Physical Therapy 1st Option to Treat Low Back Pain

Chances are, you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.  Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Medication: Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Imaging: Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful. Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common. 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not. In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge.  Just getting an image increases the chances that you’ll have surgery by 34%

Surgery: The US has sky high rates for back surgeries – 40% higher than any other country and 5x higher than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are not good! A worker’s comp study looked at a group of 1450 people with similar symptoms: half had spinal fusions and half didn’t. The surgical group had:

  • 1 in 4 chance of a repeat surgery
  • 1 in 3 chance of a major complication
  • 1 in 3 chance of never returning to work again

Physical Therapy: Current clinical practice guidelines support manual therapy and exercise. Research proves that early PT leads to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids. A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60%. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.  Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. With direct access, patients can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

Effects of Bad Posture & How to Fix It

Have you ever noticed that grandma or grandpa seem to lose inches as they age and sometimes may seem to have a rounded upper back?  Well, the truth is, some of this is just the natural aging process, but there are things we can do now to prevent and correct this curving of the spine before it’s too late!

WHAT CAUSES THIS?  Well, nature does play a role, however a sedentary lifestyle and time spent on computers and smart phones can accelerate the decline.   As Americans, we often don’t realize how easily we are sucked into the sedentary lifestyle due to our jobs and advances in technology.  Everything is just becoming too convenient! All these things have a detrimental effect on our posture, which, in turn, can have other consequences on our bodies.

THIS CAN LEAD TO OTHER ISSUES: Yes, that’s right, other than the physical effects posture has on your outward appearance, bad posture also affects you in other ways.

HEADACHES: Looking down at your desk, phone or computer causes a forward bend in your neck. Staying in this position for an extended period or even short periods several times throughout the day can cause headaches. Why?  Well, when you are hunched over and looking down, you are decreasing the curve in your cervical spine putting excess strain on the muscles in the back of your neck as they are working overtime to keep your head from falling. This excess strain on those muscles is one of the many reasons you can get headaches.

DIGESTION: Sitting with bad posture for longer periods can also have an effect on your digestive organs. Just picture your organs all curled up in the normal position and then picture them with them folded over on each other with an extra 20 lbs of pressure on them. Does that give you an uncomfortable visual? This bad posture is putting extra pressure on your digestive organs, not allowing them to function properly.

POOR MOTIVATION: Not many of us think of poor posture being related to motivation, but it is. Studies have shown that being hunched over causes increased emotions of fearfulness, low self-esteem and having higher chances of being in a bad mood.

BACK: Your body has 3 natural curves: cervical, thoracic and lumbar.  When slouching for long periods of time, whether in the car, at work, on the sofa, day after day this can negatively affect your back and put increased pressure/ stress on different areas. The longer the behavior occurs the more negative effects it can have on your body by putting your body in this unnatural position.

The bottom line is, proper posture keeps you in a position that causes the least amount of strain on your muscles and ligaments.

So, what can we do to improve our posture?

Maintaining the proper posture after having bad posture is work and it takes time, however it is worth it! You need to be consciously aware of your body’s position.  The following are suggested positioning for seated and standing posture.

SEATED: When in a seated position you should have your feet planted on the floor or a foot rest if your legs are too short for the chair. Keep feet in front of your body and do not cross your legs.  Your knees should be at a 90-degree angle with the seat of the chair far enough away from the back of your knees to create a gap. Your back should be in an upright position with low and mid back support. Shoulders are relaxed, and elbows bent at a 90-degree angle (forearms parallel to the ground).

STANDING: When standing, most of your weight should fall on the balls of your feet. Knees should be slightly bent and hip width apart. Your back should be upright and tall with your shoulders pinched back. Pulling your tummy in will give your back some extra support. Your head should be held high and level.

* images from

Again, improving your posture is not always easy. It will take a conscience effort!   Put a timer on your phone or a sticky note on your desk as a reminder for yourself. If your car or seat at work is not providing you with the correct amount of low and mid back support, you can roll up a towel and place in the area you are lacking support.  Over time good posture will put less strain on your body.

