Common New-Parent Complaint: Low Back Pain

As a father of two small children—a 26-month-old daughter and a 6-month-old son—I’ve had my share of new-parent body pain (minus the actual giving birth part). Sometimes you get so used to being in pain from holding your kids all day that you’re actually surprised when your body isn’t lingering from soreness. One of the most common complaints I hear about (particularly from my wife) is low back pain.

Now, there are many different types and causes of low pack pain, and all of them have a specific mechanism in which they need to be treated. But overall, low back pain is usually an issue of two things: posture and repetitive stress.

When lifting your cute little heavy potato sack of a baby, it’s important to be mindful of your posture and to have your hips, knees and legs do most of the lifting (kind of like when you’re doing a squat or lunge). This means keeping your back aligned above your pelvis and not having it so rounded—and always engaging the “core”.

What’s this word “core” that I’m throwing out here? I tell my wife all the time to contract her core. Contrary to what she may think, your core is not just your belly or your abs. The core is actually a group of muscles that stabilize the spine and pelvis. These muscles contract together to prevent unnecessary movement of the spine during simple activities like picking up your child.

So how does one correctly contract the core? Most people end up just holding their breath or contracting their abs—wrong! This kind of contraction doesn’t really engage the entire core and won’t protect your spine the way it needs to. The proper way to assess whether you’re doing it the right way is to feel it with your fingers. Place your fingers just outside of your ab muscles—yes, we all have them, even though some people's may be hidden—and dig your fingers in around belly button level (see below for a visual reference). Keeping your fingers there, I tell my patients to pull their belly button in and up (kind of like when you're sucking in your stomach, but without holding your breath). 

If you are able to feel hardening or your fingers pushing back out a little bit, then you are contracting your core the right way.

Another way to prevent low back pain is to always keep your child as close to your body when picking him or her up. Unless your child’s just pooped himself up the back (in which case you may want to hold him away from your body), pick your child up in close body contact to reduce the amount of force on your back. Think about picking up a big sack of rice. You probably wouldn’t try picking it up with your arms held out, right? In similar fashion, when picking up your child, it’s important to be in proper position: shoulder kept back, core engaged, legs and shoulders aligned with your hips. And also make sure that your shoulders aren’t extended out too much in front of your body.

These basic steps—along with some nightly massages from the loving husband—can help in reducing your risk of injury and could even decrease the amount of pain you’re currently in. But of course we recommend that low back pain sufferers always consult with a physical therapist to discuss the best plan of care for your specific condition and needs.

New Parent Injuries : Tennis Elbow

I am a parent of two, one of which is about 4 months old. Not only is my son a newborn but he is a chubby one at that! The other day my wife comes to me and tells me that her elbow is really bothering her. As the good husband and PT I am, I took a look and it was very clear that she has what is called “Tennis Elbow”. Now my wife does not play tennis, but in my years as a therapist I have treated many new moms/dads with the same issue.  “Tennis Elbow” is layman’s terms for a condition call lateral epicondylitis or epicondylalgia.  This is a very long and non-interesting name for a specific condition that affects the wrist extensors (the muscles that enable you to extend your wrists). This condition received its name because it is very common among tennis players. This is due to the intense amount of repetitive eccentric torque placed on the wrist during a strong backhand. Now you may be asking, “Why are new mom’s and dad’s prone to this issue”? Well, as it turns out babies need a lot of care and attention in their first few years of life. This translates to a lot of long hours holding, rocking, feeding and carrying very heavy objects like an 45lb car seat! Not only are you required to lift these heavy things but usually it is required that you lift these things in narrow corridors such as a back seat of a car or a narrow garage.  All this leads to repetitive stress injuries to your wrist and elbows.

http://orthoinfo.aaos.org/topic.cfm?topic=a00068

What do we do to prevent this?

- Modify the way you are lifting and holding the baby. Hold the baby with palms up rather than palms down or palms towards your body.

- Use baby carriers that place the babies weight on your hips and shoulders rather than your elbow.

- Hold car seat in the crook of your elbow rather than hands. Also, attempt to use stroller as much as possible.

How do you treat this?
- Physical therapy, of course is an excellent option to relieve pain and to help prevent further injury. If you continually irritate this condition it could lead to a tear of the common extensor tendon pictured above. 

- RICE, No not glutenous kind. Rest, Ice, Compression, Elevation.

- Rest is not always an option but not doing things that cause pain will go miles to your recover. Basically every time you feel sharp pain in your elbow you are re-aggravating the injury.

- Ice is extremely useful to help decrease pain and inflammation.

- Compression helps to decreases stress across those common tendons in the elbow. A tennis elbow strap should help to improve pain during everyday activities.

TRX Shoulder Strengthening Exercises

TRX Shoulder Circuit

As we have stated before, TRX straps are extremely useful in the rehab setting and can be used in a variety of ways. This video demonstrates a series of exercises to increase shoulder and rotator cuff (RTC) strength. A neglected component of RTC strengthening is actually stability of the core as well as the shoulder! One of the great things about the TRX straps is that it allows you  to strengthening RTC while simultaneously activating the core. 

