had back pain before. What this article sets out to do is to give you comfort that there is a lot you can do to manage your symptoms and keep your quality of life. If you are not sure what is causing your back pain consult a Physiotherapist or Physician for help.

What is Spinal Stenosis?

Spinal Stenosis/Foramen stenosis is the narrowing (stenosis) of the opening (foramen) on either side of the spine where the nerve comes out that supply our sensation and muscle movement.

Spinal Stenosis Low Back Pain

Reasons why Spinal Stenosis occurs:

  • Age
  • Natural change in the spine over time
  • Loss in disc height between the vertebrae
  • Arthritis around the back joints (bulkier joint with some boney growths (osteophytes))
  • Family History
  • Sedentary Lifestyle

Most commonly we see spinal stenosis in the neck (cervical) and low back (lumbar).

Why do I feel pain, tingling or numbness in my legs or arms?

Often this can be related to the Spinal Stenosis where the nerve that innervates the affected arm or leg is irritated where it exits through the foramen at the neck or low back because it is being encroached on by the smaller nerve opening (foramen). There are also other causes like, Multiple Sclerosis, pinched nerve, nerve damage, tumour, Diabetes, etc. Make sure to check with a clinical professional if this is occurring.

Why does my back feel worse with walking?

Walking keeps the curve of your spine in an backward arched position which causes more closure of the foramen (the holes on either side of the spine where the nerves exit from).

Why do I feel better leaning on a shopping cart or counter, etc?

When you bend forward, you mechanically open the foramen in the spine taking pressure off the irritated structures. Although this helps, you can’t always walk leaning on things everywhere you go.

What can I do to help reduce my pain?

MOTION IS LOTION…keep moving.

YES, this is the answer for a lot of things. You may feel like you should listen to the pain and in some cases this is true (consult your Physiotherapist or Physician to know if this is the case) but often you just need to gradually get moving.

What can I do that is safe that will help TODAY?

You can start practicing seated forward bends. Do 5 in a row and complete them many times throughout the day. Practice this when you go for your next walk, if your symptoms increase, stop at the next park bench and bust out 5-10 seated bends as shown below. These should make your Spinal Stenosis symptoms feel BETTER (i.e. less back and/or leg pain), if they don’t then STOP and consult your Physician or Physiotherapist.

Low back pain exercise

Repeat 5x times in a row throughout the day

There are other things that you can do to help with increasing your tolerance for longer distance walking and other activities. If you have success with these forward bends, then you would likely benefit from seeing your local Physiotherapist to learn more tricks like this to help manage your symptoms and to keep you moving!

Hip Flexors are More than Trouble Makers

Do you have low back pain that has been around far too long? Hip Flexors may be a contributing factor, so learn what they are and why they matter.

To put it simply, the hip flexors are a muscle group that works together to bend the hip, bringing the legs up towards your chest. If only it was that simple none of us would have low back pain, knee pain, pelvic floor issues, groin tightness, etc. The list can go on and on connecting the hip flexors to some pain or dysfunction. But the hip flexors are so much more than trouble makers, in fact, they are three very powerful muscles, the psoas and iliacus (often referred to as iliopsoas, pronounced like illy-oh-so-as) and rectus femoris (our main thigh muscle) We would be lost without them all work in concert to produce movement like kicking, walking, sprinting and dancing. These muscles are largely focused on bending the leg at the hip but the psoas muscle also helps to turn our hips outward like a ballet dancer (external rotation) and bend our trunk forward to pick up a box. The iliacus muscle also contributes to turn the hip out, but it is big helper in getting you up from laying on your back and swaying side to side like you are dancing at high school prom. Rectus Femoris has two purposes it bends the hip and straightens the knee (not shown in the image). The images below show how the muscles attach to the body.

Hip Flexors: psoas and iliacus

Tight hip flexors can put additional pressure on your spine that can contribute to lower back pain. They can also cause some exaggeration in the curve of your lower back which we often call sway back.

If the hip flexors are not working optimally, other muscle will try to jump in and do some of the work. The body is very good at coming up with compensation patterns to keep us moving. Other muscles that may start to do more work than they should include the glutes (butt muscles), the core (deep tummy & back muscles) and the pelvic floor (your pee stopping muscles). An imbalance in use of these muscles can result in some muscles overworking, while others are “underworking”. The result can be low back pain, strained posture, sacro-iliac ‘SI’ joint pain and pelvic floor issues.

