Should you Rest when your Back Hurts?

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Back pain is the most common type of problem we see here in our office. And the number one question I get from people who’ve hurt their back is, “should I rest until it feels better?” 

The short answer is “no.” 

But I understand why this is confusing. It’s scary to move, or know which exercise is best when something hurts, especially if it’s your back. We also get conflicting advice from the medical community. Many people suffering with back pain have been told they should rest, ice, lie down, and use their back muscles as little as possible until they recover. They’ve been told they should limit their movement and activity until their pain goes away.

Well what if I told you that for 80% of all back problems – movement is actually the BEST medicine.

Research even supports this. Most back pain falls into the category of what we call “mechanical low back pain” – and this type of back pain responds best to movement over anything else. It’s important to note that although movement is good when your back hurts, you want to pick the right type of movement. Generally speaking, early movement like walking is considered one of the best things you can do for your back, along with very specific mobility exercises in a direction designed to relieve your pain quickly. But you’ll want to avoid things like lifting heavy weights at first, or bending/stretching over excessively. If your back pain involves an irritated nerve, stretching forward, even though it might feel good, can often worsen your problem.

So what’s the big deal? Why is it so bad to rest until your back pain goes away?

Although most back pain will go away on its own with time, the problem with resting instead of moving is that it can prolong the time it takes to truly heal. And in some cases, rest can make your back problem worse. Too much rest leads to deconditioning of your muscles, and can even lead to biomechanical changes to the curves in your spine. Resting may take your back pain away, but it’s going to leave you feeling much stiffer and weaker, putting you at risk to just hurt your back all over again. One of the biggest problems I see with back injuries is a lack of mobility, sometimes due to weakness and sometimes due to not moving around enough. A flexible spine is a healthy spine. That’s why choosing activities like walking and corrective stretching exercises over rest will not only relieve your back pain, but will give you a better chance at keeping the pain gone over time.

Another issue with too much resting, especially lying down, is the impact on your discs.

Back problems frequently involve some variation of a bulging disc, and when you lie down, your disc changes in size. Lying down does relieve pressure from your disc, but also causes it to absorb more fluid, making it bigger. You won’t know this is happening until you go to get up. That enlarged disc will not feel good when it gets pinched. It’s why most people who are dealing with back pain feel worse first thing in the morning, just after getting out of bed. Their pain eases once they stand and start moving around a bit. When you walk around and move, you get natural compression of your disc, keeping the disc bulge smaller and thus, less of an irritant. A bulging disc in your spine is a pretty classic form of mechanical low back pain, and we already know that mechanical back pain responds best to movement.

Remember that the absence of back pain does not mean the absence of a back problem.

Back problems can be complicated and they love to linger under the surface until one day, a certain movement just tweaks you. The best way to figure out a back problem – and heal a back problem quickly – is with movement. As tempting as it is, don’t just rest to get rid of your back pain. Try walking, and even some easy stretching, and take note of what happens. You’ll either start to feel better the more you move or worse. If your pain is easing up with the movement you’ve chosen – you’re on the right track! If your pain is not responding or getting worse, then it’s a clue you need to see a professional. Either way, movement is your friend, because it’s going to tell you something. Rest won’t do that for you and if anything, potentially prolong the issue when you could have been doing something about it.

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

Shoulder Injuries after Vaccination? What to look for

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Shoulder injuries related to vaccine administration (otherwise known as “SIRVA”) is a rare, but possible occurrence when you get any vaccine.

SIRVA happens when a vaccine is injected into the capsule of your shoulder joint instead of your deltoid muscle. It can also occur if the needle being used is not the correct length for you, or if it’s administered too high or too deeply into your muscle. SIRVA is essentially a shoulder injury that occurs due to an improperly administered vaccine – not from the vaccine itself.

Now, it should be noted that this condition is very rare. However, due to the sheer volume of vaccines being administered right now – we have seen a slight uptick in unresolved shoulder problems here in our office. Anywhere from weeks to months after vaccination. For most, the shoulder pain is very mild and it goes away on its own. But for a select few, their shoulder pain has persisted and manifested into a more severe problem. This could be a sign you have SIRVA.

