September 2017

Dear Friends,

I cannot believe that I find myself writing a blog about low back pain. The interweb is FULL of blog articles about low back pain. Some are very informative/helpful and some are just personal stories or what worked for one person. See, that is the struggle with low back pain – everyone has a story about it and something that worked for them – but may not work for you!

Yes, I realize that low back pain affects 85% of people at some point during their lifetime. Yes, I realize that LBP is the leading cause of chronic pain and disability with a financial cost in the billions of dollars annually. Yes, I realize that some people have had great outcomes from Chiropractic, from pain medication, from inversion tables, from traction. But, can I just be honest for a couple of minutes here? First, let’s agree that we are only talking about nonspecific low back pain – pain that is not attributed directly to a structure in your low back. So, we aren’t going to discuss your grandma’s spinal stenosis. That is a specific cause of low back pain and is treated in a much different way! Okay, back on topic here. I have seen too many patients during my career who have had negative results from chiropractors, medication, inversion tables, and traction. In fact, a Cochrane review of 32 studies clearly shows that traction is not effective for acute, subacute, or chronic low back pain. We can talk about inversion tables if you want to – I have a great story of a patient who I fired from therapy for using an inversion table. I am not saying that inversion tables do not work for some people – it does! But, you have to know what you are dealing with before using an inversion table.

What has been substantially proven in the research and what have I learned is effective treatment for low back pain that significantly resolves the issue and decreases re-occurrence? Manual therapy (hands on treatment), trunk coordination and strengthening and endurance exercises, centralization and directional preference exercises, patient education and counseling, and progressive endurance exercise and fitness activities. Which basically boils down to hands on treatment to decrease pain and normalize movement followed by progression to an independent exercise program. That is what we offer at Physical Therapy for EveryBODY. The research proves that it works, my clinical experience tells me it works, and my patients show me it works.

So, can we please not discuss how your friend had amazing results after spending $5000 on a traction regimen at the Chiropractors office? Many thanks!

Temporomandibular disorders (TMD) involve pain and dysfunction around the TMJ (your jaw) and jaw muscles. The National Instititue of Dental and Craniofacial Research performed a 3 year study to identify biopsychosocial and genetic risk factors in the development of TMD. Potential risk factors for first-onset TMD were identified with older age, African American, pain on jaw opening and palpation tenderness of head and neck muscles, increased incidence of other regional pain conditions including low back pain and irritable bowel syndrome, other nonspecific comorbid conditions including fibromyalgia and depression, and lower overall quality of life and health status. Systematic reviews have repeatedly supported instruction in a self-management strategy including education, resting during pain, relaxation techniques, massage, hot and/or cold packs, and stretching and/or exercise. Did you know there were exercises for your jaw? Yes, there are! Use of medication and splints has not been found in the literature to be effective in decreasing pain and dysfunction from TMD. Conservative treatment with a home program has the best results found in multiple systematic reviews.

Now, headaches are a bit more complicated tale to tell because there are different types of headaches with different findings in the research. Migraines are primarily managed with pharmacological agents. Physical therapy can be beneficial if included with relaxation and biofeedback treatments. Cluster type headaches are very rare and, therefore, there is little research on the effectiveness of physical therapy with this diagnosis. Tension-type headaches are effectively treated with physical therapy which involves education regarding posture and biomechanics, an exercise program aimed at improving posture of the cervical spine, and manual therapy to reduce muscle tension.

Seventeen years of clinical experience tells me that tension type headaches respond really well to physical therapy. Migraine intensity, duration, and frequency can be dramatically altered with physical therapy. The one cluster type headache patient I saw had a significant decrease in intensity and frequency of his headaches.

If you would like to discuss your TMD or headache symptoms, please feel free to contact Amy at (360)367-0970 or amykonvalinpt@gmail.com.

Myofascial pain has been estimated to be the source of pain in 85% of patients attending a pain center. Fibromyalgia affects 4-12% of the population. Both of these are rather “new” diagnoses in our medical system and there has been a great deal of research done recently. Let’s dive into understanding WHAT these diagnoses mean and HOW they should be treated.

Myofascial pain is a local or regional pain syndrome occurring in one or two body regions. Travell (guru type person in my world) has defined the following diagnostic criteria:

1. Palpable taut band in muscle

2. Exquisite spot tenderness of a nodule in the taut band

3. Pressure on the nodule should reproduce patient’s current pain complaint

4. Restricted motion due to pain

Myofascial pain syndrome responds very well to Physical Therapy including manual therapy, exercise, and transcutaneous electrical nerve stimulation (TENS). There is some evidence to demonstrate that outcomes may be improved with use of trigger point injections (performed by an MD) before Physical Therapy.

Fibromyalgia is diagnosed as at least 3 months of widespread pain occurring in each quarter of the body. People with fibromyalgia literally hurt everywhere! Further, people with fibromyalgia commonly present with sleep disorders, fatigue, depression, and irritable bowel syndrome. (Remember, if you aren’t sleeping, you aren’t healing!) Little is known about fibromyalgia, but it is generally accepted to be a disorder of central pain amplification. This causes normally pain free input to be perceived as painful. So, there is enhanced excitability in central pain transmission pathways and loss of pain inhibition. What can be done?

Fibromyalgia treatment requires a multidisciplinary approach involving pharmacological management, psychological treatments, and physical therapy combined for best outcomes. Physical therapy emphasizes an active protocol aimed primarily at an appropriate aerobic conditioning program. There is also moderate evidence for implementing a strengthening home exercise program to decrease pain as well as increasing global well-being.

If you would like more information on either of these diagnoses, please feel free to contact Amy at (360) 367-0970 or amykonvalinpt@gmail.com.