The pelvic floor muscle group (muscles that make up the floor or bottom of our torso) plays an extremely important role with regards to support and stability of reproductive organs and other internal organs. Without the pelvic floor muscles all our organs would fall down because of gravity. Issues can occur if extra stress is placed on the pelvic floor muscles (sometimes related to shortness in the hip flexors). The pelvic floor muscles may start to “overwork” which may lead to an inability to “relax” this muscle group which can lead to potential pee leakage (incontinence) and/or low back or pelvic pain. On the other hand, the pelvic floor muscles may start to “underwork” as a result of mixed signals coming from other, overworking muscles. This can also lead to leakage, bowel incontinence and pelvic organ prolapse, where the organs start to fall down due to gravity and lack of support.

So, do you pee a little when you laugh, cough or sneeze? Do you have low back pain that seems to never really go away with trying many different treatments? Do you feel a ‘fullness’ in your pelvic floor that gets worse with long periods of standing? Well, a thorough assessment, stretching and strengthening routine with this added awareness of how some of the muscles in the lower body function would be a great place to start tackling some or any of these issues!

BOO!!! Don’t let scary medical words derail your progress.

With Halloween right around the corner, we thought it would be a great time to touch on some of those scary medical terms that patients hear everyday. If you’ve ever read the results of an X-ray, MRI or Ultrasound you most certainly have heard of some of these terms covered below.

Osteoarthritis

X-rays are the easiest way to take a look at the bones and joints in our body. Osteoarthritis (OA) describes the often normal thinning of the cartilage (smooth gliding surface) on the bones of our joints. Hip and knee osteoarthritis is the most common lifestyle process in those aged 65 years and older. Although you hear a lot about arthritis pain, it does not mean it is always a painful or debilitating condition. In fact, up to 85% of adults with signs of knee OA on x-rays have NO knee pain. This means that seeing OA changes on x-ray doesn’t guarantee that you will have pain or dysfunction . Take a look at our past blog on how exercise is the best form of treatment for mild to moderate hip and knee OA but also safe for severe end stage OA, as well.

Rotator Cuff Tear

Ultrasound or MRIs are used to look at “soft tissue” such as tendons or ligaments. A tendon attaches muscle to bone and ligaments provide stability around our joints. The rotator cuff refers to tendons connecting important muscles of the shoulder to the upper arm. Tears of the rotator cuff are a common finding when imaging shoulders with ultrasound or MRI. So common in fact, it has been shown that up to half of those aged 60 and older showed rotator cuff tears on MRI without corresponding pain or disability. Rotator cuff tears are even common in high functioning athletes. A study of baseball pitchers revealed that over one third of all the pitchers had full or partial rotator cuff tears without having any reported pain or limitations.

Degenerative Disc Disease / Bulging Disc / Joint Space Narrowing

Any back disc injury has been made out to be a scary idea. However, degenerative disc disease (DDD) is not a disease at all, it actually refers to normal changes in the discs (pads that provide cushion between the bones) of our spines. It is the difference between PATHOLOGY and MORPHOLOGY. Pathology is a true disease process like cancer but Morphology describes normal change over our life time. DDD is most often found in our necks and low backs. Studies have shown DDD of the low back is present in over 30% of people aged 30 and younger and 90% in ages 50-55. In some cases, DDD can lead to disc bulges which sounds scary but up to 25% of healthy young adults (aged 20 to 22) have low back disc bulges with no back pain and nearly 50% have at least one degenerated disc on MRI. If DDD and bulging discs were the true cause of all back pain then we would all have back pain at 20 that would only get worse as we age!

This post isn’t meant to replace the medical advice of your doctor or medical professional. But rather to help inform people that these scary terms don’t automatically subject you to a life of pain and dysfunction. We as healthcare professionals are changing the way we use these words to try and educate our patients with fact-based knowledge that does not foster fear but encourages a focus on function and optimism. We are still not perfect at this yet, but being told you have the back of an 80 year old at 25 does not help anyone heal!!

Knowing that these findings are common in healthy young and old populations can help reduce the anxiety around what “degenerative disc disease”, “rotator cuff tear” or “osteoarthritis” may mean for your future. Remember, MRIs, X-rays and Ultrasound imaging are very good at ruling out major health concerns such as fractures, tumours and spinal cord injuries, but they are also very good at picking out normal changes in our body that we would never otherwise known were there. Use the results to know that there is likely nothing BIG and ScARy going on inside of your body. If you have had medical imaging and are concerned over the result, be sure to ask your medical professional what those changes mean for you.

