July 15, 2014 Volume 2, Number 7

Transcription

1 July Newsletter July 15, 2014 Volume 2, Number 7 In This Issue: Preventing Low Back Pain During the Gardening and Yard Work Season: Anya Wechsler, DPT Hydration for Performance and Recovery: Jesse Dupre, DPT Best Physical Therapist Award Winner; Thanks Missoula: John Fiore, PT Preventing Low Back Pain During the Gardening and Yard Work Season Anya Wechsler, DPT As we enter the depths of summertime, gardening and yard-work become an integral part of many people s daily or weekly activities. Anyone who has turned over a garden bed, bent over for long periods of time in order to eliminate pesky weeds, or pushed a lawnmower around the yard understands that gardening can be a workout. If performed improperly, gardening and yard work can lead to muscle and joint pain. The following article will provide some education and tips on how to prevent these injuries. Sign up for the Sapphire PT enewsletter at sapphirept.com Links to Related Sites: Related Sites: The Runners Edge: Missoula s hub for running gear, information, and races

2 Run Wild Missoula membership promotes running, training, and racing in Missoula Missoula s choice for core strengthening and ski conditioning. From beginners to elite athletes, Momentum classes will increase your strength and reduce your injury risk. Find us on Facebook: For more information on the services provided by Sapphire Physical Therapy or to read more related articles, see our website or give us a call at Sign up for the Sapphire PT enewsletter at sapphirept.com Contact Us: (406) Anatomy of the Spine: One of the keys to low back injury prevention is understanding the anatomy of the spine and the different tissues that can become injured during various yard work activities. The spine is composed of 24 vertebrae stacked together to provide a moveable support structure, while also protecting the spinal cord. The lumbar spine consists of the last 5 vertebrae of the spine before the sacrum and pelvis. In a neutral posture, the neck and low back naturally have a slight curve into extension (hollowed from the back), whereas the mid-back curves into slight flexion (hollowed from the front). Generally, low back pain that results from gardening does not involve injury directly to the vertebral bones. The system of ligaments in the vertebral column, combined with the tendons and muscles provides a natural brace to help protect the spine from injury. Ligaments aid in joint stability during rest and movement and help prevent injury from hyperextension and hyper flexion (excessive movements). In between each vertebra is a spinal disc that serves as a cushion for each vertebra and helps minimize the impact of compressive forces on the spinal column. The ligaments, muscles and discs may become damaged from any of the following situations: prolonged postures that deviate from neutral (bending over to weed); decreased core stability; decreased leg strength; and poor body mechanics with lifting/shoveling. Situations that can contribute to low back pain Prolonged postures that deviate from neutral: When the spine is in its neutral position, it is in an optimal position to absorb shock, maintain balance, and allow optimal range of motion while you work. The ligaments and tendons are also formed to maintain the spine in this neutral alignment. When you deviate from neutral posture, as is the case with bending forward to perform weeding, harvesting, and planting activities, a phenomenon called ligament creep occurs. Ligament creep is defined as the time-dependent elongation of a ligament when subjected to a constant stress. This prolonged, low-load strain can ultimately cause tissue damage, pain, and dysfunction. The vertebral discs are another structure affected by prolonged stooping posture. Discs that have undergone prolonged stooped postures have significantly decreased overall water content (and shock absorption capability). Also, the combination of lengthened/weakened ligament tissue, and increased asymmetrical compression of the disc can lead to disc herniation.

3 Us: John Fiore, PT: Rachael Herynk, DPT: Jesse Dupre, DPT: Anya Wechsler, DPT: Jennifer Dreiling: Find Us: Sapphire Physical Therapy 1705 Bow Street * Missoula, MT Map: Our Services: Orthopedic injuries Functional strengthening Pre and post-operative rehabilitation Core strengthening & conditioning programs Back and neck pain Running overuse injury and prevention Running biomechanical gait analysis Work related injuries Functional Capacity Evaluations Decreased core stability: The core is comprised of several groups of muscles including the transverse abdominus, diaphragm, pelvic floor, multifidi, and hip musculature. When these muscles are activating optimally, they minimize forces and stresses on the spinal vertebra, ligaments, and muscles. The transversus abdominus, diaphragm, pelvic floor musculature helps to compress the ribs and viscera, providing thoracic and pelvic stability. The multifidus muscle is composed of multiple muscle segments that lie deep in the spine. It spans three joint segments, and works to stabilize the joints at each segmental level. The stiffness and stability makes each vertebra work more effectively, and reduces the degeneration of the joint structures. Decreased hip stability: Essentially, these are your buttock muscles. They are extremely important in stabilizing your pelvis so that your trunk and legs have a stable base to move from. When the gluts do are weak or do not properly activate, the pelvis will move excessively in multiple direction. Because the spine is connected to the pelvis, this will result in excessive torsional and compressive forces on the lumbar spine (low back). Decreased leg strength: In order to practice proper lifting mechanics, whether you are lifting a wheelbarrow, heavy bucket, or large rocks, it is essential that you use your leg muscles to perform the act of lifting, while your core muscles stabilize your pelvis and spine in a neutral position. If your legs are deconditioned and unable to lift the required load, it is common to abandon the neutral spine position and bend forward in your spine, relying on the large back muscles to do the work. The contraction of the large muscles that span the spine in combination with the deviation from a neutral posture causes increased shear and compressive forces on the spine, discs, and ligaments. Gardening/yard work practice guidelines to prevent Low Back Pain: Weeding: o Change positions frequently or take small (even 30 seconds can be sufficient) rest breaks every 5 minutes. o Instead of constantly bending over, try sitting on a stool. Heavy Lifting: Gardening sometimes requires some heavy lifting. To avoid injury, make sure you bend from the hips and