Here is a great video with some quick tips on proper posture while on the computer

CLICK HERE for some great workday stretches!

If you have any questions about posture or what exercises you can do to help, feel free to contact a therapist at one of our offices to make an appointment. We would love to help you achieve your goals!

5 Easy Tips for Pain-Free Gardening

For most of us, spring and summer is the time of year when the weeds in our yard start calling!  When the weeds go crazy, we might feel overwhelmed and want to do it all in one weekend, however, as I’m sure you have figured out, this is not a great idea.  Overdoing it can often mean an increase in aches and pains, especially back pain.

Whether you are planning on weeding the flower beds, mulching, pruning, planting, or all of the above, there are a few steps you can take to help prevent residual soreness the following few days.

GET THE GEAR:  Before working in the yard, it is important to have to proper gear: hat, suntan lotion, sunglasses, and a water bottle.  You’ve all heard it before, staying hydrated and protected from the sun is a must!

WARM-UP:  Get those muscles warmed and loose by going for a short 5-10 minute walk.  In addition, it is a good idea to perform some dynamic stretches, such a walking lunges with a torso twist, skipping or high knee walking.  Yard work is hard work and skipping a warm-up will put excess strain on your muscles and joints, increasing your chance of an injury.

TAKE BREAKS: Don’t get so caught up in the work, that you forget to take frequent breaks. They don’t have to be long, but it is important to take time to stretch and get a drink of water.

CHECK YOUR FORM: Whether it’s bending over weeding, shoveling or spreading mulch or pushing a lawn mower, all of these jobs put extra strain on your back. By altering your form while you do some of these activities, you can decrease your chances of having back pain.  Here are some suggestions:

– Good idea: Kneel on a soft mat to save your back and knees.
– Better idea: Sit on a stool and rest your elbows on your knees
– Change positions frequently to avoid overuse

Trimming the Hedges:
– Keep your back straight
– Utilize small strokes to prevent strain in neck and shoulders
– Rest every 5-7 minutes to give you back a rest… it will thank you later.

Wheel barrel:
– Bend your knees to lift, NOT your back
– Try not to twist while holding the handles. Wheel barrels can easily be unbalanced…if it starts to go, you do not want to be pulled down with it.
– Push, do not pull.

– Keep feet firmly planted on the ground
– Keep hips forward, facing where you are shoveling to prevent twisting of the back
– If you are moving dirt from one place to another, pick up your feet and turn your entire body to face the side you will be placing the dirt. This may seem unnatural and may take a little longer, however you could be saving your back from days of soreness.

Lifting :
– As temping as it is to get it all in one load, save your back and take two trips with smaller loads.
– Make sure to keep the load close to your body.

COOL DOWN/STRETCHINGOnce you’ve had your fill, it is a good idea to take a few moments to cool down and stretch.  Often your body might tell you what body part could use a good stretch, but if you are looking for a few suggestions, we’ve got you covered:

Yard work can be fun, especially when you get the whole family involved, but taking a few steps to lesson injury risk can go a long way to keeping the garden weed-free all summer long!

Postpartum Abdominal Separation…Is this Normal?

If you or someone you know still has a protruding belly several months after giving birth, chances are that you (or she) has diastasis recti.  To be clear, we are not talking about the flabby, loose skinned belly that plagues us all after pregnancy.  The bulge I am speaking of is most evident when the abdominal muscles are contracted, such as when coughing or sneezing and becomes more obvious once a woman returns to normal exercise.  Sometimes, it may even look like a hernia.

Diastasis recti is a separation of the two sides of the outermost abdominal muscle, called rectis abdominis.  During pregnancy, the same hormones that allow the pelvis to expand in preparation for delivery also sometimes allow other tissues to expand beyond their normal threshold.  This combined with the increased pressure (ie. a growing baby inside) on the connective tissue that binds the two sides of rectis abdominis, can lead to the separation.