Happy Halloween!

References

VOMIT poster LSP, Shoulder and kip/knee

Healthlink BC

Common knowledge or common misconception? Motion is lotion.

Raise your hand if you’ve been doing a squat or lunge and been told “don’t let your knees go past the front of your toes”. Or “never bend forward because you may cause a disc bulge”? Or “don’t squat to the floor because it’s bad for your hips and knees”

There are many misconceptions that we hear in the clinic and around the gym that in some cases, cause more limitation or fear than necessary. In some cases, if we were to follow all of the ‘rules’ we would be walking around like robots!

Now, there are certainly situations that warrant specific movement restrictions and attention to form i.e. after surgery, while lifting heavy weights or when performing high intensity repetitive movements. But in everyday life, our bodies are amazing machines and are made to move! In fact, our joints stay healthy through movement and help prevent and manage conditions such as osteoarthritis.

When you stop to think about it, there are many movements we just don’t do in our daily life. Maybe because our daily demands don’t warrant it or our jobs have us working at a desk all day, for example.

A great example to think of this is how often do we ever bend our hips and knees past 90 degrees (i.e. deeper than chair height)? Or our ankles past neutral? For a lot of us, really not often, especially when we work standing at a till, sitting at a desk or driving in a car.

Here is a great tip from a well respected physiotherapist, Bahram Jam, to help keep you feeling young and your joints mobile while reducing the dread of bending down to pick something off the floor

Practice unloaded deep squatting everyday.

  1. Try holding onto a kitchen counter, banister or rail and gently lower yourself until your bum touches your heels and your armpits touch your knees
  2. Hold it for a few seconds while you get comfortable
  3. Then repeat 5-10 times using your arms throughout to help with the movement, if needed
Deep Squats for mobility

This is a simple yet great way to keep your back, hips, knees and ankles healthy and mobile by using their available range of motion!

Obviously this goes against what we may hear about not bending our hips past 90 degrees and knees past our toes. The movement itself is not damaging. In fact, it helps keep the mobility in our joints while making things like getting on and off the floor or squatting to pick things up much easier.

Of course this should not replace any medical advice but if you have any concerns or would like ideas to help stay mobile and keep your joints healthy and strong visit a local physiotherapist or kinesiologist!

Does Physiotherapy, Physical Therapy, Physio, PT, etc, confuse you just like everyone else!!!

We fall short of clarity even in our name…what do you call us…well Physio is easy here in Canada but if you are in the USA this means nothing. You have to say Physical Therapist to be slightly better understood as to what we do as a profession. But still fundamentally there is a lack of understanding as to what our role is in the healthcare system.

I hear all the time, I have _(fill in the blank)_ pain and I need a Massage or I have back or neck pain and I need to see my Chiropractor. Very rarely do I hear I have ____ pain and I need to see a Physio to get help.

So I ask myself why are people not thinking about Physiotherapy as being on their list of professionals that can help with____ pain.

Has the Physiotherapy Association failed to make the message clear as to how integral Physios are? Have Physios failed themselves in not being able to convey their wide array of scientifically proven abilities? Have other professions done a better job at marketing themselves as the “expert” at ____ pain? How do we change the conversation to include Physiotherapy as part of the list of “experts” at helping with____ pain?

The fundamental underlying problem is that we as a Physiotherapy profession have such a broad scope of skills and vast areas of practice. Most people, even Doctors, do not know exactly what we can do and how varied it is. Here is just a simple list of some of the areas we Physiotherapists can practice in:

Private Clinics – that is the clinic down the street that might also have Massage Therapists, Chiropractors, Kinesiologists, Acupuncturists, etc.

ALL Physio’s can:

  1. Assess and diagnose injuries
  2. Determine a proven treatment plan
  3. Improve Quality of Life
  4. Treat vertigo and balance
  5. Needle trigger points/’knots’ in muscles
  6. ‘Crack’/manipulate joints
  7. Use massage techniques
  8. Perform acupuncture
  9. Manage Sports Injuries
  10. Pre and post surgical rehab i.e. hip replacement, ACL repair
  11. Help with pelvic pain and loss of bowel/bladder control
  12. Go inside you mouth and help with jaw pain

And the list goes on for Private Practice skills.

