Marin Movement Center Physical Therapy Blog

Marion Kregeloh, PT, CFP provides health information for physical therapy, osteoporosis, chronic pain, physical therapy, orthopedic therapy, Feldenkrais, in the Marin Movement Center blog.

Walk and Move Toward a Healthier Back

Posted by Marion Kregeloh
Marion Kregeloh
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on Monday, 22 April 2013
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A recent study in the Sage Journal talks about walking and its possible benefits for back pain. The study included 52 sedentary patients with chronic lower back pain between the ages 18 and 65. Half of the group walked 20 minutes twice a week, gradually working up to 40 minutes. The other half was assigned to a strengthening program, two to three sessions per week; both groups participated for 6 weeks. According to the study, the walking intervention was almost as effective as the exercise group. (Link to the Sage article http://cre.sagepub.com/content/27/3/207.full)

As a physical therapist, I see that walking is a very important element of treating back pain; one that is often underused. Walking moves the spine, activates core and leg muscles and creates some sense of wellbeing. It is not an option for everyone when impact activities trigger the pain. Hands-on manual therapy in combination with movement education (learning how to move to be safe) is often the best approach to start with. Together with the patient, we set goals such as walking time or distance for the week. The important part is to be consistent.

Walking in water is a therapeutic solution for those of my clients who cannot do much land-based walking as long they don't dislike being in the pool. Walking in the pool builds core and leg strength while unloading the spine. For many the movement education is the most enjoyable part of the therapy since it improves spinal flexibility and allows movement with less guarding and fear.

Learning how to stand tall, stand up from the sitting position, shift weight, turn and walk with less effort is like "coming back into your body," to quote one of my patients. When we become more aware of what healthy movement is like again (as we used to move before injury or sedentary lifestyles took over), we have a stronger foundation to engage in exercise routines and move beyond. Some patients get a pedometer midway in their therapy program to track their number of steps; this can be a motivating tool that helps build stamina. It seems so simple but, surprisingly, this little gadget has helped many of my patients get out there and walk; often to their own surprise they walk further and feel better. After back injuries, walking begins with small steps and short distances, sometimes in the water. When guided by a movement expert/therapist, walking can become a regular part of life again.

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Degenerative Changes in the Back: Lumbar stenosis

Posted by Marion Kregeloh
Marion Kregeloh
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on Monday, 02 April 2012
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Lumbar stenosis is a narrowing of the lumbar spinal canal. It mostly occurs in adults older than 50 and is the most common cause for spinal surgery in people older than 65 of age. Stenosis can be congenital but the most common cause is degeneration with age. Conditions such as osteoarthritis, loss of height of the intervertebral discs or thickened ligaments are aging related sources. Other conditions that can lead to stenosis are tumors, injuries to the spine or Paget's disease, to mention some.

Depending on which nerves are compressed, lumbar stenosis can cause pain or cramps in the legs, especially when standing and walking. The pain typically eases with sitting and bending forward.

Complications of lumbar stenosis can lead to incontinence, muscle weakness and cauda equina syndrome. The latter causes compression of the lower nerve roots which may lead to paralysis and requires immediate medical attention.

Many patients with lumbar stenosis that we see in my physical therapy practice can improve their symptoms through a targeted exercise approach. The focus needs to be on core/abdominal strengthening and teaching the patient unloading positions and good body mechanics. It is important to avoid twisting movements and any jerky movements of the spine. Lumbar traction of the lumbar spine can also be helpful and some of our patients like a home traction unit. It supports the unloading effect and can give pain relief. Modalities such as ultrasound, heat and/or ice packs and TENS (transcutaneous electrical stimulation) are pain management tools that impact each patient differently and can be used as needed. At times we recommend a back support belt if worn only for short periods during the day to further allow the spine to be unloaded while actively strengthen abdominal muscles as part of a daily exercise routine. Some of our patients find good pain relief while strengthening their core with aquatic therapy, especially with water walking in 3.5 - 4' deep water. The traction effect of the water is reducing pressure in the spine while the water also provides resistance and supports abdominal strengthening. We offer aquatic therapy right here at the Mt Tam Racquet club. All our patients have a floor (or bed) exercise routine that is custom-taylored to their condition and fitness level.

Steroid injections are common procedures that are performed by doctors as part of pain and inflammation management. One study (Johnsson et al.) followed 32 patients with moderate stenosis symptoms for 4 years without surgery. Results showed 16% with worsening of their pain and 30% with declined walking ability.

If symptoms persist despite a targeted conservative approach, surgery needs to be considered in patients with certain findings. Decompression laminectomies are common surgeries for stenosis while fusions may also be indicated. Several other surgery technologies are already available, as well as tested and developed. I encourage my patients to do their own research and discuss all their questions with the prospective surgeon.

If you have any questions regarding exercise routines or want more information, please contact Marion Kregeloh, PT, CFP at 415.479.1765.

 

Marin Movement Center - Helping Your Body Thrive

Your source for physical therapy in Marin

Locations in San Rafael and Larkspur

 

 

 

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Sitting and Back Pain

Posted by Marion Kregeloh
Marion Kregeloh
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on Monday, 21 November 2011
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Back Pain is the most common source for patient referrals to my physical therapy practice. Research shows that 80% of the population in the US has to deal with back pain on at least one occasion in their life time. Back pain is the second most common reason people visit their primary care physician and it ranks second behind

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Don't Let Your Back Pain Become Chronic!