This series of exercise strengthens each head of the RTC as well as requiring co-contraction of the RTC to stabilize the shoulder. This is important because strengthening without stabilization is useless and will most likely end in re-injury. To maintain this position the core has to activate and teaches patients to activate their core during all upper body activities. This is important because the core is the foundation for all upper body activities. Therefore, strengthening and stabilizing the RTC on a weak foundation would also be a worthless endeavor. This TRX circuit is good for all populations from athletes to weekend warriors, try it!

TRX As A Rehab Tool - Side Lunge

Continuing on with our sample of TRX exercises for the rehab setting, I am going to show you a lateral lunge. A lateral lunge is a good functional activity that simulates many functional activities throughout the day. For example reaching for an object behind the couch or quickly moving out of the way of a moving object.

TRX Lateral Lunge:

Position 1: Standing holding straps taught, lean back slightly while standing with feet together. Pull belly tight. 

Position 2: Take a step to the right with 80% of weight on right lower extremity. Use straps as needed, while keeping straps taught. Point foot lateral slightly, making sure to point knee towards foot. Pull belly tight.  Return to neutral position. Mirror position to left as well. 

TRX As A Rehab Tool

As we have discussed before TRX (Total Body Resistance Exercises) straps are very useful as a rehab tool. There are many times that patients are unable to perform functional activities like a squat or a lunge, but would benefit hugely from them. A TRX lunge is basically a way to perform a lunge without placing full body weight on the low extremities. A lunge, like all functional exercises, is a great way to strengthen the legs in a way that mimics every day life. For example think about how you tie your shoe, or how you pick a heavy box off the floor. A lunge is a better way to strengthening the legs than a squat machine or a knee extension machine because machines restrict movement to certain planes and ranges of motion. By restricting movement into certain planes and ranges, the movement becomes less and less functional because most movement does not take place in those small ranges. TRX straps are a way to progress to full weight bearing activities in functional movements without putting undue stress on injured or weak structures.

TRX Lunge

Position 1: Standing holding TRX straps taught, leaning back slightly, feet shoulder width apart and slightly pointing out. 

Position 2: Lean back keeping TRX straps taught. Extend back leg with knee bent to 100degs. Bend front knee keeping weight on heel (Keep 90% of weight on front knee). Return to position 1 again. 

Using TRX As a Rehab Tool - TRX squat

The TRX (TRXtraining.com) suspension straps are an extremely useful fitness tool with amazing potential in rehab. The TRX straps can be used to help progress those that are unable to tolerate full weight bearing exercises. For example, a patient that has pain in her knees, when she performs standing squats, can use the TRX straps to reduce the amount of pressure on her knees.  Here is one exercise that utilizes this amazing tool. We will introduce a few other TRX exercises the next few weeks.

TRX Squat

Position 1: Standing holding TRX straps taught, leaning back slightly, feet shoulder width apart and slightly pointing out. 

Position 2: Lean back with butt out using straps to unweight legs slightly. Keep shoulders back and back straight (do not let low back curve). Return to position 1 keeping straps taught. 

Are MRIs The End All Be All?

A patient came in the other day with an MRI report in hand that stated that she had several herniated discs in her neck. As a therapist I will always read MRI reports with a grain of salt. There have been many times in my career where an MRI stated conditions that were not necessarily the cause of the problem. Clinicians need to be careful not to assume that an MRI is the "end all be all" in diagnosis. An MRI is only another piece of a larger clinical puzzle. Too many times an MRI report will lead therapist and other clinicians, barking up the wrong tree.

The patient reported that she has numbness and tingling in her right hand that is inconsistent and increases throughout the day.

With this information some therapist might just assume that this numbness is caused by the herniated discs in her neck. Herniated discs in the neck are often the causes of this kind of numbness, however, it is very important to review several clinical tests to confirm this assumption.

First we need to discuss the patient's lifestyle. This patient was an office worker who sits at desk for many hours. She also answers the phone on the right side and stated she feels the most symptoms when sitting at work. After asking several more questions it was clear to me that this patient works in a very stressful environment and works on the computer for many hours without breaks.

After asking questions, looking at the patient's posture it was seen that she sits with her shoulders slouched with her head pushed forward.

The first clinical test we must do is the compression test, where we compress the spine in sitting to see if it increases symptoms. If it does, it is a signs that a neck disc herniation is the culprit. For this patient, this test did not increase symptoms. The next test is the distraction test which consists of pulling the head up when the patient is sitting. If this decreases symptoms it is another sign that a disc herniation is a possible cause of symptoms. For this patient she felt no difference with the distraction test.

Because of this results we can move to another set of tests to check for thoracic outlet syndrome. This diagnosis I can discuss in a future blog. As we went through these test I saw that this patient was actually experiencing numbness in her hand because of thoracic outlet syndrome. This assertion was confirmed by another therapist and neurologist that the patient saw a few weeks later.

If I assumed that the disc herniation shown in the MRI was the cause of this patient's symptom we would have wasted valuable time and energy (as well as money). So, although MRIs are a valuable tool, remember that they are only a piece of the puzzle.