Hospital Work (Public Practice Settings ie. paid for by Healthcare)

Physio’s work in:

  1. Spinal Cord Rehab
  2. Post Surgical Rehab
  3. Burns and wounds management and care
  4. Cardiorespiratory rehab
  5. Heart and Lung Rehab
  6. Emergency Rooms
  7. Community Outreach
  8. Stroke Rehab
  9. Pediatrics (like, Children’s Hospital or Queen Alexandra Centre)
  • Neonatal Intensive Care
  • Scoliosis
  • Cystic Fibrosis
  • Juvenile Arthritis

Again the list goes on and on as to the list of all the things that we can do. Our profession prides ourselves on continuing education and maintaining evidence-based practice which is why we are continually ‘morphing’ our profession and losing the clarity of exactly what it is we do.

Our fundamental principle that covers all areas of practice is that we are always physical movement ‘experts’. Meaning, whatever condition, injury, illness and/or surgery (pre or post) a patient is living with, we are the professional in charge of figuring out how to get you back to optimal movement.

In the Private Clinic setting Physiotherapists’ main responsibilities are taking information from the patient to determine a diagnosis, to create the problem list, to facilitate goal setting and to create & implement a plan to reach those goals.

It is very simple. You go to a Physio to find out what is going on and how to fix it.

So why is it so confusing?

For a couple reasons:

  1. Our Profession holds us to extremely high ethical standards and so it should! But with this comes some limitations that start to make our expertise unclear;
    1. For example;
      1. we are for the most part not able to call ourselves an ‘expert’ at anything!
      2. we are not allowed to use testimonials to convey our success
      3. we are not allowed to endorse a product that we passionately feel works
      4. we are not allowed to ask for reviews (Google, Facebook, etc.)

All of these are in place so that we do not mislead the public in anyway. But many of these factors make it difficult to lead the public in our direction as well. Therefore, our profession gets stuck in the Classic ‘Catch 22’. Our Profession morphs over time with changes in research, advances in medicine, stresses on the healthcare system to spread out the workload, etc. Our profession started out as Nurses and morphed into its own regulated, recognized healthcare profession, Physiotherapists.

If you look at the other successful professions in our industry you will notice that they have positioned themselves as ‘experts’ at something with little room for morphing.

  1. Chiropractors: experts at ‘cracking’ joints and fixing back and neck pain… but did you know that most Physiotherapists can do this as well? However we are not allowed to say we can ‘fix’ anything…but we can say that we can improve ____ pain or quality of life.
  2. Registered Massage Therapists: experts at massage which is easy to visualize and very clear…but did you know that Physiotherapists learn numerous soft tissue/massage techniques and most of us use them in our treatments every day?
  3. Kinesiologists: experts at exercise for rehabilitation…but a large portion of Physiotherapy training is in exercises for improving movement. This one most patients do seem to know, as they always ask for ‘Homework’ ie. exercises to do at home and we love to prescribe them!
  4. Acupuncturists: experts at using needles in traditional holistic ways to treat the whole body… but did you know that many Physiotherapist learn acupuncture and/or dry needling, too?
  5. Nurses: experts in day-to-day patient care, the status keeper of all the pieces of a patient’s current healthcare needs…but did you know that Physiotherapist have some overlap in this area as well with wound care, suture/staple removal, suctioning airways, etc.

So why would you go to anyone other than a Physiotherapist?

Firstly, why just access one professional when there is room for all the professions to have their niche technique and be successful at helping you reach your goals, ie. spread the love! We are all better off having each other to rely on for second opinions, a different approach and a focused expertise that a patient might need.

Secondly, there are times when you may need a longer session of treatment in just one of these areas and then you would go to see the ‘expert’ for that technique. For example, you might see your Massage Therapist for the soft tissue work on your painful calf from running, while you also see your Acupuncturist for stress management and calf inflammation control, while you see your Physio for run retraining techniques and hands on ankle work and your Kinesiologist for strength and conditioning exercises to return to running.

The big thing that Physiotherapists can do above all the other professionals and more inline with Doctors, as we are also Primary Healthcare professionals, is that we can give a Physiotherapy Diagnoses for physical conditions. For example we can say, “you have a Full ACL tear in your Right knee” or “you likely have a disc bulge at L4-5 causing your sciatica”. We have more time with you to explain the situation and promote the optimal recovery. We are also trained in knowing when to refer to the Doctor and what questions to ask in order to rule out ‘big scary things’ like cancer, heart conditions, diabetes, etc. that might be masquerading as back pain, arm pain, shortness of breath, etc.