Since the signs and symptoms don’t show up right away, I thought it would be helpful to go over with you what is considered “normal” versus not normal shoulder pain after you get a vaccine.

You’ve likely heard of the “Moderna arm” by now. This is a mild skin irritation specifically related to the Moderna vaccine for COVID-19 that typically involves a mild rash and skin sensitivity after your second shot. It usually lasts about 3-5 days and can be easily treated with topical anti-inflammatories. Moderna arm is not considered to be anything serious, and although it’s not normal to experience this after most traditional vaccines, it is considered a common reaction to the Moderna vaccine. If you’ve recently had your second Moderna shot and are experiencing what you think could be Moderna arm, speak with your doctor or dermatologist if symptoms continue to persist past 5 days, just to make sure there isn’t something else going on.

Localized shoulder pain at the site of your vaccine injection is also normal.

We see this with any type of injection or vaccine into your arm, not just with Covid vaccines. The pain you feel is from the mild trauma caused by the needle being inserted into the soft tissue (muscle) of your arm. It often feels like a bruise, and you may experience a little bit of swelling. It will typically go away after 2-3 days. Even though your arm can be quite sore, the important distinction here is that you’ll still have full, normal function of your arm. In other words, despite the soreness, you can still move your arm freely up and down if you had to without restriction. Your arm soreness will go away with time, but gently massaging the area of pain, and even some easy movement or exercise can help the soreness go away a little faster. 

The symptoms of SIRVA are different, and typically more severe than what I’ve just described above.

If not addressed, some of these symptoms could lead to long lasting shoulder problems. As I alluded to above, one of the main distinctions between “normal” shoulder pain after vaccination and SIRVA is how well your arm functions.

If the needle was accidentally inserted into your joint capsule, for example, you will notice limited mobility and possibly limited strength. When left unaddressed, symptoms like this can manifest into more serious shoulder problems down the line, such as adhesive capsulitis or frozen shoulder.

If the needle was inserted too high or too deeply, you can end up with shoulder bursitis, which means the needle was inserted beyond your muscular layer and directly into the bursa (a cushiony fluid-filled sack), causing it to become inflamed. Your mobility may or may not be impacted when this happens, but what you’ll notice is that your shoulder pain will take a lot longer than 2-3 days to subside. Bursitis is actually a really simple injury to treat, but where I see most things go wrong is that you can end up with compensatory problems in places like your neck, shoulder blade or elbow the longer it is allowed to persist.

The last thing you might see from an improperly injected needle is rotator cuff tendonitis. What you’ll notice with this is that you’ll likely have full mobility in your shoulder, but it will be very painful and weak to exert force in your arm.  Much like bursitis, this is not a complicated injury to rehabilitate, but if not rehabilitated properly, it leads to other problems that do become more difficult to treat down the line.

So to summarize, your shoulder WILL hurt after getting a vaccine.

And with the Moderna vaccine in particular, you may notice some skin sensitivity, mild swelling, and even a rash.

But these symptoms should go away after a few days.

If you have shoulder pain that persists, and especially if you’re noticing limited mobility, it’s something worth getting checked out.  The last thing you want is for these symptoms to go on longer than needed, or turn into compensatory, long lasting problems. The good news is that even with SIRVA, these problems and symptoms can be successfully treated naturally, and without medications or procedures. We’ve been successfully helping people right here in our office. If you’re worried about a potential shoulder problem after the vaccine and not sure where to turn – reach out. You can schedule a FREE Discovery Session with one of our specialists right here!

 

Why Proper Breathing is Essential for Good Core Strength

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When I’m working with clients, one of the most common things I see when someone is having trouble engaging their core is that they tend to hold their breath.

Why is this important?

Because breathing properly allows you to activate your deep core – and good activation of your deep core is essential if you want the rest of your core muscles to work properly and help you prevent things like back pain.