The literature is still unclear as to who is at risk for diastasis recti and the prevalence of it.  What I can tell you is that in the last 6 months I have seen five women– at various points of postpartum– for diastasis recti.  In addition, I have been involved in three separate facebook threads of women seeking more information about it.  Of those five women I saw in my office, only one of them was referred to me by her healthcare provider.  The other four women– and actually the 3 women on facebook as well– had very similar stories of recognizing the symptoms on their own and being somewhat brushed off by their providers.

So, when is it time to seek treatment?  To some degree, a separation is a normal part of pregnancy and most often will return to normal within the first several weeks of healing after delivery.  First and foremost, you should seek treatment if you have symptoms associated with the separation.  Symptoms might include low back pain, pelvic pain or an overall sense of decreased stability throughout the mid-section.  Without the presence of symptoms, you should seek treatment if you still have a 2+ finger width separation 2-3 months postpartum.  If left untreated, the lack of core stabilization may lead to back and pelvic pain down the road and the most severe cases may in fact lead to an abdominal hernia.

Despite what you may think, the goal of treatment isn’t actually to close the separation completely; in fact, many women will continue to have a 1-2 finger width separation and that’s perfectly normal.  The main goal is actually to create improved activation of the deeper abdominals– most specifically Transverse Abdominus.  This muscle acts like a corset.   Imagine that corset pulling everything in… allowing the top muscles to move closer to midline.

It is critical to learn how to recruit the appropriate core muscles.  Some traditional “core” exercises can in fact make it worse.  These include– but are not limited to– crunches, planks and torso twisting exercises.  The benefit of a physical therapy consult is that the exercise program will be tailored to your strengths and weaknesses and will provide very clear guidelines for exercise progression.

The assessment is simple.  While lying on your back, place your fingers at your belly button.  Perform a small crunch and if your fingers sink in between the two sides of the abdominal muscles, then you have a separation.  This same assessment is repeated both above and below the belly button.  The degree of separation is often measured by how many fingers fit into the separation.

Unfortunately, not many OBs and midwives are including this assessment in their routine 6 week postpartum check-up.  If you have recently given birth, I urge you to ask your healthcare provider to check you.  If you are past that 6 week check up and believe you might have a separation, I would highly recommend calling your physical therapist to assess it.


Pelvic Pain

Pregnant and in pain? You’ve just joined the masses: 80 percent of pregnant women experience pelvic pain at some point in their pregnancy. But what can you do about it?

The cause. As a woman’s pregnancy advances, her uterus enlarges. This enlarging uterus moves her center of gravity forward of her feet. This shift in a center of gravity causes alignment adjustments and overcompensation, consequently causing pelvic pain. Furthermore, the additional weight being carried places pressure on the bladder, hips, and pelvis and spine (increasing stress on the bones, joints and muscles). No wonder this pain is so commonly seen.

What will help? A lot! There are varying exercises and stretches that will help minimize your pelvic pain during pregnancy. These exercises include – but are not limited to – pelvic rocking, child’s pose, kegel exercises, and squats. Here is a link to more information.

In addition to exercise, you may also find it helpful to purchase a belly sling to lessen the effect of gravity and help stabilize the pelvis. Swimming or simply movement in water can also be a beneficial way to minimize pain while pregnant. The natural anti-gravity effects of water give your body a break from bearing the extra weight.

Wishing you and your baby a healthy delivery!

Low Back Pain

A Global Burden of Disease, Injuries, and Risk Factors study recently cited low back pain as the single leading cause of disability worldwide. Estimates indicate that 80% of us contend with the common ailment at some point in our lives. The intense and debilitating pain that accompanies low back injuries often prevents sufferers from going to work, participating in household chores and enjoying time with loved ones.