We are the professionals to be trusted with knowing what you need, who you need, how we can help and when you need what. Call us the ‘Triage Professional’ that has the ability to take in all the information and integrate it into one cohesive treatment plan that will likely include the use of many of the professionals mentioned above and more.

Find a Physiotherapist in your community and ask them how they can help you reach your next goal or tackle that long standing ____ pain or movement limitation! Just remember we are the experts at nothing…because we aren’t allowed to say it, but we are the best generalists at improving all movement related goals!

To Foam Roll or NOT to Foam Roll??

Is Foam Rolling going to be the NEW cupping of the 2018 Winter Olympics?

PyeongChang 2018 is on the brain, all over media and everywhere around us. This might remind you of the Summer Olympics of 2016 when Michael Phelps created quite a stir with his use of cupping for his shoulders and back. Athletes are always looking for an advantage on and off their playing field. They can’t always have their team of therapists around them and neither can you! So many people use foam rolling or trigger point balls to help with their pre and post training performance.

What is Foam Rolling? Foam rolling is the use of a stiff, smooth or nubbley foam/padded cylinder to ‘mush’ out soft tissue. It feels very uncomfortable… which makes us feel it might be needed. It definitely does not follow the fail safe adage “if it feels good do it” because it does not feel good, immediately. However, if you give it a try, even every other day for for a few weeks, you’ll notice it hurts less and you tolerate it better.

But does hurting less actually mean that you have caused a beneficial physiologic change? Like increasing range of motion, decreasing tightness and improving performance? You may hear people claim foam rolling reduces fascial (skin-like covering on muscles) restrictions, increases length of muscles, tendons, IT Band etc, improves strength output and the list goes on.

What does the peer-reviewed research say about foam rolling? We’re not sure if foam rolling does cause any of the above claimed physiological changes, but the latest research does tell us that foam rolling is effective in reducing pain perception after post workout soreness or delayed onset muscle soreness (DOMS) (Romero-Moraleda et al. 2017). Self-massage (assuming foam rolling falls into this category) has also been found to significantly improve stretch tolerance and flexibility when compared to a normal held stretch (Capobianco et al. 2018). Foam rolling even shows decreasing muscle sensitivity through muscle brain pathways, which may explain post-rolling improvements in range of motion and pressure tolerance (Young et al. 2018). However, like anything there is also a whole host of research that disagrees or finds that foam rolling has no significant positive effects.

So how do we decide whether it is right for us or not?  Some examples of situations where foam rolling may be appropriate are:

  1. Do you feel you have more tightness on one side compared to another, in the thigh for example?
  2. Do you have one-sided pain?
  3. Do you get really sore after a workout, in your calves for example, and want something to do after your workout to try and reduce this?

How do you foam roll? You may be among the crowd that looks at the foam roller and has no idea what to do with it, but would like to try without looking like a fool in the process. I have many patients say they have seen people using it in the gym and cast an awkward stare while trying to figure out what they are doing. They have even gone to Youtube for video instruction avoid looking silly. Check out ours below to learn how to roll the calf. Or you may be of the group that has figured out a few things that work for you, but would like to know some new tips and tricks. No matter what group you fall into, below are a few easy to follow instructions to get started.

DOs

  1. ROLL large meaty muscle bellies ​​examples: calves, thighs, glutes, hamstrings
  2. ROLL every other day, no more than 2-5 mins to start
  3. Stay below your shoulders and above belly button

DON’Ts

  1. DO NOT Roll over bones close to the surface examples: shin bones, hip bone, knee cap, elbow, sitting bones
  2. DO NOT roll your LOW BACK
  3. DO NOT roll your tummy or chest

MAIN MESSAGE Try foam rolling every other day or after your workouts for 2-5 minutes for at least 2-3 weeks and notice if you feel better or not. If you don’t then don’t waste your time. If you do, then keep it up and maybe try new areas of the body to foam roll, like the lats or the middle back!

Check out our foam rolling video for how to progress from basic to more advanced calf rolling! As always, if you have any questions comment below or email at [email protected]

Low Back Pain EXPLAINED

Low back pain is a symptom NOT a disease! ​There are Acute and Persistent (Chronic) episodes of Low Back Pain. And sometimes there are acute episodes that happen on top of already persistent low back pain (ie. increased pain for a short period of time and then the pain goes back down to normal levels). What is the MOST likely cause of my pain?