4 Work Hardening & Functional Conditioning Programs Cycling injuries & biomechanical bike fitting Women s health All insurance accepted & billed Cash payment discount knees, rather than the waist in order to maintain that neutral spine. Wheel Barrowing: o Just like heavy lifting, be sure to lift with the knees, not the back. o When dumping the wheelbarrow: First, position yourself so that you are lifting from underneath, including using an underhanded grip. This is because when you straighten up (from the knees), you will have leverage power to use that can save your back muscles from strain and injury. Once you are straight, you can raise your arms. While maintaining neutral spine, lean your body weight in toward the wheelbarrow to tilt it and empty out the contents. Mowing the Lawn: To avoid back strain, be sure to position yourself in a comfortable position. Minimize the amount you are bending forward in the hips and back. Take frequent rest breaks. Shoveling: Shoveling dirt (or gravel) can put a tremendous amount of strain on your back. To minimize the stress and excess muscle tension shoveling puts on your back, you must use your body as leverage. Be sure to move your entire body, not just your arms and back. If you have any questions or feedback, please anya@sapphirept.com, or call Sapphire Physical Therapy to set up an appointment with a skilled physical therapist. Hydration for Performance and Recovery Jesse Dupre, DPT With summer finally in full swing, now is a perfect time to be active and enjoy the great outdoors. But summer also brings hotter temperatures, which means while you are enjoying a great run, hike, bike ride, or any other activities, it is much easier to become dehydrated. Remember, the human body is largely comprised of water, and proper hydration is important to maintain optimal functioning, not only physically, but also mentally especially during exercise. Proper hydration promotes improved muscle function, lubrication of joints and aids in regulating metabolic processes and body temperature. Studies have shown that water loss of as little as 2% of your body weight from heat or exercise can have a significant impact on physical performance, mental capabilities, and feelings of fatigue. Unfortunately, thirst is not a very reliable indicator of hydration, so it is important to drink water before you feel thirsty in order to stay properly hydrated. It is best to make sure you are well hydrated both

5 before exercise and to replace lost body water during and after exercise. The following are recommendations for water consumption during exercise based on ACSM and NSCA guidelines. Before exercise: drink ounces of water 1-2 hours before exercise. If it is particularly warm outside or you plan a long or intense workout, ounces of water 4 hours before and 8-12 ounces minutes before exercise may be beneficial. During exercise: drink 3-8 ounces of water every minutes, but do not exceed 1 liter per hour to keep electrolyte balance in check. After exercise: drink ounces of water per every pound lost during your workout to replace water lost through respiration and sweat. For exercise sessions shorter than minutes, plain water should be adequate. For exercise lasting longer than 75 minutes, supplementing your water intake with a sports drink that contains electrolytes may be helpful to maintain blood glucose and sodium levels. If you are planning on long duration exercise where you will need to augment your water intake with other sources of nutrition, there are various options including whole foods, energy bars, gels and sports drinks. Currently there isn t definitive research that has found one method to be more effective than another. One of the most important considerations is to consume nutrients and calories that are more easily accessible for your body. This means sources that your body can break down faster, which generally means lower fat and fiber contents. References: Montain SJ. Hydration recommendations for sport Current sports medicine reports. 2008;7(4): Kalman DS, Lepeley A. A review of hydration. Strength and conditioning journal. 2010;32(2): Murray B. Hydration and physical performance. Journal of the American college of nutrition. 2007;26(5): 542S 548S. Kenefick R, Chouvront S. Hydration for recreational sport and physical activity. Nutrition reviews. 2012;70:S137 S142. Grandjean A, Grandjean N. Dehydration and cognitive performance. Journal of the American college of nutrition. 2007;26(5):549S 554S.

6 Best Physical Therapist Award; Thanks Missoula John Fiore, PT I honestly never placed much credence in the Missoula Independent s Best of Missoula award issue. Possibly because I viewed it as a popularity contest, or possibly because the award eluded me. I have never cast a ballot in the Best of Missoula competition and probably never will. I was very surprised, therefore, to find out I had been selected as Missoula s best physical therapist for Surprised because those who know me understand I prefer to fly under the radar. I began Sapphire Physical Therapy with the purpose of providing cost-effective, cutting-edge physical therapy services to the diverse Missoula population. I purposely avoided building Sapphire PT into a large, impersonal facility. We are not the biggest outpatient PT clinic. We do not have the most physical therapists of any other clinic in Missoula. We have one centrally-located facility. When a customer walks in the door, however, the uniqueness of Sapphire Physical Therapy is evident. The Sapphire PT staff works hard every day to make patients or customers feel at ease. Our goal is to maximize the time and dollars spent through one-on-one treatment with a physical therapist who is passionate and attentive to your unique injury and needs. The hardest working clinic? Yes. The most willing to delve deeper to find the underlying cause of your injury and/or impairment? Yes. The clinic with the most visible therapists in the Missoula community because we love this town and the state of Montana? Yes. The best physical therapist in Missoula? I am honored and will continue to learn from my patients every day and strive to live up this award. Thank you Missoula! John Fiore, PT john@sapphirept.com

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