Login to view Shoulder & Elbow Pain videosMaking Back Pain a Habit
March 25, 2010
I recently saw a woman who had a history of sharp stabbing back pain for about 40 years. I performed my evaluation and gave her the exercises to correct the issues I found. She felt relief but still had occasional stabbing pain. I asked her when this happened and she told me it was after sitting in a chair or getting up from bed. So I evaluated her sitting and lying habits and made a few changes. Today she told me her pain was 98% gone--in one week.
To me this highlights the importance of addressing how you do things as much as what you do. She happened to have a hypermobile spine which made it difficult for her to stabilize well. She was out of touch with her body and couldn't connect with her abdominals to stabilize the pelvis or spine. So focusing on habits such as how she stood up, sat down, slept, and worked at her desk was where we were really going to make a difference quickly. She was amazed.
This was deeply satisfying to me because she came to me a couple years ago with back pain and I wasn't able to make a big difference in her pain. Now I know why. I didn't focus on the things she did 99% of the day and instead focused on anatomical problems I found. This was a good lesson for both of us!
Chronic Neck & Shoulder Pain
March 20, 2010
I've had two patients referred to me recently with difficult neck and shoulder pain issues. Their complaints were of the typical pain distribution--from the base of the skull down the neck to the shoulder blade and across the top of the shoulder as well as pain in the front of their shoulders. MRIs and X-Rays were negative for disc or other pathologies. They had been through several specialists and felt no relief other than with steroids and Vicodin.
After examining both women, I found they had very similar problems in that the shoulder blades were sitting too low on the trunk (Figure 1.).
[caption id="attachment_220" align="alignleft" width="300" caption="Figure 1. Depressed Right Shoulder Blade (Copyright Boone Publishing. 2009)"][/caption]
Also the humeral head was sitting too far forward in the shoulder socket (Figure 2) causing pain in the front of the shoulder. I taped both the humeral head and the shoulder blades in a corrected position and their pain was eliminated--until the tape was taken off a few days later. This told me my diagnosis was correct. But how could I get them to hold these corrected positions on their own? Our attempts at specific corrective strengthening only met with irritation of their pain.
[caption id="attachment_210" align="alignright" width="267" caption="Figure 2. Humeral Anterior Glide (Copyright Boone Publishing. 2010)"][/caption]
Because the shoulder blades' position on the trunk is partially determined by ribcage orientation, I revisited this aspect of their pain and found that by elevating their rib cages, pain was eliminated. This did two things: 1. it reduced the anterior tilting of the shoulder blade and, 2. activated key scapular positioning muscles that were deficient. The other maneuver I discovered to be of great help was asking them to place their painful side's hand on the opposite shoulder. This elevated the painful shoulder blade and posteriorly glided (pushed back) the humeral head into a corrected position in the shoulder socket. Both felt about 80-99% relief from their symptoms during the following week.
Both are now able to begin their strengthening program without pain. If irritation does occur, they know exactly how to eliminate it, finally giving them a means to control their own pain.
Both of these women had one more issue in common. They were self-conscious of their breast size and therefore slouched their shoulders. Over time, I believe this established the environment for these mechanical issues to become painful. Both commented that upon fixing their posture, they felt they were sticking their chests out too much, drawing attention to themselves. They clearly saw the mechanical connection, however, as their pain returned after resuming their slouched postures (Figure 3). Ultimately they needed to come to terms about their personal issues of drawing attention to themselves in order to be better.
[caption id="attachment_207" align="alignleft" width="283" caption="Figure 3. Posture & Shoulder Blade Position (Copyright Boone Publishing. 2010)"][/caption]
This reinforces to me that, although my point of view focuses more on the mechanical causes of chronic pain, there are also significant emotional or psychological causes. I believe often there exists a combination of dietary, musculoskeletal, and psychological issues that contribute to chronic pain. There are probably others as well. Each person's pain is a function of a different combination of these issues. My training is in understanding the musculoskeletal aspects of pain but occasionally I bump into someone with more psychological issues instead.
Rick Olderman Audio Interview About Back Pain
March 17, 2010
I just had a fun interview with Ruhe Fitness who is doing an audio series about back pain. You can check it out at this link if you're interested.
Back Pain: The Edge of Healing
March 4, 2010
I've had several emails from people who have purchased my book on back pain. They've written me to say they have identified the cause of their pain and are just beginning to fix themselves. This alone has been a huge weight lifted from their shoulders after hearing multitudes of diagnoses and theories from specialists. This makes me very excited because once you understand the cause of your pain, you can take the necessary steps to fix it. I've outlined how to understand the causes of back pain and these steps in my book. I've made it as simple as possible.
I feel like a parent witnessing my kids take their first unsure steps! Yes, there will be some wobbling and mistakes but if they stick with it and think about the underlying causes of their pain, they'll be not only walking but running before you know it! It's very exciting and satisfying to know I am making a difference in these people's lives whom I've never met.
I wish I could be there to guide them personally and make sure they do all the right things. In a way, I can. I just had my first Skype session with someone who purchased my book. It went quite well. Better than I expected. Ideally though, I hope readers feel they can go it themselves. I think it's important to understand that everyone has all the tools within them to fix their back pain.
Can Back Pain be Helped Using Pilates & Yoga?
February 23, 2010
Back pain, like other areas of chronic pain in the body, is really the result of poor movement habits. These movement habits though, are often accompanied by anatomical and biomechanical problems feeding, and fed by, these movement habits. This creates a cycle of chronic pain that needs to be broken at these three levels.
If you talk to enough people (or visit enough websites), you'll find someone who swears by Pilates or Yoga as the end-all-be-all solution for their chronic pain. And rightly so. These disciplines take the body through positions and movements that it normally wouldn't go through. This is what has helped those with chronic back pain. I'm a big believer in these two disciplines and any others that responsibly help people feel and understand their bodies movement habits or functional deficits.
What you don't hear about, are those others who were not helped or even made worse by their experiences with these disciplines. Yes, there are many. So, how is it that the same movement philosophy, and even the same instructor, can be the cure for one person and not the other? The answer lies in a lack of understanding of functional anatomy as it relates to movement and chronic pain.
Ultimately many practitioners have only a general idea of how the body moves or how specific muscles work. But they don't understand how that movement, or lack of it, exactly relates to chronic back pain (or pain elsewhere in the body). So typically you are taken through a series of moves that are exactly right for your problem and others that are exactly wrong for your problem. In the case of back pain, most pain can be boiled down to either excessive arching (extension) of the lower spine or by excessive flatness (flexion) of the lumbar spine. I've posted a 1-minute test on YouTube to help you figure this out. Of course there are varying degrees of these problems and reasons contributing to them but you'll get the idea using this simple test.
If you look at a typical Yoga or Pilates repertoire, you'll notice that about half the exercises involve stretching the spine into extension while the other half stretch it into flexion. So by the end of your session, you will have done the perfect exercises for your back pain--and the wrong exercises as well. That's why so many receive temporary relief of their pain but it always returns.
In addition to being a physical therapist, I'm a Pilates instructor myself and am not picking on these disciplines. They can truly be just what the doctor ordered--if the doctor understands exactly what your problem is. Many do not, however. Fortunately understanding the roots of your pain are quite simple. Once you know why your back hurts, you can hone your workouts to focus on those exercises or poses that directly correct these issues and avoid those that contribute to it. Finding an instructor that understands these root causes can be a beautiful experience of letting go of pain and fear of movement and reclaiming your life.
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