MRI – A CLEAR PICTURE ?

We often see patients who bring a copy of their MRI results and say, “My doctor told me that I have a herniated disc in my back”. However, MRI results also need to be correlated with the clinical findings of the physical exam. Research studies have confirmed that 70% of us have disc herniations, but do not have symptoms. It is important to have a thorough physical exam to further assess if your pain is coming from the MRI findings. We have had many patients with disc herniation on MRI, but the disc herniation is not what was triggering their pain. An indication of this situation is if you had an epidural without relief. Root causes of pain are very complicated and often have multiple components. Studies have also shown that there are many people without herniated discs that are in severe pain in the neck or back with referred pain into their arms or legs.

An MRI is a picture that is taken in one position, usually supine, where the back is not having to work and things are relaxed. Just like you can take a picture with your camera and it can look different depending on the different types of lighting, the flash, the time of day, so too, the MRI can look different in different positions and different times of day. One position might show a disc herniation compressing a nerve, another may show only a bulge without pressure on a nerve. It is important to assess strength, sensation, reflexes, and how a person is moving, then compare these findings to the MRI results. Ideally the physical exam findings support and help strengthen the diagnosis. Pain is very complicated, involving multiple sub-types of pain within the body (mechanical, inflammatory, neuropathic, neurogenic, central sensitization, neurovascular, neuromuscular to name a few). Each sub-type has specific pain qualities, and sub-types can also co-exist. The MRI can be a useful tool in helping to diagnose but it should not be the only tool used. If you are having pain and have been told that your herniated disc is causing it, just make sure that someone has also performed a comprehensive physical exam testing: movement, sensation, strength, and reflexes. This will help to confirm or refute the MRI results and this way you can truly have a CLEARER picture of what is or isn’t causing your symptoms, and have an appropriate treatment plan to address all the components to your pain.

If you aren’t sure about the cause because your pain persists, give us a call at North Jersey Physical Therapy. We will happily help you get a clearer picture and identify the root cause.

Posture

Here at North Jersey Physical Therapy, we believe that one of the root causes of muscle, nerve, and fascial pain is directly related to posture. Gravity is constantly pushing down on us and stressing our bodies in ways we are not always aware of it doing. Therefore, we have to be proactive against gravity. We have to realize that when we sit or stand we should be active, not passive. This is where good posture comes in. We must focus on certain muscle groups to align our spine in order to achieve posture alignment with the least amount of effort.

Correcting posture is not only possible but simple. With a little effort it can be practiced throughout the day and yield dramatic results. In fact the more you practice correct posture the simpler it becomes.

Our belief in the critical nature of good posture is so great that one of our therapists, Polixeni Katsaros, PT, DPT wrote a book on it called, “Posture, Simply Posture, Correct Simply” where she outlines the importance of understanding how gravity affects our body and the importance of understanding how posture and proper body alignment can counteract the effects of gravity.

Your Brain – Smoke Dectector

Patient: “But it hurts when I sit or lay down… shouldn’t I feel better when I’m resting?!”
PT: Not exactly…

A common line of thinking among many PT patients is that rest will resolve pain. It’s counterintuitive to many individuals that discomfort and pain persist while resting. Let’s dive into this misconception and shed some light on the topic of rest as it relates to pain.

When it comes to pain that is musculoskeletal in nature, it’s common that the cause is overworking, stress, or strain on the muscles, tendons, ligaments, or bones. People often associate this with active movement: running, walking, or even something as simple as getting out of a chair. In reality, your body is working all the time. In fact, resting states (lying down or sitting in a chair) can be interpreted by your brain as potentially dangerous if you have overworked a muscle that is typically used for this activity. For this reason, many therapists focus on educating their clients to rest in anatomically safe postures. You might ask: what is an ideal posture? How can my resting posture be flawed? Therapists know that ideal posture is a position in which your body is working most efficiently and able to support itself with minimal effort.

In cases where an individual is experiencing pain while sitting or otherwise resting, it’s likely that the resting or seated posture causes stress on this area of the musculoskeletal system. The brain interprets this as a stressor and triggers a pain response in the physical body to alert the individual of the burden that area of the body is under. What most people don’t understand is that the body is sending them a message. Pain is a news bulletin from the brain that the position is not ideal and that a change is necessary to obtain comfort. If the individual ignores this signal, as many do, the pain will persist and the brain’s alarm system may become more sensitive. This becomes cyclical, causing a lower threshold for activity before pain comes on again. If a smoke alarm is going off in your house– do you take action to address it or let it ring and ring? More than likely, you look for a reason for the alarm. Sometimes the smoke alarm goes off when something is burning– this can be analogous to an active pain response. Other times, you are taking a shower and the steam sets it off– this is what can happen to our alarm systems they can become more sensitive to stimuli that are not dangerous– like resting postures that seem like they should be pain free.

Now that we have a clearer understanding of why rest isn’t always restful, let’s explore some solutions. A few things need to happen in order for a patient to improve tolerance for resting postures. The first is being aware of your brain’s alarm system and making adjustments to your position when pain occurs. The second is freeing up the tissue that has been overworking and experiencing strain. This is where the PT often utilizes a variety of techniques like myofascial release, instrument assisted soft tissue mobilization or cupping to name a few. The third is to support the tissue that has been overworking by re-educating inhibited muscles to turn back on and properly support the straining tissue. Finally, in some cases the fourth step is to provide the area straining with some support while the system is rebalancing. When these steps are taken with the assistance of a PT to properly assess the body and determine a treatment plan, most individuals experience a reduction in their resting pain. Like anything that is worthwhile doing this process takes time and commitment to the program outlined by your PT.