Let me explain…

Your “deep core” is made up of your diaphragm, pelvic floor, transversus abdominus (deepest layer of abdominals) and your multifidi (deepest layer of back muscles). These four muscle groups work together to make up your deep, inner core. If your deep core doesn’t function properly – your outer core muscles (abdominals, glutes, hip and back muscles) won’t have the support they need to work well. This can all lead to inefficient and compensatory movement patterns over time, and contribute to something like back or neck pain.

Your diaphragm controls how well and how deeply you breathe. When working properly, your deep core acts like a piston system, driven by your diaphragm. Upon inhalation, your diaphragm expands, causing your pelvic floor to lengthen and drop. When you exhale, your diaphragm contracts and your pelvic floor lifts like an elevator – all acting like a piston system moving down and up.

Additionally, the pressure created by this system also acts a bit like a balloon. Breathing in expands your pelvic floor and abdominal muscles out, stretching like a balloon would. Exhaling releases the air and allows your abdominals and pelvic floor muscles to contract, like the natural recoil that would occur if you let the air out of a balloon.

So, if this is a natural process, why do so many of us have problems activating our core properly?

It’s because as we age, and allow poor movement and posture habits to form, we “forget” how to breathe normally and most of the time aren’t even aware this is happening.

Here are some of the most common things I see with clients suffering from neck and back pain, and who aren’t activating their deep core properly:

1. Chest breathing

I see a lot of people breathing deeply but the only thing moving is their chest. Instead of their ribs expanding out and back, all you see is their upper chest moving out and up. This is very common, and it happens because your diaphragm isn’t expanding fully and thus, not pushing air down into your belly. Chest breathing often contributes to tight and elevated shoulders, back pain, and even tight hip flexors – because the deep abdominals can’t kick in properly, causing the rest of your body to compensate. Next time you want to take a deep breath, place one hand on your belly and make sure that it’s moving out and in along with your chest. That’s a first step to learning how to breathe properly so that your deep core can activate!

2. Your neck feels tight

Although back pain is often what’s associated with a “weak core”, people can also suffer from neck pain when they lack proper core activation. When people first start working with us for Pilates, a big complaint is they feel tightness in their necks when they are first learning how to activate their core and do a proper chest lift. The fascia (web like substance that holds and surrounds your muscles) of your deep core is connected to the deep fascia of your neck. If you’re not breathing properly and your deep core can’t activate, your neck may try and help out because it’s partly “connected”. We even see neck tightness like this in our experienced Pilates goers – and it’s a clear sign they’ve lost connection to their deep core or perhaps simply lost connection to their breath. Next time you’re doing abdominal work, check in with your neck and see if it feels tense. If so, it could be a sign you’re not fully activating your deep core. Improving how you breathe during abdominal work could help.

3. You hold your breath when you exercise

Did you know your diaphragm is a muscle? When you hold your breath, you’re contracting that muscle. For a muscle to work properly it needs to contract AND relax. If you hold your breath during exercise, it’s impossible for your diaphragm to expand (relax) and push air into your abdominals and activate that piston system we talked about earlier. In other words, your pelvic floor and deep abdominal stabilizers don’t have an opportunity to activate properly when you hold your breath. Without activation of your deep core, the rest of your body is going to have to compensate somehow. And this can set you up for unnecessary aches and pains, or worse, injury. I always say to my clients, “when in doubt, just keep breathing”. Because if you’re actively breathing, you at least have a shot at activating your deep core properly, even if you’re not 100% sure how to do it.

If you have trouble “feeling your abs” when you exercise, your neck and shoulders tense up when you work out, or your back and neck always hurt every time you work your core – it’s a sign you might not be activating your deep core very well.

Remember that good core strength starts with your breath!

Next time you work out, especially core-focused work, pay attention to the way you’re breathing. If you still have trouble, or you’re noticing back or neck pain, then reach out for a FREE Discovery Session or check out our Pilates offerings.