Low back pain doesn’t have to be a prescription for couch surfing. Current studies show no evidence that supervised physical activity increases the risk of additional back problems or work disability. Counter to the age-old recommendation of inactivity, a customized exercise program under the direction of a physical therapist is widely prescribed to reduce pain and disability.

Physical Therapist, Brian Hartz agrees “A common misconception among those who suffer from back pain is that they should rest and it’ll eventually go away. Instead, through the use of a customized physical therapy plan, back pain can be a thing of the past for many of our patients.”

Although back pain can affect anyone, the major risk factors include age, poor physical fitness, genetics, being overweight, and smoking. The National Institutes of Health suggests the following to prevent back pain:

• Exercise frequently and keep your back muscles strong.
• Maintain a healthy weight.
• Eat a balanced diet, including daily recommendations for calcium and vitamin D.
• Focus on body mechanics by standing up straight and lifting heavy objects with bent legs and a straight back.

According to the American Academy of Orthopedic Surgeons, low back pain sufferers should prioritize a supervised exercise program and a gradual return to everyday activities to restore back strength. Following an evaluation, physical therapists can recommend specific exercises to prevent and treat back pain, and provide additional treatment options to address pain and restore mobility.

Core Strength

Fitness class making sit-ups

Is Core Strength REALLY all that Important?  “Tighten your core”, “Core strength is key” …core strength, core strength, core strength!There seems to be a lot talk about core strength these days. What’s with all the hype anyway? Is it really that important? Well, the truth is, core strength can help everyone, from competitive athletes to senior who are at risk for falls. Let’s talk about core strength and some of the benefits a strong core will bring to an individual

WHAT IS IT?  Your core is made up of 3 layers:

  • upper abdominals
  • oblique muscles (along either side of your stomach)
  • a deep layer of muscles that attach to your spine (erector spinae, glutes, transverse abdominus, etc.)

WHY IS IT IMPORTANT? It is important to have a strong core because your core helps to maintain proper posture and keeps your spine in a neutral position. Balance is strongly correlated to core strength and will reduce the risk of falls. It also decreases low back pain and helps to lower the risk of injury for athletes.

WHAT CAN I DO ABOUT IT?  Here are some tips to ensure you are maintaining strong and supportive core muscles:
Get your Spine Back to Neutral Position: First you need to learn how to stabilize your core by putting your spine in a neutral position. The best way to do this is by perfecting the Abdominal Hollow stretch.  Start by lying on your back with your knees bent, feet on the floor. Simply pull your belly button down towards your spine, creating a hollow in your abdominals and pushing your back into the floor.  Be sure to breathe normally! Hold this for about 10 seconds and repeat 10 times. Once you begin to perfect this position, you can start to perform this when seated or standing. This is a key position that you will want to maintain when doing your core workouts.
Posture Counts!  Another simple way to get your core working is by just becoming more aware of your posture. Stand up straight and get into that abdominal hollow position. By doing these, you may already start to feel a decrease in low back pain. Now Strengthen: Here are two great strengthening exercises to get you started:

BridgeWoman Exercising

  • Lay on your back with knees bent up and feet shoulder width apart.
  • Pull your belly button down towards your spine and lift your hips up towards the ceiling
  • Once you are at a comfortable height, hold for 10 seconds and slowly lower
  • Work up to 20 repetitions.

Planks:Pilates exercise series

  • Lay on your stomach and gently push yourself up. Support your weight on your knees  (modified plank-beginner) or toes (full plank-advanced) and either your elbows or hands
  • Support your back by contracting your abdominal muscles. Be sure to keep your back straight. You should not feel any pain in your back, only muscle tightness in your abdominals
  • Hold for 20 seconds and repeat. Work up to 10 repetitions.
  • A variation of this exercise is side planks, where you will rolls to one side or the other.
  • Don’t forget to maintain your abdominal hollow which will help maintain proper form. These are wonderful exercises to work your core muscles!