If you experience resting pain, it might be your body’s smoke detector going off. Give us a call! Our job is to evaluate you and to help devise a treatment plan to make sure your alarm system is running correctly. We look forward to working alongside you on a treatment plan that balances your body and support getting you back to the place where rest is restorative and enjoyable, not painful.

Disclosure: If you experience pain that wakes you up at night and you are unable to fall back asleep, this may be a sign of a more serious problem and is something that should be brought to the attention of your team of healthcare professionals.

CHRONIC PAIN Neck Pain, Back Pain, Leg Pain ROOT CAUSE – HOPE & HEALING

Pain is complicated, multi-system and elusive. We in the medical and dental professions are understanding the pain science in unprecedented ways. Pain is multi-system involving the brain and changes in the brain when pain is chronic (over 3 months). Pain involves the immune system to facilitate healing in chronic, acute and sub-acute conditions, and in all cases involves soft tissue. Healing chronic pain involves different treatment strategies than acute pain.

Pain is a symptom. We at NJPTA understand pain and movement science. People in pain do not move like people without pain, and we understand how to assess and how to address not only the source of the pain, but the root cause of the pain. For example, in a potential lower back pain / leg pain condition the MRI shows you have a L45 herniated disc as the source of the pain, but the ROOT cause of the pain is gravity and how you hold your spine to cause the disc to herniate. We also understand how the body heals and how the body adapts in order to function. This adaptation is invisible and unperceptive (cannot be felt) until a threshold or tipping point is reached and then pain ensues. Studies show 70% of people have herniated or bulging discs, but do not have any symptoms. The threshold / tipping point for acute injury / back pain from an activity that occurred last week is very different than back pain ongoing for 3 years that suddenly got aggravated last week. A pre-existing back pain history requires different treatment strategies than one time acute injury. Our expertise is the knowledge and applying the correct treatment tools in our toolbox to give you the knowledge and ability for your body to completely and permanently resolve your pain.

MAXIMIZING WORK STATION COMFORT

Do you have a job that requires you to sit for the majority of the day? Do you find yourself having aches and pains in your neck and back? If so, you may want to read on to find a few simple exercises to interject during your workday to combat the negative effects of prolonged sitting. As the day wears on, especially if you do not take enough rest breaks, gravity will cause you to slump down and acquire a rounded shoulder, forward head posture. This is especially true during computer use. Additionally, you will also want to make sure your work station is optimally set up to decrease the risk of eye and neck strain. A few pointers for proper posture at your desk include the following

  • When sitting, make sure your hips are slightly higher than your knees so your thigh is on a “down slope,” with your feet flat on the floor. This will help keep you in an upright position with the least amount of demand on your postural muscles. Your elbows should be supported by the arm rests and should not push your shoulders into a “shrugged” position.
  • Your upper arms should rest at your sides and elbows bent. You should be able to reach your keyboard in this position without reaching your arms much farther forward.
  • Everything you use often should be in your “frequent reach zone,” which is defined as the space you can reach in front and to the side, with your arms resting at your sides. Things used less frequently should be placed in your “occasional reach zone” which can be defined as an arm’s length in front or to the side which can be reached without requiring any additional bending or leaning.
  • While OSHA recommends the monitor be about an arm’s length away, we recommend placing your monitor as close as possible to improve ease of viewing and decreasing eye strain. Think of it as a similar distance to that you would hold a book or newspaper from your eyes. The top of your monitor should be placed slightly below eye level so it promotes a slightly downward gaze. If you are using a laptop, you will never be able to achieve an ideal ergonomic situation without utilizing either an external keyboard or monitor.

A few exercises you may want to try during the day:

A few exercises you may want to try during the day:

  • Shoulder Roll: up, back, down 5 x every hour
  • Neck rotation: turn your head side to side, 3 times each side, every hour
  • Seated hip hinge: scoot to the edge of your chair and place your hands on your knees. Keep your back very straight, and hinge forward from the hips. Hold 1 second, do 5 times every hour.
  • Try to get up and walk around every hour, even for a short walk to get some water or use the restroom.

2 times a day (this should take you 3.5 minutes)

  • Chin tucks: sitting up tall, gently tuck your chin about 5 degrees, hold 5 seconds, do 5 reps 2 times during your work day.
  • Wrist extensor stretch: With your R arm out in front of you, palp down, wrist bent, apply over pressure with left hand until a stretch is felt in the back of the R forearm Hold 30 seconds, do 1 times each side 2 x during your work day
  • Wrist flexor stretch: with your R arm out in front of you, palm down, bend your wrist up and apply over pressure to your fingers with your left hand until a stretch is felt in the front of your forearm do 1 time each side 2 x during your work day.
  • Seated figure 4 piriformis stretch: scoot to the edge of your chair and place your right leg over your left so to form a “figure 4.” Keep your back straight as in the previous exercise, and lean forward until you feel a stretch in your R buttock. Hold 30 seconds, do 1 time each side, 2 times during your work day.