  • 90% of cases have NO specific structure at fault (ie. it could be any or no structure causing the pain) 1​. This is called Non-specific Low Back Pain, I know this is an unsatisfying diagnosis! 

Patients and back pain sufferers have the most trouble with this diagnosis. We as patients are trained to want to know the faulty structure because then we think we could fix it better. What is the LEAST likely cause of my  low back pain?

  • compression fracture 4% 
  • spinal stenosis 3% 
  • organ disease 2% 
  • tumour or cancer 0.7% 
  • infection 0.01%  2

But potentially more accurately likely fewer than 1% of Acute Low Back pain cases have a specific cause 3. Should I get an X-ray or Image of my low back?

  • NO, unless your primary health care team suspects major risk factors (ie. cancer, spinal infection or cauda equina syndrome (loss in control of bowel or bladder) or a disease process that would be managed differently then Non-specific Low Back Pain
    • WHY?
      • Because the imaging guidelines created from extensive research reviewing the harmful effects of imaging discourage imaging unless there are any of the high risk factors listed above.
        • Harmful Effects of Imaging
          • radiation exposure
          • normal results interpreted as pathology 
          • costly and time consuming

​Imaging does not improve clinical outcomes, meaning they do not positively change your pain experience or treatment plan.* 4 So what can I do to change my pain without meds?

  • Multimodal/Multidisciplinary Treatment Package
    • Manual Therapy (any of Physio, Chiro, Osteopath)
    • Massage (better for Acute than Persistent Back Pain)
    • Cognitive Behavioural Therapy (better in short term)
  • Exercise (Kinesiologist guided, pilates, yoga, tai chi, motor control)
  • Return to Work Programmes
  • Acupuncture and Dry Needling (better in short term)

What should I not do to change my low back pain? 

  • Injections
  • Radiofrequency Neurotomy (severing the nerve to the spinal level)
  • ***Epidural Steroid injection (limited effect for small group of patients only)
  • Prolotherapy (injection of irritating solution, usually glucose based)
  • Antibiotic Prescription
  • Spinal Cord Stimulator or intrathecal pump (no research results)
  • Surgery Consult
    • most often surgery is the last resort for Persistent Low Back Pain but commonly the results are no better than conservative outcomes as mentioned in the above Do’s for Back Pain

All of the above Do’s and Don’t were summarized from the 2016 UK National Institute of Health and Care Excellence (NICE) draft guidelines 5, published Cochrane reviews 6-12 and American College of Physicians and the American Pain Society (ACP/APS) 13. What is my Prognosis for Recovery? The 42-72% of patient who undergo some of the above listed Do’s for managing and treating low back pain will have a FULL recovery by 12 months 14-15.

Get on your PATH TO RECOVERY today and seek out a well rounded approach to managing and treating of your low back pain. Above all, make sure EXERCISE is part of the plan.

REFERENCES Thank you to Chris Maher, Martin Underwood and Rachelle Buchbinder for summarizing a large amount of research into one comprehensive article in the Lancet on Non-specific Low Back Pain; October 10, 2016. 1. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006; 332:1430-34 2. Deyo RA, Weinstein JN. Low Back Pain. N Engl J Med 2001; 344:363-70 3. Henschke N, Maher CG, Refshauge KM, et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary car settings with acute low back pain Arthritis Rheum 2009; 60: 3072-80 4. Chou R, Fu R, Carrino JA Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet 2009; 373: 463-72 5. National Institute of Health and Care Excellence. Non-specific Low back pain and sciatica: management. NICE guideline: short version. March 2016. 6. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev 2005; 9: CD000335 7. Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database Syst Rev 2015; 9: CD001929 8. Furlan AD, van Turder MW, Cherkin DC, et al. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev 2005; 1: CD0001351 9. Henschke N, Ostelo RW, van Turder MW, et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev 2010; 7: CD002014 10. Kamper SJ, Apeldoorn AT, Chiarotto A, Et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2014; 9: CD000963 11. Maas T, Ostelo RW, Niemisto L, et al. Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev 2015; 10: CD008572 12. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low back pain. Cochrane Database Syst Rev 2011; 2: CD008112 13. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain : a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147: 478-91 14. Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ 2008; 337: a171 15. Costa Lda C, Maher CG, McAuley JH, et al. Prognosis for patients with chronic low back pain: inception cohort study. BMJ 2009; 339: b3829.