A Balancing Act: Balance and a strong core go hand in hand. Consider adding some balance exercises into your core routine. Some examples:Exercise Ball
A. Stand on one leg, balance for 20 seconds, repeat with other leg. B. Perform squats or lunges utilizing a BOSU ball. (picture at right)
C. Sit on an exercise/physio ball, kick one leg out, hold, and then the other
D. Advance a bridge position so that your feet are resting on a physio ball and lift up your hips.

The Benefits:  By working your core you will notice several useful benefits:

  1. Your back will feel better and stronger
  2. It will be easier to maintain better posture
  3. Your balance will improve, thereby reducing your risk of falls.
  4. Athletes risk of injury will decrease

So no matter how old you are, what sport you are training for, what you may be trying to rehabilitate, strengthen or slim down, you can always benefit from adding a core workout to your regiment!   For more information about how physical therapists can help you get started on the right foot, call us today at 717-625-2228


Image courtesy of stockimages at

Sciatica is a commonly misunderstood diagnosis that can be extremely unpleasant. This little word is often batted around like a birthday piñata with few people penetrating the exterior to truly understand its meaning. Sit back, relax, and take a moment to kick your sciatica misconceptions to the curb!

NAMES ARE EVERYTHING:  First, sciatica itself names a problem, NOT the cause of your problems. The word is Latin for inflammation or irritation of the sciatic nerve which we often proclaim as pain in the butt. This nerve emerges from your lower spine and travels through the buttock and back of your thigh to the knee. The nerve continues past the knee but its name changes to the tibial nerve – much like a long road might. This road terminates at your toes. You have 2 sciatic nerves, one in each leg.  Point to remember: Sciatica is NOT a root cause of pain; it is just a structure that transmits pain and irritation. There is always another mechanism responsible for aggravating this nerve and causing sciatica pain.

A CAUSE TO GET BEHIND:  So what are some potential causes for sciatic pain?

Disc Alignment: Disc herniation is a great starting point. When a disc herniates (which can range from a bulging disc to a complete rupture of the disc), it can protrude and put pressure on one of the nerve roots that feeds into the sciatic nerve. The pressure on the nerve root irritates and potentially damages the nerve. This can create pain, numbness, burning, or many other symptoms that may travel down the nerve. Now that nerve becomes irritated. The pressure can cause problems further down the line (that road we talked about earlier).

Picture yourself grabbing a bare electrical wire (pleasant, I know). That current may have originated many miles away but you still experience a shock because the electricity travels. That’s why nerve problems close to the spine can cause pain farther down a limb.

Other Spine-Related: There are a few other causes of sciatica that involve the spine. These include bone spurs, stenosis, and some other less frequent causes. The bottom line is, all of these causes apply pressure on the nerve which causes, you guessed it, sciatica!

Piri-what? Sciatic pain does not always originate from the spinal area, however.  Let’s discuss another mechanism which causes sciatic pain AWAY from the spine.  The Piriformis is a small but very important muscle in the back of your hip/pelvis (AKA your butt) and sure enough, that sneaky sciatic nerve runs very close to it. In fact, a portion of the population has their sciatic nerve run directly through the muscle! So, if this muscle is tight or in spasm, it can harm the adjacent sciatic nerve. This cause of sciatica is called piriformis syndrome.

HOW DID THIS HAPPEN? Sciatica can occur gradually or suddenly with little to no warning. It sounds better to have had a good reason (saving a child in a burning building, making the winning TD… you get the picture) but sometimes it can happen when simply standing up from your couch. Frustrating, I know, but it happens.

HOW TO DEAL: If you, or a loved one, has sciatica, you could be in a lot of pain and wondering where to turn for help.  Physical therapy is a great starting point!  You may have been expecting to hear this from a physical therapy provider. However MANY health professionals (in addition to those directly in the field) view physical therapy as an important first treatment option. Let’s dig deeper into these strategies to fight sciatica.