Posted by Marion Kregeloh
Marion Kregeloh
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on Friday, 22 April 2011
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Researchers at the University of Utah have recently found a genetic link for back pain. While researchers typically had more difficulties ruling out environmental factors such as life styles, professions, exercise and smoking, they now found a clear connection between back pain occurrences in families. They studied more than one million Utah residents with herniated or degenerated discs. Results show that the risk of such back injuries increases when a second and third-degree relative has that condition. In case of an immediate family member with such back injury, risks are more than four times as high.Other studies point to a gene that is linked to sciatica and disc herniation.

 

While we now know that for some of us genetics can be the source for back pain, it is nevertheless most important to not let back pain become chronic. Acute back pain is a common condition and needs attention in order to prevent it from becoming chronic. When resting, applying ice packs, and anti-inflammatory drugs do not bring relief after 2-3 days, it is recommended to seek a health professional who is familiar with treating back injuries. Based on evaluation, each individual needs to have a custom-taylored exercise program that assists in the recovery as well as prevents the back pain from reoccurring.

 

Here are some examples on how to keep your back healthy:

1) Maintain a healthy weight

2) Give up smoking

3) Avoid heavy lifting

4) Walk at least three times a week for 20-30 minutes each

5) Find an exercise routine that you enjoy and that strengthens your core and legs: gym training, dancing, swimming

6) Keep improving your posture with programs like Feldenkrais or therapeutic yoga

7) Avoid hours of sitting when at work; change your position frequently

8) Manage your stress and learn how to worry less

 

If you would like more information on treating back pain from the physical therapy and Feldenkrais perspective, please contact Marion Kregeloh, CFP, PT at 415.479.1765.

Marin Movement Center - Helping Your Body Thrive

Your source for physical therapy in Marin.

Locations in San Rafael and Larkspur.

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Five Essential Exercises For Your Back

Posted by Marion Kregeloh
Marion Kregeloh
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on Tuesday, 22 June 2010
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It's summer, finally. And for that reason I decided to keep my monthly article light and easy. It actually is not much of an article but rather a list of exercises.Here are five essential back exercises that help your back to stay flexible and healthy. I am doing them on a regular basis myself, besides a variation of Feldenkrais exercises . When I injured my lumbar spine during pregnancy 17 years ago, I received manual therapy treatment from another physical therapist. After the birth of my son, my lumbar spine got injured again. After completing physical therapy treatment, I have been committed to including regular stretches and Feldenkrais movements into my exercise regime. If you experience recurrent low grade back pain or tension and fatigue in your back, you can try these exercises. Please keep in mind that this is not a substitute for an examination by a health care provider. If you have serious pain or your spine is locked up, please see your practitioner first.

The first four exercises are done lying down on the floor, both knees bent. Support your neck as needed. Always start from a comfortable starting position.

1. Pelvis clock: Bend both knees, arms at your side. Gently tilt your pelvis up and down (imagine a clock dial under your back with the 12 pointing up towards your head and the 6 pointing down towards the feet). Tilting up towards 12 will flatten your back and gently tilts the head back; tilting pelvis down towards 6 creates a gentle arch while chin moves towards the chest. Repeat at least 5 times, moving in a comfortable pace. This exercise is a basic spinal alignment exercise.

2. Knee to chest stretch: Bend both knees with arms at your side. Lift one knee at a time towards you, holding leg behind the knee with both hands. Keep the stretch at least 10 seconds or as desired. Repeat 3 to 5 times with each leg. Now lift both legs up, one at a time. Each hand holds knee from behind. You can do some gentle pelvis circles, small to larger, as tolerated. Change direction. Slowly lower one leg at time. This exercise takes pressure of the lumbar spine and releases muscle tension.

3. Bridging: Bend both knees, arms at your side. Gently tilt pelvis towards 12 and begin to lift hips off floor, gradually moving one vertebra at a time, until you are on your shoulder blades. Now begin to gradually lower your hips, one vertebra at a time. I like to coordinate this movement with breathing: exhale, lift, inhale while up on shoulder blades, exhale and lower hips. Repeat at least 3-5 times. This exercise is excellent for realigning the thoracic spine, since you move one section at a time.

You can modify arm position with arms stretched out at your side. This adds more stretch in the front shoulder-chest section.

4. Knees side to side: Bend both knees, arms at your side. Place arms at your side, shoulder-high. Inhale and lower knees to the left, exhale and return knees to the middle. Use your abdominal muscles! Inhale and tilt knees to the right, exhale and return knees to the middle. Begin with small tilting movements and gradually lower your knees further down to the side. Stay within your comfort range! Repeat at least 3-5 times to each side.

Progression: You can do the same exercise with both knees and hips bent 90 degrees towards you. You will feel more stretch in your torso, ribs and shoulders while you lower the knees. Your abs will work harder. Repeat at least 3- 5 times. Note: do not do such twisting movements if you suspect an acute disc injury!

5. Cat and Camel stretch: Get on your knees and hands. Find the "neutral" position in your spine. When exhaling, gently round your back, allowing abdominals to engage and pull naval up, head looking towards belly. Inhale and gradually unfold and extend your spine, allowing belly to protrude towards floor. Make sure your neck stays aligned with the spine.

Continue for at least 5 times, allowing breath to determine the pace of the movement. Make it your intention to move all segments of the spine, including the upper and middle back.

Please contact Marion if you have any questions, Ext. 36. Or visit one of the weekly Back classes on Wednesdays at 12 noon. You will learn more about how to keep your back in balance.

 

For more questions, please contact Marion Kregeloh, CFP, PT at 415.479.1765.

 

Marin Movement Center - Helping Your Body Thrive

Your source for physical therapy in Marin

Locations in San Rafael and Larkspur

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