Is Surgery my BEST option for Knee OsteoArthritis?

A recently published article in a peer reviewed journal, discusses medical exercise as an alternate option to surgery for a degenerative meniscal tear in the knee, otherwise known as Arthritis. Now they are not just talking about doing any exercise but working with a trained healthcare professional (ie. Physiotherapist, Kinesiologist, Chiropractor or Athletic Therapist) supervising specific exercises for rehabilitation. However, we do already know that staying fit and active will always improve your health and reduce your risk for arthritis.

So they took a group of 17 patients who had degenerative meniscal tears and they either underwent a 3 months medically supervised exercise training program or an arthroscopic partial meniscectomy surgery. They measured their pain and quality of life at time points up to 1 year after the enrolment. Both groups showed similar reductions in the pain and increases in function and quality of life. However, the group who participated in the exercise program showed significantly greater improvements in anxiety and depression.

So if you want to avoid surgery for your knee arthritis then ascribe to the old adage “Motion is Lotion…” with supervision. Try our GLA:D Supervised Exercise Program for Knee and Hip pain and stiffness. Register for a FREE education class today. If you have questions about the exercises you currently do or want to start exercising for prevention, function and pain reduction then contact a healthcare professional in your area to start medically supervised exercise today. 

3 Tips for Managing Knee Arthritis

  • Weight Lose: lose 5 lb if you are over weight, it can reduce the load on your joint by 2.2 times
  • Exercise: find a safe exercise you enjoy and do it 3-5 days a week
  • Prolonged Sitting: if you have been sitting in a restaurant or at a movie, move your knee before you try to stand on it

Most of all get out and enjoy life even with knee arthritis!

Cortisone Shot…is it worth the risk?

Cortisone Shot or Not?

Corticosteroid shots have been used for many decades now for treating pain in many joints. Corticosteroid is known to provide short-term symptomatic relief in some patients for knee arthritis, inflammation, hip bursitis, shoulder pain, etc. There is a lot of evidence that supports the short term relief and improved quality of life for 6-9months. But the long-term evidence shows some potential adverse effect of repeated corticosteroid injections, such as, disrupted collagen repair and increased risk of tendon rupture.

But getting back to the knee there has not been much high level research looking at the long-term effect of repeated corticosteroid shots and its effect on the collagen cartilage in the knee. In May, there was an article published that reported on the long-term repeated exposure to multiple corticosteroid shots over a two year period. There was two groups of participants who were all diagnosed with similar levels of knee osteoarthritis. One group was given a corticosteroid injection every 12 weeks and the other group was given a saline injection without corticosteroids every 12 weeks.  Both groups had no idea to which group they were assigned. This type of research design results in the highest quality of evidence also known as a Randomized Controlled Trial. 

The results of this trial indicated that corticosteroid treatments led to a greater loss of cartilage at 2 years compared to the saline group, with no significant differences in pain outcomes between groups.

There were some limitations to this study. There were only 140 participants which was not a large enough group to make clinical guideline changes. Also the treatment providers may not have be adequately blinded to the type of injection they were giving, which could bias the treatment effect.

However, there is significant high quality evidence coming out of Denmark on the effect of Hip and Knee osteoarthritis management using Physiotherapist led group-based exercise and education.

How to chose the best treatment?

1. Ask your clinician about the short and long-term risks and benefits

2. Ask what it will feel like

3. Ask about alternate treatment options

4. Ask how long the effect will last

Cupping

Cupping therapy is an ancient form of alternative medicine in which a Physiotherapist or Registered Massage Therapist puts special cups on your skin for a few minutes to create suction. People get it for many purposes, including to help with pain, inflammation, blood flow, relaxation and well-being, and as a type of deep-tissue massage. Cupping can leave behind very dark skin bruising but this is not typical bruising as it is not painful. You might remember seeing the post-cupping bruising on Michael Phelps during the Rio 2016 Olympics. Physiotherapist typically use plastic or silicone cups that suction with manually applied pressure. Alternative medicine therapist tend to use glass cups with the help of fire to create the suction. Clinically, I have used cupping on chronically dysfunctional scar tissue to reduce the stickiness between the layers of skin, soft tissue and muscles. If a patient is experiencing persistent pain that seems soft tissue in origin I find that cupping can be great at reducing the pain response.