FIRST LINE OF DEFENSE:  Physical Therapy is, in fact, one of the first lines of defense against sciatica.  Physical therapy utilizes exercises and manual techniques to promote nerve gliding, spine mobility, muscle flexibility and increased strength to heal the area of pain. Of course, the specifics vary from patient to patient. There is no magic list of procedures that cures every sciatic problem. Instead, a physical therapist will create a custom program that fits each individual’s specific needs. It all depends . . . . on YOU!

INJECT SOME RELIEF: If you have tried physical therapy, to no avail, there are other more radical approaches.  One such approach is steroid injections. It sounds intimidating, but it is a brief and relatively easy procedure. An injection places a steroid directly at the irritated nerve. The steroid is a way to force your nerves to be calm and decrease inflammation. Sometimes injections from your physician are a supplement to therapy and will help to increase its effect. Steroids can also be administered orally but they are usually less effective as the medication must be absorbed into your entire body, instead of focusing on the area causing pain.

WHEN ALL ELSE FAILS: Finally, surgery is the most invasive treatment option.  The actual steps in the procedure depend on the CAUSE of your sciatica.  Generally, the surgeon tries to remove the source of the nerve irritation and fix any other structural issues.

Well, that was a great start, but believe it or not, there can be much more to the problem! Now that you know the basics about sciatica and can use this term correctly. Hopefully you will never have to experience it yourself, but if you do, feel free to give us a call. We’d love to help you!

Degenerative Disc Disease

Much of the lower back (lumbar region) and neck (cervical region) pain we experience can be linked back to degenerative disc disease. This common diagnosis is broadly misunderstood. In essence, degenerative disc disease describes the pain symptoms (including weakness and numbness) caused by a degenerated disc (in the spine).

This term, degenerative disc disease, is actually a term to define the changes in your spinal discs. Spinal discs separate the vertebrae that make up the spine. These discs are soft and compressible. Think of these discs as shock absorbers. Unfortunately, even shock absorbers on a car can get worn out – just like the spinal discs in your spine. When this occurs, pain is the result.

Over the years our spinal discs can degenerate or “break down.” This can cause degenerative disc disease in some people. Degeneration often occurs through the loss of fluid in the spinal discs, which makes the disc thinner, and the cushioning between the discs is no longer protective. Additionally, tiny tears can occur in the disc, ultimately causing the loss of fluid in the disc — also leading to a disc rupturing or breaking into fragments.

Unfortunately, falls and heavy lifting can lead to herniated discs which can spark degeneration. Treating a herniated disc, or treating the pain associated with degenerative disc disease, is the first step in preventing the condition from worsening. Not lifting excessively heavy objects can help protect the discs, too. Prevention is key!

If you have questions about your lower back or neck pain, don’t hesitate to contact us.

Herniated Disc

If you’ve ever experienced a herniated disc, you know the experience can be painful. In addition to low back pain, symptoms that radiate down the leg can include burning, numbness, and/or weakness. It is of utmost importance to receive treatment for a herniated disc sooner rather than later.

Treatment of a herniated disc varies from patient to patient. Make sure a program is being designed specifically for your needs. The treatment will depend on a number of factors including age, symptoms, and activity level. Treatment may include heat or ice, exercises for back strengthening, physical therapy, and/or pain medicine.

Some believe a herniated disc means a one-way ticket to seeing a surgeon. This is not the case; in fact, surgery for a herniated disc only takes place for about one out of 10 people. Surgery may be the best option for those who have nerve damage that is worsening, or for individuals who experience pain even after more conservative treatment options are performed. It’s important to note that the majority of herniated discs resolve without surgical procedures, thanks to a combination of the aforementioned treatment options.

Preventative measures can also be taken to protect your spine. Make sure to use proper lifting techniques and always ask for help if something is too heavy. Maintaining a healthy weight can also help remove additional stress on the spine. Lastly, a back brace may be recommended by your physician. Be advised, however, that excessive use of a back brace can actually weaken the muscles that support your spine, making the issue worse.

–        Dan Herrmann, DPT