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Five Reasons People over 40 are doing Pilates

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Recently, Pilates has been gaining popularity with folks over age 40. Why? Well, let’s take a look at the history.

It was first created by Joseph Pilates almost 100 years ago, who suffered from asthma, rickets, and rheumatic fever. When traditional exercise systems failed him, he turned to anatomy books and became obsessed with the human body. Refusing to let his body ailments define him, he eventually developed his own system of exercising, now known as the Pilates method. But the original name for his method was “Contrology,” because the focus of his exercises were to have full control of your movement and to feel empowered in your body.

I’ve been incorporating Pilates into my physical therapy practice for the last 11 years – and it’s been transformational for my clients.

Pilates is a full body strengthening system that emphasizes breath, precision, coordination, and core strength. It helps our clients connect to their bodies in a way they haven’t been able to achieve with traditional strengthening methods. Most of my clients are over the age of 40, and they love Pilates because it helps them have more energy, better balance, and improved strength and mobility. It allows them to participate in all the activities they love with more ease, and significantly decreases their likelihood of injury.

If you’re over 40, and aren’t yet doing Pilates, here are five reasons to get started:

1. Pilates helps prevent back pain.

Once you hit 40, your risk of back injury starts to climb. We see a lot of folks in our office who’ve tried traditional physical therapists, chiropractors, and so many kinds of core strengthening programs – but still have recurring back pain. Getting rid of back pain in the short-term is easy, but keeping it gone is the challenge.

We specialize in keeping pain gone, and Pilates helps us do that. Our Pilates instructors work closely with our PT team and get enhanced training on how to navigate back pain. We also keep our classes small so that we can pay close attention to everyone. This is key if you’re recovering from an injury and want to consider Pilates. Beware of classes that are overcrowded and not individualized. More than 5-6 people per class could be dangerous if you’re dealing with back pain. It’s impossible for your instructor to keep a close eye on you or give you individualized modifications.

2. Pilates strengthens your whole body, not just your core.

One of the keys to lifelong fitness is what I call “balanced strength.” In other words, each part of your body works together to produce the right amount of force, at the right time. I see lots of “strong” people in my office, but they can’t do the activities they love, because their muscles aren’t working together. Pilates emphasizes full body strength that is coordinated. Coordinated strength is essential to a balanced body.

3. Pilates improves your flexibility.

Do you stretch your hamstrings every day but they never seem to improve? It could be because you’re not stretching the right way. The great thing about Pilates is that it improves your flexibility in a way that strengthens at the same time. The “old school” way of stretching was to find the most uncomfortable position for your muscle and just hold it for 30 seconds. Research has shown this is not effective. The best way to stretch is to keep moving and do it dynamically. In Pilates, we do just that! One of the central concepts to Pilates is “lengthening.” This helps you stretch your muscles in a way that results in long lasting, sustainable improvements.

4. Pilates minimizes stress to your joints.

As we age, it’s normal to have arthritis. But it doesn’t have to be the death sentence to activity that most people think. The key to combating arthritis is maintaining a mobile and well balanced joint.  When you optimize everything that surrounds your arthritic joints, your symptoms decrease. Pilates helps with all this – without causing any additional stress. Since Pilates is based on the idea of constant opposition – lengthening while strengthening – you end up with a joint that is happy and balanced. This helps to minimize the impacts of arthritis and even prevent the rate of degeneration as you age.

5. Pilates trains your nervous system.

Since Pilates emphasizes small, precise movements – it’s very good for your nervous system and coordination. We refer to this as motor control. Having good motor control is key for controlled, coordinated movement.   A strong muscle that isn’t coordinated to “turn on” when it’s needed is almost useless. It’s why strong, healthy people still get back pain. Your core could be strong – but if it isn’t trained to function properly and when it’s supposed to – it won’t help you prevent back pain. When done properly, and with a qualified instructor, Pilates is one of the best exercise methods I’ve found to train your nervous system and improve motor control – which is key for injury prevention.